Healthcare Management Clinical Pathways
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Questions and Answers

Why are multidisciplinary action plans (MAPs) necessary?

Multidisciplinary Action Plans (MAP) plan patient care by combining critical pathways and the nursing care plan.

Where did Critical Pathways originate from?

Critical pathways were first developed in the 1980s.

What does primary prevention focus on?

  • Health promotion (correct)
  • Rehabilitation
  • Minimizing deterioration
  • Early detection

    • What are DRGs?

    <p>Diagnosis-related groups (DRGs) are patient classification categories for Medicare reimbursement.</p> Signup and view all the answers

    When does discharge planning begin?

    <p>Discharge planning begins with the patient's admission to the hospital.</p> Signup and view all the answers

    How do Computerized Standardized Plans of Care help nurses?

    <p>They provide predetermined templates for specific patient problems.</p> Signup and view all the answers

    What does informatics (EHRs) provide nurses?

    <p>It integrates nursing science, computer science, and information science for better decision-making.</p> Signup and view all the answers

    What is the Outcome and Assessment Information Set (OASIS)?

    <p>It is a documentation system required for care reimbursed by Medicare.</p> Signup and view all the answers

    What is capitation?

    <p>A payment method where providers receive a fixed amount per enrollee regardless of services used.</p> Signup and view all the answers

    What roles do group-building roles serve in a team?

    <p>All of the above</p> Signup and view all the answers

    What does PICO stand for in EBP questions?

    <p>Patient, Intervention, Comparison, Outcome.</p> Signup and view all the answers

    What is an evidence-based practice (EBP)?

    <p>A best practice derived from valid and reliable research studies that considers the healthcare setting, patient preferences and values, and clinical judgment.</p> Signup and view all the answers

    What are core measures in hospitals?

    <p>Sets of performance measures used to gauge the quality of care given to patients compared to evidence-based guidelines.</p> Signup and view all the answers

    What is the role of community-based nursing?

    <p>To promote and maintain health, prevent disease progression, and improve the quality of life.</p> Signup and view all the answers

    Why is effective discharge planning important?

    <p>It facilitates the transition from acute care to home care and ensures continuity of care.</p> Signup and view all the answers

    What is the goal of case management?

    <p>To integrate health care services for individuals or groups and ensure smooth transitions of care.</p> Signup and view all the answers

    What is the impact of case management on patient clinical outcomes?

    <p>It helps coordinate care, manages treatment plans, and reduces rehospitalization.</p> Signup and view all the answers

    What are multidisciplinary action plans (MAPs) used for?

    <p>To plan patient care and move patients toward predetermined outcomes.</p> Signup and view all the answers

    What are critical pathways?

    <p>Strategies for assessing, implementing, and evaluating patient care cost-effectiveness.</p> Signup and view all the answers

    Match the levels of care with their corresponding goals:

    <p>Primary Care = Common health problems and preventive measures Secondary Care = Specialized clinical expertise for more serious problems Tertiary Care = Management of rare and complex disorders</p> Signup and view all the answers

    What are diagnostic related groupings (DRGs)?

    <p>Rate-setting systems used by Medicare to determine payment rates for inpatient hospital stays.</p> Signup and view all the answers

    What is total patient care?

    <p>A model where the nurse assumes total responsibility for all patient needs during their shift.</p> Signup and view all the answers

    When does discharge planning begin?

    <p>At the patient's admission to a hospital or healthcare setting.</p> Signup and view all the answers

    What are standardized plans of care used for?

    <p>They provide predetermined templates for specific patient problems, simplifying nursing care planning.</p> Signup and view all the answers

    What does nursing informatics provide for nurses?

    <p>Tools and systems that help manage and communicate patient data and improve healthcare delivery.</p> Signup and view all the answers

    What is a clinical pathway?

    <p>Critical pathways are a strategy for assessing, implementing, and evaluating the cost-effectiveness of patient care.</p> Signup and view all the answers

    What are clinical pathways?

    <p>Standardized interdisciplinary care map for a specific diagnosis.</p> Signup and view all the answers

    What is the nurse's primary goal when using a clinical pathway?

    <p>To standardize care while providing flexibility to meet individualized patient needs.</p> Signup and view all the answers

    What is the primary goal of clinical pathways?

    <p>To facilitate the introduction of clinical guidelines and systematic audits into practice.</p> Signup and view all the answers

    What is the Institute for Healthcare Improvement (IHI), and what did they have to do with the 5 Million Lives Campaign?

    <p>A nonprofit organization aimed at improving healthcare aimed to save 5 million lives in two years.</p> Signup and view all the answers

    What steps did the IHI and its partners encourage to reduce harm and deaths?

    <p>Prevent Pressure Ulcers, reduce MRSA infections, prevent harm from high-alert medications, among others.</p> Signup and view all the answers

    What are the principles of the 5 Million Lives Campaign?

    <p>To save 5 million lives through evidence-based guidelines implementation.</p> Signup and view all the answers

    What is the goal of evidence-based practice (EBP)?

    <p>To provide the best possible care based on the best available research.</p> Signup and view all the answers

    Match the nursing process actions with their descriptions:

    <p>Assessment = Collection, validation, and communication of patient data. Diagnosing = Analysis of patient data to identify strengths and health problems. Planning = Specification of patient outcomes and related interventions. Implementing = Carrying out the plan of care. Evaluating = Measuring achievement of patient outcomes and revising the plan if necessary.</p> Signup and view all the answers

    What are the antecedents of evidence-based practice?

    <p>Problem identification, knowledge of the importance of research, identification of patient/family preferences.</p> Signup and view all the answers

    What are the attributes of evidence-based practice?

    <p>Replicability, reliability, validity, individualized care.</p> Signup and view all the answers

    How do the Joint Commission and Medicare & Medicaid services (CMS) evaluate hospitals?

    <p>By accrediting them and using National Patient Safety Goals to improve patient care.</p> Signup and view all the answers

    What nursing interventions did the Institute for Healthcare Improvement (IHI) include in 'bundles'?

    <p>Interventions included preventing ventilator-associative pneumonia, catheter-associated infections, and others.</p> Signup and view all the answers

    What is the bridge between technology and patient care?

    <p>Nursing informatics</p> Signup and view all the answers

    What are some benefits of nursing informatics? (Select all that apply)

    <p>Improves nurse's workflow</p> Signup and view all the answers

    How do computerized standardized plans of care help nurses?

    <p>They provide a basis for nursing diagnoses, outcomes, and interventions.</p> Signup and view all the answers

    What does OASIS assess for in patients?

    <p>Sociodemographic, environment, support system, health status, functional status, and behavioral status.</p> Signup and view all the answers

    What is capitation?

    <p>A fixed amount per enrollee of the health plan</p> Signup and view all the answers

    What is group building in nursing?

    <p>Roles that promote open communication and facilitate participation by all members.</p> Signup and view all the answers

    What does PICO stand for in evidence-based practice?

    <p>Patient, Intervention, Comparison, Outcome.</p> Signup and view all the answers

    What are advanced practice nursing roles?

    <p>CNPs, CNSs, CNMs, and CRNAs.</p> Signup and view all the answers

    What changes have created a need for community nursing?

    <p>Changes in long-term care payment systems and increasing demand for such care.</p> Signup and view all the answers

    What does case management ensure?

    <p>Coordination of health care services for quality, cost-effective care.</p> Signup and view all the answers

    What is functional nursing?

    <p>A method where tasks are assigned to personnel based on skills, efficiency, and task specialization.</p> Signup and view all the answers

    What is modular or team nursing?

    <p>A system where small teams provide patient care, typically with one RN on each team.</p> Signup and view all the answers

    What is total patient care?

    <p>Nurses assume total responsibility for all needs of assigned patients during their shift.</p> Signup and view all the answers

    What is primary care nursing?

    <p>The primary nurse takes 24-hour responsibility for planning and delivering patient care.</p> Signup and view all the answers

    Study Notes

    Clinical Pathways

    • Clinical pathways, also known as critical pathways, are structured plans that standardize patient care for specific diagnoses or procedures.
    • They support assessing, implementing, and evaluating cost-effectiveness in patient care, aiming to reduce length of stay and improve quality.
    • Variance analysis addresses any patient progress deviations from the established pathway protocols.
    • Pathways emerged in the 1980s to enhance standardization and quality, ultimately benefiting patient outcomes through evidence-based practices.

    Clinical Pathway Benefits

    • Enhance communication within healthcare teams.
    • Standardize care processes and create tools for documentation and evaluation.
    • Potentially lower costs and shorten patient hospital stays.
    • Improve satisfaction levels for patients and families.

    Nursing Goals with Clinical Pathways

    • Clinical pathways provide a minimally invasive practice standard while allowing flexibility to cater to individual patient needs.
    • Facilitate measurement of the effect of pathways on patient outcomes.

    Institute for Healthcare Improvement (IHI)

    • A nonprofit organization focused on enhancing patient care through safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.
    • Launched the 5 Million Lives Campaign in 2007 to save lives through evidence-based guidelines across U.S. hospitals.

    5 Million Lives Campaign

    • Targeted saving 5 million lives over two years through hospital adherence to safety protocols and clinical guidelines.
    • Strengthened connections between scientific guidelines and hospital practices.

    Steps to Reduce Patient Harm

    • Implement evidence-based practices for pressure ulcer prevention, MRSA infection control, management of high-alert medications, and surgical complications.
    • Engage healthcare boards to cultivate a culture of safety and quality care improvement.

    Evidence-Based Practice (EBP)

    • EBP integrates clinical expertise with the best available research to make informed patient care decisions.
    • Encourages clinicians to stay informed about research to improve care delivery, fostering accountability and credibility within the nursing profession.

    EBP Concepts

    • Nursing care approaches utilize EBP at primary, secondary, and tertiary levels, with attributes such as replicability, reliability, validity, and individualized care.

    Nursing Process Actions

    • Key actions include assessment, diagnosing, planning care, intervening, and evaluating patient outcomes.
    • Continuous evaluation and documentation to track patient progress and adapt care plans as necessary.

    Evaluation by the Joint Commission and CMS

    • The Joint Commission accredits hospitals based on adherence to National Patient Safety Goals (NPSGs), emphasizing key areas for safety improvement.
    • Core measures compare treatment quality against evidence-based standards, driving hospitals to optimize care continuously.

    Community-Based Nursing

    • This approach emphasizes care continuity as patients navigate various healthcare services, focusing on health promotion, disease prevention, and quality of life enhancement for individuals and families.
    • Community health nurses advocate for resources essential for enhancing population health, such as for older adults.### Community Health Nursing Roles
    • Community health nurses serve various roles including epidemiologist, case manager, school nurse, and hospice nurse, focusing on both community and individual patient needs.
    • Preventive care and self-care are central concepts, integrated within cultural and community contexts.

    Acute Care and Community Nursing Collaboration

    • Cooperation between acute care nurses and community health nurses enhances the importance of effective discharge planning and quality improvement.
    • Discharge planning begins at the patient's admission and aims to ensure continuity of care as patients transition to community or home settings.

    Increased Demand in Public Health System

    • Rising patient numbers and an aging nursing workforce contribute to an increased demand for medical, nursing, and social services.
    • Health insurance reform has led to a larger number of insured patients, increasing the need for access to primary and preventive care.

    Shift to Community-Based Nursing

    • A shift from inpatient to outpatient care arises due to factors like growing older adult populations, insurance regulations, and decreasing hospital revenues.
    • Changing healthcare delivery patterns and disease profiles necessitate more nurses in community settings.

    Goals of Case Management

    • Case management integrates health care services for individuals from preadmission to discharge, involving multidisciplinary teams for coordinated patient care.
    • The purpose is to enhance patient progress and optimize fiscal outcomes, not to provide counseling to families.

    Impact of Case Management on Clinical Outcomes

    • Case managers facilitate communication among healthcare providers and focus on managing treatment plans for patients with complex conditions.
    • They may follow patients beyond hospitalization to coordinate services and prevent rehospitalization.

    Importance of Multidisciplinary Action Plans (MAPS)

    • Evidence-based practice tools like MAPS help in planning patient care and ensuring coordinated efforts among healthcare providers towards common patient outcomes.

    Origin of Critical Pathways

    • Developed in the 1980s to standardize patient care for specific diagnoses, critical pathways assist in monitoring care quality and reducing hospital length of stay while providing a standardized framework for care.

    Care Levels: Primary, Secondary, and Tertiary

    • Primary care addresses common health issues and preventive measures, accounting for the majority of outpatient visits.
    • Secondary care provides specialized expertise for more complex health problems, while tertiary care manages rare disorders requiring subspecialist intervention.
    • DRGs are a flat-rate payment system used by Medicare to reimburse hospitals based on patient diagnosis, promoting cost-effective care delivery.

    Nursing Care Models

    • Total Patient Care entails nurses taking full responsibility for patients, while Functional Nursing assigns specific tasks to aids, enhancing efficiency.
    • Team Nursing promotes collaboration among healthcare providers under a nursing lead, aiming to reduce fragmented care.
    • Primary Nursing emphasizes continuity by assigning an RN to manage all care aspects for a patient from admission to discharge.

    Discharge Planning Protocols

    • Effective discharge planning starts upon patient admission, focusing on preparing for post-discharge follow-up care, involving a variety of healthcare professionals.

    Computerized Standardized Plans of Care

    • Standardized care plans improve nursing efficiency by providing easy access to prioritized nursing interventions and outcome goals tailored to specific patient issues.

    Nursing Informatics Benefits

    • Nursing informatics enhances data accuracy, reduces repetitive tasks, and streamlines clinical data analysis, improving overall patient care quality.

    Outcome and Assessment Information Set (OASIS)

    • OASIS is a standardized assessment for home healthcare patients, ensuring effective care planning and quality measurement in Medicare settings.

    Capitation Payment System

    • Capitation involves a fixed payment per enrolled patient to providers, aimed at delivering comprehensive care while managing costs effectively.

    Group Building in Healthcare Teams

    • Group-building roles foster collaboration and conflict resolution within teams, crucial for maintaining effective healthcare delivery and team dynamics.### Group Roles
    • Gatekeeper: Encourages open communication and equal participation, evaluates group standards, and comments on group processes.
    • Follower: Accepts group ideas, listens actively, and participates in discussions.

    PICO Model

    • P: Defines the patient, population, or problem of interest, possibly including specific settings or subgroups.
    • I: Identifies the intervention clearly to focus the literature search, covering exposure, treatment, or diagnostic tests.
    • C: Compares with another treatment or standard care.
    • O: Specifies desired outcomes to locate relevant evidence effectively.
    • Using PICO format enhances the search for best interventions based on evidence-based practice.

    Advanced Practice Nursing Roles

    • Nurses can pursue generalist master's degrees or specialized graduate education to become Advanced Practice Registered Nurses (APRNs).
    • Specialties include Certified Nurse Practitioners (CNPs), Clinical Nurse Specialists (CNSs), Certified Nurse-Midwives (CNMs), and Certified Registered Nurse Anesthetists (CRNAs).
    • Common population foci include family health, adult-gerontology, pediatrics, and psychiatric-mental health.

    Community Nursing Needs

    • Changes in payment systems and Medicaid policies have altered long-term care requirements amidst rising demand.
    • CNPs are increasingly needed in underserved communities to compensate for the shortage of primary care providers.

    Certified Nurse Practitioners (CNPs)

    • CNPs receive focused training in primary or acute care, practicing autonomously to diagnose and treat patients.
    • CNPs' scope includes health promotion, disease prevention, and management of chronic illnesses, functioning as a substitute for primary care providers.

    Clinical Nurse Specialists (CNSs)

    • CNSs improve patient outcomes across three spheres: patient, nursing, and healthcare system.
    • Their roles encompass clinical practice, education, management, consultation, and research.
    • Often practice in acute care settings but also in community and home environments.

    Case Management

    • Case management ensures coordination and quality of healthcare services.
    • A case manager, often a nurse, focuses on meeting patient needs through effective communication and coordination.
    • Involves managing care for patients with complex conditions while preventing rehospitalization through continuity of care.

    Total Patient Care

    • Nurses assume full responsibility for all patient needs, reminiscent of private-duty nursing.
    • Provides holistic care but may lead to variability in care approaches across shifts.
    • Requires skilled personnel and can be costly, with risks if the nurse lacks adequate training.

    Functional Nursing

    • Emerged as a cost-effective care model utilizing various skill levels among healthcare workers.
    • Efficient task completion with defined responsibilities but may compromise holistic care.
    • Commonly used in long-term care and operating rooms, allowing for a minimalist RN requirement.

    Modular or Team Nursing

    • Modular nursing involves small teams (2-3 members) to provide care based on geographical patient assignments.
    • Aims to allow RNs more time for planning, reducing communication failures and improving direct patient care efficiency.

    Primary Care Nursing

    • A primary nurse is responsible for comprehensive patient care from admission to discharge.
    • Requires collaboration with associate nurses to follow established care plans.
    • High job satisfaction but challenging to implement due to responsibilities and autonomy required.

    Multidisciplinary Action Plans (MAPs)

    • MAPs integrate critical pathways with nursing care plans, indicating the timing of interventions.
    • Aims for coordinated care among healthcare providers to achieve expected outcomes.
    • Variances in a patient’s progress necessitate adjustments in the care plan.

    Critical Pathways

    • Developed in the 1980s to standardize patient care for specific diagnoses.
    • Offers a framework for monitoring quality and minimizing length of stay.
    • Challenges arise in documenting deviations from the pathway where patients' needs are unique.

    Prevention Levels

    • Primary Prevention: Focus on health promotion to prevent disease.
    • Secondary Prevention: Early detection interventions to minimize functional loss.
    • Tertiary Prevention: Rehabilitation efforts to enhance quality of life for individuals.
    • Implemented by Medicare in 1983 to control healthcare costs through fixed payments based on diagnoses.
    • Emphasizes severity of illness impacting reimbursements.
    • Hospitals cannot bill for preventable errors leading to additional conditions.

    Discharge Planning

    • Begins upon patient admission, ensuring smooth transitions from acute care to community settings.
    • Involves various healthcare professionals to create a comprehensive plan that identifies patient needs for follow-up care.

    Computerized Standardized Plans of Care

    • Offer predefined templates for patient problems, simplifying care planning for nurses.
    • Enable quick adjustments to fit individual patient situations, enhancing efficiency in care delivery.

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    Description

    Explore the concept of clinical pathways in healthcare management with this quiz. Understand how these pathways are used to assess, implement, and evaluate patient care. Test your knowledge on the standardized predictions for patient progress and their impact on cost-effectiveness.

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