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Purpose:Mobilize, monitor and control resources that a patient uses during a course of illness while balancing 9
quality and cost. Usually RN’s with experience. Coordinate outpatient management of patient with certain diagnosis (usually chronic disease) such as COPD, Heart failure, and diabetes. • Quality Assurance: Process for evaluating the care of the patients using established standards of care to ensure quality. Structures:inputs – resources, equipment, numbers and qualified staff.Process of care:Includes assessment, planning, performing treatment and managing complications. Outcomes:Complications, adverse event, short-term results of treatment and long-term results of patient health and function. • Quality Improvement Programs.Patient outcomes are an indicator of health systems quality. Goal is to improve quality of care, decrease complications, decrease hospitalizations, lower patient mortality, decrease system errors and increase patient satisfaction. Example: a problem is defined such as diabetic peripheral neuropathy, retinopathy then outcome measurement such as an A1c less than 6.5. Good outcome < 6.5 poor outcome A1c > 8• Health Risk Management (preventable errors)A systematic organization process to identify risky practices to minimize adverse patient outcomes and corporate liability. High-risk areas look for medications errors, hospital acquired infections, patient identifiers and falls. • Accreditation (joint commission, etc)Voluntary process – non-governmental associationthat certifies the organization such as hospital, clinic, nursing program. That it has met or exceeded the recommendations. ANCC, NLNAC, Peer Review / 360 degree Evaluation – employees rate other employees in the same job classification, through the use of established criteria. The system has the potential to offer honest & specific feedback that allows the individualto make improvements or adjustments to meet objectives and performance standards10
Ethical Concepts Fidelity – Loyalty & dedication; keeping a promise – Example: A women with terminal breast cancer does not want to NP to give her poor prognosis to her mother. The patient explains to the NP that her mother is very anxious and she wants to wait until the end of the week before she tells her mother the news. If the NP keeps the prognosis is confidence from the patient’s mother, she is exercising the concept of fidelity. Dignity - Respect for human dignity is important aspect of medical ethics. A person’s religious, personal and cultural beliefs can influence greatly what a person considers dignified treatment. Example. Hospital gown should be securedso that when a patient gets up there back is covered. Confidentiality -The obligation to protect the patients‘, personal information, test results and medical records. The right is also protected by HIPAA – electronic transmission of medical records, Psych and mental health require separate consent.