N108: Transition to the Registered Professional Nurse

N108: Transition to the Registered Professional Nurse Role Study Guide of 171 Never Events The National Quality Forum (NQF) has identified 29 specific negative occurrences in healthcare that have serious adverse patient outcomes and are reportable events. These are known as “never events.” The Joint Commission considers these never events to be sentinel events. Of the 29 never events, there are many directly related to nursing care. For example, patient death or serious injury related to medication errors, blood products, falls, electric shocks, burns, restraint use, and failure to follow up or communicate laboratory, pathology, or radiology test results are among the list. Any stage three, stage four, or unstageable pressure ulcers acquired after admission/presentation to a health care facility are also never events. In addition, the American Association of Critical Care Nurses has collaborated with physician groups to delineate never events in the critical setting. These include ventilator-associated pneumonia, DVT/PE, iatrogenic pneumothorax, and delirium in critically ill patients. Frontline nurses provide a critical role in preventing never events through risk anticipation and adoption of evidence-based practice. Hospital Acquired Conditions (HACs) The Centers for Medicare and Medicaid Services (CMS) deny Medicare reimbursement for eleven hospital-acquired conditions and ban hospitals from charging patients directly for these “never events.” Some of the conditions for which CMS denies reimbursement overlap the 29 NQF never events, such as blood incompatibility, stage three and four pressure ulcers, falls and trauma injuries, air embolism, foreign object retained after surgery, and surgery involving the wrong site, wrong patient, or wrong procedure. Others are not included in the never event list, such as poor glycemic control that occurs in the hospital (DKA, hypoglycemic coma, or HHNK), catheter associated urinary tract infections, and vascular catheter-associated infection. Nurses play an important role in preventing HACs by using evidence-based practices, and protecting their employers’ reimbursement by scrupulously documenting conditions present on admission. The ability of highly skilled nurses to reduce medical errors is being recognized, as more than half of all never events are nursing-sensitive, particularly pressure ulcers and patient falls. As nursing’s effect on patient outcomes becomes increasingly accepted, the CMS policy has established a permanent link between Medicare reimbursement and quality nursing care. HCAHPS and Patient Satisfaction The data from the HCAHPS survey is used to determine reimbursement, and hospitals can gain or lose up to two percent of their Medicare reimbursement fees depending on howwell they score. A hospital that chooses not to participate in HCAHPS is automatically docked two percent. Quality of care translates to patient satisfaction and patient satisfaction means payment satisfaction for the hospitals. Quality of care is heavily weighted towards nursing care and that may lead to improvements in the nursing work environment and nurse to patient ratios. Studies have linked patient satisfaction with nurse staffing levels, higher proportions of registered nurses (RNs), skill mix, nurses’ work environment, and RN and physician collaboration. Communication skills are key to quality of care and patient satisfaction. Active listening and follow through are vitally important. Providing compassionate care is essential. Patients are generally not in the healthcare setting because they want to be. They are not in control, are frightened, and they need support. ©2017 Achieve Test Prep Page 138