Presenter: Karen Mercereau, RN, iRNPA - Tucson Osteopathic Medical … · 2017-04-23 · Collect all available medical records, read and analyze for critical information Create a

© 2017 Karen MercereauPresenter: Karen Mercereau, RN, iRNPA

© 2017 Karen Mercereau

What Is a Patient Advocate?

A Patient Advocate is an independent professional

engaged and paid for by a client to help achieve

a particular health outcome for a patient.

The client can be the patient, a family

member, a friend, or even a

medical care provider.


Who is a Patient Advocate?

Hospital and insurance companies Patient Advocates (loyalty to employer)

Social Workers

Interested non-medical people (family events)

Physicians

And . . .


Experienced Clinical RNs


Non RN Based Patient Advocates:

Most have attended educational programs where an RN is not necessary

Widely variant kn0wledge bases between RN based clinical RN’s and the others


Main areas of practice for Patient Advocates

Clinical

Insurance/billing issues

Community resources

Only one program currently is only for qualified, clinical RNs –partnered with University of Arizona College of Nursing


RN Based Patient Advocates


RN Patient Advocate Scope of Practice

To formulate actions that facilitate a continuum of optimal healthcare for patient/family within the context of their preferences and their ethnic, spiritual, cultural, socio-economic and experiential background


Standards of Care RN Based Patient Advocacy Orients pt/fam to a partnership model of health

Uses current knowledge of disease etiology and progression,

the healthcare system, pt/fam preferences and

acute/chronic care models to effectively interface with

healthcare providers and payers

Uses therapeutic intervention, guidance, decision tools and

models to ensure pt/fam make informed choices aligned to

their health beliefs, values, and preferences.

Synthesizes past and current pt medical information and

clinical findings to determine relevant patterns, trends, and

obscure but related clinical data


Continuum of care problems: US Health literacy 12% (NAAL, 2003) – read medication

labels, identify some words on a medical document

The next 53% can read a med container and figure out their contribution to the employer health plan

They do not know what physicians are talking about nor what questions to ask

Information is largely forgotten within an hour of the physician appt.

Leads to lack of compliance with treatment protocols


Education is the central tenet of RN based Patient Advocacy – patients/families – identify the learners and their learning styles

Culturally sensitive

Provided in pictures and lay language

Teach them where to look up scientifically based, non-commercial information on the internet

Teach pts/families what kind of information they should report to their physicians

Continue education begun in physicians’ offices

Solution


Community Health Literacy Programs presented

Community Service Provided: Scientifically based non-commercial based

information presented to community groups

Introduce community members to leading edge

information not available on network news

Provide questions to ask their physicians

Engage them in their own healthcare


Gaps in Care during hospital

to home/institution transition

Case managers overworked, cannot attend to all necessary details re: equipment, connections with community resources

Family awareness lacking in what needs to be done and what needs to be reported to physicians immediately to avoid re-admission

Family lacks understanding of medications, dietary needs, treatments

Problem


RN based Patient Advocates – work with case managers to facilitate a more successful transition

Follow newly discharged patients to ensure professional observation and reporting to physicians

Follow up with necessary community resources

Reduce incidence of 30 days readmissions

Improve Outcomes

Reduce Costs

Solution


Patients not engaged in their own healthcare

Problem:


Engage patients/families through establishment of effective therapeutic relationships based on listening/understanding of their health stories, education provision and support, ensure that physicians have all appropriate information relative to patient/family

Engaged patients/families are more compliant and have better outcomes

Solution RN Based Patient Advocates


Physicians presented with incomplete, sometimes inaccurate patient historical information

Lab work results often not communicated amongst physician offices – can be unnecessarily repeated or missed

Patients are poor historians and reporters

ER personnel diagnosing and treating with minimal contextual historical information

Limited historical data transmission either paper or EHR – medical records

scattered and time to collate/analyze for critical data lacking

Problem


Collect all available medical records

Read and Analyze for Critical Information



Create a Medical Timeline

with chronology of events

and intake information



Create Lab Trends with all pertinent lab data over the years



Provide all physicians with this collated critical information (4-6 pages)

Ensure accurate data leading to the best Diagnostic and Therapeutic approaches and

To better direct management of patients over time



Transparency and constancy of information flow to all practitioners involved in patient care

RN Based Patient Advocate

SOLUTION


Many reasons, lack of information availability and flow is a big part of this problem

Malpractice lawsuits often based on misdiagnoses – rising malpractice costs and sequellae

Institute of Medicine Report 2015 revealed statistics of misdiagnoses –

12 million annually with cost of > $700 billion

Problem



Facilitate accurate and focused medical history

information to physicians in a timely manner:

Medical Timeline


and Lab Trends



Collect all available medical records, read and analyze for critical information

Create a Medical Timeline with chronology of events and intake information

Create Lab Trends with all pertinent lab data over the years

Provide all physicians with this collated information (4-6 pages) to ensure accurate data leading to the best diagnostic and therapeutic approaches and to better direct management of patients over time

Transparency and constancy of information flow to all practitioners involved in patient care

Solution


Data mining for critical information difficult

Office to Office Information Transition Problematic

Many older patients with multiple chronic conditions often have 4+ physicians with little time or staff availability for accurate/timely medical history information flow

Problem



Provision of Medical Timeline/Lab Trends to all treating physicians to ensure transparency and timely/up to date information flow


Polypharmacy – potential for medication based errors (106,000

deaths annually due to medication problems (those that are reported):

drug interactions

nutrient depletion

meds that repeat effect of other meds

genetic intolerances (pharmacogenomics)

Problem


Investigation of medication potential interactions, nutrient depletion effects – report to physician to effect necessary changes

Teach patients/families how to investigate this information for themselves in future

Offer pharmacogenomics testing to identify genetic tolerances/intolerances




can greatly support your practice.

Documents

Presenter: Karen Mercereau, RN, iRNPA - Tucson Osteopathic Medical … · 2017-04-23 · Collect all available medical records, read and analyze for critical information Create a