AG-ACNP - Issues, Trends, and Health Policy

AG-ACNP - Issues, Trends, and Health Policy Crisis/Acute Grief Communication Answer- Acknowledge feelings Offer self Crisis Intervention Answer- Boundaries Security if necessary, NOT police Establish trust/rapport Advance Directive Answer- Written statement of patient's intent regarding medical treatment The Patient Self-Determination Act of 1990 Answer- All patients in a hospital setting are required to be advised of their right to execute an advance directive Living Will Answer- Compilation of statements that specify which life-prolonging measures one does and does not want if they become incapacitated Durable Power of Attourney Answer- Individual designated in the living will that is authorized to make medical decisions in the event patient is incapacitated Title I of HIPPA Answer- Protects health insurance coverage for workers and their families in the event they change or lose their jobs COBRA COBRA Answer- protects health insurance coverage for workers and their families in the event worker loses or changes jobs Who enforces HIPPA Answer- Office for Civil Rights Patient Safety Rule Answer- Protects patient information to analyze patient safety events and improve True or False: A patient has the right to see their medical record Answer- True The Privacy Rule: Patient's Rights Answer- See/have their medical record Corrections added to medical record Patient Safety and Quality Improvement Act (PSQIA) Answer- Voluntary reporting system improve patient safety outcomes through anonymous reporting by providers of patient safety outcomes and events Duty to Warn Answer- Patient's condition may endanger others overrides confidentiality Patient is diagnosed with HIV. Duty to Warn applies how? Answer- Can notify providers not family Invasion of Privacy Answer- Damaging one's reputation as a result of sharing patient information without their permission When can invasion of privacy charge not be made Answer- in good faith accurate information receiver has valid reason to obtain information Initiating any change in heathcare Answer- Begin at most local level and expand outward What comes first when treating a patient with a medical and psychosocial condition Answer- Medical condition strongest method to evaluate teaching Answer- returned demonstration when to transfer to teritary care facility Answer- seriously ill or injured patients that cannot be cared for at your institution stabilize and ship Patient reluctant to undergo procedure. you should? Answer- Fully educate patient and tell them why Primary care screening exams that are not emergent Answer- do not delay hospital discharge refer to PCP most powerful data collected from patient Answer- subjective or data you observed as the np RN calls you as the night shift NP and states patient is decompensating. You would? Answer- Call primary MD when patient status changes Code goes bad and all involved are talking badly about it on the unit. You should? Answer- Hold a one time debriefing with everyone invovled What is a response that would suggest admitting a patient to a SNF would be the best action? Answer- Needing assistance with ADLs Goals of Healthy People 2020 Answer- increase the quality and years of healthy life eliminate health disparities among americans Healthy People 2020 purpose Answer- used to understand health status of the nation and plan prevention programs NP must notify department of health with what dx Answer- Gonorrhea Chlamydia Syphillis HIV TB NPs must report to state Answer- Criminal acts and injury from dangerous weapon (GSW) Gonorrhea Chlamydia Syphillis HIV TB Animal bites Suspected/actual child abuse Domestic violence Physical Therapy Answer- Strength training coordination Occupational Therapy Answer- ADLs Medicare Answer- Third party payers sets the standard for reimbursement and cutting costs 65 yo. Disabled Medicaid Answer- Third party payers Poverty Medicare A Answer- Covers inpatient hospitalizations SNF home health hospice 65 yo. Medicare B Answer- 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 Answer- Medicare pays 80% and patient pays 20% Medicare D Answer- Limited prescription drug coverage Monthly premium required Co-pay on each prescription required Incident-to-Billing Answer- 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 Answer- no same office suite and easily accesible does incident-to-billing apply to the inpatient hospital setting Answer- No. NP must bill under their NPI in the hospital setting Root Cause Analysis Answer- Tool for identifying prevention strategies to ensure safety Culture of safety and not culture of blame Root Cause Analysis involves Answer- Interdisciplinary experts those who are most familiar with the situation continually asking why at each level of cause and effect Identifying changes Impartial process Debriefing after an event is an example of Answer- root cause analysis Sentinel Events Answer- Unexpected occurrences involving death or serious physical injury or psychological injury or risk thereof immediate investigation and response Sentinel Event and medical error Answer- not synonymous not all sentinel events occur because of an error not all medical errors result in a sentinel event Response to Sentinel Event Answer- Root Cause Analysis Scope of Practice Answer- Based on legal allowances in each STATE Provides guidelines for nursing practice How can the ACNP demonstrate and advocate for full scope of practice? Answer- ACNP bills independently State Practice Acts Answer- STATE Board of Nursing grants authority includes title, authorization of scope including prescriptive authority, disciplinary grounds What dictates the nurse practitioners prescriptive authority Answer- State Nurse Practice Acts State Board of Nursing Credentials Answer- Encompass required education, licensure and certification to practice as an NP Establish MINIMAL levels of acceptable performance Licensure Answer- GOVERNMENT STATE BOARD OF NURSING Establishes a person is qualified to perform Certification Answer- NONGOVERNMENTAL AGENCIES ANCC Establishes a person has met certain standards which signify mastery of specialized knowledge and skills Licensure vs. Certification Answer- Government state board of nursing vs. nongovernmental agencies ancc Credentialing and Privileging Answer- Process by which a nurse practitioner is granted permission to practice in an inpatient setting Hospital Credentialing Committee Answer- Comprised of physcians Credentialing with hospital privileges grant Most common method of documentation in Risk Management Answer- Incident Reports Medical Futility Answer- Interventions that are unlikely to produce any significant benefit for the patient Quantitative Futility Answer- Where the likelihood that an intervention will benefit the patient is extremely poor Qualitative Futility Answer- Where the quality of the benefit an intervention will produce is extremely poor Competence Answer- Decisional capability State in which patient can make personal decisions about their care Informed Consent Answer- Patient has received adequate instruction or information regarding aspects of care to make a personal choice Informed Consent includes Answer- discussing all risks and benefits Ethics Answer- The study of moral conduct and behavior Nonmaleficence Answer- Duty to do no harm