Introduction to the Case Management Body of Knowledge
The Case Management Concepts domain also focuses on knowledge associated with case management administration and leadership, with program design and structure, with roles and responsibilities of case managers in various settings, and with skills of case managers e. In addition, this domain includes demonstrating the value of case management, case load calculation, tools such as case management plans of care, and regulations related to case management. The Principles of Practice domain consists of knowledge associated with quality and accreditation, risk management, regulatory and legal requirements, ethical practices and principles, privacy and confidentiality, and overall standards of case management practice.
It also includes knowledge of case management models, concepts, processes, services, and resources. The Healthcare Reimbursement domain consists of knowledge associated with types of reimbursement and funding systems, sources and methods, utilization review and management concepts, and roles of case managers in effective allocation and management of resources. This domain also includes quality of care, demonstrating return on investment and cost-effectiveness, and educating clients about health and wellness. In addition, this domain includes regulations pertaining to rehabilitation.
The Professional Development and Advancement domain consists of knowledge associated with the roles and responsibilities of case managers toward advancing and demonstrating the value of case management practice. Back to Top.
Introduction to the Case Management Body of Knowledge The case management knowledge framework consists of what case managers need to know to effectively care for clients and their support systems. Definition of Case Management There is no one standardized or nationally recognized and widely accepted definition of case management. Case Management Philosophy and Guiding Principles Case management is a specialty practice within the health and human services profession.
The underlying guiding principles of case management services and practices of the CMBOK follow: Case management is not a profession unto itself. Rather, it is a cross-disciplinary and interdependent specialty practice. Case management is guided by the principles of autonomy, beneficence, nonmaleficence, and justice. Case managers understand the importance of achieving quality outcomes for their clients and commit to the appropriate use of resources and empowerment of clients in a manner that is supportive and objective.
Case managers approach the provision of case-managed health and human services in a collaborative manner.
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Professionals from within or across healthcare organizations e. The healthcare organizations for which case managers work may also benefit from case management services. They may realize lowered health claim costs if payor-based , shorter lengths of stay if acute care-based , or early return to work and reduced absenteeism if employer-based. All stakeholders benefit when clients reach their optimum level of wellness, self-care management, and functional capability.
These stakeholders include the clients themselves, their support systems, the healthcare delivery systems including the providers of care, the employers, and the various payor sources. Case management helps clients achieve wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, service facilitation, and use of evidence-based guidelines or standards.
They do so while ensuring that the care provided is safe, effective, client-centered, timely, efficient, and equitable. This approach achieves optimum value and desirable outcomes for all stakeholders. Caregiver The person responsible for caring for a client in the home setting and can be a family member, friend, volunteer, or an assigned healthcare professional.
Case Management Program Also referred to as case management department. An organized approach to the provision of case management services to clients and their support systems. Payor The person, agency, or organization that assumes responsibility for funding the health and human services and resources consumed by a client. The organization or agency at which case managers are employed and execute their roles and responsibilities.
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The practice of case management extends across all settings of the health and human services continuum. Also refers to the professional background — such as nursing, medicine, social work, or rehabilitation — that case managers bring with them into the practice of case management. Knowledge Domain A collection of information topics associated with health and human services and related subjects.
Examples of case management knowledge domains are Principles of Practice and Healthcare Reimbursement. Health An individual's physical, functional, mental, behavioral, emotional, psychosocial, and cognitive condition. It refers to the presence or absence of illness, disability, injury, or limitation that requires special management and resolution, including the use of health and human services-type intervention or resource. Health and Human Services Continuum The range of care that matches the ongoing needs of clients as they are served over time by the Case Management Process and case managers.
It includes the appropriate levels and types of care — health, medical, financial, legal, psychosocial, and behavioral — across one or more care settings. Cleansing is done with plain tap water. Soap, baby wipes, or those popular bathroom wipes are not necessary and can actually interfere with pouch adherence. Once clean, the skin surrounding the stoma should be completely dry. Fanning or a hair dryer on cool will help dry the skin quickly. Ostomy Pouch Application : After the stoma has been measured, you will need to cut an opening that matches the measurement on the back of the barrier.
If a one-piece pouch is being used, be sure to pull the pouch away to prevent cutting into the plastic. The opening should match the size of the stoma leaving no exposed skin. Soft paste strips, rings or paste caulking may be used at the cut edge to help seal the junction between the stoma and skin edges. Remember that stoma paste is NOT an adhesive but is only caulking. Secure the prepared barrier onto the skin and if a two piece system is being used, you will now add the pouch. If a patient has a new stoma and a tender abdomen after surgery, the pouch can be attached to the barrier BEFORE placing the barrier onto the skin.
Encourage patients to place their hand over the stoma and appliance and apply light pressure for several minutes. This will help secure the seal. Frequency of Pouch Changes: When a drainable pouch is being used, changes should be scheduled every days depending on patient preference, the type of stoma, characteristic of the effluent, and type of pouch that is being used. Patients with a low colostomy and regular, formed stools may opt for a closed end pouch that can be changed with each bowel movement- normally once or twice a day.
Regardless of when the next scheduled change is, patients need to be prepared to do an immediate change for any burning or itching around the stoma, noticeable odor pouches are odor-proof when intact or a clear indication of a leak. With each lesson, encourage an increasing level of patient involvement with a goal of complete independence within a reasonable number of lessons. Review the lessons with each visit and add new information and accessory products when appropriate.
Teaching is about more than managing basic pouch changes. With so many good options available, patients need to be able to select supplies that best meet their lifestyle. Options include but are not limited to standard vs extended wear, one piece systems vs two piece systems, adhesive coupling vs snap together two piece systems, flat vs convex barriers, fecal vs urinary options, drainable vs closed end, clear vs. Ostomy supplies are readily available from a wide number of sources such as specialty pharmacies, companies offering durable medical equipment, and online catalog companies. You may need to help patients find the best distributor for the equipment that they need and one that works with their insurance.
In addition to teaching basic pouch changes, it is your responsibility to teach patients how to live full and productive lives with their ostomy. That includes basic information such as emptying a drainable pouch whenever it is one-third to one-half full. Pouches should be emptied directly into the toilet from a sitting position whenever possible. Although pouch failures should be rare, ostomy patients should be taught to ALWAYS travel with the equipment necessary for an unexpected pouch change. As patients are recovering, it is important to remember that they have had abdominal surgery.
Lifting more than ten pounds may increase their risk of complications such as the development of a hernia. Good nutrition is important for healing but nutrition is another area that will require some teaching. Patients with an urostomy will need to drink adequate amounts of fluid throughout the day to maintain a continuous flow of urine and prevent infections. Patients with an ileostomy are at a higher risk of bowel blockage because of the decreased lumen of the small bowel.
This can cause insoluble fiber to lodge near a fascia-muscle layer.
Although there are common foods that have been tied to an increased risk of blockage, other foods can cause blockage as well. Patients need to judiciously add foods such as corn, cabbage, celery, popcorn nuts, raisins, etc. In addition, because ileostomy patients no longer have the colon available to reabsorb water from the stool, increased intake of fluids must be encouraged. Dehydration is a common complication in the early post-op period.
After that, they can eat any of their favorite foods. Sexuality is a very real part of being human. When providing pre-operative or post-operative ostomy teaching and support, it is important to introduce the topic of sexuality. You cannot wait for your patient to ask, you have to open the discussion so that patients are comfortable addressing any concerns that they may have. Sexuality needs to be discussed with every post-adolescent patient. This is regardless of sexual orientation, marital status, or age. Finally, patients are entitled to ongoing support as they adjust to their life with an ostomy.
The United Ostomy Association of America is a wonderful resource, providing access to local support groups and a wide variety of online discussion rooms. With nurses providing quality education and facilitating ongoing support for patients, hope will be infused, independence reestablished and a normal life regained. This blog is intended as a cursory overview of basic ostomy management. Space and the intent of this blog are not intended as a comprehensive outline on best practice for assisting ostomy patients.
Nurses who would like to know more about ostomy management should seek further information and specialty training. About the Author Diana Gallagher has over 30 years of nursing experience with a strong focus in wound, ostomy, continence, and foot care nursing. As one of the early leaders driving certification in foot care nursing, she embraces a holistic nursing model. A comprehensive, head to toe assessment is key in developing an individualized plan of care. In fact, very few companies do.
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The best GMs willingly make the tough calls it takes to upgrade an organization. Making tough people decisions has to start at the top. Otherwise, managers will postpone action, rationalize marginal performance, or mistake the recruitment of one or two outsiders for real upgrading. For this reason, the best GMs lead annual personnel reviews instead of delegating that job to department heads or division presidents.
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They also understand how critically important job rotation is and break down functional empires that get in the way. Finally, they directly influence important appointments by exercising a veto or offering subordinates a slate of candidates to choose from. Above all, they get line managers deeply involved in the upgrading process by forcing periodic, tough-minded appraisals of individuals and groups.
They constantly ask how their high-potential people are performing and how managers are solving their people problems. But action, not questions, is the key, especially against the bottom quartile performers. To that end, they make sure the process produces better results each year and that it gets pushed farther down in the organization.
The best GMs also know that compensation is a means to an end, not an end in itself. Rewards are linked to performance. They pay their best performers considerably more, even if that means paying the average performers less than they expect. Finally, the best GMs invariably surround themselves with good people—achievers, not cronies or loyalists. One of the most innovative GMs I know once proudly told me about his plan to reorganize and decentralize his business in order to make faster decisions, improve execution in local markets, and reduce costs. The new decentralized organization would cost roughly what the old one did—in the early stages, before it had a chance to grow.
The best GMs seem to look for the simplest ways to do things, which usually means fewer layers, bigger jobs, and broader responsibilities. They also get personally involved in solving important problems, regardless of what the organization chart says.
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To reduce hurt feelings, they make sure—in advance—that subordinates understand how the system works and why intrusion is sometimes required. Another organizational bias worth noting is that the best GMs organize around people rather than concepts or principles. When they have a strategy or business problem or a big opportunity, they turn to the individual who has the right skills and style for that job. Then, having made the match, they delegate responsibility without hemming the person in with a tight job description or organizational constraints.
Then managers feel more responsible for results simply because they are more responsible. Naturally, those reorganizations accomplished very little. But people are usually the dominant consideration. Trite as it may sound, somewhere along the line, the best GMs have learned the value and impact of teamwork. They learn to push their ideas through a small, narrowly based group of subordinates and peers but not how to manage a diverse team of executives from several areas.
And they learn almost nothing about the problems of implementing their ideas in other functional areas or integrating the efforts of a disparate, often geographically dispersed group of managers. In contrast, the best GMs routinely bring managers together to talk about the business, to get multiple inputs on important projects, and to line up their support. As a result, line managers respect and use the staff instead of writing unfriendly memos or playing unproductive political games. The sixth and last area of responsibility for a GM is supervising operations and implementation.
That means running the business day-to-day by producing sound plans, spotting problems and opportunities early, and responding aggressively to them. Top GMs are usually very results-oriented. But they also know that surprises will occur, so they keep enough flexibility in their spending to allow for competitive threats, good new ideas, or softer volume.
If business drops off sharply, they move faster than others to scale back costs, cut discretionary expenditures, and eliminate losers. Next, they push for functional excellence all across the business. In contrast to the GM who is satisfied to have one or two high-performing departments only, they demand superior execution in every function.
As a result, they get more out of every strategy and every program than their competitors do. They also understand the impact of concentrating on a few things at one time. These managers are also bugs on costs. They continually search for ways to do things better at lower cost. Finally, top GMs use information better than their colleagues do to spot problems early and to identify potential competitive edges.
But it goes beyond that. Figures and facts mean something to them because they know their customers, products, and competitors so well. And they never stop trying to read those facts and figures for clues to an edge in the marketplace. But when you have good people, make darned sure you listen to what they have to say. To sum up, outstanding GMs affect their companies in six important ways. They develop a distinctive work environment; spearhead innovative strategic thinking; manage company resources productively; direct the people development and deployment process; build a dynamic organization; and oversee day-to-day operations.
Individually, none of these things is totally new or unique. But successful GMs are better at seeing the interrelationships among these six areas, setting priorities, and making the right things happen. As a result, their activities in these areas make a coherent and consistent pattern that moves the business forward.