Organizing Patient Care Flashcards
5 Traditional means of Organizing Nursing and Patient Care
Total patient Care
Functional nursing
Team and modular nursing
Primary nursing
Case management
Another name for primary nursing
professional practice model
Another name for team nursing
partner in care or patient service partners
Total Patient Care
Oldest Mode of organizing patient care
“The case method of assignment”
patients are assigned to a caregiver and each caregiver is under a charge nurse
Advantage of total patient care organization
provides care givers with high autonomy and responsibility
assigning patients is simple and direct
Disadvantages of total patient care organization
each caregiver caring for the patient can theoretically modify the care regimen meaning if there are three shifts then the patient is getting 3 different approaches to care
if a caregiver is inexperienced of inadequately prepared this leads to issues
Functional Nursing
method of delivering nursing care and organization
started in WWII
personnel assigned to complete tasks rather than specific patients, and relatively unskilled workers gained task proficiency through repetition
RNs then became managers of care rather than direct care providers (“Care through others”)
Advantage of Functional nursing
efficiency - tasks are completed quickly with little confusion regarding responsibilities and allows minimal RN needs
Disadvantage of Functional Nursing
can lead to fragmented care and the possibility of overlooking patient priority needs
Team Nursing
personnel collaborate in providing care to a group of patients under a direction of a professional nurse
so the charge nurse is above team leaders who direct nursing staff at a specific patient
Advantage of Team Nursing
comprehensive care and extensive team communication
Disadvantage of Team Nursing
improper implementation rather than the philosophy itself
team leaders have to be excellent practitioners and have good communication, organization, management, and leadership skills
Modular Nursing
more modern
mini teams of 2-3 members with at least one member being an RN (Care Pairs)
patients are divided into modules or districts and assignments are based on the geographical location of patients
also try to assign same patients to same team as much as possible
similar to team nursing
Primary Nursing
Relationship Based Nursing
A primary nurse has 24 hour responsibility for planning the care of one or more patients from admission to discharge - during work hours the nurse provides total direct care and when not on duty associate nurses follow the primary’s care plan
the primary nurse and patient are then at the center with other personnel like other nurses physicians and such connecting to them
Disadvantage of Primary Nursing
Difficult to implement due to degree of responsibility and autonomy needed of the primary nurse
improper implementation preparation or incompetence
Benefit of Primary nursing
job satisfaction is high
skills developed well
often feel challenged and rewarded
Interprofessional or Multidisciplinary Health Care Team
complex process involving 2 or more health professionals with complementary backgrounds and skills
team members share common health goals in patient care through collaboration, communication, and shared decision making
Primary Health Care Teams (PHCTs)
interprofessional teams that include but are not limited opt physicians, NPs, nurses, physical therapists, dentists, occupational therapists, social workers who all work collaboratively to deliver coordinated patient care
Strategies for working with an interdisciplinary health care team
know your role and expertise as well as that of your team members
know the end goal / purpose of your interdisciplinary team
communicate compassionately so that all members of the interdisciplinary team feel comfortable voicing their opinions
establish a support structure whereby all members feel like they play an important role
Case Management
A collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individuals and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes
professional and collaborative process that assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet an individual’s health needs. It uses communication and availableresources to promote health, quality, and cost-effective outcomes in support of the “Triple Aim” of improving the experience of care, improving the health of populations and reducing per capita costs of health care
What do case managers use to plan patient care
critical pathways and multidisciplinary action plans (MAPS)
Maps are combos of nursing care plans and critical pathways
Population Based Health Care and Continuous Health Improvement (Disease Management Programs)
Comprehensive integrated approach to care and reimbursement of high cost chronic illnesses
disease management = DM
case managers use this and the goal is to address illness or conditions with maximum efficiency across treatment settings regardless of typical reimbursement patterns - this will prevent cost drivers which increase costs over time since early detection and intervention are used
The focus of population based health care is…
COVERED LIVES (populations of patients rather than on the individual patient)
Disease Management programs are efficiency when what happens
cost drivers are reduced, whereas patient needs are met
Common features of DM programs
comprehensive integrated approach to care and reimbursement of common high cost and chronic illnesses
focus on prevention as well as early disease detection and intervention to avoid costly acute care episodes but provide comprehensive care and reimbursement
target population groups rather than individuals
employ a multidisciplinary health care team including specialists
use standardized clinical guidelines - critical pathway reflecting best practice research to guide providers
use integrated data management systems to track patient progress across care settings and allow continuous and ongoing improvement of treatment algorithms
frequently employ progression nurses in the role of case manager or program coordinator
2 New Emerging Roles in healthcare
Nurse Navigators
Clinical Nurse Leaders (CNLs)
Common Themes of newer care delivery models
elevating the role of nurses and transitioning from caregivers to care integrators
taking a team approach to interdisciplinary care
bridging the continuum of care outside of the primary care facility
defining the home as a setting of care
targeting high users of health care, especially older adults
sharpening focus on the patient including an active engagement of the patient and his or her family in care planning and delivery and a greater responsiveness to the patients wants and needs
leveraging technology
improving satisfaction, quality, and cost
Nurse Navigator
new role
helps patients and families navigate the complex health care system by providing information and support
helpful in areas like oncology where the nurse helps guide a patient through the course of the illness
needs further definition to set apart from case manager
Clinical Nurse Leader (CNL)
advanced generalist nurse with a masters in nursing - is a leader in the health care delivery system in all settings in which health care is delivered - practices across settings
NOT A ROLE OF ADMINISTRATION OR MANAGEMENT - assumes accountability for patient care outcomes through the assimilation and application of EBP information to design implement and evaluate patient care processes and models of care delivery
a provider and manager of care at the point of care to individuals and cohorts of patients anywhere healthcare is delivered and plays a key role in collaborating with interdisciplinary teams
Historically, nursing has developed models of patient care delivery based on what`
societal events like nursing shortages and war rather than on well researched models with proven effectiveness and that promote professional practice
Is there one widely accepted definition of case management
no it is a specialty practice with no one standardized definition
Professional Case Management requires…
wisdom, judgment, and critical thinking
Before 1983, how did reimbursement work…
hospitals were reimbursed per day, there was no concern for length of stay and continuing costs
DRG
Diagnostic related groups payment system
as standardized payment system that encourages cost containment initiatives
reimbursement by diagnosis not length of stay
occurred in 1983
Is national certification required for case management
encouraged after 2 years but not required
Responsibilities of a Case Manager
- Medical Necessity for the Patient - Does the patient need to be in the hospital, can the care be done in a less intensive setting, observation vs inpatient, LoS (length of stay)
- Provide clinical information to insurance companies (payor) via clinical intelligence software (xsolis)
What is done during Assessment of Discharge planning by the CM
use current or historical medical records
look at results of tests and procedures
verbal reports from providers, other clinicians, and/or healthcare organizations
patients and/or support systems looked at
26 Billion is spent on what regarding acute care medicare patients yearly
poor transitions of acute care patients
The planning phase of the nursing process for a CM involves
discharge and transitions of care
Discharge and Transitions of Care Standards
process of transferring a patients care from one setting or level of care to another (hospital to home or skilled nursing facility).
Particularly vulnerable points in the health care continuum occur here!!!
Discharge planning is initiated…
within 24 hours of admission by the case manager and it is reassessed regularly to ensure needs of the patient have not changed
Barriers to Discharge Planning
patient ability to participate in plan
lack of support network
lack of payor or payor approved services
complexity of the discharge needs-wound care, IVAB, etc
limited availability of resources - skilled nursing facilities, home care, etc
Implementation and Evaluation of discharge planning means you have to ID patients at risk for poor transitions by looking at what?
the 6 social determinants of health
6 Social Determinants of Health
Financial limitations
poor health literacy
housing and food insecurity
lack of social support
unreliable transportation
unhealthy behaviors
Task for the CM during the implantation phase of discharge planning
Complete a comprehensive transition assessment:
review health utilization and insurance benefits
patient, family, caregiver goals and potential care needed are looked at
evaluate and document patient, family, caregiver understanding
assess self management abilities and activity’s of daily living (ADLs)
ID designated decision maker and advanced directives
What is highly important to do for the CM before discharge
accurate review of medications on admission and discharge and changes as well as doses
Tasks involved in establishing a care management plan
send referrals online to home care/skilled nursing facilities
arrange equipment needed; oxygen, wound vac, IVAP, BiPap
Assistance providing medications if needed - meds to beds, transitional care pharmacist
What is important for the CM to do across the continuum of care
communicate essential care transition information to key stakeholders like pharmacy, physicians, EMS, palliative care, home care, community support, long term care, etc
make follow up appointments, insurance approval, provide needed documentation etc
Challenges for CM in the COVID-19 Pandemic
availability of safe care environments
transportation issues
prevention of exposures to other people and communities
timely access to care
staffing shortages
surge capacity
patient throughput
social media misinformation
lack of education on spread of disease and vaccines
fear
isolation
Hospital Care at Home Program
prevents or decreases number of days in the hospital
improves hospital throughput
daily virtual visits with a provider
nurse navigator calls daily
provides O2, EKG, X ray, Labs, Pulse Ox, Med management, patient monitoring, virtual visits, and understanding of CDC guidelines and quarantine protocols
