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Older Adult Exam 1 > NP in LTC > Flashcards

NP in LTC Flashcards

1
Q

how are APNs reimbursed in LTC in relation to physicians?

A

reimbursed at 85% of physician rate for same services

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2
Q

by whom may an APN in a LTC facility be employed?

A
  • by NH
  • work for affiliated physician or group practice
  • by MCO
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3
Q

what are some other duties APNs may have beyond clinical care?

A
  • administration
  • education
  • nursing consultation
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4
Q

what is the primary goal of care for NH residents?

A
  • improve or maintain functional status
  • stabilize medical conditions
  • deliver dignified end-of-life care
  • high risk for re-hospitalization
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5
Q

what services do APNs provide in LTC?

A
  • sick/urgent visits
  • preventative care/monthly visits
  • wound care
  • end-of-life care
  • psychiatric consultation
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6
Q

what organization has established regulations regarding delegation of tasks to NPs and PAs?

A

CMS (centers for medicare and medicaid)

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7
Q

what are some factors that effect delegation of tasks to NPs?

A
  • care setting: SNF vs NF

- employment of NP by facility

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8
Q

what is the typical case load of NPs in LTC?

A
  • varies depending on practice structure

- some facilities have reported 80-110 residents

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9
Q

may NPs employed by the facility perform/sign the initial comprehensive visit (H&P) in SNFs?

A

no

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10
Q

may NPs NOT employed by the facility perform/sign the initial comprehensive visit (H&P) in SNFs?

A

no

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11
Q

may NPs employed by the facility perform/sign the initial comprehensive visit (H&P) in NFs?

A

no

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12
Q

may NPs NOT employed by the facility perform/sign the initial comprehensive visit (H&P) in NFs?

A

YES

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13
Q

may NPs employed by the facility perform other required visits in SNFs?

A

yes, but alternate visits

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14
Q

may NPs NOT employed by the facility perform other required visits in SNFs?

A

yes, but alternate visits

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15
Q

may NPs employed by the facility perform other required visits in NFs?

A

NO

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16
Q

may NPs NOT employed by the facility perform other required visits in NFs?

A

yes

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17
Q

may NPs employed by the facility perform/sign other medically necessary visits and orders in SNFs?

A

yes

18
Q

may NPs NOT employed by the facility perform/sign other medically necessary visits and orders in SNFs?

A

yes

19
Q

may NPs employed by the facility perform/sign other medically necessary visits and orders in NFs?

A

yes

20
Q

may NPs NOT employed by the facility perform/sign other medically necessary visits and orders in NFs?

A

yes

21
Q

may NPs employed by the facility sign certification/recertification in SNFs?

A

no

22
Q

may NPs NOT employed by the facility sign certification/recertification in SNFs?

A

yes, if state allows

23
Q

what are some major outcomes of using NPs in LTC?

A
  • decreased health care utilization

- improved quality of care

24
Q

in what particular areas is there decreased health care utilization due to use of NPs?

A
  • ED
  • specialty referrals
  • acute hospitalization
  • medication prescribing
  • lab services
25
Q

in what ways do we see an increased quality of care of residents from use of NPs in LTC?

A
  • satisfaction of resident, families, physicians, NH staff
  • medication attention, i.e. frequency of visits, frequency/timing of medical orders
  • disease-specific quality indicators, i.e. CHF, HTN, incontinence
  • preventive health quality indicators, i.e. decubitus ulcers, diabetic foot care
  • end-of-life care, i.e. DNRs, feeding tubes, DNH
26
Q

in what 6 areas can NPs strongly impact reduced hospitalizations?

A
  • identifying residents at high risk for readmission
  • modifying visit pattern to better manage high risk residents
  • improving communication between nurses and providers
  • improving communication between NH and acute care setting
  • providing support to residents and families to impact clinical decision-making
  • discussing advanced directives, code status, and hospice
27
Q

what do studies show are some clinical outcomes of NPs in LTC?

A
  • lower rates of depression, urinary incontinence, pressure ulcers, restraint use, and aggressive behaviors
  • residents had improvements in meeting personal goals
  • families had satisfaction with medical services
  • provide RESIDENT AND FAMILY-CENTERED CARE
  • enhanced quality of care
  • better relationships with residents and families with better information and emotional support
  • perception of improved availability and timeliness of care
  • perception of preventing unnecessary hospitalization
28
Q

how do NPs and MDs compare in terms of quality of care delivered in NHs?

A
  • NPs provide comparable care that is both substitutive and complementary to that provided by MDs in LTC
  • health screening rates were similar, although NPs had higher completion rates of advanced directives related to DNR orders
29
Q

are NPs safe providers in LTC?

A
  • in absence of physician oversight or supervision, NPs are safe providers and prescribers
  • often prove to be more cautious - spend more time with patient and less likely to prescribe medication as only therapy or intervention
30
Q

what is the evercare model and what is its goal?

A
  • capitated $ paid for each NH enrollee
  • underlying premise: enhanced primary care = reduced hospitalization
  • intense management at NH by NP as well as use of intensive service days (ISD) which reimburses a facility for care for acutely ill residents vs. hospital
31
Q

what do studies show about the effectiveness of the evercare model?

A
  • reduction in acute care transfers

- mixed results on other clinical outcomes (functional status, falls, depression, preventive health, etc.)

32
Q

what are the components of the admission visit and who performs this visit?

A
  • performed by MD
  • indicate reason for admission
  • complete medical and surgical hx
  • meds
  • physical exam
  • screening tools
  • functional assessment
  • risks assessments
  • advance directives
  • code status
  • complete assessment and plan
  • capacity for decision making
  • rehab potential
33
Q

when should the 1st visit after admission be completed and what should it include?

A
  • within 30 days of admission
  • should incorporate additional data obtained (hospital records, lab data, consults, and other tests)
  • review and revise medical plan of care
34
Q

how often should scheduled visits be completed and who completes these?

A
  • every 30 days for 1st 90 days and at least once every 60 days thereafter
  • most providers visit every 30 days
  • visits usually will alternate between NP and physician
  • considered timely if within 10 days of due date
35
Q

what consists of acute visits? when are these completed?

A
  • for illness or changes reported by nursing staff
  • focused HPI
  • exam
  • tx plan
36
Q

what consists of monthly visits?

A
  • detailed assessment of of resident’s current problems,
  • PE
  • chart review
  • staff interview
  • observation of care
  • documentation of visit
  • consent for care
  • communication of tx plan
37
Q

what are the facility goals for nosocomial pressure ulcers?

A

< 5%

38
Q

what are some of residents’ rights?

A
  • access to health care including selection of medical provider
  • privacy: visit should not occur in hallway or other public area, HIPAA
  • consent: residents have the right to know the results of the visit as well as implications for care; they have the right to refuse care
  • communication: findings, tx plan, referrals
39
Q

what are some challenges that NPs face in the NH?

A
  • obtaining hx from a cognitively impaired resident
  • resident and staff routines that impact the timing of visits
  • possible facility barriers that impact tx plan
40
Q

what are some goals of care of the NP?

A
  • provide timely, quality visits
  • reduce meds
  • reduce restraints
  • reduce need for hospitalization
  • address pain and recommend strategies
  • recommend strategies to improve function
  • be part of the team!
  • involve resident/family in decision-making
  • get involved in QI initiatives

Older Adult Exam 1 (7 decks)

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