CNL flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Care Coordination

Deliberate organization of patient care activities and sharing of information among participants so care is safer, more effective, and higher quality across settings and providers.

Shared Care Plan

A single accessible patient-centered document listing goals, preferences, medications, providers, appointments, and red flags, co-created and continually updated by patient and team.

Case Management

A payer-linked component of care coordination focused on resource utilization, cost containment, and arranging services for high-cost or high-risk patients under insurance rules.

Care Coordination Complexity Stratification

A decision rule assigning intensive coordination to patients with multiple chronic conditions, recent unplanned use, medication burden, or limited social support, while lower-risk patients receive standard coordination.

Donabedian Quality Framework

A model evaluating quality through three linked domains: structure (resources and settings), process (what clinicians actually do), and outcomes (results experienced by patients).

Process Indicator

A measure of actions performed during care delivery, such as the percentage of patients receiving medication reconciliation within 24 hours of admission.

Outcome Indicator

A measure of the end result of care, including mortality, infection rates, readmissions, functional status, cost per case, and patient-reported outcomes or experience.

Thirty-Day Readmission Rate

The number of unplanned inpatient readmissions within 30 days of discharge divided by index discharges, multiplied by 100 and reported as a percentage.

Risk Adjustment

A statistical method accounting for differences in patient age, severity, comorbidity, and social factors so outcomes can be fairly compared across units or hospitals.

Transitional Care

Time-limited, coordinated services designed to ensure continuity and prevent avoidable complications when patients move between settings or between levels of care.

Medication Reconciliation

A formal process comparing the patient's current medication list with new orders at admission, transfer, and discharge to catch omissions, duplications, and interactions.

Teach-Back Method

A technique in which the patient restates discharge instructions in their own words, letting the nurse confirm understanding and re-teach instead of asking whether they understand.

Discharge Bundle

A set of evidence-based discharge elements: medication reconciliation, written instructions, teach-back confirmation, a scheduled follow-up appointment, and a follow-up telephone call within 48 to 72 hours.

Care Transitions Intervention

Coleman's four-week program built on four pillars: medication self-management, a personal health record, follow-up with a provider, and a written list of red-flag symptoms.

SBAR

A structured handoff tool communicating Situation, Background, Assessment, and Recommendation, reducing omission of critical information when clinicians transfer care.

TeamSTEPPS

A teamwork training framework with four core skills: communication, leadership, situation monitoring, and mutual support, used to reduce team-related patient harm.

I-PASS Handoff

A handoff mnemonic: Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by receiver; associated with fewer medical errors.

Closed-Loop Communication

The sender gives a message, the receiver repeats it back, and the sender confirms accuracy, ensuring the order or request was actually heard and understood.

Braden Scale

A six-item pressure injury risk tool scoring sensory perception, moisture, activity, mobility, nutrition, and friction/shear; totals range 6 to 23 and lower scores mean higher risk.

Morse Fall Scale

A six-item fall risk tool in which a score of 45 or higher indicates high risk and triggers intensified precautions such as bed alarms and hourly rounding.

CAM Delirium Screen

The Confusion Assessment Method: delirium is present with acute onset or fluctuating course plus inattention, and either disorganized thinking or altered level of consciousness.

LACE Readmission Index

A readmission risk score combining Length of stay, Acuity of admission, Comorbidity, and Emergency visits in the prior six months; 10 or more is high risk.

qSOFA

A sepsis screening tool giving one point each for respiratory rate 22 or above, altered mentation, and systolic blood pressure 100 or below; 2 or more points signals high risk.

PICO Question

An evidence-based practice question format specifying the Population, Intervention, Comparison, and Outcome, which structures the literature search and the appraisal of findings.

Levels of Evidence

A hierarchy ranking study designs from systematic reviews and meta-analyses of randomized trials at the top, through randomized trials, quasi-experimental, and nonexperimental designs, to expert opinion.

Five A's of EBP

The cycle of ask, acquire, appraise, apply, and assess that structures how clinicians translate research evidence into decisions at the point of care.

RE-AIM Framework

An implementation evaluation framework covering Reach, Effectiveness, Adoption, Implementation, and Maintenance, used to judge whether a practice change produces real-world impact and can be sustained.

Implementation Fidelity

The degree to which a practice is delivered exactly as designed, measured through audit and observation, because poor fidelity breaks the link between evidence and expected outcomes.

PDSA Cycle

Plan-Do-Study-Act: a rapid iterative improvement method that tests a small change, studies the result, and acts on what was learned before scaling up.

Common Cause Variation

Random variation inherent in a stable process; reacting to it with constant adjustments, called tampering, increases variation instead of reducing it.

Failure Mode and Effects Analysis

A proactive team method that maps a process, identifies where it could fail, and scores each failure by severity, likelihood, and detectability to prioritize corrective actions.

Run Chart Versus Control Chart

Run charts display data over time against a median line; control charts add statistically derived upper and lower limits that separate common-cause from special-cause variation.