Comment1

The Centers for Medicare and Medicaid Services (CMS) implemented a non-reimbursement policy for certain never events(serious hospital acquired conditions) to encourage hospitals to fast track improvements of patient’s safety by applying standardized protocols.  The newly defined never events limits the hospitals to bill Medicare for adverse events and complications that are deemed reasonably preventable using evidence-based guidelines (Lembitz & Clarke, 2009).

CMS adopted the non-reimbursement policy for certain “never events” – defined as “non-reimbursable serious hospital-acquired conditions” – in order to motivate hospitals to accelerate improvement of patient safety by implementation of standardized protocols. These newly defined “never events” limit the ability of the hospitals to bill Medicare for adverse events and complications. The non-reimbursable conditions apply only to those events deemed “reasonably preventable” through the use of evidence-based guidelines (Lembitz & Clarke, 2009).

The Centers for Medicare and Medicaid Services (CMS) implemented never events in 2008 as non-reimbursable hospital acquired conditions to create motivation for hospitals to improve patient safety.  Never events are medical errors that should never happen to a patient.  The list includes events which are chiefly avoidable and are obvious negligence.  The Centers for Medicare and Medicaid Services (CMS) adopted never events in 2008 as non-reimbursable hospital-acquired conditions in to create motivation for hospitals to improve patient safety (Votroubek, 2018).

Comment2

Patients have turned to hospitals, especially via emergency departments, as a result of lack of access to health care at a much higher cost than primary care. This has forced hospitals to provide care at a portion of the expense used to being the safety net of health care. In the beginning of this surge, organizations could not foreseen the financial brunt this would cost. Patients went from wanting to be cared for at home by loved ones, to expecting end all care at the hospitals taking a toll on such organizations. Many providers loathe and accept the endless cycle of patients returning to the hospital for care. The U.S Centers for Medicare & Medicare recognized that many of these return visits in short time frames, less than a month, are a reflection of lack of adequate care, education, and resources, so they created policies that hinder repayment for the diagnosis that were recently treated. “These patient safety policies are part of CMS’ efforts to promote higher quality, more efficient health care through value-based purchasing, which are initiatives use performance-based financial incentives and public reporting of quality information to encourage improvement in all aspects of quality, including patient safety” (CMS, 2008). These new reimbursement rules guide providers towards holistic patient care, driving them to decrease readmission rates, diagnostic imaging rates, and focusing on closing the loop in health care.

 Scenario: Mary and Elmer’s fifth child, Melvin, was born 6 weeks prematurely and is 1-month old. Sarah, age 13, Martin, age 12, and Wayne, age 8, attend the Amish elementary school located 1 mile from their home. Lucille, age 4, is staying with Mary’s sister and her family for a week because baby Melvin has been having respiratory problems, and their physician told the family he will need to be hospitalized if he does not get better within 2 days.

1. Choose two or three areas of prenatal care that you would want to discuss with Mary, and then write brief notes about what you know and/or need to learn about Amish values to discuss perinatal care in a way that is culturally congruent.
2. Discuss three Amish values, beliefs, or practices to consider when preparing to do prenatal education classes with Amish patients.
3.  Should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 

School Health

Occupational Health

Please read chapters 29 and 30 of the class textbook and review the attached PowerPoint presentations.  Once done answer the following questions;

1.  Discuss how Healthy People 2020 can be used to shape the care given in a school health setting.  Give at least one example.

2.  Identify and discuss the eight components of a comprehensive school health program.

3.  Identify and discuss the skills and competencies germane to occupational health nursing.  

4.  Describe and discuss a multidisciplinary approach for the resolution of occupational health issues.

INSTRUCTIONS:

As stated in the syllabus present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion tab of the blackboard titled “Week 15 discussion questions” and the SafeAssign exercise in the assignment tab of the blackboard(which is mandatory).  A minimum of 3 evidence-based references besides the class textbook no older than 5 years must be used and quoted according to APA guidelines.  You must post two replies to any of your peers sustained with the proper references no older than 5 years in two different days to verify attendance and as well make sure the references are properly quoted and mention to whom you are replying to.  The reply is a comment to your peer, not an extension of what you posted in your assignment.  What I mean is that you can’t post in your replies the same that you posted in your assignment or literally what is written in the reference that you.  Please make sure you quote the references properly.   A minimum of 800 words is required.  Please make sure to follow the instructions as given and use either spell-check or Grammarly before you post your assignment.  I will also pay close attention to spelling and/or grammar.  Please review the rubric attached to the lecture.  You must present the assignment according to how it is posted, answering the questions by number and essay-style assignments will not be accepted unless otherwise specified.  I’ve been grading a lot of assignments with quite a few spelling/grammar errors.  As a BSN student, you should be able to present an assignment according to APA and without errors.  This reflects our University.

We are entering week 15 of our course which means we are entering the final curve and your performance in the class will influence your grade. As a student’s close graduation perhaps planning to continue graduate studies it is very important that you follow the instructions as given.

  Write the below in an APA format with references and all the questions answered. 

The nurse is caring for a patient with diabetes type 1 who comes in for Day Surgery and takes insulin (aspart and NPH). On admission to the unit, the patient’s blood sugar is 200. 

Discuss the pathophysiology of this disease process, assessment of the patient, lab work and diagnostic tests appropriate for this patient before he goes to surgery.

Discuss the pharmacology, discuss what you would do pertaining to the blood sugar and the administration of the insulins- provide rationale, 

Discuss the nurses role in caring for this patient before and after the procedure. 

 

Soap Note 2 Chronic Conditions

Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

Late Assignment Policy

Assignments turned in late will have 1 point taken off for every day assignment is late, after 7 days assignment will get grade of 0. No exceptions

 Follow the MRU Soap Note Rubric as a guide:

Grading Rubric 

Student______________________________________

This sheet is to help you understand what we are looking for, and what our margin remarks might be about on your write ups of patients. Since at all of the white-ups that you hand in are uniform, this represents what MUST be included in every write-up.

1)      Identifying Data (___5pts): The opening list of the note. It contains age, sex, race, marital status, etc. The patient complaint should be given in quotes. If the patient has more than one complaint, each complaint should be listed separately (1, 2, etc.) and each addressed in the subjective and under the appropriate number.

2)      Subjective Data (___30pts.): This is the historical part of the note. It contains the following:

a) Symptom analysis/HPI(Location, quality , quantity or severity, timing, setting, factors that make it better or worse, and associate manifestations.(10pts).

b) Review of systems of associated systems, reporting all pertinent positives and negatives (10pts).

c) Any PMH, family hx, social hx, allergies, medications related to the complaint/problem (10pts). If more than one chief complaint, each should be written u in this manner.

3)      Objective Data(__25pt.): Vital signs need to be present. Height and Weight should be included where appropriate.

a)      Appropriate systems are examined, listed in the note and consistent with those identified in 2b.(10pts).

b)      Pertinent positives and negatives must be documented for each relevant system.

c)        Any abnormalities must be fully described. Measure and record sizes of things (likes moles, scars). Avoid using “ok”, “clear”, “within normal limits”, positive/ negative, and normal/abnormal to describe things. (5pts).

4)      Assessment (___10pts.): Diagnoses should be clearly listed and worded appropriately.

5)      Plan (___15pts.): Be sure to include any teaching, health maintenance and counseling along with the pharmacological and non-pharmacological measures. If you have more than one diagnosis, it is helpful to have this section divided into separate numbered sections.

6)      Subjective/ Objective, Assessment and Management and Consistent (___10pts.): Does the note support the appropriate differential diagnosis process? Is there evidence that you know what systems and what symptoms go with which complaints? The assessment/diagnoses should be consistent with the subjective section and then the assessment and plan. The management should be consistent with the assessment/ diagnoses identified.

7)      Clarity of the Write-up(___5pts.): Is it literate, organized and complete?