NURS 601B Week 7 Discussion APRN Bridge course
NURS 601B Week 7 Discussion APRN Bridge course
NURS 601B Week 7 Discussion APRN Bridge course
Please respond to the discussion prompt.
In the primary care setting, discuss how a problem list may be used and discuss the rationale for maintaining a medication list. Discuss the challenges and benefits of advanced practice registered nurses using social medial sites for professional purpose.
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas. This is required. In addition, you may also provide an example case, either from personal experience or from the media, which illustrates and supports your ideas. All sources must be referenced and cited using correct APA (including a link to the source).
Since the introduction of the problem-oriented medical record by Lawrence Weed in his landmark article “Medical Records that Guide and Teach” (1), problem lists have become standard in nearly all medical record systems. Although problem lists are designed principally for use in patient care, and they are especially important in primary care, an accurate and complete problem list has many other uses. Problem lists can be used to create patient registries, identify patient populations for quality improvement activities, or conduct research (2–4). Many clinical decision support (CDS) rules also depend on accurate, complete, and coded problem lists (5–11). They can also be shared directly with patients to improve their engagement in their care (12). Furthermore, evidence suggests that more complete and accurate problem lists may improve quality of care (13).
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Consider the case of a hypothetical patient with diabetes. If diabetes is properly documented on his or her problem list, it may trigger CDS tools which help remind the patient’s care providers to assess for nephropathy or retinopathy, to measure his or her cholesterol and assess for the risk of heart disease, and to more tightly monitor blood pressure. The presence of diabetes on the problem list may also trigger inclusion in care management programs, registries, and research studies. And, of course, an accurate listing of diabetes on the problem list will inform other care providers, including specialists, covering providers, and emergency physicians who do not otherwise know the patient, that he or she has diabetes. If the same patient’s diabetes is omitted from the problem list, he or she would receive none of these benefits. Appreciating this, the ability to create and maintain a problem list is required for electronic health record (EHR) certification under the Office of the National Coordinator for Health Information Technology’s Authorized Certification Body process (14). Moreover, maintaining a “complete” problem list is a requirement for stages 1 and 2 of the “meaningful use” (15, 16) financial incentive program for EHR adoption in the United States (US), with stage 3 of meaningful use expanding the criteria to include regular review and reconciliation of problem concepts (17).
Despite these benefits and incentives, problem lists are often inaccurate, incomplete, and out-of-date (18–20), leading providers to find it a major struggle to keep them current. A prior study conducted at the Brigham and Women’s Hospital (BWH) in Boston, MA found that problem list completeness for outpatients ranged from a low of 4.7% for renal insufficiency or failure, to 50.7% for hypertension, to 78.5% for breast cancer (18). In a qualitative study, we found that when problem lists are incomplete, providers stop relying on them and, in turn, stop updating them, perpetuating a vicious cycle of problem list inaccuracy (21). To date, no systematic investigation of problem list completeness across sites has been conducted, nor have success factors for improving problem list completeness been identified. In this article, we report on these dual investigations conducted to further explore problem list completeness.
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