Other

Question 1

Acuity Rating Systems

Answer 1

Nurses use acuity rating systems to determine the hours of care and
number of staff required for a given group of patients every shift or every
24 hours.A patient’s acuity level, usually determined by the assessment
data an RN enters into a computer program, is based on the type and
number of nursing interventions (e.g., IV therapy, wound care, or
ambulation assistance) required by that patient over a 24-hour period. The acuity level is a classification that compares one or more patients
with another group of patients. An acuity system classifies patients from 1
(independent in all but one or two aspects of care; almost ready for
discharge) to 5 (totally dependent in all aspects of care; requiring intensive
care). Using this system, a patient returning from surgery requiring
frequent monitoring and extensive care has an acuity level of 3, compared
with another patient awaiting discharge after a successful recovery from
surgery who has an acuity level of 1.

Question 2

Documentation in the Long-Term Health

Care Setting

Answer 2

Long-term health care settings include skilled nursing facilities (SNFs), in
which patients receive 24-hour-a-day care, including housing, meals,
specialized (skilled) nursing care, treatment services, and long-term care facilities, in which patients with chronic conditions receive 24-hour-a-day care, including housing, meals, personal care, and basic nursing care.

Question 3

Documentation in the Home Health Care

Setting

Answer 3

Documentation in the home care setting is different from other areas of
nursing. The use of laptop and tablet computers makes it possible for
home health care records to be available in multiple locations (i.e., the
patient’s home and the home care agency). This system improves
accessibility to information and facilitates interprofessional collaboration. Information used for reimbursement is gathered from
documentation of care provided in the home care se􀄴ing. Documentation
is the quality control and the justification for reimbursement from
Medicare, Medicaid, or private insurance companies.

Question 4

Case Management and use of Critical

Pathways

Answer 4

The case management model incorporates an interprofessional approach
to delivery and documentation of patient care (see Chapter 2). Critical
pathways (also known as clinical pathways, practice guidelines, or
CareMap tools) are interprofessional care plans that identify patient
problems, key interventions, and expected outcomes within an established
time frame (AHC Media, 2015). Critical pathway documents facilitate
integration of care because all members of the health care team use the
same document to monitor a patient’s progress during each shift or, in the
case of home care, every visit. Evidence-based critical pathways can
improve patient outcomes.Unexpected outcomes, unmet goals, and interventions not specified
within a critical pathway are called variances. A variance occurs when the
activities on the critical pathway are not completed as predicted or a
patient does not meet the expected outcomes.Once you identify a variance, you modify the patient’s care
to meet the needs associated with the variance. A positive variance occurs
when a patient makes progress faster than expected (e.g., an indwelling
urethral catheter is discontinued a day earlier than anticipated according
to the critical pathway). An example of a negative variance is when a
patient develops pulmonary complications after surgery, requiring oxygen
therapy and monitoring with pulse oximetry.