...Running head: CLINICAL DECISION UNIT Clinical Decision Unit: What is it exactly? Healthcare is a topic that can be discussed, researched and debated and still never answer many questions. In the hospital environment many people use the Emergency Department as their doctor’s office. Insurance companies require that the doctors closely look at why they are admitting a patient and how long their feel the stay will last. If they feel that it will be less than two midnights, then the patient is admitted as an observation patient to the clinical decision unit. Case managers play an important role in the admission process as well. They are required to screen the patients once admitted to determine if their admission status is appropriate. There are several computer programs available to assist them with this. This is a very important task and according to the American College of Emergency Physicians, “The observation vs. inpatient admission decision is an important one because there are significant consequences for getting it wrong. An inpatient admission that should have been observation can result in payment errors and compliance concerns, and carries the risk of payment denial and lost revenue for the hospital. An observation that should have been an inpatient admission might decrease the revenue that the hospital should have received.” I currently work on a Clinical Decision Unit. When I was hired six months ago, my unit director told me that the unit had only been open for...
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...Nursing Process and Clinical Decision Making Janet NUR/300 Kimberly Tomsai October 12, 2011 Nursing Process and Clinical Decision Making Not all nurses have the same knowledge and experience therefore nurses need to understand clinical judgment, decision making, and the nursing process to administer the best nursing care regardless of personal skill level. Nurses make clinical decisions based on knowledge and experience. A variety of theories and conceptual frameworks have developed to explain the science of nursing and clinical judgment, one of the most notable is that of Patricia Benner. Benner’s theory presents that nurses operate in five stages of clinical judgment from novice to expert (Bias, Hayes, Kozier, & Erb, 2011). The novice is the student nurse who has very little or no knowledge whose main concern is with rules and guidelines to complete tasks. Next is the advanced beginner or the graduate nurse who understands the concepts of nursing but sees difficult situations as more difficult tasks to complete and more rules to learn and often feels overwhelmed frequently consulting with more experienced nurses. For example a new patient arrives to the unit the nurse has not completed the tasks for the patients she already has becomes overwhelmed with how to prioritize and meet each patient’s needs. At the competent stage the nurse no longer functions entirely within a set of rules. Organizational and technical skills have improved the nurse is...
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...Discussion In order to understand evidence-based practice (EBP), it is important to recognize that EBP is detrimental to the quality improvement of patient outcomes while also helping to control the cost of health care. EBP is an approach to problem-solving and clinical decision- making that incorporates the best available evidence from well-designed studies based on clinician experiences and patients’ principles, values and preferences (Melnyk & Fineout-Overholt, 2015). The assessment of the effectiveness of EBP models can help to decide which models would be most practical and applicable to the actual practice setting. The Iowa Model of Evidence-Based Practice stands out as a model that will be carefully deliberated for the reason that it can be used successfully to initiate a practice change at the unit and organizational levels. The Iowa model is used throughout a multitude of clinical and academic settings. This model merges research utilization and quality improvement using processes that are innately clear and logical to nurses and is unique in that it uses the concept of “triggers” meaning that evidence-based practice may possibly be prompted by either facts or data from an outside organization, or by specific clinical problems (Brown, 2014). The Ace model uses an interdisciplinary approach for conveying knowledge for use in healthcare and nursing practice to help meet quality improvement objectives. The Ace model focuses mutually on interpretation and execution of the...
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...by feeding few important notes in the EMR during patient visits. | 1) Incomplete notes at start, which are filled later- taking extra time. 2) Many prescriptions not signed at the end of day. 3) Undercoding due to fear. 4) Reduction in patient revenue due to incomplete work & undercoding. 5) Prescriptions entered using CPOE. | 1) Professional training of EMR use required to sharpen EMR skills. 2) Training will increase confidence thereby reducing wastage of time, incompleteness of notes, timely updating prescriptions. 3) Revenue might pick up(per patient and number of patients) as the time taken will reduce, thereby facilitating more patient intake and proper coding measures. 4) An effective CPOE system needs clinical decision support (CDS) to help prescribers, pharmacists, nurses, and others use the system effectively. So use of CDS is required for increased efficiency. | Dr Johnson | 1) Most positive approach towards EMR- pre visit preparation of notes, checking of lab test results in EMR, nurse entering vitals and meds into EMR, and reusing EMR after the patient leaves...
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...organizational improvements can help. The research highlights some important considerations to be aware of that gives evidence-based medicine a bad name, the pitfalls to avoid, and some ways providers and institutions are working to overcome them. Introduction This paper begins by giving an overview of evidence-based medicine, what it is, and the benefits to be realized by providers, insurers, and patients. I compared that to what providers were using before EBM. Next, I examine the barriers to successfully incorporating evidence-based medicine, and the negative perceptions that dissuade their use by clinicians. Identified are the disadvantages such as source information bias, ethics considerations, and the dangers in using EBM to set Clinical Practice Guidelines (CPG). The research highlights some important considerations to be aware of that gives evidence-based medicine a bad name. I looked at pitfalls to avoid and some ways providers and institutions are working to overcome them. Finally, I included an overview, from a pharmacy management perspective, of how improvements techniques...
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...is known as the cornerstone of Good Clinical Practice for ensuring patient safety. In a normal clinical paced environment, time is given to ensure patients are provided all the required information and the time to make a rational and voluntary decision to participate in a study. At times this process is not feasible do to emergency situations, such as when a patient arrives in the emergency room in a compromised mental and physical state that does not permit ample time for this process. Such cases may also be further aggravated when a family member or a Legal Authorized Representative (LAR) is not available to decide if the patient should participate in a clinical trial that offers a treatment may increase the of survival more than the current standard of treatment. We must than think of the patient’s best interest at this point. History of Informed Consent Following World War II, the Nazis who performed medical experiments on prisoners of war without obtaining their consent were convicted of murder, but not for their actions of conducting unethical research. Their actions helped bring to life the Nuremberg Code of 1948; the first legal document to enforce the idea that subjects’ participation in clinical research must be voluntary. Many of the elements that help make up the Nuremberg Code are included in the code of federal regulations (CFR) parts 50 and 312 and the International Conference on Harmonisation (ICH) E6 good clinical practice guidelines2. Some key guidelines...
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...performance by utilizing highly reliable services and efficient clinical interventions. EBP has been supported by an electronic clinical procedural resource which helps in standardization of care and annual cost savings (Schoville et al., 2014).This electronic reference tool gives you efficient reference in no time and improves bedside patient care and safety. By using updated evidences the clinical experts save time since there is no need for written policies and procedures. An overview of costs and savings analysis explained an apparent savings of $360,899 annually....
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...diagnostic question Key terms: Clinical practice guidelines Evidence-based practice Randomised controlled trial Systematic review Evidence-based practice: the use of best research evidence, along with clinical expertise, available resources and the patient's preferences to determine the optimal management option in a specific situation. Randomised controlled trail: a clinical trail where participants are randomly assigned to groups in order to receive different interventions. This randomization removes many of the effects that may bias the true result. Systematic review: a comprehensive identification and synthesis of the available literature on a specified topic. Clinical practice guidelines: systematically developed statements that assist the health professional and the patient to make decisions about what is the appropriate health care in specific circumstances. Critical summaries (systemic reviews and clinical practice guidelines) now provide practitioners with readily accessible access to research evidence. The availability of theses documents on the web means that patients have almost as much access to the 'critical summaries' as their doctors. The underlying assumption of EBP is that if health care is based on evidence about what is most effective, the quality of care will be better than if it is not. Sackett's adopted 5-step approach to EBP provides framework for practising EBP: Ask an answerable clinical question: recognise a knowledge-gap...
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...rights regarding the nature of that care. The main objective of these rights is to make sure that care provided is of high quality and safety (Dunbar,2009). The Charter allows patients, consumers, families, carers, clinicians and services providing health care to share an understanding of the rights of people receiving care (Dunbar, 2009). The rights that are included in Charter are as follows: • Access: I have right to health care. • Safety: I have right to receive safe and high- quality care • Respect: I have right to be shown respect, dignity, and consideration. • Communication: I have right to be informed about the services, treatment, options and costs in clear and open way • Participation: I have right to be included in the decisions and choices about the care. • Privacy: I have the right to privacy and confidentiality of my personal information. • Comment: I have right to comment on my care and to have my concerns addressed (Australian Charter of Healthcare Rights, 2008) The purpose of this essay is to look at the evidence- based approaches to psychosocial intervention offer better respect and participation for a patient with Coronary Heart disease and Depression than bio-medical intervention. As described in ACHR (2008), Respect means, "all the participants in the health care system are to be treated with respect and not to be discriminated against anyway. The patient or consumers have a right to receive a care in a manner that is respectful of their culture,...
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...29th August 2005. John Smith, head of portfolio management and strategic planning, was paging through the slides he had prepared for the Portfolio Management Board (PMB) meeting which would start at 9 am, and which was scheduled to last until Friday. “We have been preparing this meeting for weeks”, he thought, “and it seems the PMB has some tough decisions to make”. The PMB of XYZ Pharma, the pharmaceutical division of XYZ, one of the world’s leading companies in the life science sector, convenes yearly in August to review the composition of the research and development (R&D) project portfolio. It also meets on a monthly basis to monitor the project portfolio and make decisions regarding new developments. According to John Smith, “The PMB is an important decision making body because it shapes the future of the company by determining its product pipeline”. The PMB members include the CEO of XYZ, the CEO of XYZ Pharma, the heads of the different business units, the heads of Development, Research, Global Marketing and Strategic Planning, the regional heads for the US, Europe and Japan and the functional managers for Regulation, Clinical, Licensing, Technical Research and Development, and Patents. The portfolio group, led by John Smith, had analysed the project portfolio carefully and had highlighted several potential threats that required action. According to John, “There will be an indepth discussion of which projects will be allocated additional resources, and at expense of which...
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...August 2005. John Smith, head of portfolio management and strategic planning, was paging through the slides he had prepared for the Portfolio Management Board (PMB) meeting which would start at 9 am, and which was scheduled to last until Friday. “We have been preparing this meeting for weeks”, he thought, “and it seems the PMB has some tough decisions to make”. The PMB of XYZ Pharma, the pharmaceutical division of XYZ, one of the world’s leading companies in the life science sector, convenes yearly in August to review the composition of the research and development (R&D) project portfolio. It also meets on a monthly basis to monitor the project portfolio and make decisions regarding new developments. According to John Smith, “The PMB is an important decision making body because it shapes the future of the company by determining its product pipeline”. The PMB members include the CEO of XYZ, the CEO of XYZ Pharma, the heads of the different business units, the heads of Development, Research, Global Marketing and Strategic Planning, the regional heads for the US, Europe and Japan and the functional managers for Regulation, Clinical, Licensing, Technical Research and Development, and Patents. The portfolio group, led by John Smith, had analysed the project portfolio carefully and had highlighted several potential threats that required action. According to John, “There will be an indepth discussion of which projects will be allocated additional resources, and at expense...
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...business strategy for different clinical trials phases and ultimately short-term and long-term business strategy. Nucleon is a small biotechnology company who focus on developing Cell Regulating Protein-1 (CRP-1) pharmaceutical product. Company started with research scientists and their entire focus was on research and development. Nucleon finished the pre-clinical trial with positive results and they are ready to perform clinical trial on human. Nucleon also has very good advantage over technology and has very good linkage to the universities and research group. Till this point Nucleon’s focus was entirely on R&D with no consideration CRP-1 manufacturing process at the large scale. Now as Nucleon ready to perform clinical trial on human, nucleon has to consider different manufacturing options and finalize it before it is too late. Nucleon has three manufacturing process option for phase I and II: 1) Build an in-house pilot plant. 2) Contract production to a third-party. 3) License the development and manufacturing right to corporate partner for initial fee and royalty on sale. By considering advantages, disadvantages and SWOT analysis of different manufacturing options, Nucleon has to choose the right decision to sustain in short run and to last in long term business in highly competitive pharmaceutical industry. Key points, opportunities and recommendation: * Key issue of the case is to identify the right manufacturing option for clinical trial Phase I and Phase II. Nucleon...
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...University of Maryland Case Study Analysis Eli Lilly: Developing Cymbalta Case Study AMBA 650 Section 1131 Kelvin Harris January 24, 2012 Executive Summary Eli Lilly and Company resounding success was the arrival of Prozac in 1988. By mid-1988, a new anti-depressant team was formed to find and develop a drug that would be the successor to Prozac. The strategic issues and problems they faced were developing a new drug to replace Prozac, meeting the company budget constraints to perform clinical trials, and finally launch the new drug by mid-2001. The analysis and evaluation revealed that the pharmaceutical industry is changing fast and it usually takes a long time and millions of dollars to develop a new drug. The recommendation for Eli Lilly is to take the lead in developing the new drug Cymbalta, invest a stable share of the company revenue, seek the FDA approval for the development of Cymbalta before going to market, and not change their market plan from the FDA approved Cymbalta dosage of 20 mg twice daily. Introduction Eli Lilly and Company was founded by Colonel Eli Lilly, Lilly’s namesake, in 1876 when he purchased a laboratory on Pearl Street in Indianapolis, Indiana. Eli Lilly was a pharmacist who had served in the Union Army during the Civil War. The company success included creating the process for applying gelatin-coating to pills for easier swallowing and the introduction of Iletin which was the first mass-produced insulin. Iletin...
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...attention is being directed toward the development of methods that can provide valid and reliable information about what works best in healthcare. The careful scientific evaluation of clinical practice became a prominent focus during the second half of the 20th century.1 More recently, attention has been paid to methods of determining which of multiple proven approaches to a healthcare problem works best for which patients.2 Evidence-based practice encompasses implementing the best-known practices into the clinical setting using a scientific approach. It evolved from evidence-based medicine, which was developed in Canada to teach medical students. “Evidence-based medicine has been defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”3, p. 3 The National Quality Forum’s report A National Framework and Preferred Practices for Palliative and Hospice Care Quality is a consensus report that is a first step toward introducing evidence-based measures into palliative practice on a formal, national level.4 The Agency for Healthcare Research and Quality (AHRQ) supports organizations in their efforts to improve the quality and efficiency of healthcare by facilitating the use of evidence-based research findings in clinical practice.5 The nursing discipline has also embraced evidence-based practice over the past 25 years, initially through its support of “research utilization,” the integration of research...
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...are very good at seeking information from their clients and their families and also from the settings in which they work but however they have not been as aware of the information that they can gain from research. Although they need information from many sources, evidence based practice shows how research can also play a role in informing clinical decisions, (Hoffmann ,2010). Health professionals use the five steps of evidence-based practice (EBP) as a structure to overcoming barriers and applying best research. Examples of this include use of professional protective equipment and safety considerations when using equipment. Liamputtong (2010) states that evidence based practice is a “process that requires the practitioner to find empirical evidence about the effectiveness or efficacy of different treatment options and then determine the relevance of the evidence to a particular clients situation” (pp. 252). Sackett (1996, pp.71) states that “conscientious, explicit and judicious use of current best evidence in making decisions about the care of individuals patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external evidence from systematic research, and the more thoughtful identification and compassionate use of individual patients’ predicaments,...
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