Test #1 Managed Care & Case Mgmt

Front 1

1. Name 4 types of nursing care delivery models

Back 1

1. Functional model-1940s; each nurse did 1 task: all meds, all dressings
2. Team Nursing - 1950s; had nurse and nurse's aide
3. Primary Nursing - 1960s-70s; nurse resp for planning care 24 hrs
4. Pt Focused Care: mostly delegating; have RN does charts, meds, LPN: some meds; Nurse's Aide: baths, ambulates

Front 2

1. Managed care allows ________
2. 2 types of managed care org?

Back 2

1. hospitals to make money via prepayment; insurance based approach
2. HMO ( Health Maintenance Org; forces doc to minimize lab tests/procedures; pt doesn't go to specialists
PPO (Preferred Provider Org); pt can go in & out of network w/o permission from doc, but must pay more copay.

Front 3

1. Case Mgmt is outcome- based mgmt w 2 obj?
2. Role of Case/Care Mgr?
3. What are Clinical/Critical Pathway aka Care Maps?

Back 3

1. good care and reasonable costs
2. prevents fragmentation & duplication of services; provides continuity of care for pts who require multiple settings
3. Ensures diff pts with same disease get similar interventions.

Front 4

1. Pathways are not successful due to ____.
2. Name the 3 kinds of variances?

Back 4

1, Variances
2. Pt Variance: rel'd to pt var; Clinical Variance: rel'd to staff; System Variance: related to hosp, equip

Front 5

1. If pt came into hosp w/ infec & it delayed recovery/care, it's a ____ variance.
2. If pt acquired inf at hosp and was delayed due to poor care that's a _____ variance
3. If pt needed IV, but there were no pumps and that delayed recovery, that's a ___ variance.

Back 5

1. Patient
2. Clinical
3. System

Front 6

1. If only 2 nurses cover 100 pts, & therefore there are delays, it's a ___ variance
2. If pt care is delayed because MRI machine was being serviced, it's a ___ variance.

Back 6

1. System
2. System

Front 7

1.Goal of risk mgmt?
2. Purpose of incident rpts?

Back 7

1. Improve pt care; if you make mistake, incidence rpt issued; risk mgmt gives in-service to help explain & reinforce right behavior.
2. for teaching, not punishment

Front 8

1. Hosp w magnet status promote educ, treat nurses w respect, and are better places to work. T or F?
2. CQI?
3.How do you evaluate CQI?

Back 8

1. T
2. Continuous Quality Improvement- process evaluates outcomes and ensures each pt receives high std of care.
3. via indicators

Front 9

1. Structure indicator?
2. Process indicator?
3. Outcome indicator?

Back 9

1. looks at env: clean, safe?
2. looks at what's being done: care plan, nurse to pt ratio
3.

Front 10

Define outcome?

Back 10

measurable change in pt status in relation to nursing care

Front 11

Name 4 goals of CQI?

Back 11

- provide quality pt care
- continuously improve pt care
- deliver pt satisfaction
-satisfy healthcare providers

Front 12

-JCAHO is an org that accredits healthcare org T or F
- JCAHO accreditation is required for hosp to be reimb by Medicare Tor F

Back 12

- T
- T

Front 13

The mission of JCAHO is to enhance the quality of healthcare provided to the public. T or F

Back 13

T

Front 14

What are some 2008 JCAHO Natl Pt Safety Goals. For each goal, name 2 ways to implement?
1) Improve the accuracy of pt identification
2) Improve communication effectiveness among caregivers

Back 14

1) need 2 IDs: read bracelet, ask pt's birthday,ask name
2) A- verify comm by having person receiving info to read back. B- have a std approach to "hand off" comm. C- standardize abbrev that sh not be used.

Front 15

JCAHO Natl Pt Safety Goals. Name ways to implement
3) Improve safety of using meds
4) Reduce risk of healthcare infections

Back 15

3) A- Identify & review annually list of look-alike/sound-alike drugs & prevent errors B- Label all meds & med containers. C- reduce harm assoc with anticoagulant therapy.
4) A- follow CDC hand hygiene guidelines

Front 16

JCAHO Natl Pt Safety Goals. Name ways to implement?
5) Reduce risk of pt falls
6) Encourage pt involvement in their care
7) Implement wrong-site, wrong pt, & wrong proced surgery

Back 16

5) implement a fall prev prg & evaluate eff of this prg
6)Encourage pts to ask q's; encourage pt teaching
7)nurse and or doctor ask pt before surgery what part of body being operated on; mark that body part; have doctor ask again right before surgery

Front 17

1) Define Scope of Practice?
2) Define Stds of Practice?

Back 17

1) Describes the who, what, where, when, why and how of nursing practice
2) Authoritative stmts by which the nursing profession describes the responsibilities for which its practitioners are accountable

Front 18

1) Name some Stds of Practice?

Back 18

1) Assessment, Diagnosis, Outcomes Identification, Planning, Implementation, Evaluation

Front 19

1) Name some Stds of Prof Perf?

Back 19

Quality of Practice, Education, Perf Appraisal, Collegiality, Collaboration, Ethics, Research, Leadership

Front 20

What are some themes emerging from the Stds of Practice?

Back 20

- Provide age-approp, culturally/ethnically sens care
- Maintain safe env
- Educate pts
- Assure continuity of care
- Communicate effec
- Utillize technology
- Manage info- if you have critical results, don't hold them

Front 21

What is IHI?

Back 21

Institute for Healthcare Improvement; independent, not-for-profit org w mission to improve healthcare

Front 22

What are the 6 IHI Evidenced-based Interventions that are saving 100,000 lives?

Back 22

- rapid response team deployment
- give evidence-based care: ex: giving aspirin to MI pts
- prevent adverse drug events by reconciling meds
- prevent central line infections through "central line bundle"
- Prevent surgical site infec by del correct periop care
- prevent ventilator-assoc pneumonia utilizing the "ventilator bundle"

Front 23

Define "bundle?"

Back 23

collection of effective case processes combined to improve pt outcomes

Front 24

Characteristics of Managed Care?

Back 24

- Focuses on care longitudinally; views an entire episode of an illness
- Proactive rather than reactive
- Critical pathways are used