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NRS 493 Topic 6 DQ 1 name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal
Sample Answer for NRS 493 Topic 6 DQ 1 name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal Included After Question
Topic 6 DQ 1
After discussion with your preceptor, name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal. Explain how your proposal will directly and indirectly impact each of the aspects.
A Sample Answer For the Assignment: NRS 493 Topic 6 DQ 1 name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal
Title: NRS 493 Topic 6 DQ 1 name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal
Over the last 2 decades there has been an undeniable rise in health care costs which has caused a shift in focus toward measuring care quality. Studies have shown that improved quality of care has been associated with lower health care costs through decreased complications and length of stay (Agarwal, Youngerman, Kaakaji, Smith, McGregor, Et. Al, 2021). In efforts to improve care quality, providers use clinical practice guidelines, which are statements that include recommendations, informed by systematic reviews of evidence, intended to optimize patient care. CAUTI caused by improper testing of urine can have financial ramifications. A urine culture can cost $80 or more. Antibiotic treatment for a UTI cost from $3 to over $300. In addition, drug-resistant infections (caused by improper treatment with antibiotics) add costs for extended lengths of stay, expensive medicines, and nursing care (ABIM Foundation, 2014).
After discussion with my preceptor, a urine culture stewardship initiative will reduce costs associated with improper testing and the treatment. Implementation of this initiative will affect clinical practice by decreasing the total number of urine cultures ordered and reducing the number of inappropriate treatments. Regarding quality, a urine culture stewardship will help identify areas where routine ordering and inappropriate practices increase costs and affect patient outcomes, as well as used to reduce excessive ordering, lower contamination rates, and decrease unnecessary antibiotic prescribing (Sinawe, Casadesus, 2022).
References
Agarwal, N., Youngerman, B., Kaakaji, W., Smith, G., McGregor, J. M., Powers, C. J., Guthikonda, B., Menger, R., Schirmer, C. M., Rosenow, J. M., Cozzens, J., & Kimmell, K. T. (2021). Optimizing Medical Care Via Practice Guidelines and Quality Improvement Initiatives. World Neurosurgery, 151, 375–379. https://doi-org.lopes.idm.oclc.org/10.1016/j.wneu.2021.02.013
American Board of Internal Medicine Foundation. (2014). Tests & treatments for urinary tract infections (UTIs) in older people When you need them—and when you don’t. https://www.choosingwisely.org/wp-content/uploads/2014/09/ChoosingWiselyUTIAGSAMDA-ER.pdf
Sinawe H, Casadesus D. Urine Culture. (2022). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557569
A Sample Answer 2 For the Assignment: NRS 493 Topic 6 DQ 1 name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal
Title: NRS 493 Topic 6 DQ 1 name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal
Sharia, your capstone proposal regarding a urine culture stewardship initiative is an excellent idea to improve healthcare costs. Our facility adopted a policy to reduce the laboratory cost of urine cultures last year. Our facility must have a signed “ticket to ride” by the nurse and charge nurse that checks a list of qualifications for the patient before a specimen can be sent for culture. The checklist helps to reduce over-testing. An article from the International Journal of Urology highlighted a study that discusses the overuse of prescriptions for ASB (asymptomatic bacteriemia) due to over-testing of UCx (urine cultures). The authors stated that “another impetus to avoid UCx testing is to decrease the likelihood of treatment for ASB. Unnecessary antibiotic treatment of ASB is common, occurring in up to 83% of patients which undermines patient safety initiatives due to increased risk of development of resistant organisms” (Richards et al., 2018).
Since the implementation of our facility’s urine culture checklist, AKA ticket to ride, I have found that we continually have to educate physicians who order urine cultures when in fact the patient may not qualify for urine culture testing based on the new protocol guidelines. It will be of great financial benefit and positive health outcomes for patients should continued reduction in urine cultures be achieved.
Reference
Richards, K. A., Cesario, S., Best, S. L., Deeren, S. M., Bushman, W., & Safdar, N. (2018). Reflex urine culture testing in an ambulatory urology clinic: Implications for antibiotic stewardship in urology. International Journal of Urology, 26(1), 69–74. https://doi.org/10.1111/iju.13803
A Sample Answer 3 For the Assignment: NRS 493 Topic 6 DQ 1 name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal
Title: NRS 493 Topic 6 DQ 1 name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal
The urine culture stewardship program included monthly 1-hour discussions with ICU house staff emphasizing avoidance of “pan-culture” for sepsis workup and obtaining urine culture only if a urinary source of sepsis is suspected. The urine culture utilization rate metric (UCUR; i.e., no. urine cultures/catheter days ×100) was utilized to measure the effect. AN INTERACTIVE QUALITY
DASHBOARD REPORTED monthly UCUR, catheter utilization ratio (CUR), and CAUTI rate. Catheterized ICU patients (2015-2016) were evaluated for 30-day readmission for UTIs to ensure safety. Time-series data and relationships were analyzed using Spearman correlation coefficients and regression analysis. The urine culture stewardship program was effective and safe in reducing UC overutilization and was correlated with a decrease in CAUTIs. The addition of urine-culture stewardship to standard best practices could reduce CAUTI in ICUs.
Reference
Al-Bizri LA, Vahia AT, Rizvi K, Bardossy AC, Robinson PK, Shelters RT, Klotz S, Starr PM, Reyes KQ, Suleyman G, Alangaden GJ.(2021 ) Effect of a urine culture stewardship initiative on urine culture utilization and catheter-associated urinary tract infections in intensive care units. Infect Control Hosp Epidemiol. 2021 Jul 8:1-4. DOI: 10.1017/ice.2021.273. Epub ahead of print. PMID: 34236024.
Grading Rubric Guidelines
Performance Category | 10 | 9 | 8 | 4 | 0 |
Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic decisions. |
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Performance Category | 10 | 9 | 8 | 4 | 0 |
Application of Course Knowledge –
Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations |
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Performance Category | 5 | 4 | 3 | 2 | 0 |
Interactive Dialogue
Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. (5 points possible per graded thread) |
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Summarizes what was learned from the lesson, readings, and other student posts for the week. |
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Minus 1 Point | Minus 2 Point | Minus 3 Point | Minus 4 Point | Minus 5 Point | |
Grammar, Syntax, APA
Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition |
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0 points lost | -5 points lost | ||||
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per discussion thread |
The student answers the threaded discussion question or topic on one day and posts a second response on another day. | The student does not meet the minimum requirement of two postings on two different days | |||
Early Participation Requirement
per discussion thread |
The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week. | The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT. |
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