Preparing the Discussion

You are a family nurse practitioner working in an outpatient primary care office of a large hospital system. The practice has been operating for over 15 years, and many of the administrative and clinical staff were hired when the practice opened. You have been in the practice for less than 3 months. In that short amount of time, you have witnessed several of the clinical staff engaging in heated arguments with each other, sometimes in patient areas. You overhear an argument occurring today between two staff. You pick up a patient's chart and notice a very low blood pressure that the medical assistant failed to notify you about. When you confront the MA, she states that she was going to report the vital signs to you when she became engaged in the heated argument you overheard and forgot to notify you. 

Unfortunately, this pattern of behavior is not unusual in this practice. Working with staff who cannot cooperate effectively can negatively influence your ability to spend time with patients, can impede the flow of patients through the office, and could impact patient safety. 

Case Study Responses: 

1. Analyze the case study for potential issues for members of the healthcare team from office conflict. Contrast the potential effects for each member of the healthcare team based on the required readings from the week. Discuss the potential ethical and legal implications for each of the following practice members: 

· Medical assistant

· Nurse Practitioner

· Medical Director

· Practice

2. What strategies would you implement to prevent further episodes of potentially dangerous patient outcomes? 

3. What leadership qualities would you apply to effect positive change in the practice? Focus on the culture of the practice.

4. A scholarly resource must be used for EACH discussion question each week.

Make a follow-up of a student's weekly discussion and respond with your opinion regarding to her post

——You don't have to post this in APA format necessarily, it's just giving feedback to the student .

Jacqueline Kenney

Good Evening Professor,

 

              I work in one of the largest hospital systems in Atlanta. The facility I work for has the bed capacity for 686 patients. The hospital specializes in cardiovascular procedures (the implantation of the LVAD) and transplantation of liver, and kidneys. The hospital attracts people from across the country. People coming from literally every state, and sometimes from out of the country.

            The area where I see the EHR impeding patient care, and again this might be in part, due to end-user negligence, are providers not utilizing the information and data contained within the patient's EHR frequently enough.  We run off a system called EPIC (EHR). I have come to realize most hospitals in the state of Georgia, and other states use EPIC as well.  Embedded within the EPIC system is a hyperlink called Care Everywhere. The Care Everywhere tab allows all providers on the EPIC system to see notes, documentation, tests results, frequency of visits, and more. This data covers every hospital, clinical, urgent care, and office visit the patient has encountered so as long as the facility is on the EPIC system. I believe the shear amount of medical information becomes overwhelming and time consuming to comb through, especially for medical providers who are already seeing numerous patients at the bedside and in specialty offices. 

          Despite medical documentation being readily available to providers across the healthcare spectrum, there seems to be little time for a busy Cardiologist to review necessary documentation from the patient's Pulmonary doctor, or the notes placed from Endocrinology. Often a patient comes for a visit due to CAD, but the patient is also a diabetic with uncontrolled elevated blood glucose. We know one disease process feeds the other, but in spite of the EHR containing valuable patient data, providers are still missing imperative clinical information required to treat the patients holistically. 

          The one department which I see consistently using chart review to coordinate care with patients, providers, and families are RN Case Managers within the hospital setting.  RN Case Managers, and Care Coordinators are responsible for knowing what is missing in the patient continuum of care. The RNCM interfaces with the providers, and assists in providing education to both medical MDs and patients regarding critical clinical information which will advance the clinical process and bring better patient outcomes. McBride & Tietze (2018) discussed unintended harm, or consequences suffered by patients with the implementation of the EHR. One such consequence has to do with physicians required to research, and review copious amounts of previous documentation, as well as being required to spend greater amounts of time entering documentation.  Such time consuming tasks often create information, and important patient data not being read, or documented in an effort to save time, and so providers can physically see more patients. 

 

Resources

                FAAN, S.M.P.R. C., & FAAN, M.T.P.R. F. (2018). 
Nursing Informatics for the Advanced Practice Nurse (2nd ed.). Springer Publishing LLC. 

https://ambassadored.vitalsource.com/books/9780826140555Links to an external site.

           Williams, M. D., Asiedu, G. B., Finnie, D., Neely, C., Egginton, J., Finney Rutten, L. J., & Jacobson, R. M. (2019). Sustainable care coordination: a qualitative study of primary care provider, administrator, and insurer perspectives. 
BMC health services research, 
19(1), 92. https://doi.org/10.1186/s12913-019-3916

 Reply

1-Write a case conceptualization (2-5 paragraphs) from a CBT perspective that includes a hypothesis. Do NOT include any multicultural factors.

2- Write another case conceptualization (2-5 paragraphs) from a multicultural perspective that includes a hypothesis. Focus on all multicultural and contextual factors associated with this case.

Both case conceptualizations (Word document, single-spaced, 12pt font,

 

Think about the articles you have been reading each week.

Were there any recommendations for practice that you thought could be implemented in your clinical practice tomorrow? Next week? Next year? Provide rationale to support your response.