NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College O, Exams of Nursing

Download NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College O and more Exams Nursing in PDF only on Docsity! NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing ● Ethical decision making ■ ANA (2015) provides specific guidance for ethical decision making via its Code of Ethics for Nurses with Interpretive Statements ● Respect for human dignity ● Respect for the individual right to self-determinism ● Primary commitment to the patient (defined as individual, family, group, or community) ● Advocacy for the patient ● Participation in the creation, maintenance, and improvement of healthcare environments ● Advancing the profession ● Collaboration with others to meet health needs ● Shaping social policy ○ Ethical Issues with HIT and Nursing Informatics ■ As with everything, a new way of viewing the world = enduring values of the previous worldview NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing ■ As healthcare transforms digitally (communications, telehealth, and wearable technologies) it brings some familiar tools and skills recognized in the form of values, such as privacy, confidentiality, autonomy, and nonmaleficence. ● Although those basic values should remain unchanged, the standards for living out these values will take on new meaning as health professionals confront new and different moral dilemmas brought on by the adoption of technological tools for: ○ information management ○ knowledge development ○ and evidence-based changes in patient care ■ The ethical-decision frameworks should not change but only become more complex. ■ Examples of issues having an ethical component include the following: ● Failure to adapt technology or use it adaptly ● Lack of regard to data integrity such as discrepancies in record information that are noted but no corrective action is taken ● Failure to address threats to privacy and personal health information ● Inappropriate access to PHI without a need to know NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing ■ In addition to the use of EHRs, there is a growing use of social media to market provider services and provide support. ● Many organizations struggle with questions surrounding the proper use of social media. ● Genomics, or personalized medicine targeted to one's specific genetic make-up, is an area within our grasp but still not widely known. ● And, technological advancements and miniaturization are quickly making nanotechnology an area that we will need to address. ● Nanotechnology is science, engineering, and technology that is conducted at the level of the nanoscale (nano.gov, n.d.). For reference purposes, a nanometer is equal to one billionth of a meter. ● Bioethical standards ○ The study of healthcare ethics ○ Study and formulation of healthcare ethics. ○ Bioethics takes on relevant ethical problems experienced by healthcare providers in the provision of care to individuals and groups. ● Telehealth and Point-of-Care (POC) Technologies ○ Many mHealth technologies are being used to broaden access to care, either by extending the reach of providers through remote monitoring of patients or by giving advice when users NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing otherwise would not visit a medical professional. ○ Apps like Pocket Doctor and iTriage, which suggest possible diagnoses on the basis of inputs from patients, are proliferating. ○ Making medical advice available beyond traditional settings could broaden access to care for the uninsured, those living in rural areas, immigrants, and perhaps even elderly patients. Tremendous strides have been made in deploying mHealth technologies to expand access to care in less developed countries. ○ Telehealth is still an evolving technology; while the offsite interventions or contacts often lead to less time being wasted on non-care-oriented tasks because of the efficiencies offered by the technology applications, its use must never be associated with less care. It is also important to note that nursing activity in telehealth still follows the same best-practice standards as those espoused in conventional care. ○ Clinical Uses for Telehealth ■ Transmitting images for assessment or diagnosis ● Wounds for assessments and treatment consults NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing ■ Transmitting clinical data for assessment, diagnosis, or disease management ● Remote patient monitoring and transmitting patients’ objective or subjective clinical data, such as monitoring of vital signs and answers to disease management questions. ■ Providing disease prevention and promotion of good health ● Case management is provided via telephone or smartphone app and patient education is provided through asthma and weight management programs conducted in schools. ■ Using telephonic or video interactive technologies to provide health advice in emergent cases ● Performing teletriage in call centers or real-time stroke consultation between a rural health center and an academic medical center. ■ Using real-time video ● Exchange health services or education ○ POC testing ■ Point-of-care (POC) testing allows for testing and diagnosis at the patient's side and can be conducted anywhere the patient is, such as the home, physician’s office, ambulance, or hospital bedside (National Institutes of Health, 2010). ■ This technology allows for quick, on-the-spot NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing Medical Applications Guidance for Industry and Food and Drug Administration Staff” → which offers a clear distinction between an unregulated mobile application and a mobile medical application that are subject to overt FDA regulation. ■ This guidance focuses on apps that possess a greater risk to patients if they don’t function as they intended. ● Medical Device vs. Mobile Application? ■ The Food and Drug Administration (FDA) (2013) recognizes the extensive variety of actual and potential functions of mobile apps, the rapid pace of innovation in mobile apps, and the potential benefits and risks to public health represented by these apps. ■ The FDA intends to apply its regulatory authorities to select software applications intended for use on mobile platforms. ■ Given the rapid expansion and broad applicability of mobile apps, the FDA is issuing this guidance document to clarify the subset of mobile apps to which the FDA intends to apply its authority. ■ Many mobile apps are not medical devices, meaning such mobile apps do not meet the definition of a device by the Federal Food, NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing Drug, and Cosmetic Act (FD&C Act); therefore, the FDA does not regulate them. ■ Some mobile apps may meet the definition of a medical device but because they pose a lower risk to the public, the FDA intends to exercise enforcement discretion over these devices (meaning it will not enforce requirements under the FD&C Act). ● One example is a mobile app that makes a light- emitting diode (LED) operate. If the manufacturer intends the system to illuminate objects generally (i.e., without a specific medical device intended for use), the mobile app would not be considered a medical device. ● If, however, through marketing, labeling, and the circumstances surrounding the distribution, the mobile app is promoted by the manufacturer for use as a light source for providers to examine patients, then the intended use of the light source would be similar to a conventional device such as an ophthalmoscope. ○ Examples of mobile apps for which the FDA intends to exercise enforcement discretion: ● Privacy ○ An important issue related to personal information ○ Restricted access to patient information or data NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing ● Confidentiality ○ With the rapid growth of social media → healthcare providers need to maintain confidentiality with the increased use of mobile devices by health professionals as well as the public ■ Smartphones can take pictures and record ● Cybersecurity ○ Another federal regulatory agency with a role in the privacy and security of health care data is the Food and Drug Administration (FDA). ■ The FDA oversees the safety of medical devices, which includes addressing the management of cybersecurity  risks and hospital network security. ■ Recent guidelines issued (FDA, 2013) recommend that medical device manufacturers and health care facilities take steps to ensure that appropriate safeguards are in place to reduce the risk of failure caused by cyberattacks. ● Introduction of malware into medical equipment ● Unauthorized access to configuration settings in medical devices and hospital networks NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing ● APNs also need to realize the potential that currently lies just beyond our reach as we compile huge data sets that now remain largely untapped within many separate silos. ● Consider how HIT legislation has positioned us to make good use of the foundation of the knowledge model to acquire new knowledge, improve our knowledge-processing capabilities, and enable us to generate more knowledge. ● Medical Coding: codes to communicate procedures performed & why ○ 2 designated coding systems used to standardize terminology and simplify medical records ■ Common Procedural Terminology (CPT) System ● Official procedural coding rules & guidelines to report medical services and procedures performed ○ Recognized universally ○ Provides logical means to track health care data, tends, and outcomes ○ Service is represented by a 5 digit code in a specific area ■ Evaluation & Management (see below) ■ Anesthesiology ■ Surgery NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing ■ Radiology ■ Pathology ■ Medicine ■ International Classification of Diseases ● ICD-10 is the 10th revision ○ Shorthand for the diagnosis ○ Used to provide the payer with the necessity of visit/procedure performed ○ Example: ■ CPT: 69210 (removed cerumen from ear canal) ■ Diagnosis code: I10 (HTN) ● When reviewed: the procedure is not likely to be reimbursed because the diagnosis code is not tied to necessity ○ Example Reviewed: ■ CPT: 69210 ■ Diagnosis Code: H61.20 (cerumen impaction) ● Diagnosis does explain the need = $ ● Medical Billing: the process of submitting claims to receive payment NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing ● Evaluation and Management Coding ○ Administrative data → billing information derived from insurance claims, inpatient discharges (or hospital bills), and outpatient visits (the bill from the emergency room visits that do not result in being admitted to the hospital or services delivered in a hospital but not part of an overnight admission). ○ Administrative data include documentation of clinical diagnoses and use of health services as recorded through predefined coding systems such as the International Classification of Diseases, ninth revision, Clinical Modification (ICD-10-CM), Current Procedural Terminology (CPTs), or Healthcare Common Procedure Coding System (HCPCS). ● Reimbursement Coding ○ Reimbursement codes are assigned contingent upon data input from clinical team members based on a summative review of the clinical record by trained coders. ○ This is a critically important intersection between the clinical and administrative teams. ■ If the patient encounter, procedure, or diagnosis are incorrectly entered into a clinical management system, the billing and coding process will also be incorrect. ■ Providers play an important role in ensuring the success of the business by clearly identifying the diagnosis and service codes that are appropriate for each patient visit. ■ Therefore, it is imperative for APNs to have knowledge of NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing ● Each must have a specific number of elements documented to meet the visit requirements → quantifies the complexity of the visit ○ Based on 3 criteria: ■ Risk ■ Data ■ Diagnosis ○ Examples: 2 patients with an ear infection requiring abx ■ Patient 1: 15 yo, no medical problems and no medications ■ Patient 2: 72 yo, comorbid conditions and many medications ● While you are there, the patient asks for a refill on his metformin that he has not taken for 3 weeks. You check his A1C and it is at 10 while on the metformin. So now, you change that dose as well. NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing ■ You would NOT be reimbursed the same amount for both patients. ● Diagnosis-related groups (DRGs) vs. Major diagnostic categories (MDCs) ○ Systemically group these more specific codes into meaningful broader categories ■ The purpose of the DRG group is to facilitate payment through the prospective payment system ■ While MDCs organize diagnoses and utilization → primary purpose is for billing. ● *More expensive services are likely to be identified first in the administrative record, not necessarily as events or procedures that occurred chronologically or even simultaneously. ● Clinical Support Tools ○ As a process designed to aid directly in clinical decision making, in which characteristics of individual patients are used to generate patient-specific interventions, assessments, recommendations, or other forms of guidance that are then presented to a decision-making recipient or recipients that can include clinicians, patients, and others involved in care delivery. ■ CDS tools existed prior to EHRs ■ Examples: practice guidelines carried in clinicians’ pockets, patient cards used by providers to track a patient’s treatments, and tables of important medical knowledge. NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing ○ The primary goal of implementing a CDS tool is to leverage data and scientific evidence to help guide appropriate decision- making. CDS tools include but are not limited to: ■ Computerized alerts and reminders for providers and patients ■ Drug-drug interaction alerts ■ Underdose or overdose alerts based on renal or liver function or age or drug levels ■ Actionable clinical guidelines ■ Condition-specific order sets ■ Focused patients data reports and summaries ■ Diagnostic support ■ Contextually relevant reference information ○ CDSSs are quickly becoming essential tools for providers as the volume of available data increases alongside their responsibility to deliver value-based care. ■ Reducing clinical variation and duplicative testing, ensuring patient safety, and avoiding complications that may result in expensive NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing ● The most complex decision support systems attempt to aid clinical decisions = costly to maintain ● The application of artificial intelligence to medicine has a long history; however, most diagnostic expert systems have been stand-alone, requiring effort by the clinician outside of their normal workflow and have thus seen limited clinical implementation. ○ The primary goal of a CDSS is to leverage data and scientific evidence to help guide appropriate decision-making. ■ The CDSS team needs to approach the project in a data-driven manner supported by the evidence. ● This requires an in-depth analysis of the scientific evidence coupled with data-analysis methods to identify gaps in practice within the organization. ● It is equally important to identify where there are gaps in the ability to report how an organization is doing with respect to patient care and if recommended practice guidelines are being followed. This constitutes the absence of data captured to track that information. ● The gaps will tell an organization where to focus with respect to adding where a CDSS tool should be. ■ It is the role of the CDSS teams to identify the elements of a process and use data to identify areas where processes NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing might be enhanced with the use of CDSS tools to provide users with the best evidence and to support appropriate decision-making and treatment decisions. ● Workflow analysis ○ Workflow is a term used to describe the action or execution of a series of tasks in a prescribed sequence. ■ Another definition is a progression of steps (tasks, events, interactions) that constitute a work process, involve two or more persons, and create or add value to the organization’s activities. ● Workflows: ○ Sequential: each step depends in the occurrence of the previous step ○ Parallel: two or more steps can occur concurrently ○ Workflow is sometimes interchangeable with process or process flows, particularly in context of implementations. NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing NR 599 Final Exam / NR599 Final Exam (Latest Study Guide 2023/2024): Chamberlain College Of Nursing ■ Observation and documentation of workflow to better understand what is happening in the current environment and how it can be altered is referred to as process or workflow analysis ● Critical aspect is the workflow design ○ Nursing informatics is uniquely positioned to engage in the analysis and redesign of processes and tasks surrounding the use of technology NR 599 Final Exam / NR599 Final Exam (Latest 2023/2024): Chamberlain College Of Nursing