issues trends and health policy Flashcards
What are your 2 priorities in therapeutic communication for crisis/acute grief?
acknowledge feelings, offer self
Advance Directive x3
written statement of intent regarding medical treatment
- aka Healthcare Directive
- may include Living Will and/or specifications regarding Durable Power of Attorney (1 or 2 separate documents)
- Patient Self-Determination Act of 1990
Patient Self-Determination Act of 1990
All patients entering hospital MUST be advised of their right to execute an advance directive
Living Will x2
compilation of statements that specify which life-prolonging measures one does AND does not want if incapacitated
- can designate DPOA
Durable Power of Attorney x3
- designated in Living Will
- authorized to make medical decisions if pt incapacitated
- responsible for articulating Advance Directive
COBRA
protects health insurance coverage for workers + fams in if job loss/change
- aka Title I of HIPAA
Patient Safety Rule
Protects patient information to analyze patient safety events and improve
The Privacy Rule: Patient’s Rights x6
- see/receive copy of records
- have corrections added
- receive notice (how info used/shared)
- give permission before info can be used/shared
- receive report: why info was shared
- file complaints if rights denied/info not protected
Patient Safety and Quality Improvement Act (PSQIA) x5
voluntary reporting system, federal privilege
- assess/resolve patient safety & healthcare quality issues
- pt safety info called “pt safety work product”
- providers report/examine events w/o fear of increased liability risk
- Agency for Healthcare Research and Quality (AHRQ) lists pt safety orgs (PSO): external experts that collect/analyze info
Duty to Warn x2
supersedes confidentiality if
- patient’s condition may endanger others
- patient may harm self (protect them!)
Patient is diagnosed with HIV. Duty to Warn applies how?
notify providers, not family
invasion of privacy
damaging reputation d/t sharing info without pt permission
Invasion of Privacy does not apply in what circumstances?
info is accurate & given in good faith
received has valid reason to obtain info
- REMEMBER - when initiating any change in health care delivery
chain of command: hospital, community, region, state, national
- strongest method to evaluate teaching
returned demonstration
- “show me”, “tell me”, grand rounds
when to transfer to teritary care facility?
what is the process? x4
usual scenario: seriously ill/injured patient @ community hospital
- assess all injuries
- stabilize
- assess facility capabilities
- transfer as appropriate
If a patient is reluctant to undergo diagnostics/procedure, what is your priority step?
full educate patient regarding their condition
what is your next step if you are about to discharge a patient (hospital/acute care facility) and they need a screening exam?
DO NOT DELAY DC. Refer to PCP.
- for screening exams that are not vital
most powerful data collected from patient
- their subjective data
- data you observed yourself
caution with interpreting family, friends, others
RN calls you, the night shift NP, and states patient is decompensating. When do you call primary MD?
when patient status changes
What is a scenario in which admitting a patient to a SNF would be the best action?
needing assistance with ADLs
Goals of Healthy People 2020 x2
- increase quality & years of healthy life
- eliminate health disparities among americans
Healthy People 2020 purpose x2
- understand health status of the nation
- plan prevention programs
NP must notify State Health Department of which 5 infectious diagnoses?
gonorrhea chlamydia syphillis HIV TB
NP are required to report… x4
- criminal acts & injury from dangerous weapon = police
- ID: gonorrhea, chlamydia, syphillis, HIV, TB = health dept
- animal bites = animal control (DHHS)
- suspected/actual child/elder abuse (police via social services)
occupational vs physical therapy
physical therapy: strength & coordination
occupational: fine motor skills, swallow test
Medicare
- third party payer -
sets standard for reimbursement & cutting costs
covers 65+ & diabled
Medicaid
- third party payer -
federally supported, state administered
for impoverished fams/individuals
- benefits vary by state
- payments made after other insurance/third party pays
Medicare A
x5
covers inpatient, SNF, home health, hospice assoc w inpt event
most qualify at 65
Medicare B
supplemental with a premium
- physician services, oupt services, labs/diagnostics, med equipment
Medicare B covers how much of bill
80% + patient pays 20%
Medicare D
LIMITED prescription drug coverage w MONTHLY premium
- co-pay for each prescription
- penalty possible if not enrolled when first eligible
- assistance available for those w limited income, resources
Does “direct supervision” require MD to be physically in the room with NP to be eligible for “incident-to” billing
NO, but must be in same office suite and immediately available
Does “incident-to” billing apply in the inpatient setting?
No. NP must bill under their provider number in the hospital setting.
root cause analysis is…
a tool for identifying prevention strategies to ensure safety
- part of the process of building a “culture of safety not a culture of blame”
- interdisciplinary, experts, impartial
- ask why and ID changes needed
Debriefing after an event is an example of what concept?
root cause analysis
sentinel events are…
unexpected occurrences involving death, serious physical or psychological injury, or risk thereof
“sentinel” = immediate investigation/response needed!
Sentinel Event and medical error
not synonymous
not all sentinel events occur because of an error
not all medical errors result in a sentinel event
Response to Sentinel Event
Root Cause Analysis
Scope of Practice
- legal allowances based on individual STATE Nurse Practice Act
- guidelines for nursing practice, key elements of NP role
How can the ACNP demonstrate/advocate for full scope of practice?
by billing independently
State Nurse Practice Acts
authorizes State Board of Nursing to establish statuatory authority for licensure of RNs
- authority over: use of title, scope of practice including prescriptive authority, disciplinary grounds
- states vary in requirements
What dictates prescriptive authority of NPs?
State Nurse Practice Acts
State Board of Nursing
what are NP credentials? x4
required education + licensure + certification to practice as NP
establishes MINIMAL levels of acceptable performance (scope of practice, accountability, professional standards)
licensure
GOVERNMENT: granted by State Board of Nursing
- establishes qualification to perform specific role
certification
NON-GOVT: granted by agencies like ANCC, AANP
- establishes certain STANDARDS met which signify MASTERY of specialized knowledge/skills
licensure vs.certification
licensure: STATE board
certification: NON-GOVT agency, like ANCC
credentialing & privileging
process through which NP granted permission to practice w/in inpatient setting
- via Hospital Credentialing Committee
Hospital Credentialing Committee
grants hospital privilege credentials to NPs
- comprised of physicians w privileges at said hospital
Most common method of documentation in Risk Management?
incident reports
medical futility
interventions unlikely to produce significant benefit
- two types: quantitative vs qualitative
“does the intervention have any reasonable prospect of helping this patient?”
qualitative futility
type of medical futility: quality of intervention benefit is extremely poor
competence is…
decisional capability; state in which pt can make personal decisions about care
- implies ability to understand, reason, differentiate good/bad, communicate
informed consent
state in which pt has rec’d adequate instruction/info regarding aspects of care to make prudent, personal choice regarding tx
- all risks/benefits included
- assumed if life-threatening condition
informed consent if life threatening condition
assumed
ethics
study of moral conduct & behavior
- governs conduct & therefore protects individual rights
NONMALEFICENCE
duty to do no harm
UTILITARIANISM
right act = greatest good for greatest number
BENEFICENCE
duty to prevent harm & promote good
JUSTICE
duty to be fair
FIDELITY
duty to be faithful
VERACITY
duty to be truthful
AUTONOMY
duty to respect individual’s thoughts/actions
How long must medical records be kept after practice closes?
5 years, minimum
three reasons NPs expanded to inpatient setting
managed care
hospital restructuring
↓ medical residency programs
NON-EXPERIMENTAL RESEARCH DESIGN
“no experiment” design
- includes descriptive & ex post facto/correlational research
DESCRIPTIVE STUDY
DESCRIBES situations, experiences, phenomena as they exist - a type of non-experimental design
EX POST FACTO/CORRELATIONAL STUDY
EXAMINES relationships among varables - a type of non-experimental design
CROSS SECTIONAL STUDY
population has a very similar attribute but differs in one specific variable (ex: asthma / age)
finds relationships between variables @ SPECIFIC POINT IN TIME
COHORT STUDY
COMPARES PARTICULAR OUTCOME in groups of individuals who are mostly alike but differ by specific characteristic
ex: lung cancer in female RN smokers vs non-smokers
LONGITUDINAL STUDY
multiple measures of population over an extended period to find relationships between variables
EXPERIMENTAL RESEARCH DESIGN
manipulation of variables using RANDOMIZATION & CONTROLS to test effects of intervention/experiment
QUASI-EXPERIMENTAL RESEARCH DESIGN
manipulation of variables that lacks randomization or controls/comparisons
QUALITATIVE RESEARCH DESIGN
- case studies
- open ended questions
- field study
- participant observation
- ethnographies
explore phenomena via detailed descriptions of people, events, situations, observed behavior; v rich data!
two potential problems of qualitative research
- researcher bias
- generalizability?
level of significance
probability of false rejection of the null hypothesis in a statistical test
- used to establish statistical significance; p value
p value
level of significance
t test
statistical test evaluating difference in means between two groups
RELIABILITY
degree to which instrument measures a population the same way over time
- consistency of measurement
- estimates repeatability of measurement
- reliable = exam score on same test similar when given twice
RELIABILITY: TWO WAYS TO ESTIMATE
test/re-test: more conservative
internal consistency: estimates reliability by grouping questions in questionnaire that measure same concept
- run correlation between two different tests with similar questions
2 administrations of test vs 1
VALIDITY
degree to which a variable measures what it is intended to measure