Archive for August 23rd, 2010

Financial Repercussions of Insufficient Client Charting

August 23, 2010

In an age of electronic records and an economic recession, the nurse must be diligent about thoroughly assessing the client using a head-to-toe format and charting all findings in detail. Medicaid/Medicare has really tightened their laws on what they will and will not reimburse. For example, if a patient is admitted to the hospital and the nurse fails to chart that the client had an already present pressure ulcer, Medicare will refuse to reimburse the hospital for fees, supplies, and procedures related to the treatment of that wound. However, if the pressure ulcer is charted as being present upon arrival, the hospital is not at fault and will be reimbursed fully. Another example, separate from charting, is when a patient is discharged from the hospital following a heart failure “tune-up” and is readmitted within 30 days. The hospital in penalized for the re-admission. The problem is that there are other factors that could cause the re-admission that is not the fault of the hospital or physicians. What if the patient is non-compliant with the prescribed medication regiment? Should the hospital be a fault? Also, we care for a high risk, end stage heart failure population, so is it fair that our stats must match up to a rural hospital that only cares for mild cases of heart failure and does not perform transplants?

I agree that our government has to be careful as to how dollars are spent, but perhaps there are better ways. As healthcare professionals our voices could be beneficial and therefore need to be heard, but unfortunately I am unsure as to how this is happens. Perhaps if all master degree programs for healthcare professionals also included a Public Health component, more people would know how to be a part of healthcare reform.

Online Healthcare Informatics College wanted

Online Nursing College wanted

Online Professional Speaking College wanted

Attorneys Lawyers handling Government Insurance Reimbursements

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Assessment of the Pregnant Client and Healthcare Informatics

August 23, 2010
With the assessment of the pregnant client, healthcare informatics comes quickly to mind.  The use of healthcare informatics is beneficial and necessary with the pregnant client.  The benefits of using an electronic medical record (EMR) with the pregnant client is important and necessary.  The benefits of having this record readily available and up-to-date ensures appropriate and timely health care of this client especially in an emergency or high risk situation.  This also ensures appropriate and timely health care for the fetus to also assist in producing positive health care outcomes.
With healthcare informatics and the diagnostic testing that is available to the pregnant client and fetus are concise and thorough.  Diagnostic evaluation and intervention also allows timely and accurate care of the pregnant client.  With any assessment, the pregnant client needs a complete evaluation with analysis of the fetus.  This assessment needs to be detailed with follow-up on any issues if they should arise.  With any issues, the follow-up should be quick to ensure the safety of both client and fetus.  Seek resources if needed for clinical issues with this client. This assessment ensures safety but also positive clinical outcomes.

With the assessment of the pregnant client, healthcare informatics comes quickly to mind.  The use of healthcare informatics is beneficial and necessary with the pregnant client.  The benefits of using an electronic medical record (EMR) with the pregnant client is important and necessary.  The benefits of having this record readily available and up-to-date ensures appropriate and timely health care of this client especially in an emergency or high risk situation.  This also ensures appropriate and timely health care for the fetus to also assist in producing positive health care outcomes.
With healthcare informatics and the diagnostic testing that is available to the pregnant client and fetus are concise and thorough.  Diagnostic evaluation and intervention also allows timely and accurate care of the pregnant client.  With any assessment, the pregnant client needs a complete evaluation with analysis of the fetus.  This assessment needs to be detailed with follow-up on any issues if they should arise.  With any issues, the follow-up should be quick to ensure the safety of both client and fetus.  Seek resources if needed for clinical issues with this client. This assessment ensures safety but also positive clinical outcomes.

Online Healthcare Informatics College wanted

Online Nursing College wanted

Online Professional Speaking College wanted

Informatics and the Ventilated Patient

August 23, 2010

ICU nursing frequently involves caring for the patient who is artificially ventilated.  This could be for numerous reasons: i.e. failure to wear off ventilator following surgery, respiratory failure, PE, pneumonia, etc.  Without advances in informatics, care of this difficult patient would be made even more difficult.  Assist controlled ventilation is the most often used.  In this mode, tidal volume and rate are pre-set.  In other words the ventilator is taking over the work of breathing, filling the lungs with air and enabling gas exchange to occur so the patient remains well-oxygenated.  If the patient does indicate respiratory effort, the ventilator is programmed to respond though it still delivers the preset tidal volume.  Nurses must be attentive to the patient’s respiratory rate and the ventilator’s assistance in order to avoid hyperventilation and subsequent respiratory alkalosis.  Generally, the nurse checks and records ventilator settings and respiratory effort frequently throughout the shift.  The patient will be monitored with vital signs, cardiac rate and rhythm, respiratory rate and pulse oximetry, via electronic monitors which transmit information directly to nurses in preset intervals (often as frequently as 2-5 minutes) and alarm when abnormals occur.  Without this form of monitoring, care of this patient would be much more difficult.  If the ventilator is alarming, the nurse attends to the patient first, then, if all is well, attends to the alarms which may indicate water in the tubing or a loose connection.  The patient should be assessed for skin color (nail beds and lips particularly), lung sounds, bilateral chest expansion, need for suctioning and respiratory effort.  The physician may order labs, arterial blood gases, chest x-ray or alteration of settings.  Again, thanks to computerized information retrieval continuity of care on a multi-disciplinary level is more accessible than in the past.  In most ICUs, physicians, nurses and respiratory therapists have access to electronic bedside charting to allow for continuous monitoring.  This form of charting makes the work of documentation and information retrieval safer for the patient.  Simply put, breathing supplies the human anatomy with life-giving oxygen a necessity for every cell in the human body; thus the “A” in ABCs.  Nurses always must attend to airway first, for without a patent airway, no other intervention could help the patient achieve homeostasis.

Online Healthcare Informatics College wanted

Online Nursing College wanted

Online Professional Speaking College wanted


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