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64 Cards in this Set

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  • Back
What is benificence?
first harm myst be avoided
second good must result
befificence is action oriented and requiers positive steps
What is an act of benificence for a CRNA?
giving Zofran
What is Standard of Care?
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
How do Standards of Practice affect the CRNA?
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
How does a CRNA act as an Advocate for the patient?
Safeguard the patient from incompetant professionals
& advocate for pts wellfare
-note- to act as an advocate you must first know the patient's goals
Explian how the 11 standards of Care can be incorporated into your patient care setting?
The standard of care is the same regardless of the setting you practice in.
What are the Standards of Care?
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
How do clinical practice guidelines differ from standard of care?
Practice guidelines (not mandated)are guides commonly accepted.
Standards of care are (not flexible) are behaviors a prudent CRNA should follow.
What does a position statement represent?
Less rigid then any other...addressing new trends and issues
what is Nonmalficience?
do no harm
Why is it difficult to give a standard definition to "Managed care" plan?
Confusing and change frequently, not consitant, often outdated
Why are actions in one market dealing with managed care are not effective in another market?
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.
Why were HMO so attractive when they were started?
1.) Perceived to be less $$
2.) emphasized prevention
3.) decreased health disparities
What is a PPO
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
What factors are healthy when linking your future as a CRNA to healthcare plan?
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
What are the challenges facing managed care?
-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
What are Five words of advice for practitioners?
-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
What is Primary Anesthesia Practice?
who employes the CRNA?
MDA, Hospital or CRNA group.
What is secondary anesthesia practice?
ways anesthesia can be delivered. MDA only
CRNA only
MDA & CRNA with limited interation
ACT (medically directed)
What Tertiary Anesthesia Practice?
Evaluating the overall economic impact of primary and secondary practice environments.
What are Measurements of Anesthesia time?
Durration of anesthesia service in 15 min increments or exact min of service.
How does OB time get measured?
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
How does Pain management get measured?
Meaured on a RBRVS a resource based relative value scale.
intensity measurement on all aspects.
What is practice valuation?
Valuation is the process trying to place $ value of a particular service.
How to maximize billing reimbursement for anesthesia services?
understanding coding
supporting the AANN
effective billing
What is medically supervised?
MD is supervising more then 4 CONCURENT CRNA's.

may be the surgeon or dentist
What is medically directed?
MD supervising up to 4 concurrent CRNA's

MDA gets 50% CRNA gets 50%
What is the conversion factor?
How is it determined geographically?
the conversion factor is set by the CMS for areas based on cost of living.
Know the goal of the recommedation on "continues competancy"
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.
What is Certifiation?
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.
What is the purpose of certification?
to assure the public that an individual has mastered a body of knowledge and acquired skills in a particular specialty
what are the eligibility requirements for the National Certification Examination for Nurse Anesthesia?
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
what is included in the content outline for the national certification?
Basic sciences, basic and advance principles of anesthesia, equipment, instrumentation and technology, and professional aspects.
What are the aspects included on the criteria for full recertification of a CRNA?
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
What does interim recertification include?
provisional recertification and conditional recertification.
What is provisional recertification?
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.
What is Conditional recertification?
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
what is the focus of a good resume?
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.
Describe what choice employment settings should be based on.
-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
Differentiate between different communities and what they individually offer to the work force of the CRNA.
family financil job
FINDING A CHURCH
What is solo practice?
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
What is group practice?
Less autonomy, limited call,
depending on size, better benifits
What does institutional practice involve?
Hospitals, medical center, clinics HMO's
-con- at will employment
What are the pros of
solo practice?
Advantages
-Level of autonomy “Being your own boss”
-Establishing one’s own salary structure
-Establishing preferred work schedules
What are the cons of solo practice?
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
What are the Pro's of group practice?
Advantages
-Hours and routines are relatively stable and predictable
-Predictable benefits
-Shared clinical responsibilities and access to other providers
What are the Cons of group practice?
-Lack of decision-making authority
-Losing some economic autonomy
Describe the interview process and know what points are important, as well as what questions to ask.
eye contact
dress well
do your homework
Ask to meet future co-workers and shadow
ask about benifits and schedule
What is ICD-9?
International classification of diseases 9th ed. primarily used to classify diseases and diagnosises
What is CPT coding?
Current Procedural Terminology
-a system to assign numbers to every task or service a practitioner provides
What is the difference between ICD-9 and CPT?
both are updated anually. and both are computerized.
ICD classifies diseases
CPT classifies procedures
Why is entering administrative management a big transition for CRNA'S?
Overall increase in responsibility for aligning financial, clinical, and service,-- The need to provide adequate presence in the operating room with reduced resources
More factors making administrative management a big transition for CRNA'S...
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,--
What are the factors (related to interdisciplinary collaboration) that significantly decrease mortality rates in a hospital.(1 OF 3)
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.
What are the factors (related to interdisciplinary collaboration) that significantly decrease mortality rates in a hospital.(2 OF 3)
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.
What are the factors (related to interdisciplinary collaboration) that significantly decrease mortality rates in a hospital.(3 OF 3)
Knowledge of diversity of values among the professions
Lack of good communication skills (BAD)
What are the strategies that work to promote a team ethos in the OR environment?
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.
On what three things should the ideal OR schedule be based?
-policies derived from mutual agreement
-effective communication
-common sense
What three factors contribute to good communication skills in the operating room?
-Knowing how to listen effectively
-Being assertive without being aggressive
-Knowing the proper way to use nonverbal communication
What are the benefits of performance appraisals?
employers are able to determine how to improve retention.
CRNAs are able to voice needs
How do variances related to performance appraisals and the financial performance review?
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
What are ways to control labor expenses of an anesthesia department?
Eliminate OT, Flexible staffing(send staff home in times of work shortage), Reduction in workforce turnover (turnover costs exceed salary costs by 56%)
what does what gross revenue represents?
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.
what are tips for administrators and managers that aid in their recruiting and retaining CRNAs?
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