WELCOME TO MEDICAL PROFESSIONS I MRS. NGUYEN MSN, RN CEN F-303 Cleveland Clinic YouTube Empathy: The Human Connection to Patient Care

CHAPTER 1 Introduction to Health Care Agencies

HEALTH CARE AGENCIES The person is always the focus of care. Staff members have special talents, knowledge, and skills.  All work to meet the person’s needs.

AGENCY PURPOSES The purposes of health care include:  Health promotion  The goal is to reduce the risk of illnesses.  Disease prevention  Detection and treatment of disease  Rehabilitation and restorative care Many agencies are learning sites for students.  The students assist in the purposes of health care.

TYPES OF AGENCIES Hospitals Rehabilitation and subacute care agencies Long-term care centers (nursing homes, nursing facilities, nursing centers)  Skilled nursing facilities (SNFs) Assisted living residences Mental health centers Home care agencies Hospices Health care systems

ORGANIZATION  An agency has a governing body called the board of trustees or board of directors.  The board makes policies.  An administrator manages the agency.  Directors or department heads manage certain areas.  The health team (interdisciplinary health care team) involves the many health care workers whose skills and knowledge focus on the person’s total care.  The goal is to provide quality care.  The person is the focus of care.

ORGANIZATION (CONT’D) Nursing services  The director of nursing (DON) is an RN.  The DON is responsible for the entire nursing staff.  Nurse managers assist the DON.  Nursing areas usually have charge nurses for each shift.  Staff RNs report to the charge nurse.  LPNs/LVNs report to staff RNs or to the charge nurse.  You report to the nurse supervising your work.  Nursing education (staff development) is part of nursing services.

THE NURSING TEAM The nursing team involves those who provide nursing care.  Registered nurses  Licensed practical nurses and licensed vocational nurses  Nursing assistants

NURSING CARE PATTERNS The pattern used depends on how many persons need care, the staff, and the cost.  Functional nursing focuses on tasks and jobs.  Team nursing involves a team of nursing staff led by an RN.  Primary nursing involves total care.  Case management is like primary nursing.  A case manager (an RN) coordinates a person’s care.  Patient-focused care is when services are moved from departments to the bedside.

PAYING FOR HEALTH CARE Private insurance is bought by individuals and families. Group insurance is bought by groups or organizations for individuals.

PAYING FOR HEALTH CARE (CONT’D) Medicare is a federal health insurance program for persons 65 years of age or older.  Some younger people with certain disabilities are covered.  Part A  Part B Medicaid is a health care payment program sponsored by the federal government and operated by the states.

PAYING FOR HEALTH CARE (CONT’D) Prospective payment systems limit the amount paid by insurers, Medicare, and Medicaid.  Diagnosis-Related Groups (DRGs) are for hospital costs.  Resource Utilization Groups (RUGs) are for SNF payments.  Case Mix Groups (CMGs) are used for rehabilitation centers.  Home Health Resource Groups (HHRGs) are used for home health care.

PAYING FOR HEALTH CARE (CONT’D)  Managed care  Managed care deals with health care delivery and payment.  Managed care limits:  The choice of where to go for health care  The care that doctors provide  Managed care as pre-approval for services.  Many insurers must approve the need for health care services.  If the need is approved, the insurer pays for the services.  If the need is not approved, the person pays the costs.

MEETING STANDARDS Standards are set by:  The federal and state governments  Accrediting agencies An agency must meet standards for:  Licensure  Certification  Accreditation AZ SBON / AZ MB

AZ SBON LNA CREDENTIALING (ENDORSEMENT PROCESS) PROCESS

AZ SBON LNA EXAM PROCESS 2016

AZ SBON LNA RENEWAL PROCESS 2016

SCOPE OF PRACTICE (STANDARDS OF CONDUCT)  RN – R  LVN/LPN – R  LNA- R

OMNIBUS BUDGET RECONCILIATION ACT (OBRA) Omnibus Budget Reconciliation Act of 1987 On December 22, 1987, President Ronald Reagan signed the Omnibus Budget Reconciliation Act of 1987 (OBRA-87) also known as the Federal Nursing Home Reform Act. While not all components have to do with drugs and pharmacology, there are a few points you should be aware of. OBRA-87 was enacted to protect the rights of patients in long- term care facilities such as nursing homes, skilled nursing facilities, and assisted living homes. It sets forth regulations for Medicare and Medicaid Conditions of Participation in long-term care facilities. It states that residents should not be given unnecessary medications, and that antipsychotic drugs can only be given to patients who have a condition that necessitates them. These patients must have documentation stating that they have a condition requiring antipsychotic drugs. For those who do receive it, doses must be gradually tapered off, and behavior modification and “drug holidays” (a drug-free period) can be used to see if the medication can be stopped completely. In addition, long-term care residents should not have any significant medication errors, and all necessary drugs, both routine and emergency, must be given as required. The facility itself is required to have a consultant pharmacist, and medications must be labeled and stored according to federal and state laws.

INFORMED CONSENT & ADVANCED DIRECTIVE  Informed Consent  Advance Directives  Do Not Resuscitate (DNR)  Living Will  Medical Power of Attorney (MPOA)

MEETING STANDARDS (CONT’D)  Surveys are done to see if the agency meets set standards.  If standards are met, the agency receives a license, certification, or accreditation.  When problems (deficiencies) are found, the agency: Is given time to correct them Is given time to correct them Can be fined for uncorrected or serious deficiencies Can be fined for uncorrected or serious deficiencies Can lose its license, certification, or accreditation Can lose its license, certification, or accreditation

MEETING STANDARDS (CONT’D)  You have an important role in meeting standards and in the survey process.