Issues, Trends & Health Policy Flashcards
1
Q
4 Malpractice examples
A
- Professional misconduct
- Unreasonable lack of skill
- Illegal/Immoral conduct
- Allegations resulting in harm to pt
2
Q
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
A
Malpractice
3
Q
4 Components of Malpractice
A
- Duty to the patient
- Violate a standard of care
- That violation is the cause of damages
- Damages have to actually have occured
4
Q
Name for the HIPAA Title II
A
Administrative Simplification provisions (AS)
5
Q
Who enforces HIPAA?
A
Office for Civil Rights
6
Q
3 main provisions of AS (HIPAA Title II)
A
- Privacy of identifiable pt info
- HIPPA security rule (electronic info)
- Patient Safety Rule (info used for safety events)
7
Q
Covered Entities Required to follow HIPPA?
A
Health plans (HMO, Medicare, Medicaid)
Health care providers
Health care clearinghouses
8
Q
Examples of HPI
A
Written info (chart)
Converstions
Electronic info
Billing infor
9
Q
Written permission is required to disclose HPI for what 3 situations?
A
Disclosing to a pt’s employer
Using HPI for marketing
Private notes about pt’s healthcare
10
Q
Who is NOT required to follow HIPPA?
A
Life insurers
Employers
Workman’s comp
Schools
State agencies
Law enforcement
Municipal offices
11
Q
Privacy Rule: pt’s rights
A
See a copy of records
Corrections
A notice of how their HPI is used and shared
Give permission
File a complaint
12
Q
Situations where HPI can be shared:
A
Coordination of care
payment
With others significant to pt unless they object
Quality
Public health
Police reports
13
Q
HIPAA
A
Health insurance portability and accountability act
14
Q
Title I HIPAA
A
provides COBRA for workers and families who lose or change jobs
15
Q
PSQIA
A
Patient Safety and Quality Improvement Act
Voluntary reproting system for safety and quality of health care issues
16
Q
PSQIA provides federal privilage and confidentiality protections called:
A
patient safety work product
17
Q
Who lists patient safety organizations (PSO’s)?
A
Agency for Healthcare Quality and Research (AHRQ)
A list of external expertsestablished by the Patient Safety Act
18
Q
Which is greater: the duty to warn or the right to confidentiality?
A
Duty to warn if a pt’s condition may harm others
19
Q
Invasion of privacy is a result of what?
A
Damaging one’s reputation as a result of info being shared without permission of the patient
20
Q
5 steps to establishing rapport and professional therapeutic relationships
A
- Non-judgemental
- Mutual trust
- Professional boundaries
- Confidentiality
- Cultural competency - respect and spiritual needs
21
Q
Therapeutic communication strategies:
A
Listen more than talk
Tell me….
Never “Why”
Focus on feelings
No euphemisms
22
Q
Who to protect first in a crisis?
A
Self then everyone else
23
Q
Evil eye
A
Maldeojo
Middle eastern, Mexican, PR
24
Q
Who is the decions maker in AA family?
A
Minister if family cannot agree
25
2 steps for crisis/grief communication
Offer self
Acknowledge feeling
"that's awful, how can i help"?
26
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
27
Which act requires that all pt's be informed of their right to execute an AD?
Patient self-determination act of 1990
28
When initiating change, at what level do you begin?
Local then move up
29
Which is treated first, medical or psychosocial conditions?
Medical
30
What is the strongest method for evaluating teaching?
Return demonstration
31
Steps to determining if a patient needs higher level of care?
1. assess pt
2. stabilize
3. assess capability of current facility
4. Turf
32
What is the most powerful data collected from the pt?
Subjective data or observations of the NP
vs interp of family and friends
33
Goal of Healthy People 2020
Improve health and access to health care
1. -Increase the quality and years of healthy life
2. -Eliminate health disparities
contains health objectives, plan prevention programs, all levels are responsible for determining how to meet these goals
34
5 conditions to report
1. Gonorhhea
2. Chlamydia
3. Syphillis
4. HIV
5. TB
35
Other things to report non-communicable?
Animal bites
Criminal acts and injury from dangerous weapon
Suspected child or elder abuse
(NOT DV)
36
What is collaborative practice?
True partnership with comon goalsk, share power and accept different areas of responsibility
37
Coding (E&M)
Matches the level of service to the complexity of the presenting problem
38
Who sets the standard for reimbursement and cutting costs?
Medicare
39
Levels of physical exam
Problem focused
Expanded problem focused
Detailed
Comprehensive
40
Which medicare covers hosptialization and SNF and hospice associated with the hosptialization?
Medicare A
41
Which Medicare covers physician services and labs/diagnostics/ DME/ HHN?
Medicare B
Requires premium
42
A+B=
C called Medicare Advantage
HMO/PPO
43
Medicare D
Copay and premiums
Penalty may apply if you don't apply right away
44
Under Medicare, what percentage does Medicare pay of the physician's services?
80%, pt pays 20%
45
How much does an NP receive of phsycian reimbursement for services provided in collaboration with a physician?
85%
46
Examples of things that do NOT meet physician services criteria?
regular phsycial exams- must be a "follow-up"
health screenings
counseling for well pts
47
To qualify for Medicare the NP must:
Hold a state licensce as NP
Be certified by national body
Hold at least an MSN
48
Procedure payment?
80% 0f the 85% phsyician fee rate
49
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
50
Medicaid
Federally supported, state administered for low income persons and families
Benefits vary by state
Payments made AFTER other insurance or third party
51
Purpose of case management
comprehensive and systematic approach to provide quality care
Mobilize and monitor and control resources while balancing quality and cost
52
Who delineates the steps for Continuous Process Improvement? (CPI)
JCAHO
53
Toyota Way in healthcare
CPI +
Structures
Processes of care
Outcomes
Used to assess, monitor and improve care
54
Purpose of care map
multi-disciplinary tool for planning, managing and monitoring outcomes of care
55
What is the purpose of a root-cause analysis?
Tool for identifying prevention strategies to ensure safety
Asks why, why, why?
56
IS sentinel event and medicl error synomymous?
No
"or the risk thereof" is a significant phrase
57
Who determines scope of practice?
State BON
58
Which Act delineates scope of practice?
State Nurse Practice Act
59
What are the key elements of the NP role?
Integration of care
EBP
clincial leadership
family assessment
discharge planning
60
Who delineates the Standards of Advanced Practice?
ANA
Measures quality of practice, service, or education
61
Who establishes authority to grant licensure?
Sate practice act of the BON
62
What items does the State practice act describe?
Title
Scope
Prescriptive authority
Disciplinary grounds
63
Who determines the ability and extent of a NP's ability to prescribe?
State practice act
64
Who registers the NP for narcotic prescribing and tracking?
DEA
65
What is in a credential after your name?
Education, licensure, certification
66
Why is credentialing necessary?
Ensure dsafe care
comply with state and federal regulations
Accoutnability
enforce professional standards
67
What does licensure establish?
Person is qualified to perform in a role
68
What does certification establish?
Establishes that person has met standards and minimum mastery
Granted by non-governmental agencies
69
When were Np's granted the permission to admit?
1983 by JCAHO
70
Who gives privilages?
Hosptial credentialing board
71
Examples of risk management strategies
Utilizes a formal, written plan
Satisfaction survey
Incident report
complaint
Action initiatives including documentation and education
72
What constitutes abandonment?
Terminating pt-caregiver relatioinshiop without reasonable arrangements for ongoing care
73
Interventions that are unlikely to produce any significant benefit to patient
MEdical Futility
Can be quantitative or qualitative
74
4 Criteria for ability to give informed consent
i.e defintion of competence
1. Understand
2. reason
3. differentiate between good and bad
4. communicate
75
Duty to do no harm
non-maleficence
76
right act to produce the greatest good for the greatest number of people
utilitarianism
77
duty to prevent harm and do good
beneficence
78
duty to be fair
justice
79
duty to be faithful
fidelity
80
the duty to be truthful
veracity
81
duty to respect an individual's rights and thoughts
autonomy
82
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
83
duties when closing practice
* give adequate time
* keep files 5 years
* provide names of other providers and resources for future care
84
Steps in research process
1. formulate research problem
2. review lit
3. formulate hypothesis
4. select research design
5. identify population
6. specify data collection methods
7. design study
8. conduct study
9. analyze data
10. interpret results
11. communicate findings
85
Research types: 3
non-experimental
experimental
qualitative
86
2 types of non-experimental research designs
* descriptive
* ex-post facto/correlational
other types:
cross=sectional
cohort
longitudinal
87
aims to describe situations, experiences,phenomena as they exist
descriptive/non-experimental
88
examines relationships among variables
ex=post facto -non-experimental
89
study that examines a population with a very similar attribute but vary in one specific variable
cross=sectional = non-experimental
90
compares a particular outcome in a groups of individuals who are alike in many ways but differ by a certain characteristic
cohort=non-experimental
91
study that involves taking multiple measures of a group population over an extended time period to find relationships
longitudinal=framingham
non-experitmental
92
experimental research studies include what 2 things:
randomization
control group
93
what is characteristic of quasi-experimental research?
manipulation of variables but lacks either a control group or randomization
94
problems with qualitative research
researcher bias
lack of generalizability due to limited sample sz
95
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
96
how much of the population fits between 2 standard deviations from the mean?
1 SD?
2 SD's=95%
1 SD= 68%
97
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
98
a measure of interdependence of two random variables
correlation
-1 perfect negative correlation
0 asbence of correlation
+1 perfect postitive correlation
99
evaluates the difference in means between two groups
t test
100
the consistency over time of a measurement with the same subject
repeatability of a measurement
reliability
101
two tests of reliability
test/retest
internal consistency
102
does the test measure what it is supposed to test
validity
103
what test is used to measure reliability
crohnbach's alpha
\>0.7 is greater reliability
104
failure to meet the standard of care resulting in actual or potential harm
liability
105
failure to o what a resaonable person would do, resulting in injury to the patient
negligence
106
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
107
threat or apprehension of harm
assault
108
willfull or negligent striking of a person
battery
can be commited on an unconscious pt
109
communication that causes a damaged reputation
defamation
libel: written
slander: verbal
110
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
111
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)
112
Concept of cultural competence
1. social justice
2. critical reflection
3. transcultural nursing knowledge
4. cross cultural practice
5. healthcare systems and organizations
6. pt advocacy and empowerment
7. multicultural workforce
8. education and training
9. cross cultural communication
10. cross cultural leadership
11. policy developement
12. EBP and research
113
CLAS
culturally and linguistically appropriate services
1. bilibnfual staff and interpreter at no cost at all times in a timesly manner
2. preferred language services both verbal and written noticies of rights to receive language assistance
3. don't use family and friends for informed consent or translation
114
What is the purpose of credentialing?
verifying education, licensure, and experience
115
What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number?
Balanced budget act
116
When reading a systematic review, an adult-gerontology acute care nurse practitioner ensures that the review?
Describes the study inclusion criteria
117
Four roles of the NP
Clinician
Consultant/collaborator
Educator
Researcher
118
