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Issues, Trends, Health Policy > Issues, trends and health policy > Flashcards

Issues, trends and health policy Flashcards

1
Q

Advanced Directives

A

patient’s intent regarding medical treatment.
the patient self-determination act of 1990 requires that all patients enter a hospital should be advised of their right to execute an advanced directive

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2
Q

Health Care directive

A

a type of advanced directive that may or may not include a living will and or specifications regarding durable power of attorney in one or two separate documents

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3
Q

Living will

A

written compilation of statements in document format that specifies which life-prolonging measures one does and does not want to be taken if he/she becomes incapacitated

often include POA

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4
Q

adv directive vs living will

A

adv directive talks about medical care of pt (no tube, cpr, no feed etc)

living will: specifies life prolonging measures one wants or doesn’t want and often includes POA

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5
Q

what needs to be reported to department of health and human services?

A 
Gonorrhea
chlamydia
syphilis
HIV
TB
animal bites
suspected or actual child or elder abuse (police via social work)
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6
Q

What can NPs bill for?

A

diagnosis
therapy
surgery consultation
care plan oversight

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7
Q

services that do not meet medicare’s definition of physician services

A

regular physical exams
health maintenance screenings
counseling for well patients

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8
Q

which medicare plans do you have to pay a premium?

A

B & D

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9
Q

what is Quality Assurance?

A

a process for evaluating the care of patients using established standards of care to ensure quality

evaluates care and establishes standards and involves 3 processes. if we can continually monitor we can be continually better

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10
Q

Root Cause Analysis

A

a tool for identifying prevention strategies to ensure safety. a process taht is part of the effort to build a culture of safety and move beyond the culture of blame

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11
Q

Root cause analysis involves and incorporates:

A

inter-disciplinary experts from the frontline services

  • those who are the most familiar with a situation
  • continually digging deeper by asky why at each level of cause and effect
  • identifying changes that need to be made to systems
  • a process that is as impartial as possible
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12
Q

what is an institution to do after a sentinel event?

A

conduct a root cause analysis

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13
Q

Medical Futility

A

refers to interventions that are unlikely to produce any significan benefit for the patient

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14
Q

quantitative futility

A

where the likelihood that an intervention will benefit the patient is extremely poor

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15
Q

qualitative futility

A

where the quality of benefit an intervention will produce is extremely poor

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16
Q

7 major ethical principles

A
  • nonmaleficence: the duty to do no harm
  • utilitarianism: the right act is the one that produces the greatest good for the greatest number
  • benefiance: the duty to prevent harm and promote good
  • Justice: the duty to be fair
  • Fidelity: the duty to be faithful
  • Veracity: the duty to be truthful
  • Autonomy: the duty to respect an individual’s thoughts and actions
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17
Q

which ethical principles tend to be in conflict to eachother

A

Fidelity and veracity

Beneficence and autonomy

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18
Q

what are 3 reasons you can discharge a patient from practice?

A

-abuse from the patient
-non complaince
refusal to pay for services

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19
Q

How did NPs expand into acute care?

A

result of:

  • managed care
  • hospital restructuring
  • reduction in residency hours
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20
Q

nonexperimental research

A

usually include two broad categories of research, descriptive and ex post factor/correlational research

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21
Q

Descriptive research

A

aims to describe situations, experiences and phenomena as they exist

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22
Q

ex post factor or correlational research

A

examines relationships among variables

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23
Q

cross sectional

A

study that examines a population with a very similar attribute (asthma) but differ in one specific variable (age) designed to find relationships between variables at a specific point in time

24
Q

Cohort

A

research study that compares a particular outcome (such as lung cancer) in groups of individuals who are alike in many ways but differ by a certain characteristic (female nurses who smoke compared with those who do not smoke)

25
Q

Longitudinal:

A

study that involved taking multiple measures of a group/population over an extended period of time to find relationships between variables

26
Q

Quasi Experimental studies

A

involves manipulation of variables but lacks a comparison group or randomization

27
Q

qualitative studies

A

includes case studies, open-ended questions, field studies, participant observation and ethnographic studies, where observations and interview techniques are used to explore phenomena through detailed descriptions of people, events, situations, or observed behavior

28
Q

what are 3 key points about qualitative research?

A
  • researcher bias is a potential problem
  • calls into question the generalizability of the findings
  • produces very rich data through no other means of research
29
Q

what are the two things you need for experimental studies?

A

randomization

control group

30
Q

Liability

A

The legal responsibility that a NP has for actions that fail to meet the standards of care, resulting in actual or potential harm to a patient

standards of care are used as criteria to measure whether negligence has occurred

31
Q

Negligence

A

failure of an individual to do what a reasonable person would do resulting in injury to the patient

32
Q

Malpractice

A

failure of a professional to render services with the degree of care, diligence and precaution that another member of the same profession under similar circumstances would render to prevent injury to someone else

33
Q

what are some examples of Malpractice

A
  • professional misconduct
  • unreasonable lack of skill
  • illegal/immoral conduct
  • other allegations resulting harm to a patient
34
Q

when does malpractice insurance not cover an APN

A

if the APN is practice outside the legal scope of practice for that state. they can then be charged with practicing medicine without a license

35
Q

Assault

A

an intentional act by one person that creates an apprehension in another of an imminent harmful or offensive contact
-an assault is carried out by threat of bodily harm coupled with an apparent present ability to cause the harm
-

36
Q

what are some examples of assault

A

-shaking a fist in the air in the direction of another person

making the motion to inject someone against his will

37
Q

Battery

A

illegal, willful, angry, violent or negligent striking of a person, his clothes or anything with which he is in contact
-one can commit battery on an unconscious person but not assault

38
Q

Defamation

A

a communication that causes someone to suffer a damaged reputation

39
Q

what are two examples of defamation?

A

Libel: defaming, distributed written material
Slander: spoken defamation (spoken to other than the defamed party)

40
Q

Involuntary commitment

A
  • duty to commit someone who is in danger of hurting himself or others
  • an NP is potentially liable if a pateint is discharged while in danger of hurting himself or others
41
Q

Use of restraints

A
  • it is legal to forcefully restrain someone to prevent harm
  • the NP must document the exact reason/rational for why restraints are being ordered
  • an np may be liable if excessive restraints are employed, the exact reason for using restraints is not documented, or safety checks of the restraints are not charted
42
Q

example of negligence

A

-not doing an EKG when he said his chest was sore but you thought it was a pneumonia

43
Q

illegal or imoral conducts

A

selling schedule 2 narcotics to your neighbor who is selling them on the street and giving you a kickback

44
Q

assault vs battery

A

assault: gesturing to hurt
battery: actually doing it

45
Q

What is Title 1 of HIPPA?

A

protects health insurance coverage. COBRA

46
Q

what is title 2 of HIPPA?

A
  • known as Administrative Simplification provisions
  • protects records
  • requires establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans and employers
47
Q

Who enforces HIPPA?

A

-Office for Civil Rights

48
Q

Who is required to follow HIPPA regulations?

A
  • Health plans
  • health care providers (esp those who use electronic billing to health insurers)
  • Healthcare clearinghouses
49
Q

who is NOT required to follow HIPPA?

A
  • Life insurers (but need permission)
  • employers
  • workers comp
  • schools
  • state agencies like CPS
  • many law enforcement agencies
  • many municipal offices
50
Q

What is the Patient Safety and Quality Improvement ACT (PSQIA)

A

-establishes voluntary reporting system to enhance data available to assess and resolve patient safety and health care quality issues
-provides federal privilege and confidentiality protections for patient safety information called patient safety work product to encourage reporting and analysis of medical errors
-

51
Q

what is patient safety work product?

A

includes information collected and created during the reporting and analysis of patient safety events

52
Q

what is Confidentiality vs Duty to Warn?

A

-duty to warn supersedes right to confidentiality if a patient’s condition may endanger others

53
Q

what are goals of Healthy People 2020?

A
  • increase quality and years of healthy life
  • eliminate health disparities among Americans
  • access and improved healthcare
54
Q

what is continuous quality improvement (CQI)?

A

quality can be improved by continually monitoring structure, process and outcome standards

Sturctures: inputs into care such as resources, equipment, or numbers and qualifications of staff

Processes of care: assessments, planning, performing treatments and managing complications

outcomes: include complications, adverse events, short term results of treatment and long term results of patient health and functioning

55
Q

what are the steps of CQI/QA outlined by Joint Commission?

A
  • quality planning
  • delineate scope of care (identify important indicated r/t aspects of care)
  • establish thresholds for evaluation related to the indicators
  • collect and organize data
  • evaluate care when thresholds are reached
  • assess effectiveness of the action and document improvement

Issues, Trends, Health Policy (1 decks)

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