Practice Issues, Trends, and Health Policy Flashcards
Living Will
Written compilation of statements in document format that specifies which life-prolonging measures one does and does not want to be taken if he/she becomes incapacitated
Which office did HIPAA come out of?
Office of Civil Rights
This means it’s a right.
PSQIA
Patient Safety and Quality Improvement Act:
1. Establishes a voluntary reporting system to enhance the data available to assess and resolve patient safety and health care quality issues
- Includes privilege and confidentiality protections for patients
- AHRQ lists patient safety organizations, which are external experts established by the Patient Safety Act to collect and analyze patient safety information
Duty to Warn v. Confidentiality
- Duty to warn supersedes the right to confidentiality if a patient’s condition may endanger others. Must warn the “others” who are in danger, and not just authorities, etc.
- Duty to protect a patient from harming him/herself supersedes the right to confidentiality
Reason Healthy People 2020 was established
- Increase quality and years of healthy life
- Eliminate health disparities among Americans
(Exam LOVES Healthy People 2020)
Mandatory Reporting
- Criminal acts and injury from a dangerous weapon
- Certain STDs
- Animal Bites
- Suspected or actual child or elder abuse
5 STDs that need to be reported
- Gonorrhea
- Chlamydia
- Syphilis
- HIV
- TB
Collaborative Practice
- Exists to enhance the quality of care and improve pt outcomes
- A “true partnership” in which all players have and desire power, share common goals, and recognize/accept separate ares of responsibility and activity
5 categories of 3rd party Payers
- Medicare
- Medicaid
- Commercial indemnity insurers
- Commercial management organizations (Insurance)
- Businesses or schools wanting health services for employees or students
Medicare A
Inpatient hospitalization, home health services and/or hospice associated with the inpatient event
Medicare B
Outpatient services
Lab/diagnostics
Medical equipment
Some home health
Medicare C
If a patient is entitled to parts A and B, they may choose to receive their services through a Part C provider organization (Insurance company)
Medicare D
Limited prescription drug coverage
Services that do not meet Medicare’s def. of phys services
- Regular physical exams (annual exams)
- Health maintenance screenings
- Counseling for well patients
(All of these are changing under ACA, but that won’t be on our exam yet)
Deming’s 3 components of continued quality improvement (CQI)
Structures
Processes
Outcomes
Structures
Inputs into care such as resources, equipment, or numbers and qualifications of staff
Processes
Includes assessments, planning, performing treatments, and managing complications
Outcomes
Includes complications, adverse events, short term results of treatment and long term results of patient health and functioning
Root Cause Analysis
A tool for identifying prevention strategies to ensure safety
RCA involves and incorporates
Inter-disciplinary experts from the frontline services
Those who are the most familiar with the situation
Identifying changes that need to be made to systems
Impartiality
To be thorough, RCA must include:
- Determination of human and other factors
- Determination of related processes and systems
- Analysis of underlying cause
- Identification of risks and their potential contributions
- Determination of areas of potential improvement
To be credible, a RCA must include:
- Participation by the leadership of the organization and those most closely involved
- Be internally consistent
- Include consideration of relevant literature
- Use the facts and ask, “So what?” to determine all possible consequences of a fact
- Include 5 Whys
LACE
Licensure
Accreditation
Certification
Education
Scope of Practice
- Based on legal allowances in each state, according to and delineated by individual State Nurse Practice Acts
- Provides guidelines for nursing practice
Standards of Advanced Practice
Delineated by the ANA as authoritative statements by which to measure quality of practice, service, or education
Prescriptive Authority
The ability and extent of the NP’s ability to prescribe medications to patients is dependent on state nurse practice acts
Determination of patient abandonment
- Did the NP accept the patient assignment?
- Did the NP provide reasonable notice before terminating the NP-patient relationship?
- Were reasonable arrangements made to continue patient care when the adequate notification was given?
Medical Futility
Does the intervention have any reasonable prospect of helping this patient?
Quantitative Futility
Where the likelihood that an intervention will benefit the patient at all is extremely poor.
Qualitative Futility
Where the quality of the benefit an intervention will produce is extremely poor.
Danforth Amendment, 1991
Patient has the right to refuse care
Nonmaleficence
The duty to do no harm
Utilitarianism
The right act is the one that produces the greatest good for the greatest number
Beneficence
The duty to prevent harm and promote good
Justice
The duty to be fair
Fidelity
The duty to be faithful
Veracity
The duty to be truthful
Autonomy
The duty to respect an individual’s thoughts and actions
Advanced Directives
Written statement of a patient’s intent regarding medical treatment
2 Doctors that pioneered the NP programs
Loretta Ford
Henry Silver
First NP program: Type and year
Pediatric
1964
Cross-sectional Study
Study that examines a population with a very similar attribute but differs in one specific variable is designed to find relationships between variables at a specific point in time or “surveys.”
Longitudinal Study
Involves taking multiple measures of a group/population over an extended period of time to find relationships between variables
Experimental Research
Includes experimental manipulation of variables utilizing randomization and a control group to test the effects of an intervention or experiment
Quasi-experimental Research
Involves manipulation of variables, but lacks a comparison group or randomization
Confidence Interval
An interval, with limits at either end, with a specified probability of including the parameter being estimated
Standard Deviation
Indicates the average amount of deviation of values form the mean
Percentage of the sample that falls within one SD from the mean
66%
Percentage of the sample that falls within 2 SD of the mean
95%
Level of significance
The probability level of which the results of statistical analyses are judged to indicate a statistically significant differences between groups
T-test
Statistical test to evaluate the differences in means between two groups
Reliability
The consistency of a measurement, or the degree to which an instrument measures the same way over time with the same subjects
Validity
The degree to which a variable measures whether negligence has occurred
Negligence
Failure of an individual to do what a reasonable person would do, resulting in injury to the patient
Malpractice
Failure of a professional to render services with the degree of care, diligence, and precaution that another member of the same profession under similar circumstances would render to prevent injury to someone else.
