Professional Aspects 2

Front 1

What is benificence?

Back 1

first harm myst be avoided
second good must result
befificence is action oriented and requiers positive steps

Front 2

What is an act of benificence for a CRNA?

Back 2

giving Zofran

Front 3

What is Standard of Care?

Back 3

Standard of Care are the rules you are judged on
intended to
-evaluate quality of care
-provide a common base
-assist the public in understanding what to expect
-Support and preserve the basic rights of the patient

Front 4

How do Standards of Practice affect the CRNA?

Back 4

Standards of Practice change with the setting you are in.
Use knowledge and experience for quidance, as standards of practice are not available for every situation

Front 5

How does a CRNA act as an Advocate for the patient?

Back 5

Safeguard the patient from incompetant professionals
& advocate for pts wellfare
-note- to act as an advocate you must first know the patient's goals

Front 6

Explian how the 11 standards of Care can be incorporated into your patient care setting?

Back 6

The standard of care is the same regardless of the setting you practice in.

Front 7

What are the Standards of Care?

Back 7

1.)Preanethesia assessment
2.) informed consent
3.) pt specific anesthesia plan of care
4.) Implement and adjust the plan of care
5.) Monitor the patient
6.) Document
7.) Transfer the reponsibility of the patient to the care of a qualified professional (safe)
8.) Adhere to safety precautions
ie check all equipment
9.) Minimize the risk of infection
10.) Assess the anesthesia care using review (also self review)
11.) Respect and maintain the basic rights of the pts

Front 8

How do clinical practice guidelines differ from standard of care?

Back 8

Practice guidelines (not mandated)are guides commonly accepted.
Standards of care are (not flexible) are behaviors a prudent CRNA should follow.

Front 9

What does a position statement represent?

Back 9

Less rigid then any other...addressing new trends and issues

Front 10

what is Nonmalficience?

Back 10

do no harm

Front 11

Why is it difficult to give a standard definition to "Managed care" plan?

Back 11

Confusing and change frequently, not consitant, often outdated

Front 12

Why are actions in one market dealing with managed care are not effective in another market?

Back 12

The market power can be different in another market.
Practice Management needs to chage rapidly as managed care rises or falls in a short period of time.

Front 13

Why were HMO so attractive when they were started?

Back 13

1.) Perceived to be less $$
2.) emphasized prevention
3.) decreased health disparities

Front 14

What is a PPO

Back 14

Preferred Provider Organization
members receive more coverage if they choose an approved provider
in network is less expensive
no referrals
deductibles, premiums & co-payment required

Front 15

What factors are healthy when linking your future as a CRNA to healthcare plan?

Back 15

contolling allocation of premium
Managing across the continum of care in most appropriate settings
Linking data on cost and treatment with outcomes
providing incentive for performance
added savings through enrollee management
educating consumers to reduce risks and improve health

Front 16

What are the challenges facing managed care?

Back 16

-Providers demanding higher fee
-Consumers want more freedom
-Industry has not invested enough information technology to manage care
-direct contracts are a better alternative then HMO's
-PPO are more price competitive

Front 17

What are Five words of advice for practitioners?

Back 17

-read contract before signing
-never sign what you don't understand
-avoid contracts reimbursing care below the cost to provide it
-practitioners need clearly defined protections and rights
-be familiar with the current and evolving trends

Front 18

What is Primary Anesthesia Practice?

Back 18

who employes the CRNA?
MDA, Hospital or CRNA group.

Front 19

What is secondary anesthesia practice?

Back 19

ways anesthesia can be delivered. MDA only
CRNA only
MDA & CRNA with limited interation
ACT (medically directed)

Front 20

What Tertiary Anesthesia Practice?

Back 20

Evaluating the overall economic impact of primary and secondary practice environments.

Front 21

What are Measurements of Anesthesia time?

Back 21

Durration of anesthesia service in 15 min increments or exact min of service.

Front 22

How does OB time get measured?

Back 22

equal to face to face time with CRNA- NOT the full 24 hours of labor, when Epidural was started when it was D/C'd

Front 23

How does Pain management get measured?

Back 23

Meaured on a RBRVS a resource based relative value scale.
intensity measurement on all aspects.

Front 24

What is practice valuation?

Back 24

Valuation is the process trying to place $ value of a particular service.

Front 25

How to maximize billing reimbursement for anesthesia services?

Back 25

understanding coding
supporting the AANN
effective billing

Front 26

What is medically supervised?

Back 26

MD is supervising more then 4 CONCURENT CRNA's.

may be the surgeon or dentist

Front 27

What is medically directed?

Back 27

MD supervising up to 4 concurrent CRNA's

MDA gets 50% CRNA gets 50%

Front 28

What is the conversion factor?
How is it determined geographically?

Back 28

the conversion factor is set by the CMS for areas based on cost of living.

Front 29

Know the goal of the recommedation on "continues competancy"

Back 29

Recommendation- certification organizations, licensure boards, and professional associations should adopt requirements and procedures that will assure the continued competancy of health personnel.
Goal: this will separate evaluation of professional competancy from association activities, allow AANA to respond to the members need for increased political and economic area activity.

Front 30

What is Certifiation?

Back 30

a process by which a professional agency of association certifies that an individual licensed to practice a profession has met certain standards specified by that profession for specialty practice.

Front 31

What is the purpose of certification?

Back 31

to assure the public that an individual has mastered a body of knowledge and acquired skills in a particular specialty

Front 32

what are the eligibility requirements for the National Certification Examination for Nurse Anesthesia?

Back 32

Completed a nurse anesthesia educational program-accredited by the Council on Accreditation
Application with transcript
Fee payment
Sign and agree to the eligibility certifications
License in (good stand
Absence of mental or physical conditions which might interfere with the practice
No drug of alcohol addiction
Has not been convicted of and is not currently under indictment for any felony
Has not been the subject of any documented allegation of misconduct, incompetent practice of unethical behavior

Front 33

what is included in the content outline for the national certification?

Back 33

Basic sciences, basic and advance principles of anesthesia, equipment, instrumentation and technology, and professional aspects.

Front 34

What are the aspects included on the criteria for full recertification of a CRNA?

Back 34

initial accreditation
-40 CEU during 2 yr period
-substantial practice for the last 2 yrs
not crazy not druggie not a convict never had license revoked

Front 35

What does interim recertification include?

Back 35

provisional recertification and conditional recertification.

Front 36

What is provisional recertification?

Back 36

pending review of an application, pending fulfillment of the practice requirements, pending completion of a treatment or rehabilitation program, pending completion of probation and pending the outcome of an investigation or disciplinary or legal action.

Front 37

What is Conditional recertification?

Back 37

Conditional recertification is granted to those CRNAs who meet the recertification criteria but have restrictions placed on their professional nursing license.
example-practice with supervision or complete drug rehab

Front 38

what is the focus of a good resume?

Back 38

it is a salient promotion of facts about your educational and work history that would prompt a potential employer to invite you for a personal interview. Can be chronological or functional or a combination of the two.

Front 39

Describe what choice employment settings should be based on.

Back 39

-larger facility and formalized anesthesia department-better cases
-Smaller hospital more independent
-Solo practice-be your own boss but 24 call, billing issues!
-Group Practice-less autonomy
but good benifits and predictable hours
-Institutional Employment -
good learing environment, stable- but could be at will employment

Front 40

Differentiate between different communities and what they individually offer to the work force of the CRNA.

Back 40

family financil job
FINDING A CHURCH

Front 41

What is solo practice?

Back 41

a single CRNA is a sole anesthesia provider
increased autonomy
-requires careful thought, proven clinical expertise, and advanced planning consultation in preparation for the role
-consult other CRNA's CPA, attorney

Front 42

What is group practice?

Back 42

Less autonomy, limited call,
depending on size, better benifits

Front 43

What does institutional practice involve?

Back 43

Hospitals, medical center, clinics HMO's
-con- at will employment

Front 44

What are the pros of
solo practice?

Back 44

Advantages
-Level of autonomy “Being your own boss”
-Establishing one’s own salary structure
-Establishing preferred work schedules

Front 45

What are the cons of solo practice?

Back 45

Disadvantages
-Functional support is limited to staff
-24-hour clinical responsibilities and expense of relief services
-Obligation to stay active in governance of facility and in political arena
-More immediately impacted by the economics of anesthesia practice

Front 46

What are the Pro's of group practice?

Back 46

Advantages
-Hours and routines are relatively stable and predictable
-Predictable benefits
-Shared clinical responsibilities and access to other providers

Front 47

What are the Cons of group practice?

Back 47

-Lack of decision-making authority
-Losing some economic autonomy

Front 48

Describe the interview process and know what points are important, as well as what questions to ask.

Back 48

eye contact
dress well
do your homework
Ask to meet future co-workers and shadow
ask about benifits and schedule

Front 49

What is ICD-9?

Back 49

International classification of diseases 9th ed. primarily used to classify diseases and diagnosises

Front 50

What is CPT coding?

Back 50

Current Procedural Terminology
-a system to assign numbers to every task or service a practitioner provides

Front 51

What is the difference between ICD-9 and CPT?

Back 51

both are updated anually. and both are computerized.
ICD classifies diseases
CPT classifies procedures

Front 52

Why is entering administrative management a big transition for CRNA'S?

Back 52

Overall increase in responsibility for aligning financial, clinical, and service,-- The need to provide adequate presence in the operating room with reduced resources

Front 53

More factors making administrative management a big transition for CRNA'S...

Back 53

Ability to manage and promote the overall mission of the organization,- -Understanding the concepts of interdisciplinary collaboration, --Demonstrate effective communication skills, --the ability to adopt this leadership role within a corporate culture,--Must have quality relationships with key players within the organization as well as other perioperative managers, nurses, CRNAs, surgeons, anesthesiologists, and hospital administrators-Increasing staff loads,--

Front 54

What are the factors (related to interdisciplinary collaboration) that significantly decrease mortality rates in a hospital.(1 OF 3)

Back 54

Clarification of Work Roles, Processes and Procedures
-A collection of protocols, policy and procedures, and training systems will help deter sources from interdisciplinary conflict
-Roles must be clarified, analyzed, and redesigned if needed.
-Multiple disciplines will need to work in close, sometimes overlapping roles.

Front 55

What are the factors (related to interdisciplinary collaboration) that significantly decrease mortality rates in a hospital.(2 OF 3)

Back 55

Understanding Unique Characteristics of the Operating Room
-The perioperative team forms a unique unit,--Possess specific techniques, tools, and even reimbursement methods that separate them from other hospital units--Some factors can cause disconnect,- -Must maintain strategies to promote a team ethos in the OR environment.

Front 56

What are the factors (related to interdisciplinary collaboration) that significantly decrease mortality rates in a hospital.(3 OF 3)

Back 56

Knowledge of diversity of values among the professions
Lack of good communication skills (BAD)

Front 57

What are the strategies that work to promote a team ethos in the OR environment?

Back 57

Proximity
-The development of policies that allow for efficient functioning of the OR.
A prime example would be policies related to the overall scheduling of cases.

Front 58

On what three things should the ideal OR schedule be based?

Back 58

-policies derived from mutual agreement
-effective communication
-common sense

Front 59

What three factors contribute to good communication skills in the operating room?

Back 59

-Knowing how to listen effectively
-Being assertive without being aggressive
-Knowing the proper way to use nonverbal communication

Front 60

What are the benefits of performance appraisals?

Back 60

employers are able to determine how to improve retention.
CRNAs are able to voice needs

Front 61

How do variances related to performance appraisals and the financial performance review?

Back 61

The difference between actual expenditures and budget will be reported as a variance. The variance %=variance/budget ; if greater than 5% difference an explanation will be necessary. Details in this report permit CRNA director to specifically target significant variances

Front 62

What are ways to control labor expenses of an anesthesia department?

Back 62

Eliminate OT, Flexible staffing(send staff home in times of work shortage), Reduction in workforce turnover (turnover costs exceed salary costs by 56%)

Front 63

what does what gross revenue represents?

Back 63

Gross revenue is not real money, rather an indicator of billable activity that can be compared to other months. Gross revenue minus contractual allowances=net patient revenue.

Front 64

what are tips for administrators and managers that aid in their recruiting and retaining CRNAs?

Back 64

Mentorship programs -Promoting autonomy-- Promoting employee participation in decisions related to patient care and work environment-- Allowing staff to function within their full scope of practice -- Providing opportunities for advancement-- Early clarification of job performance, requirements, & competencies-- Providing educational programs- Tuition reimbursement-- Paid travel expenses to professional meetings—Bonuses—Advertising-- Online employment sites-- Job fairs-- Student recruitment/programs