Challenges for RNs in ambulatory settings - ANSWER Social changes
HC environment (more regulation, higher expectations, PCP shortage, fragmentation)
No integration of HC records
No billing recognition for nursing care
PHCN workforce (still developing team-based care model)
Lack of appropriate ...
Challenges for RNs in ambulatory settings - ANSWER Social changes
HC environment (more regulation, higher expectations, PCP shortage, fragmentation)
No integration of HC records
No billing recognition for nursing care
PHCN workforce (still developing team-based care model)
Lack of appropriate ambulatory nursing education
CCTM Dimensions - ANSWER 1) Nursing Process
2) Pop Health Management
3) Teamwork + Collaboration
4) Patient-Centered Care Planning
5) Support for Self-Management
6) Advocacy
7) Education and Engagement of Pt. and Family
8) Cross-Setting Communication and Transition
9) Coaching + Counseling for Pt. and Family
ACA impact on ambulatory care nursing - ANSWER Emphasis on APRNs
Viewed as critical in : care coordination, clinical leadership, access, and chronic illness management
Others: AWV, PCMH, inc. PHC reimbursement, value-based reimbursement, CCTM model
Consequences of poor care coordination - ANSWER Duplicative care
Preventable admissions
Conflicting HC advise
Unnecessary pain + suffering
, Adverse drug events
Poor fxn status
Why is care coordination difficult? - ANSWER Shared accountability --> ambiguity as to who is
responsible for the process
PCPs don't have personal connections anymore with consultants, specialists, and hospitals --> poor
communication
Added time and effort for TCM is not reimbursed
PCPs don't have personnel or infrastructure to coordinate care effectively
IOM Standards for high-quality care - ANSWER Timely
Effective
Pt-centered
Efficient
Equitable
Safe
(TEPEES)
Role of pharmacist in ambulatory care - ANSWER Assess VS
Review lab parameters
Order appropriate tests
Pt. education
Screen for drug interactions
ID barriers to adherence
Adjust med regimens
Assess therapeutic efficacy
Gather info of adverse effects
J Co requirements for organization addressing intimidating behaviors - ANSWER Code of conduct
defining acceptable and unacceptable behaviors
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