ANCC AGPCNP Non-Clinical Terms, Accurate definitions. Rated A

ANCC AGPCNP Non-Clinical Terms, Accurate definitions. Rated A Level of Evidence Hierarchy: - ✔✔1. Meta-analysis 2. Systemic review 3. Randomized Controlled Trial (RCT) 4. Experiment 5. Cohort Study 6. Case Report ...

ANCC AGPCNP Non-Clinical Terms, Accurate definitions. Rated A Level of Evidence Hierarchy: - ✔✔1. Meta-analysis 2. Systemic review 3. Randomized Controlled Trial (RCT) 4. Experiment 5. Cohort Study 6. Case Reports/Series 7. Expert Opinions/Editorials Types of Research - ✔✔• Meta-analysis • Systemic review • Randomized Controlled Trial (RCT) • Experiment (Classic Research) • Cross-Section • Longitudinal Design • Case Study (Report/ series) • Field study or Naturalistic study • Survey study • Cohort research Statute of Limitations: - ✔✔• The time limit when a lawsuit can be filed or action against a nursing licensee for alleged violation can occur. Most states are 2-3 years. • A period of limitation for the bringing of certain kinds of legal action. Standards of Practice - ✔✔• Authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty are expected to perform • It is developed by professional societies (ANA) and specialty organizations (AANP) Emancipated Minor - ✔✔• Can sign own legal documents • Legally married or divorce • Active duty in the armed forces • These are people under the age of 18 y/o but do not require an adult for consent. • Legal court document HITECH - ✔✔• Heath Information Technology or Economic and Clinical Health Act • Promotes adoption and meaningful use of health information technology • ACT approved in 2009 for the use of electronic health information. • Protection of PHI enacted in 2009. PHI must be encrypted prior to sending. • Patients must be informed if their PHI has been disclosed inappropriately even if the disclosure was accidental. • Providers will be offered financial incentives for demonstrating meaningful use of EHR until 2015 then penalties. • HITECH- signed by President Obama to transition to electronic health records. No more paper charting. The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law with the explicit intention of accelerating the adoption and promoting the "meaningful use (MU)" of electronic health records (EHRs) by US physicians. Patient in EOL (end of life) stage ask of hospice: - ✔✔• The patient is already end stage so beneficence is not correct unless you are educating about smoking cessation or vaccination. This is to promote good. Utilitarianism is the greater good for a population of patients. Justice is to be fair. Which leaves us to autonomy. This is allowing the patient to make his own choice after giving him all the information to make a good informed decision. • AFTT (adult failure to thrive). This is a secondary diagnosis for hospice eligibility. So when you consult hospice for weight loss and not eating with no other major diagnoses, this is not a good referral. Hospice is no longer able to use this as a primary diagnosis. Prescriptive Authority - ✔✔• The majority of states require NPs to have a collaborative agreement with a physician in order to prescribe. • All states now allow NPs to prescribe certain controlled drugs, but with limitations DEA - ✔✔• Drug Enforcement Administration • NP must obtain prescriptive authority before getting a DEA number to prescribed controlled substances. • Allows advanced practice nurses to obtain registration numbers for prescribing controlled medication • Though DEA is federal, prescriptive authority is managed by the state board Certification - ✔✔• Generally a "voluntary" process and is done through a nongovernmental entity such as professional nursing association or specialty organization. • Many states mandate certification as a condition to obtain licensure Licensure - ✔✔• Legal requirement to practice as an NP • Obtained through a governmental entity, the SBON • Must meet minimal educational and clinical requirements in order to become licensed Incidence - ✔✔• Conveys information about the risk of contracting a disease • Measure of disease that allows us to determine a person's probability of being diagnosed with a disease during a given period of time. • Rate of new cases of the disease Prevalence - ✔✔• How widespread the disease is • Measure of disease that allows us to determine a person's likelihood of having a disease, number of alive cases with the disease What are the 4 ethical principles? (and define) - ✔✔• Beneficence (promoting well-being for pt. and society) • Nonmaleficence - "above all, do no harm" • Autonomy (person acts intentionally after being given informed consent) • Justice (equitable distribution of social benefits) Beneficence - ✔✔• To do good. The obligation to help the patient; to remove harm, prevent harm, and promote good • Acting in the patient's best interest • Compassionate patient care • The core principle in patient advocacy. • Encourage a patient to stop drinking and enroll in AA program. • Education on a new prescription about how to take the medication, health promotion, education, smoking cessation Nonmaleficence - ✔✔• Obligation to do no harm; protecting a patient from harm • Your patient has asthma. She brown bags her medication on this visit and you notice a beta-blocker. You educate her that she is not a good candidate for these drugs • Example: Discussing risks vs. benefits of a treatment; working within SOP (standard operating procedures). Utilitarianism - ✔✔• The outcome of the action is what matters with utilitarianism. It also means to use a resource for the benefit of most (e.g., tax money). It may resemble justice, but it is not the same concept • The Women, Infants, and Children food (WIC) program is only for pregnant women and children. • Outcome of the action is what matter with utilitarianism. • It also means to use a resource for the benefit of most. • It may resemble justice, but it is not the same concept. • Example: WIC program is only for pregnant women and children. It is not open to adults and elderly males. The reason maybe that it would cost society more if women (and their fetuses), infants, and children are harmed by inadequate food intake (affects the brain growth). • Obligation to act in a way that is useful to or benefits the majority Justice - ✔✔• The quality of being fair and acting with a lack of bias • The fair and equitable distribution of societal resources • Example: Low income individuals do not pay some types of taxes to the government but still have equal access to the public services supported by taxes. Informed consent - ✔✔• Research subjects must be informed that they have the right to withdraw at any time without consequences or penalty • All information must be presented on what to expect, risks, benefits, alternatives, compensation, and confidentiality • Permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. Durable Power of Attorney - ✔✔• A legal document that gives someone you choose the power to act in you place. Advance Directive - ✔✔• A written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should be the person be unable to communicate them to a doctor. Living Will - ✔✔• A written statement detailing a person's desire regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive. CPOE - ✔✔• Computerized Provider Order Entry- electronic entry of medical practitioner instructions for the treatment of patients under his or her care EHR - ✔✔• Electronic health record; digital version of patient's chart; makes information available instantly and securely to authorized users Electronic Medical Record - ✔✔• Electronic version of the patient's chart; should remain confidential as the paper chart; providers should log out of patient identifying screens when away from the computer. ICD 10 - ✔✔• International Classification of Diseases • Used to indicate the diagnosis, including family history disorders. • Each disease is assigned an ICD-10 code. • Global health information standard for mortality and morbidity statistics. • Increasingly used in clinical care and research to define disease and study disease patterns, as well as manage health care, monitor outcomes and allocate resources. CPT - ✔✔• Current Procedural Terminology • List of descriptive identifying codes that are used to identify procedures and medical services. • It owned by the AMA. • Medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies, and accreditation organizations. CMS - ✔✔• Centers for Medicare and Medicaid Services • Agency under the U.S. Department of Health and Human Services Claims Based Policy - ✔✔• Policy that provides coverage when a claim is made against the policy, regardless of when the claim event took place. • A claims-made policy is most likely to be purchased when there is a delay between when claims are filed when they occur. • ONLY beneficial if a claim is made while your policy active. • You are covered when you have the policy for that period of time... ie.... you have the policy from 2017-2018. • If a claim is made while you have the policy you are good, but if a claim is made in 2019 and you do not have tail coverage then you're up the creek. Even if the incident occurred in 2017-2018. • Type of malpractice insurance that will cover claims only if the incident occurred when the NP paid the premium and only if the NP is still enrolled with the same insurance company at the time the claim is filed in court. Occurrence Based Policy - ✔✔• This includes tail coverage so it is more expensive. It will cover you even if you no longer have the policy. As long as you had the policy, if the claim is filed in the future.. ie... your insured from 2000-2017 then you retire. A patient makes a claim in 2018 for something that happened in 2016. This means you are covered. • Type of malpractice policy is not affected by job changes or retirement. If a claim is filed against the NP in the future, it is covered at the time the incident occurred Tail Coverage - ✔✔• When you are retired and had claims based coverage. It will protect you if you have retired or changed providers against any claim made NPI - ✔✔• A number used to identify healthcare providers and is used for billing purposes. The Joint Commission - ✔✔• Has developed practice standards for which to measure quality. • Establishes performance standards for hospitals to follow for accreditation • Holds organizations accountable for sentinel events • Implements the Core Measures program The Centers for Medicare and Medicaid Services (CMS) - ✔✔• Responsible for administering several key federal health programs, such as Medicare and Medicaid. Third Party Payers - ✔✔• Medicare • Medicaid • Commercial Indemnity Insurers • Commercial management organizations (HMO) • Businesses or schools wanting health services for employees or students. Issues regarding Access to Care - ✔✔• Home health - Nurse/Therapy/HHA/MSW in the home - Cheaper Model than Hospital • Hospice - death diagnosis of the patient with 6 month survival with no additional treatment • Skilled nursing facilities - Nursing home with therapy room. Decrease of cost. • Private duty Nursing - $$$$$ - Nurse, Expensive Medicare - ✔✔• Federal health insurance program for people who are 65 and older, certain younger people with disabilities, and people with end stage renal disease. • Sets the standard of reimbursement and controlling cost • ie- aarp, blue cross Reimbursement rate for NP w/o incidence to - ✔✔• 85% of physician reimbursement for services provided in collaboration with a physician Medicare Part A - ✔✔• Medicare plan that you receive if you are 65 or older no matter the income, severely disabled, or have ESRD. • "Automatic" at 65 if person paid premiums • Covers persons with ESRD at any age • Will pay for certain "medically necessary" services: a. Inpatient hospitalization(including IP psych) b. Hospice associated with inpatient care c. Home health d. Skilled nursing facility • Will not pay for custodial care (nursing home, retirement home) Medicare Part B - ✔✔• Outpatient insurance • Supplemental medical insurance requiring recipients to pay a premium • Voluntary program with monthly premiums; must enroll during general enrollment period • Will pay for a. OP doctor visits b. Labs, EKG, Xray, CT c. Durable medical equipment - wheel chairs, walkers, etc d. 2nd opinions e. OP dialysis, self-dialysis equipment, organ transplant, surgeries f. Some health prevention services • Will not pay for: eyeglasses/exams, hearing aids, dentures/dental care, cosmetic surgery, OTC and most RX drugs Medicare Part C - ✔✔• Medicare Advantage • Cover IP (A) and OP (B) and some plans cover RX drugs • Administered by private health insurance companies approved by Medicare • "Choice" plan that includes for additional services: vision, dental. • Can keep Medicare Part A and pay for Medicare Part B. • Entitled to A, enrolled in B are eligible to receive all their health care services through one of the provider organizations (HMO,PPO) Medicare Part D - ✔✔• Prescription drug benefit; only those who are enrolled/eligible for A and B are eligible • Formulary for preferred drugs • D=Drug • Limited prescription drug coverage • Monthly premium required • Co-pay on each prescription is required Medicaid - ✔✔• Authorized by social security act • Federal and state matching program • Provides health insurance coverage for low-income individuals and their families who meet the federal poverty level criteria • Covers children, pregnant women, adults, seniors, and individuals with disabilities • Pays for health care and RX drugs • Health care program that assists low-income families or individuals in paying for long-term medical and custodial care costs. • Joint program, funded primarily by the federal government and run at the state level, where coverage may vary. HIPAA - ✔✔• Health Insurance Portability and Accountability Act • Provides protections for the "use and disclosure of individuals' health information"--called "protected health information" by organizations subject to the Privacy Rule, which are called "covered entities" • Health Insurance Portability and Accountability Act that was passed by Congress in 1996. • Must keep all information confidential, do NOT need consent for consultation with other providers. • Only healthcare providers that are active in the patients care can review any medical information. "Covered Entities" - ✔✔• All health care providers, health insurance companies, health care plans, laboratories, hospitals, SNFs, and 3rd party administrators who electronically transmit health information must follow HIPAA regulations HIPAA Requirements - ✔✔• Health providers are required to provide each pt a copy of their office's HIPAA policy (pt sign) • HIPAA form must be reviewed and signed