policy Flashcards
What are the two main goals of HP 2020?
Increase quality and years of healthy life
eliminate health disparities
Test that measures a patient’s risk of falling
Get-up and Go Test
pain assessment tool for non-communicating patients
Critical Care Pain Observation Tool
CPOT
What are the 5 behaviors that are assessed in the Pain assessment in advanced dementia scale?
breathing negative vocalization facial expression body language consolability
Type of Advance Directive that may or may not include a living will
Healthcare Directive
What assessment tool identifies if a complete assessment for anxiety is needed
Generalized Anxiety Disorder 7
In case of emergency call?
security
What are nursing informatics roles
Practice
Education
Government
Industry
Scale that assess the severity of pain and impact of daily functions
Brief Pain Inventory
What supersedes the right to confidentiality
duty to warn
Equipment and supplies ordered by a healthcare provider for everyday or extended use
Durable Medical Equipment
What is the life expectancy of DME
at least 3 years
What are the principles of Benchmarking
Maintaining quality
Improving customer satisfaction
improving patient safety
continuous improvement
When initiating change, where do you begin?
most local, move upward and outward.
hospital, community, region, state and then national
What is the key to therapeutic communication
LISTEN MORE THAN YOU TALK
Examples of HIPAA protected information
written medical record
conversations about treatment
patient billing information
What assessment tool identifies the need for further assessment for alcohol or drug screening
CAGE-AID
Assessment tool for dementia and delirium
Mini-mental state exam
What are examples of meaningful use in electronic medical records
improved quality, reduced disparities, engage patients, improve care coordination, maintain privacy
What are methods or establishing rapport and therapeutic relationships with patients?
non-judgmental approach
mutual trust
professional boundaries
confidentiality
A written statement of a patient’s intent regarding medical treatment
Advance Directive
Self Determination Act 1990
What is the strongest method to evaluate teaching
return demonstration
What is the initiative that provides future nurses with the knowledge, skills and attitude to ensure continuous improvement in quality
QSEN
Quality and Safety Education for Nurses Initiative
Who are the covered entities that are required to follow HIPAA
Health plans
Health care providers
Healthcare clearinghouses
Who makes patient safety goals
Joint Commission
What acts must be reported
criminal acts
acts with dangerous weapon
suspected or actual child abuse
suspected or actual elder abuse
What assessment tool screens for behavioral health symptoms
Patient Stress Questionairre
Peer review is required for?
Magnet recognition
What are examples of those not required to follow HIPAA
life insurers
employers
workers comp
state agencies
Supplemental insurance that covers physician services, outpatient hospital services, labs and diagnostic procedures
Medicare B
A limited exam of the affected body area or organ system
expanded problem focused
What complementary medicine (alternative medicine) can aid with coordination in Parkinsons?
Tai Chi
Who enforces HIPAA
The Office for Civil Rights
What is the comparison and measurement of healthcare organization’s services against other national healthcare organizations
Benchmarking
scale that assess the conscious state of a patient
Ramsay Sedation Scale
Who do you work for?
the patient
Used to assess the progression of illness, need for care and effectiveness of rehab/treatment
Katz Index of ADL
10 point Scale that assess the levels of anxiety, Agitation and sedation
Richmond Agitation Sedation Scale
What is the most common screening tool for depression
PHQ9
Patient Health Questionairre 9
Provides limited prescription drug coverage
Medicare D
HIPAA title 2 covers who
confidentiality provisions- sets national standards for the security of electronic protected health information
In acute grief or crisis offer?
self…and acknowledge feelings
CAGE
Cut down drinking
Annoyed by people
Guilt about drinking
Eye opener
an extended exam of the affected body area or organ system and other symptomatic areas
detailed
HIPAA Title 1 covers who
The patient. This is COBRA
Comprehensive Omnibus Reconciliation Act
Act that establishes a voluntary reporting system to enhance the data available to asses and resolve patient safety and health care quality issues
The Patient Safety and Quality Improvement Act
provides confidentiality
A written compilation of statements in a document that specifies which life prolonging measures? Often grants durable power of attorney to a significant other with incapacaitation
Living Will
Do you delay discharge for routine exams?
no, refer to their primary provider
What are the three principles of instruction
Mentoring, role modeling and counseling
What diagnoses must be reported in most states?
Gonorrhea Chlamydia Syphilis HIV TB
What is the most powerful data collected?
Subjective data from the patient
Type of Medicare that covers inpatient
Medicare A
What is the process by which registered nurses systematically access, monitor and make judgment about the quality of nursing care by peers?
Peer review
A general multi-system exam or a complete exam of a new patient
comprehensive
What is the AGACNP’s role in tests and procedures?
facilitate the scheduling
educate the patient
perform or assist with the procedure
assess the patient for adverse reactions
Does Medicare cover hearing aids?
no
What are the goals of technology in nursing?
capture the tasks performed
enhance scope of practice
make practice knowledge driven
Who sets the standards for reimbursement and cutting costs
Medicare
A limited exam of the affected body part
problem focused
Medicare that reimburses 85% of physician for services provided with collaboration of physician
Medicare B
When treating patients, what first?
medical conditions before psychosocial
What promotes self-regulation in practice
peer review
What does drawing a clock assess
cognitive impairment
Assess for depression in the geriatric
Geriatric depression scale
The legal responsibility the NP has for actions that fail to meet the standard of care
liability
failure of an individual to do what a reasonable person would do- resulting in injury
negligence
failure of an individual to render services with the degree of care, diligence and precaution
malpractice
fear of harm
assault
actual harm
battery
communication that causes damaged reputation
defamation
defamation by written material
libel
defamation by speech
slander
true positives; the degree to which those who have a disease screen or test positive
sensitivity
true negatives; the degree to which those who have a disease or test negative
specificity
The frequency with which a disease appears in a population
incidence
The proportion of a population that is affected by a disease
prevalence
level of prevention that promotes health
primary
level of prevention that focuses on the early identification
secondary
level of health that includes rehabilitation and restoration of health
tertiary
This contributes to the elimination of racial and ethnic health disparities and to improve the health of all Americans
Culturally and Linguistically Appropriate Services
CLAS
HC organizations must offer language assistance services
Standard 5
HC organizations must provide notices in preferred language
Standard 6
HC organizations must assure competence of language- not using family/friends to translate
Standard 7
Services that do not meet Medicare’s definition of physician services
regular physical exam
health maintenance screenings
counseling for well patients
In the OFFICE setting, services billed under the physicians provider number to get the full physician fee
Incident to billing- not allowed in the inpatient setting
This is federally funded and benefits vary from state to state
Medicaid
QA, QI and CPI all do what?
monitoring, evaluating and continuous review for the improvement of quality in health care
This is a tool for identifying prevention strategies to ensure safety- moves beyond the culture of blame
Root Cause Analysis
Who determines the scope of practice?
The individual state nurse practice act
Who identifies the standards of advanced practice
the American Nurses Association
Who dictates the level of prescriptive authority
the state
This ensures the required level of education, licensure and certification
credentials
This means you are qualified
licensure
This means you have a mastery of knowledge
certification
in 1983 the JC did what?
allowed non-physicians to admit to the hospital
Who sets forth privileges?
the hospital credentialing committee
The likelihood that an intervention will benefit the patient is extremely poor
quantitative futility
The quality of the benefit of an intervention to the patient is poor
qualitative futility
This implies that the patient is able to understand, reason, differentiate good and bad and communicate
competence
Do no harm
nonmaleficence
The duty to prevent harm and promote good
beneficence
the duty to be fair
justice
the duty to be faithful
fidelity
The duty to be truthful
veracity
the duty to respect an individuals thoughts and actions
autonomy
the right act is the one that produces the greatest good to the greatest number
utilitarianism
What are the steps in discharging a patient from a practice
- certified letter
2. provide coverage for first 15-30 days post termination
What are the obligations in closing a practice?
- give the patient time to find another provider
- keep files for a min of 5 years
- provide timely notification and names of other providers for future care
When was the NP role developed
the early 1960s
What was the first NP program
pediatric NP
What expanded the role of the NP
managed care
decrease in medical residency programs
hospital reconstruction
What is the best way for the AGACNP to get involved in policy making
Join a hospital committee
What is the best way for the AGACNP to demonstrate and advocate for full scope of practice?
Bill for independent services
Which of the following is considered a high acuity role for the AGACNP?
a. Primary care clinic
b. Cardiology office**
c. Community health department
d. Minute Clinic
- Which of the following is most important to evaluate statistical significance when reviewing the literature?
Consider the sample size
When closing a practice, the NP is required to do all of the following except
a. Give the pt adequate time to find another provider
b. Keep all of the patient’s records for a minimum of five years
c. Send a certified letter with a return receipt requested (this is for discharging/firing a patient from your practice)**
d. Provide names of other providers for future care
Which of the following components of an evidenced based research process is the most important for NP to participate in?
Formulating the research problem
A former pt of an NP is writing blog posts, sending emails, and distributing false, accusatory statements about the NP’s practice. Which of the following forms of defamation is this?
libel
Can you tell the pt’s wife, for her protection, that her husband has HIV?
No, not without his permission.
How can the ANCP prepare to get involved in future mass casualty event
Pre-enroll in disaster volunteer program
An 80-year-old male patient with dementia requires long-term care placement. To which funding agency does the patient apply after “spending down” to qualify?
Medicaid
Your pt is worried about insurance coverage and asks you for advice on Medicaid. You instruct the patient that Medicaid:
Pays after insurance and 3rd party payers have paid
You are giving a dinner presentation to a group. The pharmaceutical rep calls you the night before and wants you to say that their drug is the only one that works. What ethical principles does this challenge?
Veracity and Fidelity
Quality assurance
a process for evaluating the care of pts using established standards of care to ensure quality
CPI measures what 3 measures to improve nursing?
Structure, processes, and outcomes
A root cause analysis of a crisis situation in the ICU identified a lack of clinician-family communication as the basis for the resulting adverse outcome. As part of the performance improvement plan, the NP is asked to develop evidence-based polices to establish clinician-family communication standards in the unit. These policies should include:
guidelines for having discussions with family members that are geared toward establishing treatment goals.
Which clinical scenario does the NP evaluate for a quality improvement process change
An increased incidence of postoperative sternal wound infections
Goals set forth in “Healthy People 2020” by the United States Department of Health and Human Services include
elimination of health disparities. (and ↑QOL/LOL)
Based on the individual’s culture, ethnicity, and personal choices, the NP can optimize the therapeutic partnership w/the patient by
Tailoring his or her communication style to the patient’s preference.
A 70-year-old pt with a hx of DM, HTN, OAs, and a new diagnosis of coronary artery disease, is being discharged. The adult-gerontology acute care nurse practitioner teaches the patient that the first point of contact for health care needs is the:
primary care provider
The NP is asked to provide evidence to the hospital administration about the safety of NP placing central lines. Which resource provides the strongest level of evidence?
A systematic review (meta-analysis is even stronger)
What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number?
Balanced Budget Act
True/False: restraining an unwilling patient is grounds for malpractice
False, if they are a danger you can restrain
Pt presents to the clinic for routine f/u and passes out. You revive the pt and admit overnight. Which of the following would qualify as incident-to-billing?
Temperature and weight recording
The NP program initiated, primarily, because of what issue in healthcare at the time?
Pediatric physician shortage
Elderly F pt takes a turn for the worse. The husband is crying when you enter the room and begins telling you what end-of-life care he prefers. What do you do?
Ask him to speak candidly with you
Pt calls to complain about bills and states he has Medicare, which should cover all costs. You explain:
Since you are healthy, exams are not covered.
