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NUR 550 Quality Improvement Initiatives and Clinical Prevention Intervention

NUR 550 Quality Improvement Initiatives and Clinical Prevention Intervention

Quality improvements are frameworks used to systematically enhance how care is delivered to patients (Dixon-Woods & Martin, 2016). To use the frameworks, health professionals establish problems and areas of waste, develop and implement a plan for improvement, track the initiative over time and adjust it when necessary to achieve the set objectives. In doing so, health professionals become patient advocates since they make decisions that enhance the delivery of care. The purpose of this paper is to analyze a quality improvement initiative in a health care setting, evaluate the success of the initiative using recognized benchmarks and outcome measures, incorporate interprofessional perspectives on the QI functionality and outcomes and recommend additional indicators and protocols to improve and expand the quality outcomes of the QI.

Eliminating Discharge Delays

Managing the bed capacity in a hospital is a critical issue because increased inefficient discharges slow care, increase cost and impact patient flow (Khalifa, 2017). In the assessed hospital, the initial projects aimed at discharging a specific percentage of patients at a given time of day to free up beds. Nevertheless, system inefficiencies were still there and they contributed to delayed admissions and transfers. Patient flow was hampered by unpredictable discharges and length delays which increased the cost for everyone involved. The hospital had fragmented discharge planning, sub-optimal assessment of readiness for discharge, a breakdown in information transfer and communication between physicians and inadequate post-discharge care and follow-up (Khalifa, 2017). After an analysis of the available evidence, a project team came up with standard discharge criteria for eleven common inpatient diagnoses.

The information was then embedded in the electronic medical record and the new discharge process focused on patient needs first by ensuring that patients were discharged when medically ready.  The nurses could monitor and signal when patients met discharge goals and physicians could prioritize early rounding (Emes, Smith, Ward & Smith, 2019). The process also created a streamlined pharmacy prescription process which improved discharge efficiency. Additionally, there was consistent communication of patient needs between all care providers regardless of the time of day. Due to the process, 80% of eligible patients are released within two hours of meeting the discharge criteria. The project decreased waste linked to inefficient discharges and it saved money for families, hospitals and health plans. Equally, the process focused on patient needs and thus higher acuity patients benefited from the more existing bed. It also reduced the length of stay in line with the global aim of reducing the cost of care (Emes, Smith, Ward & Smith, 2019).

Benchmarks and Outcome Measures

The absence of a standardized process in the discharge planning system results in inconsistencies as well as poor patient outcomes like avoidable hospital re-admissions. The best way to analyze the project on eliminating discharge delays is through internal benchmarking since it identifies best practices within an organization, compares practice within the organization and compares practice over time (Davidson et al., 2017). The analysis looks at a hospital in terms of effectiveness, efficiency and customer satisfaction. To help in the analysis of the quality initiative, the Centers for Medicare and Medicaid Services (CMS) outcome measures were used. The first assessment looked at the mortality rates in the hospitals. The mortality rates reduced after the implementation of the project since it automated the discharge process. The automation increased workflow efficiency and staff productivity and it freed hospital resources which made it possible for the physicians to cater to more complicated cases. Automation also reduced clerical functions by 75% which offered staff more time to interact with patients and initiate interventions when needed (Davidson et al., 2017).

The second outcome measure assessed was readmissions. The number of readmissions decreased due to the effectiveness of discharge planning. It ensured that medications are prescribed and given correctly and the family members are prepared to take over the care of their loved ones. The discharge process covers patient education, medication reconciliation and follows up which has not only enhanced patient satisfaction but reduced rehospitalization (Davidson et al., 2017).  In terms of patient experience, decreasing the discharge delays has led to increased patient satisfaction especially because patients are only discharged when medically ready. The last outcome measured is the timeliness of care. In terms of access to care, reducing the discharge delays has increased the number of available bed which in turn has led to reduced overcrowding in the emergency department (Davidson et al., 2017). The number of patients who leave without being seen has reduced in the hospital. In overall, the project has enhanced patient flow and decreased cost since a 38% increase in patient discharged within two hours has been seen and the hospital has saved $5.9 million.

Interprofessional Perspectives

To get a better understanding of the quality improvement initiative, the interprofessional perspectives were taken. The nurses indicated that before the project, everyone was stressed due to delayed discharges. Among the reasons attributed to the stress were lengthened waiting list which created pressure for some patient to be discharged home (Pinelli, Stuckey & Gonzalo, 2017). The effect was frustration and guilt among health professionals who felt like patients were pressured to leave the hospital. The concern shifted from providing care to those in need to discharging patients to meet government targets. The overall effect was a negative experience among patients due to the delay and also a negative reaction from the staff. However, after the project was implemented, interprofessional communication and pre-discharge planning became effective eventually helping the health professionals meet the government targets while enhancing the patient experience. Patients were less depressed and bored. Patients are no longer rushed to free beds and can ask any questions making them engaged in discharge planning (Pinelli, Stuckey & Gonzalo, 2017).

The nurses noted that the new discharge system has reduced the number of stressed, bored and anxious inpatients. Additionally, it has reduced the lengths of time and thus other service users can access therapeutic interventions and care packages can be arranged effectively. The hospital previously felt overstretched and with insufficient staff but the streamlined system has enhanced care coordination (Pinelli, Stuckey & Gonzalo, 2017). The risk for serious incidents, self-harm, substance misuse, aggression and violence on the wards has reduced and the potential delays when admitting appropriate at-risk service users, as well as premature discharges, have reduced. The nurses also pointed out that the hospital had an inappropriate transfer of service users between services and wards which have changed. The patients also faced an increased risk of service user dependence on inpatient care and lost coping skills post-discharge while the staff morale, retention, and recruitment were affected (Pinelli, Stuckey & Gonzalo, 2017). The new system has tackled these issues since staff input was obtained when implementing the system.

Reducing Discharge Delays Further

To enhance the initiative further, the hospital should adopt a centralized billing system between various departments to facilitate easy real-time billing. A billing system will help in informing the patient about interim pending amount any time they enquire which will prevent discount requests at the wrong times (Stelfox et al., 2015). The hospital should also improve its information system in a way that various departments in the hospital have a central platform. The platform will ease communication among the department and clearance from the various department will be reduced. With a centralized platform, once a consultant triggers a discharge, the concerned departments are notified right away and they clear the patient automatically (Stelfox et al., 2015). The effect is reduced delays since final bill preparation can be done within the shortest time possible.

The hospital should also create a centralized bed management system. The system will indicate whether beds are available and make room and bed assignments to new patients more efficient. The system will also trigger bed cleaning notice during discharge reducing the number of hours needed to assign beds to new patients (Stelfox et al., 2015). Lastly, an automated inventory management system should be in place to ensure that discharge medication from the pharmacy reaches the ward as early as possible. The system will ensure that excess medication return to the pharmacy and discharge medication to the wards is completed ahead of time enhancing the discharge process.

Conclusion

Quality improvements initiatives enhance the care offered to patients. The analyzed healthcare facility had implemented an initiative that eliminated discharge delays. The hospital had started with a project that aimed at discharging a specific percentage of patients at a given time to free up beds but it resulted in system inefficiencies.  A team was set and analyzed the weakness and it came up with standard discharge criteria that were embedded in the electronic medical record. The initiative has enhanced care and analyzing healthcare outcomes reveals that mortality rates have reduced, readmissions have reduced, patient experience enhanced as well as timeliness of care.  Even the health professionals in the hospital outline a positive impact of the initiative which has enhanced morale and satisfaction. The system, however, can benefit from a centralized billing system, a central information system, centralized bed management system and an inventory management system.

References

Dixon-Woods, M., & Martin, G. P. (2016). Does quality improvement improve quality?. Future Hospital Journal, 3(3), 191-194.

Pinelli, V., Stuckey, H. L., & Gonzalo, J. D. (2017). Exploring challenges in the patient’s discharge process from the internal medicine service: A qualitative study of patients’ and providers’ perceptions. Journal of interprofessional care, 31(5), 566-574.

Emes, M., Smith, S., Ward, S., & Smith, A. (2019). Improving the patient discharge process: implementing actions derived from a soft systems methodology study. Health Systems, 8(2), 117-133.

Davidson, G. H., Austin, E., Thornblade, L., Simpson, L., Ong, T. D., Pan, H., & Flum, D. R. (2017). Improving transitions of care across the spectrum of healthcare delivery: A multidisciplinary approach to understanding variability in outcomes across hospitals and skilled nursing facilities. The American Journal of Surgery, 213(5), 910-914.

Ulin, K., Olsson, L. E., Wolf, A., & Ekman, I. (2016). Person-centered care–An approach that improves the discharge process. European Journal of Cardiovascular Nursing, 15(3), e19-e26.

Stelfox, H. T., Lane, D., Boyd, J. M., Taylor, S., Perrier, L., Straus, S., & Zuege, D. J. (2015). A scoping review of patient discharge from intensive care: opportunities and tools to improve care. Chest, 147(2), 317-327.

Khalifa, M. (2017, August). Reducing Length of Stay by Enhancing Patients’ Discharge: A Practical Approach to Improve Hospital Efficiency. In ICIMTH (pp. 157-160).

Description

Objectives:

1. Integrate appropriate information and communication technologies for a clinical preventative intervention.
2. Evaluate clinical prevention interventions that promote health and wellness for populations.
Study Materials

Population Health: Creating a Culture of Wellness

Description:

Read Chapter 9 and review Chapter 1 in Population Health: Creating a Culture of Wellness.

Evidence-Based Practice in Nursing and Healthcare

Description:

Read Chapter 19 in Evidence-Based Practice in Nursing and Healthcare.

The Role of the Nurse in Quality Improvement and Patient Safety

Description:

Read “The Role of the Nurse in Quality Improvement and Patient Safety,” by Hickey and Giardina, from Journal of Neurological and Neurosurgical Nursing(2019).

Reviewing the Literature: Essential First Step in Research, Quality Improvement, and Implementation of Evidence-Based Practice
Description:

Read “Reviewing the Literature: Essential First Step in Research, Quality Improvement, and Implementation of

NUR 550 Quality Improvement Initiatives and Clinical Prevention Intervention

NUR 550 Quality Improvement Initiatives and Clinical Prevention Intervention

Evidence-Based Practice,” by Bernhofer, from Journal for Nurses in Professional Development (2015).

Clinical Preventive Services

Description:

Read “Clinical Preventive Services,” by Guerrero Ayres and Bradley, from Encyclopedia of Nursing Research (2017).

Reviewing the Literature

Description:

Read “Reviewing the Literature,” by Bryne, from Sage Research Methods’ Project Planner (2017).

How to Conduct a Literature Review

Science teaches us to explore and question. In medicine, it the same. There is always something to explore in medicine, whether its to improve upon interventions or to learn complex diseases. Throughout my career as a nurse and nursing student, it was always expressed to me that in order for me to become a successful nurse I would need to engage in continuing education for the life of my career. In life, we should always strive for continuing education for personal development and growth. The future of nursing will require nurses to question, explore and take initiative making decisions on patient care, interventions, in leadership and public health. “Explain the importance of a spirit of inquiry in an evidence-based culture and what you can do as an advanced registered nurse to encourage this within your practice or organization. In response to your peers, compare the role and implementation of EBP in your specialty area with another advanced registered nurse specialty” (National League of Nursing, 2014, para. 1). The COVID-19 pandemic was a wake up call in that we as a nation need to focus on improving our nursing practice. Nurses will need to be encourage and pushed into leadership roles, executive positions and in the areas a research and development. Many nurses took the lead in saving their patients and hospitals as the pandemic ravaged hospitals throughout the country. There was also a spike in people researching how to get into the field of medicine (particularly in nursing and nursing research). There became a fascination into epidemiology, public health and medical research as people and nurses became curious about vaccine development and how outbreaks of disease and virus happen. As a advanced registered I would encourage evidence based culture by being an example of someone who uses EBP and work in collaboration with other staffers to implement EBP research into the real world. During the heigh of the pandemic, EBP research was used to help patients as other interventions and methods failed.

Implementing EBP

 

In the field of advanced nursing practice, there are various ways advanced nurses implement EBPs. Nurse practitioners implement and EBP “when she/he prescribes a treatment for a patient that is substantiated by scientific research; Often, nurse practitioners look for an experimental study that compares the efficacy of a treatment with an untreated control group” (Nurse Practitioner Schools, 2021).

 

Certified mid-wifery

 

For nursing midwives, EBP is are used to enhance the lives of the mother, child and community. Mothers are the backbone of communities and the health and safety of woman determines the health and safety of their respective communities. Areas of challenges are identified and EBP are used to improve the lives of women in order to safely carry, deliver and raise children.

References:

National League of Nursing. (2014). Practical/Vocational Nursing Program Outcome: Spirit of Inquiry. https://www.nln.org/docs/default-source/default-document-library/spirit-of-inquiry-final.pdf?sfvrsn=0

Nurse Practitioner Schools. (2021). Guide to Evidence-Based Nursing Practice for NPs. Retrieved from https://www.nursepractitionerschools.com/resources/guide-to-evidence-based-nursing-practice/

Description:

Read “How to Conduct a Literature Review,” by Watts, from Podiatry Review (2020).

Preventative Care Benefits for Adults

Description:

Explore “Preventative Care Benefits for Adults,” located on the Healthcare.gov website.

My Healthfinder

Description:

Explore “My Healthfinder,” located on the U.S. Department of Health and Human Services website.

Healthy People 2030

Description:

Explore “Healthy People 2030,” located on the Healthy People 2030 website.

Health Communication and Health Information Technology

Description:

Read “Health Communication and Health Information Technology,” located on the HealthyPeople.gov website.

Using E-Health and Information Technology to Improve Health

Description:

Read, “Using E-Health and Information Technology to Improve Health,” located on the World Health Organization website.

Technology and the Future of Mental Health Treatment

Description:

Read “Technology and the Future of Mental Health Treatment,” located on the Mental Health Information page of the National Institute of Mental Health website.

Impacts of Information and Communication Technologies on Nursing Care: An Overview of Systematic Reviews (Protocol)
Description:

Read “Impacts of Information and Communication Technologies on Nursing Care: An Overview of Systematic Reviews (Protocol),” by Rouleau, Gagnon and Cote, from Systematic Reviews (2015).

Tasks

Course Code Class Code Assignment Title Total Points
NUR-550 NUR-550-O503 Evidence-Based Practice Project: Evaluation of Literature Table 150.0

Criteria Percentage Unsatisfactory (0.00%) Less Than Satisfactory (80.00%) Satisfactory (88.00%) Good (92.00%) Excellent (100.00%)
Content 100.0%
PICOT 5.0% The PICOT is omitted. NA NA NA The PICOT is clearly and accurately presented.

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Articles 10.0% Required number of sources are not included. Article citations and permalinks are omitted. Number of required sources is only partially met. Article citations and permalinks are presented. One or more links do not lead to the intended article. Number of required sources is met, but some sources are outdated or inappropriate. Article citations and permalinks are presented. Article citations are presented, but there are errors. Sources are current and generally appropriate for the assignment criteria and nursing content. Article citations and permalinks are presented. Article citations are presented, but there are minor errors. Sources are current and highly appropriate for the assignment criteria and nursing content. Article citations and permalinks are presented. Article citations are accurate. NUR 550 Evidence-Based Practice Project Evaluation of Literature Table

Research Question, Hypothesis, Purpose or Aim of Study 10.0% Research question, hypothesis, purpose or aim of study for one or more articles is omitted. Research question, hypothesis, purpose or aim of study for each article is presented, but key information is consistently omitted. There are inaccuracies throughout. Research question, hypothesis, purpose or aim of study for each article is presented. Key aspects are missing for one or two articles. There are minor inaccuracies. Research question, hypothesis, purpose or aim of study for each article is adequately presented. Minor detail is needed for accuracy or clarity. A discussion on the research question, hypothesis, purpose or aim of study is thoroughly and accurately presented for each article.

Study Design 10.0% The study design for one or more article is omitted. The study design for each article is presented, but key information is consistently omitted. There are inaccuracies throughout. The study design is indicated for each article. Key aspects are missing for one or two articles. There are minor inaccuracies. The study design is adequately presented for each article. Minor detail is needed for accuracy or clarity. A thorough and accurate discussion on the study design for each article is presented.

Setting and Sample 10.0% The setting and sample are omitted for one or more of the articles. The setting and sample are indicated for each article, but key information is consistently omitted. There are inaccuracies throughout. The setting and sample are indicated for each article. Key aspects are missing for one or two articles. There are minor inaccuracies. The setting and sample are adequately presented for each article. Minor detail is needed for accuracy or clarity. The setting and sample in which the researcher conducted the study are detailed and accurate for each article. NUR 550 Evidence-Based Practice Project Evaluation of Literature Table

Methods 10.0% Method of study for one or more articles is omitted. Overall, the methods of study are incomplete. The method of study is presented for each article, but key information is consistently omitted. There are inaccuracies throughout. The method of study for each article is presented. Key aspects are missing for one or two articles. There are minor inaccuracies An adequate discussion on the method of study for each article is presented. Minor detail is needed for accuracy or clarity. A thorough and accurate discussion on the method of study for each article is presented.

Analysis and Data Collection 10.0% Analysis and data collection for one or more articles is omitted. Overall, the analysis and data collection are incomplete. Analysis and data collection are presented for each article, but key information is consistently omitted. There are inaccuracies throughout. Analysis and data collection for each article are presented. Key aspects are missing for one or two articles. There are minor inaccuracies. An adequate discussion on the method of study for each article is presented. Minor detail is needed for accuracy or clarity. A thorough and accurate discussion on the analysis and data collection for each article is presented.

Outcomes and Key Findings 10.0% Outcomes and key findings for one or more articles are omitted. Overall, the outcomes and key findings are incomplete. Outcomes and key findings are presented for each article, but key information is consistently omitted. There are inaccuracies throughout. Outcomes and key findings for each article are presented. Key aspects are missing for one or two articles. There are minor inaccuracies. An adequate discussion on outcomes and key findings for each article are presented. Minor detail is needed for accuracy or clarity. A thorough and accurate discussion on the outcomes and key findings collection for each article are presented.

Recommendations 10.0% Researcher recommendations are omitted for one or more of the articles. The recommendations described for three or more articles are inaccurate or incomplete. Researcher recommendations are indicated for each article. The researcher recommendations described for two of the articles are inaccurate or incomplete. Researcher recommendations for each article are presented. Researcher recommendations described for one article are inaccurate or incomplete. Researcher recommendations for each article are accurately presented. Minor detail is needed for accuracy or clarity. Researcher recommendations are accurately and thoroughly described for each article. NUR 550 Evidence-Based Practice Project Evaluation of Literature Table

NUR 550 Evidence-Based Practice Project Evaluation of Literature Table Explanation of How Articles Support Proposed Evidence-Based Practice Project Proposal 10.0% An explanation of how the article supports the proposed evidence-based practice project proposal is omitted for one or more of the articles. The explanation for three or more articles is inaccurate or incomplete. An explanation for how each article supports the proposed evidence-based practice project proposal is presented. The explanation for two of the articles is inaccurate or incomplete. A general explanation for how each article supports the proposed evidence-based practice project proposal is presented. The explanation for one article is inaccurate or incomplete. Support for the evidence-based project proposal is generally evident. An explanation for how each article supports the proposed evidence-based practice project proposal is presented. Minor detail is needed for accuracy or clarity. Adequate support for the evidence-based project proposal is demonstrated. A detailed explanation for how each article supports the proposed evidence-based practice project proposal is presented. Support for the evidence-based project proposal is clearly evident.

Mechanics of Writing (includes spelling, punctuation, grammar, and language use) 5.0% Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is employed. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied. Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed. Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech. The writer is clearly in command of standard, written, academic English.

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