NUR 550 Topic 6 Assignment : Quality Improvement Initiatives and Clinical Prevention Intervention

NUR 550 Topic 6 Assignment : Quality Improvement Initiatives and Clinical Prevention Intervention

NUR 550 Topic 6 Assignment : Quality Improvement Initiatives and Clinical Prevention Intervention

https://www.onlinenursingessays.com/nur-550-topic-6-assignment-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.

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

Clinical Preventive Services

Re: Topic 6 DQ 2

Obesity in Pregnancy has been associated with many complications, exercise in pregnancy has been proven to decrease the effects of obesity on the newborn (Reichetzeder, 2021). Patients are more compliant when they understand the why behind the intervention. Improving maternal health is a major priority for the Department of Health and Human services, education of obesity and use of exercise to prevent this complication (ODPHP, n.d.). Education to the patient of the why and how to fight importance of exercise in pregnancy can share the information to patients. Education of mothers the importance of physician activity and the action plan to guide to safe physical activity can f eve effective. The Move your way campaign is a multichannel communication campaign to promote the physical activity guidelines for pregnancy (ODPHP, n.d.).

Nursing education to patients should be tailored to their education level, culture and language as well as offered in many ways to ensure the information is available easily. The move your way program printed material and also includes videos, social medial support, interactive tool for exercise. Understanding the way patients access information to educate and support health care promotion is how the program will be the most successful. Nurses are the most trusted profession with a teaching intervention that established this trust and offers supportive information on the disease process and how to help prevent becomes a powerful tool that will lead to improved health promotion for mother and baby alike.

ODPHP. (n.d.). New Move your way Material emphasize importance of physical activity during and after pregnancy. Health.gov. https://health.gov/news/202012/new-move-your-way-materials-emphasize-importance-physical-activity-during-and-after-pregnancy

Reichetzeder, C. (2021). Overweight and obesity in pregnancy: Their impact on epigenetics. European Journal of Clinical Nutritionhttps://doi.org/10.1038/s41430-021-00905-6

RESPOND HERE (150 WORDS, 3 REFERENCES)

Hello Deanna,

I do agree with you that as an appropriate intervention measure involves educational programs that sensitize women on proper nutrition, keeping fit through regular exercise and medical checkup. Educational programs have the power to transform the community way of life and perception about the disease (Lee et al., 2019). In the end the objective of promoting health and reducing the mortality rate associated with cancer is achievable. Nurses have the responsibility to ensure that the method of delivery of the educational program is consistent with the society’s religious, social and economic values. It is imperative to understand the diversity of the communities and ensure that the program is tailor-made to suit the audience. Additionally, the information should be disseminated in a simple language that will be understood by majority of the community members. It is also important to have regular follow-up on the impact of the program and this can be achieved through carrying out oral interviews, surveys and questionnaires (Spiegelman, 2016).

References

Spiegelman, D. (2016). Evaluating Public Health Interventions: 4. The Nurses’ Health Study and Methods for Eliminating Bias Attributable to Measurement Error and Misclassification. American Journal of Public Health, 106(9), 1563–1566. https://doi.org/10.2105/ajph.2016.303377

Lee, A., Lo, A. S. C., Keung, M. W., Kwong, C. M. A., & Wong, K. K. (2019). Effective health promoting school for better health of children and adolescents: indicators for success. BMC Public Health, 19(1). https://doi.org/10.1186/s12889-019-7425-6

 

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

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.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NUR 550 Topic 6 Assignment : Quality Improvement Initiatives and Clinical Prevention Intervention

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.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed