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MEDS 580 > Lecture 6: Interprofessionalism in Healthcare: Effective Teams, C Diff > Flashcards

Lecture 6: Interprofessionalism in Healthcare: Effective Teams, C Diff Flashcards

1
Q

What is a surrogate?

A

A family member that makes medical decisions for the patient.

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2
Q

Through which models can a surrogate interact with physicians?

A

Can interact with physicians in the patient in charge fashion or in the partnership model

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3
Q

What is a POLST?

A

(Physician Orders for Life-Sustaining Treatment)

Go to document to directly identify a surrogate

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4
Q

What is an Advance Care Plan/Directive?

A

Legal document clarifying patient’s goals, values, and beliefs and inform physicians about care choices/decisions the patient would make

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5
Q

How does an Advance Care Plan/Directive help surrogates?

A

Helps clarify choice of surrogate

Guides decision making “in the moment” (i.e. during a code)

Surrogates should make decisions based on what the patient wants

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6
Q

What is palliative care?

A

Interdisciplinary specialty that seeks to improve the quality of life for both the patient and their family when life limiting illness is present

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7
Q

When is palliative care appropriate?

A

Appropriate at any stage of illness, not just when dying

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8
Q

T/F: Palliative care refers to therapies that relieve symptoms but do not provide cures (i.e. nausea medication)

A

TRUE!

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9
Q

T/F: Palliative care goals don’t overlap with hospice care goals

A

FALSE! Their goals overlap

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10
Q

T/F: Patients with no further options or those who wish to decline further treatment may be put on hospice

A

TRUE!

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11
Q

What is hospice?

A

Specialized care for dying patients

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12
Q

What is the goal of hospice care?

A

Meet needs of the WHOLE person, including physical, psychological, spiritual issues and other problems faced by those affected

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13
Q

What are some medical conditions for hospice?

A 
Cancer
Lung disease
Kidney or liver failure 
AIDS
Alzheimer's disease or other dementia
Multiple sclerosis
Heart disease
Neurological diseases
Liver disease
Diabetes
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14
Q

Who cares for the patient?

A

Family member (primary care giver, help make decisions for patient)

Hospice staff (regular visits for assessment and additional care, 24/7 on call)

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15
Q

Who is apart of the hospice team?

A 
Patient's personal physician
Hospice physician
Pharmacist
Nurses
Home health aides
Social workers
Clergy, counselors
Trained volunteers
Speech, physical, and occupational therapists
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16
Q

What services are provided in hospice care?

A

Pain and symptoms management
Emotional and psychosocial and spiritual aspects of dying
Provides needed drugs, medical supplies, and equipment
Coaches family on how to care for patient
Delivers special services like speech and physical therapy when needed
Makes short-term inpatient care available
Bereavement care and counseling to surviving friends and family

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17
Q

What is the purpose of an effective healthcare team?

A

To deliver excellent healthcare

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18
Q

T/F: An effective team delivers high quality care and meet the 6 aims set by the Institute of Medicine

A

TRUE! These are aims for the improvement of healthcare and thus a definition for quality in healthcare

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19
Q

What is the National Academy of Medicine?

A

Non-profit NGO that is a part of the National Academies of Sciences, Engineering, and medicine

Adviser to the nation to improve health aims to provide unbiased, evidence-based, and authoritative information and advice concerning health and science policy

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20
Q

What does the “Crossing the Quality Chasm” report focus on?

A

The second/final report of the Committee on the Quality of Health Care in American focuses more broadly on how the health care delivery system can be designed to innovate and improve care

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21
Q

What does quality healthcare mean?

A

HIGH QUALITY CARE!

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22
Q

What are the 6 aims for healthcare improvement in an effective team?

A
  1. Safety
  2. Effectiveness
  3. Patient-centeredness
  4. Timeliness
  5. Efficiency
  6. Equity
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23
Q

What is the definition of safety?

A

Free of errors that cause injuries to patients (i.e. giving wrong meds, failing to diagnose, performing surgery on wrong body part)

24
Q

What is an inherent risk in treatment?

A

SIDE EFFECTS, so important that treatments only undertaken if benefits outweigh risks

25
Q

What is effective care?

A

Achieves the undoing of the ill effects of disease or prevents it from occurring

Expected to prevent, cure, or alleviate symptoms of a disease

26
Q

What is evidence-based practice?

A

the integration of best research evidence with clinical expertise and patient values

27
Q

What are the 4 main types of research evidence comes from?

A
  1. Lab experiments
  2. Clinical trials
  3. Epidemiological research
  4. Outcomes research (including analyses of systematically acquired and properly studies case reports involving one or a population of patient
28
Q

What is patient-centeredness?

A

Healthcare that is focused on achieving the patient’s goals and is consistent with their values and preferences

29
Q

What is timeliness?

A

Care that is free of unnecessary delays (i.e. waits to obtain appt, to see a physician, waiting in ER, waiting to receive test results, waiting for a procedure, etc)

30
Q

What is efficient healthcare?

A

Uses the fewest resources possible to achieve the desired outcome

31
Q

T/F: Some experts estimate that most physicians are productive only 50% of their time

A

TRUE :(

32
Q

What is equity healthcare?

A

Health care that is delivered without regard to the considerations that are irrelevant to health needs

Pursuing disparities across different populations

Providing same level of care to everyone

33
Q

What is a major threat to equity?

A

lack of health insurance

34
Q

Characteristics of C. diff (3)

A
  1. gram positive
  2. anaerobic spore forming
  3. bacillus
35
Q

What are the 2 exotoxins produced by C. diff?

A

Enterotoxin –> Toxin A

Cytotoxin –> Toxin B

36
Q

Function of Enterotoxin (Toxin A) of C. diff

A

Destroy tight cell junctions leading to increased permeability of the intestinal wall and thus diarrhea

37
Q

Function of Cytotoxin (Toxin B) of C. diff

A

Targets actin and destroys cellular cytoskeleton

Produces surface layer proteins which allow organism to bind to intestinal epithelium and cause local damage

38
Q

Is Toxin A or B necessary for causing disease?

A

Toxin B

39
Q

Risk factors associated with C. diff (7)

A
  1. antibiotic exposure
  2. PPIs
  3. GI surgery/manipulation
  4. long stay in healthcare settings
  5. serious underlying illness
  6. immunocompromising conditions
  7. advanced age
40
Q

Antibiotics usually associated w/ C. diff (2)

A
  1. Fluoroquinolones (cipro and levaquin)

2. Clindamycin

41
Q

Diseases caused by C. diff (5)

A
  1. pseudomembranous colitis (PMC)
  2. toxic megacolon
  3. perforations of the colon
  4. sepsis
  5. death (rarely)
42
Q

T/F: Spore are NOT resistant to many cleaning agents including alcohol based hand gels

A

FALSE! They ARE resistant to many cleaning agents

43
Q

How does C. diff spread?

A

Mainly spread by spores, which can be transmitted via environmental surfaces and contaminated hands

44
Q

Transmission of C. diff

A

Fecal-oral route (ingestion of spores)

45
Q

Clinical symptoms of C. diff (5)

A
  1. Watery diarrhea (3 loose stools in <24hrs)
  2. Lower abdominal pain/cramps
  3. Fever
  4. Nausea
  5. Leukocytosis
46
Q

Diagnosis of C. diff

A

Detection of toxin in stool/clinical signs

47
Q

T/F: Labs distinguish between active and carrier state of C. diff?

A

FALSE! Labs DON’T

48
Q

Prevention of C. diff (4)

A
  1. Wash your hands!
  2. Gloves and gown
  3. Clean w/ sporicidal antiseptic agent
  4. Disposable equipment
49
Q

Steps in treating C. diff (4)

A
  1. Stop antibiotics
  2. Place in isolation
  3. Oral vancomycin or fidaxomicin
  4. Fecal transplant (if recurring)
50
Q

When do you reconsider ordering a C. diff test? (2)

A
  1. If patient is on laxatives

2. Patient was tested in past 7 days

51
Q

C. diff testing (4)

A
  1. Initial test is PCR
  2. GDH ELISA
  3. Toxin ELISA
  4. Cytotoxin neutralization assay
52
Q

What is a PCR test for C.diff?

A
  1. Sensitive lab technique that uses DNA primers to amplify copies of a targeted gene in test sample
  2. Looks for genes in toxigenic strains
  3. Does not test for active production of toxin so picks up asymptomatic carriers
53
Q

What is the GDH ELISA test for C. diff?

A
  1. Antibodies to test for presence of GDH enzyme

2. GDH is a constitutive enzyme produces in large amounts by all strains of C. diff independently of toxigenicity

54
Q

What is the Toxin ELISA test for C. diff?

A
  1. Assay uses antibodies to detect presence of C. diff to detect presence of C. diff toxin A or toxin B
  2. Specificity of this test is nearly perfect but low sensitivity (75%) so results in high rate of false negatives
55
Q

What is the cytotoxin neutralization assay test for C. diff?

A
  1. Functional assay that tests for cytopathic effect on human tissue cells (GOLD STANDARD)
  2. Specimen prepared by centrifuging liquid stool samples, harvesting supernatant, and then inoculating different dilutions onto a monolayer of human foreskin cells in cell culture

MEDS 580 (9 decks)

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