AG-ACNP - Issues, Trends, and Health Policy Questions and Answers

AG-ACNP - Issues, Trends, and Health Policy Questions and Answers Crisis/Acute Grief Communication Acknowledge feelings Offer self Therapeutic communication Listen more than talk Tell me.. "open ended questions" Don't ask why Focus on feelings, don't mince words Crisis Intervention Boundaries, put something between you and the patient Security if necessary, NOT police Establish trust/rapport Advance Directive Written statement of patient's intent regarding medical treatment The Patient Self-Determination Act of 1990 All patients in a hospital setting are required to be advised of their right to execute an advance directive Living Will Compilation of statements that specify which life-prolonging measures one does and does not want if they become incapacitated Durable Power of Attourney Individual designated in the living will that is authorized to make medical decisions in the event patient is incapacitated Healthcare directive Type of advance directive - May or may not have a living will or specifics for power of attorney in 1-2 documents Title I of HIPPA Protects health insurance coverage for workers and their families in the event they change or lose their jobs COBRA Title II of HIPPA Known as ASA, establishes national standards for EHR transactions and ID's for providers, insurance and employers COBRA protects health insurance coverage for workers and their families in the event worker loses or changes jobs Who enforces HIPPA Office for Civil Rights What does HIPPA II protect Privacy of health info National standards for protection of health info Patient Safety And Quality Improvement Act Protects patient information to analyze patient safety events and improve health care quality issues You can report patient safety outcomes without liability, managed by AHRQ True or False: A patient has the right to see their medical record True Required to follow HIPPA Health Plans Health care providers Health care clearinghouses (those that process health info data) The Privacy Rule: Patient's Rights See/have their medical record Corrections added to medical record Be told how their health info may be used or shared Received report about when or why health info was shared File complaints for illegal sharing Patient Safety and Quality Improvement Act (PSQIA) Voluntary reporting system improve patient safety outcomes through anonymous reporting by providers of patient safety outcomes and events When can health info be shared TO ensure proper treatment (between providers) To pay for services Whenever someone is involved with the health care or bill payment (unless pt says otherwise) To protect the public To make police reports Those not required to follow HIPPA Life Insurance Employers Workers comp Schools CPS Law enforcement Duty to Warn Patient's condition may endanger others overrides confidentiality Patient is diagnosed with HIV. Duty to Warn applies how? Can notify providers not family Invasion of Privacy Damaging one's reputation as a result of sharing patient information without their permission When can invasion of privacy charge not be made If info was accurate and given in good faith & receiver has valid reason to obtain information Initiating any change in heathcare Begin at most local level and expand outward What comes first when treating a patient with a medical and psychosocial condition Medical condition strongest method to evaluate teaching returned demonstration when to transfer to teritary care facility seriously ill or injured patients that cannot be cared for at your institution stabilize and ship Patient reluctant to undergo procedure. you should? Fully educate patient and tell them why Primary care screening exams that are not emergent do not delay hospital discharge refer to PCP most powerful data collected from patient subjective or data you observed as the np RN calls you as the night shift NP and states patient is decompensating. You would? Call primary MD when patient status changes Code goes bad and all involved are talking badly about it on the unit. You should? Hold a one time debriefing with everyone invovled When initiating change start where Most local level and progress upward and outward What is a response that would suggest admitting a patient to a SNF would be the best action? Needing assistance with ADLs What Abuse do you have to report Child or elder What abuse do you not have to report Domestic violence Goals of Healthy People 2020 increase the quality and years of healthy life eliminate health disparities among americans Healthy People 2020 purpose used to understand health status of the nation and plan prevention programs NP must notify department of health with what dx Gonorrhea Chlamydia Syphillis HIV TB NPs must report to state Criminal acts and injury from dangerous weapon (GSW) Gonorrhea Chlamydia Syphillis HIV TB Animal bites Suspected/actual child abuse or elder abuse Qualify for hospice when 6 month survival & no additional tx other than symptom relief Physical Therapy Strength training coordination Occupational Therapy ADLs What identifies the level of care provided for billing E&M codes Medicare Third party payers sets the standard for reimbursement and cutting costs 65 yo. Disabled Problem focused exam A limited exam of the affected body area or organ system Expanded problem focused exam Limited Exam of the affected body are or organ system and ANY OTHER symptomatic or related area/system Detailed exam Detailed Exam of the affected body are or organ system and ANY OTHER symptomatic or related area/system Comprehensive exam Multi-system exam (generalized) or complete exam of organ system and other symptomatic areas Medicaid Third party payers Poverty Medicare A Covers inpatient hospitalizations SNF home health hospice 65 yo. Medicare B Covers physician services outpatient hospital services labs/diagnostic procedures medical equipment Pay premium NPs 85% physician scheduled fee Medicare B pays how much of bill Medicare pays 80% and patient pays 20% Medicare C Medicare A + B, eligible to reviewed all services under HMO or PPO Medicare D Limited prescription drug coverage Monthly premium required Co-pay on each prescription required Not covered under Medicare B Regular physicals Health maintenance screenings Counseling well patients Hearing aids Medicare NP payments 85% of physician fee For procedure NP gets 80% of the 85% physical fee schedule IF incident-to-billing a practice is reimbursed all 100% Incident-to-Billing Services billed under MD provider number to get the full physician fee Under MD direct supervision Does direct supervision require MD to be physically in the room with NP to be eligible for incident-to-billing no same office suite and easily accesible does incident-to-billing apply to the inpatient hospital setting No. NP must bill under their NPI in the hospital setting What must the MD perform to qualify for incident-to-billing -initial service -subsequent services of a frequency that reflects his participation Root Cause Analysis Tool for identifying prevention strategies to ensure safety Culture of safety and not culture of blame If physician and NP see patient same day can both bill No only one How do you decide if both NP and MD see pt who bills Depends on services rendered What does case management do? Mobilize, monitor, and control resources that a patient uses during a course of illness while balancing quality and cost Root Cause Analysis involves Interdisciplinary experts those who are most familiar with the situation continually asking why at each level of cause and effect Identifying changes Impartial process Whats the point of root cause analysis Ensure patient safety, builds culture of safety and move beyond culture of blame Debriefing after an event is an example of root cause analysis Sentinel Events Unexpected occurrences involving death or serious physical injury or psychological injury or risk thereof immediate investigation and response Quality assurance Evaluates the care of patients using established standards of care to ensure quality Continuous Quality Improvement (CQI) involves: Structures: Inputs such as resources or numbers Processes of care: Assessments, planning, performing treatments Outcomes: Include complications, adverse events, short term results of treatment Steps of CQI (8 steps) 1. Quality planning 2. Delineate scope of care (identify aspects of care) 3. Establish thresholds to evaluate these aspects of care 4. Collect data 5. Evaluate when thresholds are hit 6. Take action to improve 7. Assess the effectiveness of the action and document improvement 8. Communicate findings Critical path Key patient care activities and time frames for these activities which are needed for a DRG Critical Map Newer version of critical path, blueprint for managing and delivering care Day-to-day-goals for all disciplines Monitoring outcomes of care is very important Sentinel Event and medical error not synonymous not all sentinel events occur because of an error not all medical errors result in a sentinel event Response to Sentinel Event Root Cause Analysis Scope of Practice Based on legal allowances in each STATE Provides guidelines for nursing practice How can the ACNP demonstrate and advocate for full scope of practice? ACNP bills independently Who sets standards for advanced practice ANA has the authoritative statements to measure quality of practice State Practice Acts STATE Board of Nursing grants authority includes title, authorization of scope including prescriptive authority, disciplinary grounds What dictates the nurse practitioners prescriptive authority State Nurse Practice Acts State Board of Nursing Who decides level of prescriptive authority State practice acts Credentials Encompass required education, licensure and certification to practice as an NP Establish MINIMAL levels of acceptable performance Licensure GOVERNMENT STATE BOARD OF NURSING Establishes a person is qualified to perform Certification NONGOVERNMENTAL AGENCIES ANCC Establishes a person has met certain standards which signify mastery of specialized knowledge and skills Who said NP's can admit JC in 1983 Licensure vs. Certification Government state board of nursing vs. nongovernmental agencies ancc Credentialing and Privileging Process by which a nurse practitioner is granted permission to practice in an inpatient setting Hospital Credentialing Committee Comprised of physcians Credentialing with hospital privileges grant What factors into medical abandonment - Whether the NP accepted the assignment - If the NP provided reasonable notice before terminating provider relationship - If reasonable arrangements to continue patient care could have been made to continue care when the notifications was given What doesn't qualify as patient abandonment 1. If the NP refuses the assignment due to lack of competence for the particular patient 2. IF the NP refuses to work double shift or additional hours when proper notification has been given Most common method of documentation in Risk Management Incident Reports What should incident policy reports address Who can complete a report Who can review the report What needs to happen after the report, who's responsible for it Monitoring the aftermath of the report Where the report will be stored Medical Futility Interventions that are unlikely to produce any significant benefit for the patient Satisfaction surveys Track and analyze to identify problems, employee and patient Quantitative Futility Where the likelihood that an intervention will benefit the patient is extremely poor IE the chance of the actual benefit Qualitative Futility Where the quality of the benefit an intervention will produce is extremely poor IE quality of the benefit Competence Decisional capability State in which patient can make personal decisions about their care When is someone competent If they understand, reason, differentiate good and bad and can communicate