Purpose

This week’s graded discussion topic relates to the following Course Outcome (CO).

• CO 5: Apply improvement methods, based on data from the outcomes of care processes, to design and test changes to continuously improve the quality and safety of healthcare. (PO 8)

The Assignment

Review the story at the link below before posting to the discussion:

Rau, J. (2015). Half of nation’s hospitals fail again to escape Medicare’s readmission penalties. Kaiser Health News. Retrieved from http://khn.org/news/half-of-nations-hospitals-fail-again-to-escape-medicares-readmission-penalties/ (Links to an external site.)Links to an external site.

After you have finished, consider how you would respond to the following situation:

Your local hospital has received notice from CMS (Centers for Medicare and Medicaid) regarding their readmission rates.

1. As a BSN prepared nurse, you have been asked to serve as a consultant to suggest a new Quality (Performance) Improvement process for ONE of the areas of deficiency. Write some brief steps (suggestions) for improvement as you contemplate accepting the consulting opportunity.
2. Share practice improvements utilized from your own clinical nursing experiences that have led to enhanced patient outcomes.

Patient outcomes are a direct result of quality care. What would be your primer for one area of improvement that data has presented as an opportunity? What national benchmark are you comparing your benchmark to?

 

Example

I have been asked, as a BSN prepared nurse to evaluate and promote a quality performance improvement plan process for patient readmissions involving those patients with congestive heart failure, CHF (Rau, 2015). The first step is to review the pharmacy medication reconciliation to ensure the medications prescribed reflect the core measures for the type of CHF the patient has. Patients with systolic dysfunction with an ejection fraction less than 40%, require an angiotensin receptor blocker. Other targeted measures require some patients to take a beta blocker (American Heart Association, 2013). The diagnosis of hypertension needs to be addressed. If present, an ACEI or ARB, beta blocker, and hydralize should be on the medication list. In addition to cardiac medications,  an evaluation of diuretics such as Lasix needs to be evaluated with consideration of the dose and if a dose increase is warranted. The second step requires a recent echocardiogram within the last six months to be on the record, if there is not, then one needs to be done during the concurrent hospitalization. During the hospitalization, DVT prophylaxis needs to be given, as many patients with CHF are non-ambulatory (American Heart Association, 2013).

The reason for hospital readmission needs to be evaluated, such as an acute on chronic episode of systolic, diastolic or combined systolic and diastolic heart failure needs to be known. Has the patient been compliant with mediation, sodium intake, and daily weight?  Follow-up physician appointments with a reminder and resources available for the patient to get to and from appointments are other considerations. The last item to review is those patients requiring a CPAP at night or oxygen. Does the patient have a working machine and enough oxygen on hand? These are all items that can be tracked in order to prevent readmission in less than 30 days. Upon discharge, information on the heart failure clinic needs to be reviewed with both the patient and family member. The heart failure clinic has additional resources available such as a customized management plan for home, a calendar to record daily weight and symptoms, bathroom scale, sodium tracker, and if needed a pill organizer.

Clinical experience that can be drawn from my current nursing role as a clinical documentation specialist, CDS includes the identification of a specific diagnosis. An abundant number of patients are admitted with CHF, but further clarification is required if the physician simply documents the reason for admission is CHF. The acuity comes first. The difference between acute and chronic or acute on chronic is mediation, lab values, and patient presentation. Symptoms such as a BNP over 100, increased shortness of breath, increased edema, lung sounds with crackles, orthopnea and an increase in diuretic dosage especially if the change is from oral to intravenous requires clarification if the patients are having an acute exacerbation. Next includes the identification of the type of heart failure such as systolic or diastolic CHF. Systolic heart failure includes patients with a reduced EF, while diastolic CHF are those with a preserved EF and diastolic dysfunction. There are also patients that have both diastolic dysfunction and a reduced EF. Identification of the type of heart failure is paramount, as treatment and medication choices can differ.

 References

American Heart Association. (2013). Get with the guidelines heart failure. Retrieved from http://www.heart.org/idc/groups/heart-public/@private/@wcm/@hcm/@gwtg/documents/downloadable/ucm_310967.pdf (Links to an external site.)Links to an external site.

Finkelman, A. (2016). Leadership and management for nurses: Core Competencies for quality care (3rd ed.). Boston, MA: Pearson.

Licking Memorial Health. (2018). LMH heart failure clinic services. Retrieved from https://www.lmhealth.org/Services-Facilities/Hospital-Services/Heart-Care (Links to an external site.)Links to an external site.

Rau, J. (2015). Half of nation’s hospitals fail again to escape Medicare’s readmission penalties. Kaiser Health News. Retrieved from https://khn.org/news/half-of-nations-hospitals-fail-again-to-escape-medicares-readmission-penalties/ (Links to an external site.)Links to an external site.

 

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Please refer to this link to assist with this discussion

 

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1. What are the benefits of patient portals?  Discuss two benefits of patient portal usage to the patient and two benefits to the provider.
2. Why do some patients fail to participate in the use of the patient portal?  List at least two different valid reasons

 

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Changes in culture and technology have resulted in patient populations that are often well informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex.

What has your experience been with patient involvement in treatment or healthcare decisions? 

In this Discussion, you will share your experiences and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.

To Prepare:

• Review the Resources and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan. 
• Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at https://decisionaid.ohri.ca/. 
  • Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.

NOTE: To ensure compliance with HIPAA rules, please DO NOT use the patient’s real name or any information that might identify the patient or organization/practice.

QUESTION

Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.

 

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• For this assessment you need to read widely and demonstrate your understanding of the topic to your peers. Students will present for 12 minutes on individual topics. And should set aside an additional 3 minutes for group discussion arising from the questions you pose. . You will not be using power point rather a discussion in the round. Provide a handout to group participants of at least the case study and your questions. Provide your list of readings to your tutor.
• You are required to introduce your self and your topic (3 Marks)
• Define and discuss your reading about the implications for health care practice. (10 Marks)
• Prepare and present a case study to illustrate your topic and how it relates to health care practice. (10 Marks)
• Develop discussion questions for the group to consider and respond to about the case study you have developed. (6 Marks)
• Conclude with key points. (3 Marks)
• Provide hand-outs to your group and give your tutor a list of the key readings you have used in APA 6th edition style. (3 marks)

Student Name:

Student Number:

Group and week:

Topic:

Marking Rubric

Introduces self and topic (3 Marks)

Not achieved (0)

Introduces self but not clear about focus of topic (1)

Introduces self and some objectives for topic for discussion (2)

Introduces self and clear focus of topic for discussion (3)

Define and discuss your reading about the implications for health care practice. (10 Marks)

Not achieved (0)

Very few references and does not convince that they have read widely  (2)

Clarity of presentation needs improvement but extensive references (4)

Is descriptive of the readings and implications for clinical practice (6)

Is critical or the readings and implications for practice  (8)

Can also provide a balanced discussion (10)

Prepare and present a case study to illustrate your topic and how it relates to health care practice. (10 Marks)

Not achieved (0)

Case study has some relationship to topic (2)

Case study has some relationship to topic and engages the group (4)

Case study is relevant and illustrates most key points (6)

Case study is relevant and illustrates major key points (8)

A well written case study that is presented well as a teaching resource (10)

Develop discussion questions for the group to consider and respond to about the case study you have developed. (6 Marks)

Not achieved (0)

Discussion questions developed but not focussed (1)

Discussion questions developed that are relevant to the case study (2)

Discussion questions developed that are relevant to case study and engaging (4)

Discussion questions developed that are relevant to the case study, relate back to the literature and engage the group (6)

Conclude with key points. (3 Marks)

Not achieved (0)

Is able to conclude key points but not reflect on key points from discussion (1)

Is able to conclude key points from presentation and discussion (3)

Provide hand-outs to your group and give your tutor a list of the key readings you have used in APA 6th edition style. (3 marks)

Not achieved (0)

Provides but references are not in APA 6th edition style and would need edits (1)

Provides and MOST references are in APA 6th edition style (2)

Provides and ALL references are in APA 6th edition style (3)

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