• Health People 2010 – to improve access to comprehensive, quality, primary care services.
Goals:
o Increase the quality and years of healthy life
o Eliminate health disparities among Americans
• Health People 2020 - The program is an initiative that develops evidence-based practice objec...
PROFESSIONAL Health People 2010 – to improve access to comprehensive, quality, primary care services.
PRACTICE – 17% Goals:
(30 QUESTIONS) o Increase the quality and years of healthy life
o Eliminate health disparities among Americans
Terms & Definitions
Health People 2020 - The program is an initiative that develops evidence-based practice
objectives designed to improve the health of all Americans. These objectives are targeted to be
followed over a 10-year period
4 foundational healthcare measures
1. General health status
2. Health-related quality of life & well-being
3. Determinants of Health – aim to create social & physical environments that promote
good health for all
4. Reduce Health Disparities
Electronic Medical Record (EMR) – Pros: allows for sharing of health information between
healthcare entities & with patients, thereby reducing the cost of care, improving care
efficiency, avoiding readmission and decreasing duplicate testing. Cons: the potential for
data loss in the event of computer or system failure
Medicaid - a government health insurance program for low-income individuals funded by federal
& state entities and administered by the state. * Varies from state-to-state.
Medicare – federally funded health insurance program for those >65yrs, those with severe
disability no matter income level, or those with ESRD. Qualifying conditions: US citizen, non
US citizens after 5 years of permeant residence in the US, veterans are eligible after 65yrs.
A. Medicare Part A covers medically necessary inpatient care and supplies; skilled nursing
facility
B. Medicare Part B covers nursing home/custodial care (ADL’s), home health services, durable
medical equipment, out patient care & preventative services (i.e. 1 mammogram every
12 months) in women 40 and older. Part B DOES NOT cover eyeglasses or routine
dental care.
The Barthel Index is a measurement of ability to perform ADL’s
C. Medicare Part C – HMO
D. Medicare Part D covers prescriptions
A single payer healthcare system refers to a system where in essence the government runs a
nationwide insurance plan that pays for all healthcare costs of its members.
Peer Review / 360 degree Evaluation – employees rate other employees in the same job
classification, through the use of established criteria. The system has the potential to offer honest
& specific feedback that allows the individual to make improvements or adjustments to meet
objectives and performance standards
Fidelity – Loyalty & dedication; keeping a promise
Beneficence – promote good & prevent harm
Non-Maleficence – To do no harm
Justice - right to fair and equitable treatment
Autonomy – The right of patients to make clinical decisions about their medical care, assuming
the patient is rational & can make informed decisions about care
Veracity – The duty to be truthful
Utilitarianism – produces the greatest good for the greatest number of people
PROFESSIONAL State Nurse Practice Act (NPA) – approved by vote through the processes of each individual states
PRACTICE – 17% legislature. The Act delineates the legal scope of practice within the geographical boundaries of
(30 QUESTIONS) the jurisdiction. The purpose of the Nurse Practice Act is to protect the public.
Policies & Practice State Board of Nursing (BON) – determines laws governing nurse practitioner authority; has the
Standards authority to develop administrative rules or regulations that clarify the NPA & make scope of
practice interpretations more specific. The state BON rules and regulations must be consistent
with the legislature.
Indian Health Care Improvement Act of 2010 – part of patient protection & affordable Care Act.
, Only Native American enrolled as members of a federally recognized tribe can be eligible
for health care services. Services obtained under the IHS must be prioritized with life
threatening illness or injuries being given the highest priority. IHS formulary drug list may
not include all drugs & medicines.
Emergency Medical Treatment & Labor Act (EMTALA) – designated to prevent inappropriate
transfers and “patient dumping” for indigent patients. Requires hospitals to assess & treat
patients regardless of ability to pay and provides specific provision for when transfers are
allowed.
The Genetic Information Nondiscriminatory ACT (GINA) – prohibits the use of genetic
information in employment & health care insurance decisions.
Health Information Technology for Economic & Clinical Health Act of 2009 (HITECH) –
healthcare providers would be offered financial incentives for demonstrating meaningful use of
EHR until 2015 after which penalties may be levied for failing to demonstrate such use. ***
CMS announced in mid 2015 that it will delay final penalties until 2017**
➢ Meaningful Use – to implement clinical decision support (CDS) rule relevant to specialty or
high clinical priority (i.e. abnormal vitals signs appear in red)
➢ Clinical Decision Support (CDS) – provides clinicians, staff, patients & other individuals
with knowledge and person-specific information, intelligently filtered & presented at
appropriate times to enhance health & healthcare. CDS encompass a variety of tools to
enhance decision-making in the clinical workflow. These tools include computerized
alerts & reminders to care providers and patients; clinical guidelines; conditions specific
order sets; focused patient data report summaries; documentation templates; diagnostic
support; contextually relevant reference information.
Affordable Care Act of 2010 – expands healthcare coverage using a variety of mechanisms on
the state & federal level.
‘ Only US citizens can purchase health insurance through the online market place
‘ Expands Medicaid as well as subsidies available for low income individuals who cannot
afford individual plans. Subsidies are based on the state you live in, # of adults, children
& ages, and annual incomes.
‘ Tax penalties for individuals who do not get health coverage
The Patient Protection & Affordable Care Act (PPACA)- federal legislation that principally
reforms health reimbursement systems and establishes an individual mandate requiring people
to have health insurance.
Consensus Model for Advanced Practice Registered Nurse (APRN) – a multifaceted proposal
established by the National Counsel of the state BON in conjunction with numerous
professional organizations. Advocates for the APRN title, independent prescriptive authority &
establishes certain minimum standards for NP’s. ***NP’s are not required to have
collaborating physician
supervision under the consensus model.
Medical Home Model – Medical home is the phrase assigned to a model aimed at reorganizing
the delivery of primary healthcare. The purpose of the model is to improve healthcare in
America by transforming how primary care is organized & delivered. In addition, to providing
comprehensive care, patients & their families are encouraged to be active participants in care.
The patient-centered
medical home concept is designed to meet the increase demands of both access to and
management of healthcare thereby improving patient outcomes.
IOM (5) Core Competencies of effective healthcare providers & leaders
1. patient-centered care
2. Work in interprofessional teams
3. Employ evidence-based practices
4. Apply quality improvement
5. Utilize informatics (integrate information technology into care)
National Institute of Medicine (6) Quality Aims (PPEEET)
1. Patient Safety – care should be as safe for patients in healthcare facilities as in their homes
2. Patient Centeredness- the system of care should revolve around the patient, respect
patient preferences & put the patient in control
3. Effectiveness – the science & evidence behind healthcare should be applied and serves
a standard of care in healthcare delivery
4. Efficiency – service & care should be cost effective and waste should be removed from
the system
5. Timeliness – There should be no waits or delays in the delivery of healthcare or
health services to patients
6. Equity – Unequal treatment should be a fact of the past
, National Practitioner Data Bank (NPDB) – a national databank of medical malpractice claims &
specifically defined adverse actions associated with healthcare care providers. Any state
licensure or certification action is also a reportable item.
Prescriptions for Controlled Substances – must include the following:
1. date of issue
2. patient’s name & address
3. practitioner’s name, address & DEA
4. drug name, dosage form, quantity, direction for use
5. # or refills
6. manual signature
**prescriptions for scheduled II controlled substances may be telephoned to pharmacy but must
be followed up with a written prescription within 7 days** Prescriptions for schedule III-V may be
written, oral or transmitted by fax.
American Telemedicine Association Practice Guidelines – providers shall follow federal, state
& local regulatory & licensure requirements related to their scope of practice and shall abide by
state board & specialty training requirements. Providers shall ensure that the patient is
physically located in a jurisdiction in which the provider is duly licensed and credentialed.
Providers shall
practice within the scope of their licensure and shall observe all applicable state and federal legal
& regulatory requirements.
Criteria to Hospice Admission
❖ The patient must give consent
❖ Have a life expectancy < 6mos
❖ Agree to not use life-sustaining equipment in the event of a life-threatening situation
State Reportable to Department of Health
5 diagnoses: Gonorrhea, Chlamydia, Syphilis, HIV, TB
Criminal acts & injury from dangerous weapons
Animal bites
Suspected and/or actual child or elder abuse
➢ Elder abuse, also know as elder mistreatment, involves the physical abuse, emotional
abuse, financial abuse, sexual abuse, neglect, and self-neglect inflicted upon an elderly
individual. Abandonment or neglect is the most common elder abuse
***Domestic violence is NOT state reportable***
The Swiss Cheese Model (James Reason) – systems approach to understanding errors. Declares
PROFESSIONAL humans are fallible & errors ae to be expected even in the best organizations. The holes
PRACTICE – 17% represent opportunities for the process to fail.
(30 QUESTIONS)
Kotters 8-Step Change Model
FRAMEWORKS/MODELS 1. Create a sense of urgency
2. Build a guiding coalition - assembling a group with the power & energy to lead and
support a collaborative change effort (i.e. NP’s creating a task force to address scope of
practice concerns)
3. Form a strategic mission & initiative
4. Enlist a volunteer army
5. Enable action by removing barriers
6. Generate short-term wins
7. Sustain acceleration
8. Institute change
Lewin’s Change Model
1. 1st Stage (Unfreezing) “reason for the change” – where barriers to change should be
assessed. Dissatisfaction with the status quo is identified, bench mark operations are
identified and internal barriers, driving forces & resistant forces to performance are
understood. Unfreezing involves formulating a plan to modify or eliminate an
existing practice that is the target of change.
2. 2nd Stage (Driving forces) – redesigning organizational roles, responsibilities/relationships,
training for newly required skills, promoting supporters, removing resisters. The change
phase is the actual modification of practices, beliefs, or thoughts surrounding the
targeted change.
3. 3rd Stage (refreezing) – involves aligning pay/reward systems, re-engineering
measurement/control systems & creating new organizational structure to support the
change. Refreezing is the establishment of the new practice as a habit or standard
procedure.
Family Developmental Theory Framework (Duvall & Miller)
❖ Examines and analyzes the basic changes & developmental tasks common to most
families during their life cycle
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