Issues, Trends & Health Policy Flashcards
4 Malpractice examples
- Professional misconduct
- Unreasonable lack of skill
- Illegal/Immoral conduct
- Allegations resulting in harm to pt
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
Malpractice
4 Components of Malpractice
- Duty to the patient
- Violate a standard of care
- That violation is the cause of damages
- Damages have to actually have occured
Name for the HIPAA Title II
Administrative Simplification provisions (AS)
Who enforces HIPAA?
Office for Civil Rights
3 main provisions of AS (HIPAA Title II)
- Privacy of identifiable pt info
- HIPPA security rule (electronic info)
- Patient Safety Rule (info used for safety events)
Covered Entities Required to follow HIPPA?
Health plans (HMO, Medicare, Medicaid)
Health care providers
Health care clearinghouses
Examples of HPI
Written info (chart)
Converstions
Electronic info
Billing infor
Written permission is required to disclose HPI for what 3 situations?
Disclosing to a pt’s employer
Using HPI for marketing
Private notes about pt’s healthcare
Who is NOT required to follow HIPPA?
Life insurers
Employers
Workman’s comp
Schools
State agencies
Law enforcement
Municipal offices
Privacy Rule: pt’s rights
See a copy of records
Corrections
A notice of how their HPI is used and shared
Give permission
File a complaint
Situations where HPI can be shared:
Coordination of care
payment
With others significant to pt unless they object
Quality
Public health
Police reports
HIPAA
Health insurance portability and accountability act
Title I HIPAA
provides COBRA for workers and families who lose or change jobs
PSQIA
Patient Safety and Quality Improvement Act
Voluntary reproting system for safety and quality of health care issues
PSQIA provides federal privilage and confidentiality protections called:
patient safety work product
Who lists patient safety organizations (PSO’s)?
Agency for Healthcare Quality and Research (AHRQ)
A list of external expertsestablished by the Patient Safety Act
Which is greater: the duty to warn or the right to confidentiality?
Duty to warn if a pt’s condition may harm others
Invasion of privacy is a result of what?
Damaging one’s reputation as a result of info being shared without permission of the patient
5 steps to establishing rapport and professional therapeutic relationships
- Non-judgemental
- Mutual trust
- Professional boundaries
- Confidentiality
- Cultural competency - respect and spiritual needs
Therapeutic communication strategies:
Listen more than talk
Tell me….
Never “Why”
Focus on feelings
No euphemisms
Who to protect first in a crisis?
Self then everyone else
Evil eye
Maldeojo
Middle eastern, Mexican, PR
Who is the decions maker in AA family?
Minister if family cannot agree
2 steps for crisis/grief communication
Offer self
Acknowledge feeling
“that’s awful, how can i help”?
Difference between advanced directive and living will?
AD is written statement regarding pt’s intent for medical treatment=wishes
LW specifies desires if incapacitated
-often includes granting POA or proxy who is responsible for articulating the pt’s AD
LW=wishes and POA
Which act requires that all pt’s be informed of their right to execute an AD?
Patient self-determination act of 1990
When initiating change, at what level do you begin?
Local then move up
Which is treated first, medical or psychosocial conditions?
Medical
What is the strongest method for evaluating teaching?
Return demonstration
Steps to determining if a patient needs higher level of care?
- assess pt
- stabilize
- assess capability of current facility
- Turf
What is the most powerful data collected from the pt?
Subjective data or observations of the NP
vs interp of family and friends
Goal of Healthy People 2020
Improve health and access to health care
- -Increase the quality and years of healthy life
- -Eliminate health disparities
contains health objectives, plan prevention programs, all levels are responsible for determining how to meet these goals
5 conditions to report
- Gonorhhea
- Chlamydia
- Syphillis
- HIV
- TB
Other things to report non-communicable?
Animal bites
Criminal acts and injury from dangerous weapon
Suspected child or elder abuse
(NOT DV)
What is collaborative practice?
True partnership with comon goalsk, share power and accept different areas of responsibility
Coding (E&M)
Matches the level of service to the complexity of the presenting problem
Who sets the standard for reimbursement and cutting costs?
Medicare
Levels of physical exam
Problem focused
Expanded problem focused
Detailed
Comprehensive
Which medicare covers hosptialization and SNF and hospice associated with the hosptialization?
Medicare A
Which Medicare covers physician services and labs/diagnostics/ DME/ HHN?
Medicare B
Requires premium
A+B=
C called Medicare Advantage
HMO/PPO
Medicare D
Copay and premiums
Penalty may apply if you don’t apply right away
Under Medicare, what percentage does Medicare pay of the physician’s services?
80%, pt pays 20%
How much does an NP receive of phsycian reimbursement for services provided in collaboration with a physician?
85%
Examples of things that do NOT meet physician services criteria?
regular phsycial exams- must be a “follow-up”
health screenings
counseling for well pts
To qualify for Medicare the NP must:
Hold a state licensce as NP
Be certified by national body
Hold at least an MSN
Procedure payment?
80% 0f the 85% phsyician fee rate
Incident to billing
100% if provider is in the same office, out-pt setting only
Under direct supervision
otherwise, must bill under your own number
not allowed in the hospital
Medicaid
Federally supported, state administered for low income persons and families
Benefits vary by state
Payments made AFTER other insurance or third party
Purpose of case management
comprehensive and systematic approach to provide quality care
Mobilize and monitor and control resources while balancing quality and cost
Who delineates the steps for Continuous Process Improvement? (CPI)
JCAHO
Toyota Way in healthcare
CPI +
Structures
Processes of care
Outcomes
Used to assess, monitor and improve care
Purpose of care map
multi-disciplinary tool for planning, managing and monitoring outcomes of care
What is the purpose of a root-cause analysis?
Tool for identifying prevention strategies to ensure safety
Asks why, why, why?
IS sentinel event and medicl error synomymous?
No
“or the risk thereof” is a significant phrase
Who determines scope of practice?
State BON
Which Act delineates scope of practice?
State Nurse Practice Act
What are the key elements of the NP role?
Integration of care
EBP
clincial leadership
family assessment
discharge planning
Who delineates the Standards of Advanced Practice?
ANA
Measures quality of practice, service, or education
Who establishes authority to grant licensure?
Sate practice act of the BON
What items does the State practice act describe?
Title
Scope
Prescriptive authority
Disciplinary grounds
Who determines the ability and extent of a NP’s ability to prescribe?
State practice act
Who registers the NP for narcotic prescribing and tracking?
DEA
What is in a credential after your name?
Education, licensure, certification
Why is credentialing necessary?
Ensure dsafe care
comply with state and federal regulations
Accoutnability
enforce professional standards
What does licensure establish?
Person is qualified to perform in a role
What does certification establish?
Establishes that person has met standards and minimum mastery
Granted by non-governmental agencies
When were Np’s granted the permission to admit?
1983 by JCAHO
Who gives privilages?
Hosptial credentialing board
Examples of risk management strategies
Utilizes a formal, written plan
Satisfaction survey
Incident report
complaint
Action initiatives including documentation and education
What constitutes abandonment?
Terminating pt-caregiver relatioinshiop without reasonable arrangements for ongoing care
Interventions that are unlikely to produce any significant benefit to patient
MEdical Futility
Can be quantitative or qualitative
4 Criteria for ability to give informed consent
i.e defintion of competence
- Understand
- reason
- differentiate between good and bad
- communicate
Duty to do no harm
non-maleficence
right act to produce the greatest good for the greatest number of people
utilitarianism
duty to prevent harm and do good
beneficence
duty to be fair
justice
duty to be faithful
fidelity
the duty to be truthful
veracity
duty to respect an individual’s rights and thoughts
autonomy
duties when terminating a pt from a practice
- give notice by certified letter with return receipt
- provide coverage for 15-30 days
- provide copies of all records to subsequent provider
- written and signed copy of rec care, appt cancelation etc can serve as reason for termination
duties when closing practice
- give adequate time
- keep files 5 years
- provide names of other providers and resources for future care
Steps in research process
- formulate research problem
- review lit
- formulate hypothesis
- select research design
- identify population
- specify data collection methods
- design study
- conduct study
- analyze data
- interpret results
- communicate findings
Research types: 3
non-experimental
experimental
qualitative
2 types of non-experimental research designs
- descriptive
- ex-post facto/correlational
other types:
cross=sectional
cohort
longitudinal
aims to describe situations, experiences,phenomena as they exist
descriptive/non-experimental
examines relationships among variables
ex=post facto -non-experimental
study that examines a population with a very similar attribute but vary in one specific variable
cross=sectional = non-experimental
compares a particular outcome in a groups of individuals who are alike in many ways but differ by a certain characteristic
cohort=non-experimental
study that involves taking multiple measures of a group population over an extended time period to find relationships
longitudinal=framingham
non-experitmental
experimental research studies include what 2 things:
randomization
control group
what is characteristic of quasi-experimental research?
manipulation of variables but lacks either a control group or randomization
problems with qualitative research
researcher bias
lack of generalizability due to limited sample sz
what size confidence interval indicates a very precise range of values?
small
ie: 2.8-3.2 episodes of nausea in cancer pts in 24 hrs
how much of the population fits between 2 standard deviations from the mean?
1 SD?
2 SD’s=95%
1 SD= 68%
the probablity that the results of statistical analyses are judged to indicate a statistically significant difference between groups
level of significance or p value
p<.05 => not due to chance
a measure of interdependence of two random variables
correlation
-1 perfect negative correlation
0 asbence of correlation
+1 perfect postitive correlation
evaluates the difference in means between two groups
t test
the consistency over time of a measurement with the same subject
repeatability of a measurement
reliability
two tests of reliability
test/retest
internal consistency
does the test measure what it is supposed to test
validity
what test is used to measure reliability
crohnbach’s alpha
>0.7 is greater reliability
failure to meet the standard of care resulting in actual or potential harm
liability
failure to o what a resaonable person would do, resulting in injury to the patient
negligence
failure 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 a patient
malpractice
may involve
- professional misconduct
- lack of skill
- illegal/immoral conduct
- other allegation
threat or apprehension of harm
assault
willfull or negligent striking of a person
battery
can be commited on an unconscious pt
communication that causes a damaged reputation
defamation
libel: written
slander: verbal
duty to commit someone who is in danger of harming self or others
involuntary commitment
can be liable if pt is discharged before this is resolved
documentation of restraints
need to document rationale
lack of documenation is responsiblity of np, otherwise can be held liable (failure to meet standard of care that results in actual or potential harm to pt)
Concept of cultural competence
- social justice
- critical reflection
- transcultural nursing knowledge
- cross cultural practice
- healthcare systems and organizations
- pt advocacy and empowerment
- multicultural workforce
- education and training
- cross cultural communication
- cross cultural leadership
- policy developement
- EBP and research
CLAS
culturally and linguistically appropriate services
- bilibnfual staff and interpreter at no cost at all times in a timesly manner
- preferred language services both verbal and written noticies of rights to receive language assistance
- don’t use family and friends for informed consent or translation
What is the purpose of credentialing?
verifying education, licensure, and experience
What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number?
Balanced budget act
When reading a systematic review, an adult-gerontology acute care nurse practitioner ensures that the review?
Describes the study inclusion criteria
Four roles of the NP
Clinician
Consultant/collaborator
Educator
Researcher
