An ICD-9-CM coding primer: incorporating changes made from October 1, 2003.
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Community Health Nursing↗
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Results for “International Code for Nurses”
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Belgian nurses' views on codes of ethics: development, dissemination, implementation.
The aim of this study was to explore how Belgian nurses view issues related to the development, dissemination and implementation of a code of ethics for nurses. Fifty nurses took part in eight focus groups. The participants stated that, on the whole, a code of ethics for nurses would be useful. They stressed that a code should be a practical and useful instrument developed by nurses for nurses, and that it should be formulated and presented in a practical way, just as educational courses dealing specifically with codes of ethics require a practical approach to be effective. They emphasized that the development of a code should be an ongoing process, enabling nurses to provide input as they reflect on the ethical issues dealt with in the code and apply the code in their practice. Finally, they stressed the need for support at institutional level for the effective implementation of a code.
Adult↗
Bibliometric analysis of nursing research in Taiwan 1991-2004.
This study examined nursing research performance in Taiwan from 1991 to 2004 by conducting bibliometric analysis of papers published by researchers affiliated with nursing institutes in Taiwan. Bibliometric information of papers that were published between 1991 and 2004 and had contact address including the words "Taiwan", and "nursing" were downloaded from the ISI Web of Knowledge website. The information used for this research included number of papers, number of authors, number of references listed, impact factors of publishing journals, times cited, and whether the paper was written through international or domestic collaboration. The information was coded and tabulated. Bibliometric characteristics were compared between 1995- 1999 and 2000-2004. Furthermore, an exponential model was fitted to show the past growth trend in research outputs. The results showed that there was a significant growth in quantity of papers from 1991 to 2004. In general, recent papers had averaged more authors, more domestic collaboration, more international collaboration, higher impact factors, and more references listed than earlier papers. Papers written with collaboration tended to have a higher average number of authors and more references listed, and tended to be published in journals with higher impact factors. The exponential model proved to be in good fit with the past growth pattern. The authors speculate that the recent increase in research collaboration, both internationally and domestically, may have contributed to the significant increase in output. It is not clear whether the growth in quantity of papers will continue or for how long. Based on past data, however, no sign of leveling off has been observed. More research is needed to understand what societal and individual level factors were involved in fueling such a dramatic increase in quantity in the last decade. Furthermore, as the quantity of papers has increased steadily, more focus can be placed on improving the quality of research papers.
Academies and Institutes↗
Psychiatry billing for nursing home services: understanding coding options.
This article reviews information on coding options, documentation, and payment for both initial and follow-up visits in the nursing home setting. Specific information is provided for both the psychiatry as well as the Evaluation & Management (E&M) code series. Payments are compared for comparable services in order to provide the nursing home psychiatrist with an understanding of the options available. Documentation, background information, and proposed note formatting are also provided. Proper use of the E&M series can provide valuable coding options.
Aged↗
Lifelong learning--the key to competence in the intensive care unit?
With continual advances in technology and changes in medical and nursing practice there is a need to continue professional development whilst working within the Intensive Care environment. This paper aims to consider why and how nurses working within the Intensive Care environment learn knowledge and skills. To explore nurses' experiences, a qualitative approach using a semi-structured questionnaire comprising open questions was used. The questionnaires were then analysed using line by line coding. The findings revealed that intensive care nurses learn knowledge and skills continually through a lifelong learning process in order to become a competent practitioner. Three themes were identified within this process: learning, opportunity, and outcome, all being affected by three factors: internal, external and patient-related. It is suggested that in order to organise and support effective learning, there needs to be an awareness of all of these factors and to be able to overcome the negative aspects to enhance the learning experience for all. The ultimate outcome of learning for the intensive care nurses was to practice competently in order to deliver high quality patient care.
Attitude of Health Personnel↗
Participation in change: self-reflection of staff in a psychiatric admission unit.
This paper reports on a comprehensive nursing research and development project carried out in the psychiatric admission unit of The Mental Hospital, Keropudas, Finland. The purpose of the project was to plan, implement and evaluate the functioning of the ward in order to orient it more towards patient-centered practices. This study was an action research project, the methodological foundations of which were based on the action theory and dialectics. This article reports on the staff's written essays based on self-reflection concerning the orientation of action towards change. The essays were analyzed using the method of continuous comparison. This analysis yielded a conceptual outline of how the orientation of action towards change manifested itself in the internal regulation of the ward staff. The main category of data to result from selective coding was participation in change. Participation was enthusiastic, hesitant or withdrawn.
Attitude of Health Personnel↗
Comparison of two schema for classifying nursing research.
To examine trends in nursing research during the last five years of the 1980s and to test the reliability and validity of two taxonomic schemes to classify nursing research, 811 abstracts from three years of a national nursing research conference (Council of Nurse Researchers, 1983, 87, 89) were reviewed and classified independently by three investigators. Taxonomies were research topics as categorized in the Sigma Theta Tau International Directory of Nurse Researchers (STT) and the Classification of Nursing-Related Dissertations (DISSER). More than half of abstracts addressed clinical topics, and clinical research topics increased significantly over time (p less than .001). At least two of the three raters agreed on coding for 62.8 percent of abstracts with STT schemes, 70.9 percent with DISSER scheme (p less than .01). Additional testing and standardization of taxonomies for nursing research is needed to improve reliability and validity.
Clinical Nursing Research↗
Out-of-hospital coronary death in an urban population--validation of death certificate diagnosis. The Minnesota Heart Survey.
To assess the validity of death certificate diagnoses of out-of-hospital coronary heart disease deaths, the authors studied a one-third random sample of out-of-hospital deaths occurring in 1979 in Minneapolis-St. Paul, Minnesota, residents. Death certificates with diagnoses possibly containing coronary heart disease deaths were enumerated, and cause of death was recorded from the certificate in two ways: as the first listed ("immediate") cause and as the "underlying cause" assigned by a trained nosologist. Validation was performed by standardized physician review of information obtained about the death, which included one or more of the following: an interview with a relative or friend, physician report, autopsy report, medical record, and/or nursing home record. Missing information was frequent, but cases with at least an informant interview and/or autopsy report (82%) were representative and could be used for validation. The sensitivity and specificity of the underlying cause of coronary heart disease (International Classification of Diseases, Ninth Revision, codes 410-414, 427) on the death certificate were 90.3% and 82.7%, respectively, compared with the physician-assigned diagnosis. For the immediate cause, sensitivity and specificity were 90.3% and 67.9%, respectively. These findings suggest that the validity of death certificates for out-of-hospital coronary heart disease death is high, as assessed by this method of retrospective physician review.
Coronary Disease↗
[Preventable adverse drug events in hospitalized patients].
BACKGROUND AND OBJECTIVE: To determine the incidence of adverse drug events (ADE) in hospitalized patients, identify those that were potentially preventable, and asses the drug classes involved, the clinical symptoms and the type of medication errors that led to the preventable ADE. PATIENTS AND METHOD: An observational study of ADE prevalence in hospitalized patients in internal medicine, pneumology, gastroenterology, nephrology and neurology wards, over a six-month period, at a tertiary university hospital. ADE were prospectively detected through physician and nurses reporting fostered by daily visits of a clinical research and retrospectively through review of medical records using event codes as defined by the IDC-9-CM system. RESULTS: In a total of 2,643 hospitalized patients, 191 (7.2%) ADE were detected. Of these, 38 cases (19.9%) were classified as preventable, of which 21.1% were mild; 60.5% moderate and 18.4% serious or life-threatening. Preventable ADE were frequently associated with anti-infective drugs (22.9%), diuretics (18.8%) and digoxin (16.7%). Inadequate therapy monitoring (28.3%), excessive dosage (21.7%), selection of an inappropriate drug according to patient characteristics and/or to diagnosis (15.0%), lack of prescription of a necessary drug (15.0%) and drug-drug interactions (11.7%) were the most common identified type of errors leading to preventable ADE. CONCLUSIONS: 1.4% of hospitalized patients in medical wards experienced potentially preventable ADE. Healthcare professionals and administrators must be made aware of the scope of this problem so that they will implement effective safety practices directed to reduce the incidence of medication errors, particularly prescription and monitoring errors.
Drug-Related Side Effects and Adverse Reactions↗
Stroke in a biracial population: the excess burden of stroke among blacks.
BACKGROUND AND PURPOSE: Excess mortality resulting from stroke is an important reason why blacks have higher age-adjusted mortality rates than whites. This observation has 2 possible explanations: Strokes occur more commonly among blacks or blacks have higher mortality rates after stroke. Our population-based epidemiological study is set in the Greater Cincinnati/Northern Kentucky region of 1.31 million people, which is representative of the US white and black populations with regard to many demographic and socioeconomic characteristics. METHODS: Hospitalized cases were ascertained by International Classification of Diseases (ninth revision) discharge codes, prospective screening of emergency department admission logs, and review of coroner's cases. A sampling scheme was used to ascertain cases in the out-of-hospital setting. All potential cases underwent detailed chart abstraction by study nurses, followed by physician review. Race-specific incidence and case fatality rates were calculated. RESULTS: We identified 3136 strokes during the study period (January 1, 1993, to June 30, 1994). Stroke incidence rates were higher for blacks at every age, with the greatest risk (2- to 5-fold) seen in young and middle-aged blacks (<65 years of age). Case fatality rates did not differ significantly in blacks compared with whites. Applying the resulting age- and race-specific rates to the US population in 2002, we estimate that 705,000 to 740,000 strokes have occurred in the United States, with a minimum of 616,000 cerebral infarctions, 67,000 intracerebral hemorrhages, and 22,000 subarachnoid hemorrhages. CONCLUSIONS: Excess stroke-related mortality in blacks is due to higher stroke incidence rates, particularly in the young and middle-aged. This excess burden of stroke incidence among blacks represents one of the most serious public health problems facing the United States.
Adult↗
Phase II evaluation of clinical coding schemes: completeness, taxonomy, mapping, definitions, and clarity. CPRI Work Group on Codes and Structures.
OBJECTIVE: To compare three potential sources of controlled clinical terminology (READ codes version 3.1, SNOMED International, and Unified Medical Language System (UMLS) version 1.6) relative to attributes of completeness, clinical taxonomy, administrative mapping, term definitions and clarity (duplicate coding rate). METHODS: The authors assembled 1929 source concept records from a variety of clinical information taken from four medical centers across the United States. The source data included medical as well as ample nursing terminology. The source records were coded in each scheme by an investigator and checked by the coding scheme owner. The codings were then scored by an independent panel of clinicians for acceptability. Codes were checked for definitions provided with the scheme. Codes for a random sample of source records were analyzed by an investigator for "parent" and "child" codes within the scheme. Parent and child pairs were scored by an independent panel of medical informatics specialists for clinical acceptability. Administrative and billing code mapping from the published scheme were reviewed for all coded records and analyzed by independent reviewers for accuracy. The investigator for each scheme exhaustively searched a sample of coded records for duplications. RESULTS: SNOMED was judged to be significantly more complete in coding the source material than the other schemes (SNOMED* 70%; READ 57%; UMLS 50%; *p < .00001). SNOMED also had a richer clinical taxonomy judged by the number of acceptable first-degree relatives per coded concept (SNOMED* 4.56, UMLS 3.17; READ 2.14, *p < .005). Only the UMLS provided any definitions; these were found for 49% of records which had a coding assignment. READ and UMLS had better administrative mappings (composite score: READ* 40.6%; UMLS* 36.1%; SNOMED 20.7%, *p < .00001), and SNOMED had substantially more duplications of coding assignments (duplication rate: READ 0%; UMLS 4.2%; SNOMED* 13.9%, *p < .004) associated with a loss of clarity. CONCLUSION: No major terminology source can lay claim to being the ideal resource for a computer-based patient record. However, based upon this analysis of releases for April 1995, SNOMED International is considerably more complete, has a compositional nature and a richer taxonomy. Is suffers from less clarity, resulting from a lack of syntax and evolutionary changes in its coding scheme. READ has greater clarity and better mapping to administrative schemes (ICD-10 and OPCS-4), is rapidly changing and is less complete. UMLS is a rich lexical resource, with mappings to many source vocabularies. It provides definitions for many of its terms. However, due to the varying granularities and purposes of its source schemes, it has limitations for representation of clinical concepts within a computer-based patient record.
Abstracting and Indexing↗
Radiation hazards during cobalt 60 plaque therapy for choroidal melanoma.
Prompted by the concerns of the staff and patients, radiation hazards from Cobalt 60 (Co 60) plaque therapy for choroidal melanoma were recently assessed when two patients were concurrently treated at Christchurch Hospital. The risks from radiation to the attending medical staff, nursing personnel from the operating theatre and ward, and the patients' visitors were investigated. The radiation dose for all staff and visitors involved with the two patients was found to be well below the recommended weekly limits set by the International Commission on Radiological Protection. Our department code of practice to minimise radiation hazard during plaque therapy has been revised.
Brachytherapy↗
Evaluating the Beta version of the International Classification for Nursing Practice for domain completeness, applicability of its axial structure and utility in clinical practice: a Norwegian project.
The purpose of this Norwegian project was to evaluate the International Classification for Nursing Practice (ICNP) Beta version for domain completeness, applicability of its axial structure and utility in clinical practice. A subset of terms addressing the areas of circulation and elimination were abstracted from the nursing records of a cardiac intensive care unit and a nursing home. Abstracted terms were mapped to terms in the ICNP. In the ICNP, the same or similar terms were found for 47% of the documented circulation terms and 69% of the documented elimination terms that addressed nursing phenomena. For nursing interventions, 27% of the documented circulation terms and 35% of the documented elimination terms mapped to the ICNP. The research team encountered difficulty in coding terms with the ICNP that expressed patients' perspectives, preferences, behaviours and experiences, and terms that represented signs-and-symptoms. Recommendations for further development of the ICNP include improvement in granularity, precision and conceptual definitions of terms; inclusion of time-related terms for representing nursing phenomena; and an easier method for navigating around the ICNP.
Abstracting and Indexing↗
Impact of prospective payment and discharge location on the outcome of hip fracture.
OBJECTIVE: To determine the impact of prospective payment by diagnosis-related groups (DRGs) on length of stay in the hospital, ambulatory status, and level of post-hospital care needed for patients hospitalized with hip fracture. DESIGN: Retrospective chart review of a consecutive series of cases before and after the reference date of implementation of the prospective payment system (PPS). SETTING: Academic, tertiary-care hospital. PATIENTS/PARTICIPANTS: 181 patients 69 years of age or older admitted with International Classification of Diseases (ICD) or DRG codes for hip fracture. RESULTS: Length of stay was shorter by 1.37 days in the post-PPS era (p = 0.05). Poorer discharge ambulation was found in the post-PPS group (p = 0.089). At one year, differences in ambulation and nursing home residence were found to be related not to the implementation of PPS, but rather to the nursing home to which the patient was discharged. Patients discharged to a facility with active physical rehabilitation were less likely to remain institutionalized (p = 0.0025) than those in "ordinary" nursing homes and ambulated more independently (p = 0.05). CONCLUSIONS: The PPS did not have a significant long-term impact on hip fracture outcome. Post-hospital care may be of crucial importance to the future quality of life of hip fracture patients.
Aftercare↗
The 1989 Loma Prieta earthquake: impact on hospital patient care.
STUDY OBJECTIVE: To provide an overview of the Loma Prieta earthquake regarding patient care in affected hospitals. DESIGN: A retrospective review of medical records using International Classification of Disease, ninth revision (ICD-9) codes and a personal interview questionnaire. SETTING: Fifty-one hospitals in the six-county area most affected by the earthquake. TYPE OF PARTICIPANTS: Patients seeking care in emergency departments of study hospitals and supervising emergency physicians and ED nurses at the time of the earthquake. MEASUREMENTS: ED census data, complaint and diagnosis, disposition, and operative procedures for patients seen during the study period. MAIN RESULTS: Affected hospitals experienced a 15% increase in ED census during the study period. Minor trauma was the most common patient complaint. Open wound (870-897), contusion (920-924), and fracture (800-829) were the most common ICD-9 diagnostic categories. The percentage of patients presenting to EDs during the study period who were hospitalized increased slightly compared with baseline. Seventy-five percent of operative procedures were earthquake related; 63.7% of these were for fracture reduction. Physicians and nurses had somewhat conflicting opinions on adequacy of ED staffing. A small number of emergency physicians had difficulty in obtaining diagnostic tests on the night of the earthquake. Physicians noted no differences in diagnosis or treatment resulting from the earthquake. CONCLUSION: The Loma Prieta earthquake resulted in minimal negative impact on patient care in hospitals in the study area. The use of the ICD-9 classification deserves further consideration and study to improve the predictive value of disaster illness and injury reporting. The event has provided the stimulus for Bay Area hospitals to further improve plans for patient care during a disaster.
California↗
[Ethical aspects concerning nurses' managerial activity].
Aiming at addressing the ethical aspects concerning nurses' managerial activities, the authors of this work referred to Etzioni and adopted a hospital classification as a reference of organization in which consent is based on the internalization of rules accepted as legitimate. Regarding patients, their need to adapt to medical behavior and hospital rules through internalization is considered to be a result of physicians', nurses' and the hospital's power. However, the authors view that such internalization is naive, without consent, especially by taking into account that most Brazilian patients do not know that they should or should not consent and are used to obeying. Thus, the work focused on nurses' managerial actions, indicating that they must be based on professional values, the Nursing ethical code as well as on the rights of hospitalized patients, thus integrating qualified care guided by respect, free consent and promotion of patients as the protagonists and subjects of care.
Brazil↗
Determinants of hospital length of stay among patients with pneumonia admitted to a large Canadian hospital from 1991 to 2001.
BACKGROUND: Pneumonia is a common reason for hospital admission, and the cost of treatment is primarily determined by length of stay (LOS). OBJECTIVES: To explore the changes to and determinants of hospital LOS for patients admitted for the treatment of community-acquired pneumonia over a decade of acute hospital downsizing. METHODS: Data were extracted from the database of Vancouver General Hospital, Vancouver, British Columbia, on patients admitted with community-acquired pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification codes 481.xx, 482.xx, 483.xx, 485.xx and 486.xx) from January 1, 1991 to March 31, 2001. The effects of sociodemographic factors, the specialty of the admitting physician (family practice versus specialist), admission from and/or discharge to a long-term care facility (nursing home) and year of admission, adjusted for comorbidity, illness severity measures and other potential confounders were examined. Longitudinal changes in these factors over the 10-year period were also investigated. RESULTS: The study population (n=2495) had a median age of 73 years, 53% were male and the median LOS was six days. Adjusted LOS was longer for women (10% increase, 95% CI 3 to 16), increasing age group (7% increase, 95% CI 4 to 10), admission under a family physician versus specialist (42% increase, 95% CI 32 to 52) and admission from home with subsequent discharge to a long-term care facility (75% increase, 95% CI 47 to 108). Adjusted hospital LOS decreased by an estimated 2% (95% CI 1 to 3) per annum. The mean age at admission and the proportion admitted from long-term care facilities both increased significantly over the decade (P<0.05). CONCLUSIONS: Results suggest that the management of hospitalized patients with pneumonia changed substantially between 1991 and 2001. The interface of long-term care facilities with acute care would be an important future area to explore potential efficiencies in caring for patients with pneumonia.
Adolescent↗
Protecting human research subjects: an international perspective.
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Ethics, Medical↗