Lecture 6: Interprofessionalism in Healthcare: Effective Teams, C Diff Flashcards
What is a surrogate?
A family member that makes medical decisions for the patient.
Through which models can a surrogate interact with physicians?
Can interact with physicians in the patient in charge fashion or in the partnership model
What is a POLST?
(Physician Orders for Life-Sustaining Treatment)
Go to document to directly identify a surrogate
What is an Advance Care Plan/Directive?
Legal document clarifying patient’s goals, values, and beliefs and inform physicians about care choices/decisions the patient would make
How does an Advance Care Plan/Directive help surrogates?
Helps clarify choice of surrogate
Guides decision making “in the moment” (i.e. during a code)
Surrogates should make decisions based on what the patient wants
What is palliative care?
Interdisciplinary specialty that seeks to improve the quality of life for both the patient and their family when life limiting illness is present
When is palliative care appropriate?
Appropriate at any stage of illness, not just when dying
T/F: Palliative care refers to therapies that relieve symptoms but do not provide cures (i.e. nausea medication)
TRUE!
T/F: Palliative care goals don’t overlap with hospice care goals
FALSE! Their goals overlap
T/F: Patients with no further options or those who wish to decline further treatment may be put on hospice
TRUE!
What is hospice?
Specialized care for dying patients
What is the goal of hospice care?
Meet needs of the WHOLE person, including physical, psychological, spiritual issues and other problems faced by those affected
What are some medical conditions for hospice?
Cancer Lung disease Kidney or liver failure AIDS Alzheimer's disease or other dementia Multiple sclerosis Heart disease Neurological diseases Liver disease Diabetes
Who cares for the patient?
Family member (primary care giver, help make decisions for patient)
Hospice staff (regular visits for assessment and additional care, 24/7 on call)
Who is apart of the hospice team?
Patient's personal physician Hospice physician Pharmacist Nurses Home health aides Social workers Clergy, counselors Trained volunteers Speech, physical, and occupational therapists
What services are provided in hospice care?
Pain and symptoms management
Emotional and psychosocial and spiritual aspects of dying
Provides needed drugs, medical supplies, and equipment
Coaches family on how to care for patient
Delivers special services like speech and physical therapy when needed
Makes short-term inpatient care available
Bereavement care and counseling to surviving friends and family
What is the purpose of an effective healthcare team?
To deliver excellent healthcare
T/F: An effective team delivers high quality care and meet the 6 aims set by the Institute of Medicine
TRUE! These are aims for the improvement of healthcare and thus a definition for quality in healthcare
What is the National Academy of Medicine?
Non-profit NGO that is a part of the National Academies of Sciences, Engineering, and medicine
Adviser to the nation to improve health aims to provide unbiased, evidence-based, and authoritative information and advice concerning health and science policy
What does the “Crossing the Quality Chasm” report focus on?
The second/final report of the Committee on the Quality of Health Care in American focuses more broadly on how the health care delivery system can be designed to innovate and improve care
What does quality healthcare mean?
HIGH QUALITY CARE!
What are the 6 aims for healthcare improvement in an effective team?
- Safety
- Effectiveness
- Patient-centeredness
- Timeliness
- Efficiency
- Equity
What is the definition of safety?
Free of errors that cause injuries to patients (i.e. giving wrong meds, failing to diagnose, performing surgery on wrong body part)
What is an inherent risk in treatment?
SIDE EFFECTS, so important that treatments only undertaken if benefits outweigh risks
What is effective care?
Achieves the undoing of the ill effects of disease or prevents it from occurring
Expected to prevent, cure, or alleviate symptoms of a disease
What is evidence-based practice?
the integration of best research evidence with clinical expertise and patient values
What are the 4 main types of research evidence comes from?
- Lab experiments
- Clinical trials
- Epidemiological research
- Outcomes research (including analyses of systematically acquired and properly studies case reports involving one or a population of patient
What is patient-centeredness?
Healthcare that is focused on achieving the patient’s goals and is consistent with their values and preferences
What is timeliness?
Care that is free of unnecessary delays (i.e. waits to obtain appt, to see a physician, waiting in ER, waiting to receive test results, waiting for a procedure, etc)
What is efficient healthcare?
Uses the fewest resources possible to achieve the desired outcome
T/F: Some experts estimate that most physicians are productive only 50% of their time
TRUE :(
What is equity healthcare?
Health care that is delivered without regard to the considerations that are irrelevant to health needs
Pursuing disparities across different populations
Providing same level of care to everyone
What is a major threat to equity?
lack of health insurance
Characteristics of C. diff (3)
- gram positive
- anaerobic spore forming
- bacillus
What are the 2 exotoxins produced by C. diff?
Enterotoxin –> Toxin A
Cytotoxin –> Toxin B
Function of Enterotoxin (Toxin A) of C. diff
Destroy tight cell junctions leading to increased permeability of the intestinal wall and thus diarrhea
Function of Cytotoxin (Toxin B) of C. diff
Targets actin and destroys cellular cytoskeleton
Produces surface layer proteins which allow organism to bind to intestinal epithelium and cause local damage
Is Toxin A or B necessary for causing disease?
Toxin B
Risk factors associated with C. diff (7)
- antibiotic exposure
- PPIs
- GI surgery/manipulation
- long stay in healthcare settings
- serious underlying illness
- immunocompromising conditions
- advanced age
Antibiotics usually associated w/ C. diff (2)
- Fluoroquinolones (cipro and levaquin)
2. Clindamycin
Diseases caused by C. diff (5)
- pseudomembranous colitis (PMC)
- toxic megacolon
- perforations of the colon
- sepsis
- death (rarely)
T/F: Spore are NOT resistant to many cleaning agents including alcohol based hand gels
FALSE! They ARE resistant to many cleaning agents
How does C. diff spread?
Mainly spread by spores, which can be transmitted via environmental surfaces and contaminated hands
Transmission of C. diff
Fecal-oral route (ingestion of spores)
Clinical symptoms of C. diff (5)
- Watery diarrhea (3 loose stools in <24hrs)
- Lower abdominal pain/cramps
- Fever
- Nausea
- Leukocytosis
Diagnosis of C. diff
Detection of toxin in stool/clinical signs
T/F: Labs distinguish between active and carrier state of C. diff?
FALSE! Labs DON’T
Prevention of C. diff (4)
- Wash your hands!
- Gloves and gown
- Clean w/ sporicidal antiseptic agent
- Disposable equipment
Steps in treating C. diff (4)
- Stop antibiotics
- Place in isolation
- Oral vancomycin or fidaxomicin
- Fecal transplant (if recurring)
When do you reconsider ordering a C. diff test? (2)
- If patient is on laxatives
2. Patient was tested in past 7 days
C. diff testing (4)
- Initial test is PCR
- GDH ELISA
- Toxin ELISA
- Cytotoxin neutralization assay
What is a PCR test for C.diff?
- Sensitive lab technique that uses DNA primers to amplify copies of a targeted gene in test sample
- Looks for genes in toxigenic strains
- Does not test for active production of toxin so picks up asymptomatic carriers
What is the GDH ELISA test for C. diff?
- Antibodies to test for presence of GDH enzyme
2. GDH is a constitutive enzyme produces in large amounts by all strains of C. diff independently of toxigenicity
What is the Toxin ELISA test for C. diff?
- Assay uses antibodies to detect presence of C. diff to detect presence of C. diff toxin A or toxin B
- Specificity of this test is nearly perfect but low sensitivity (75%) so results in high rate of false negatives
What is the cytotoxin neutralization assay test for C. diff?
- Functional assay that tests for cytopathic effect on human tissue cells (GOLD STANDARD)
- Specimen prepared by centrifuging liquid stool samples, harvesting supernatant, and then inoculating different dilutions onto a monolayer of human foreskin cells in cell culture
