+1443 776-2705 panelessays@gmail.com
  

Question Description

Paula Miller

RE: Discussion – Week 5

COLLAPSE

Scenario one in this week’s discussion topic is centered around sending many nursing home residents with Alzheimer’s disease, predominantly with Medicare and Medicaid, to the ED and may not need to be seen. With this scenario, both leadership styles can be incorporated. However, the transformational leadership style will be discussed. All team members will need to be involved, and I would share the concerns and review the issues with the nurse manager. The process would begin with an analysis of nurse to patient ratios, as many ED visits can be prevented with better nurse staffing level at the nursing home. Inadequate staffing can lead to limited time to provide proper medical interventions. Therefore, the ED is used to provide medical coverage that is lacking at the nursing home.

A staff survey would allow feedback as to why too many patients are being sent to the emergency department, and at the same time, this will encourage staff to present their ideas and give them a sense of empowerment (Yoder-Wise, 2015). Another plan of action would be to petition the ED and encourage an ED utilization review to reduce the unnecessary visits to the ED and learn why the hospital is inquiring about the misuse of the ED visits in question and validate or rescind the problem in question according to data (Spath, 2018).

A more precise understanding of the driving factor associated with inappropriate transferring of nursing home residents to the ED may result in better nursing home practice recommendations and allow for the implementation of quality improvement interventions (Perrin et al., 2017). Once the data from the Ed and staff surveys are validated, a protocol/ map of when a patient would need to be transferred would be implemented. Educating staff on all levels would help to identify the protocol for transferring patients to the ED. Nursing staff would first need to evaluate the patient, having responsibility, and ownership. Guidelines would help the nursing staff complete a conclusive assessment of the medical complaint presented. Determining what an emergent is and what medical complaint can be achieved at the nursing home is vital. The nursing home is part of a more extensive system that includes a major medical network that can be utilized as a part of an integrated network. The nursing staff would need to collaborate with other medical providers and determine the needs of the patient. The collaboration within a provider network would decrease the misuse of the ED visits in the nursing home facility.

References

Perrin, A., Tavassoli, N., Mathieu, C., Hermabessière, S., Houles, M., McCambridge, C., … & Lauque, D. (2017). Factors predisposing nursing home resident to inappropriate transfer to emergency department. The FINE study protocol. Contemporary clinical trials communications, 7, 217-223.

Spath, P. (2018). Introduction of healthcare quality management (3rd ed.). Chicago, IL: Health Administration Press.

Yoder-Wise, P.S. (2015). Leading and managing in nursing (6th ed.) St. Louis, MO: Mosby

REPLY QUOTE EMAIL AUTHOR

14 hours ago

Allison Wright

RE: Discussion – Week 5

COLLAPSE

Main Post

For this discussion, I have selected scenario one. The nurse manager reports that residents are being sent to the ED unnecessarily despite having alternative health care resources available. To figure out what could be done differently in the nursing home to prevent these avoidable ED visits, I would first implement a retrospective review. Used to evaluate the intervention received versus what was needed, this type of review is a look back at the nursing home’s decision making regarding appropriate use of available resources (Spath, 2018).

Utilization management (UM) is a solid choice for this facility because of the variety of services they have available. UM maintains the quality of patient care while providing services that are the most cost effective (Spath, 2018). However, transitional management would allow the facility to empower the staff by opening the lines of communication to assist in this investigative process (Yoder-Wise, 2019). Knowing why they made the decision to send patients to the emergency room instead of utilizing other care options will provide areas of opportunity for the UM team to focus on.

Concurrent and prospective review strategies will be an integral piece in this improvement process. Having the tools to evaluate patient need in real time while receiving care in the emergency department will allow for changes to be made that provide the best patient outcome at the lowest cost. Prospective review assists in placing the patient within the appropriate level of care prior to treatment received (Spath, 2018).

Every improvement project needs a cohesive team to lead the process. Putting staff nurses on the team solidifies ownership and accountability. Nurses that are empowered to share their knowledge and experience are apt to deliver best-care practices with consistency (How to Get Health Care Employees Onboard with Change, 2016). Putting these strategies in place will ensure that the residents at this facility are provided the best care at the lowest cost.

References

How to get health care employees onboard with change. (2016, November 23). Harvard Business Review. https://hbr.org/2016/11/how-to-get-health-care-employees-onboard-with-change

Spath, P. (2018). Introduction to healthcare quality management, third edition. Health Administration Press.

Yoder-Wise, P.S. (2019). Leading and managing in nursing (7th ed.) St. Louis, MO: Mosby

REPLY QUOTE EMAIL AUTHOR

April Tomberlin

RE: Group B Practice Experience Discussion – Week 5

COLLAPSE

The Quality Improvement Project (QI) is Medication/Vaccine Safe Practices to allow for standardized processes to eliminate errors system-wide. To support the need for this process improvement, risk data was provided to identify medication/vaccine safety events ranking 3rd across the organization. Since the beginning of the QI project plan, data pulled identified the top reasons for medication/vaccine errors. The top findings are drug administration and monitoring, medication distribution of storage, communication, drug prescribing, and drug verification.

The QI plan to address the system’s breakdown leading to errors is implementing a standardized process across the large integrated health system (630 ambulatory clinics) to allow for safer practices. First, the process changes will include the implementation and utilization of an organizational specific formulary and standardized preference list/order sets made available in the electronic health record; to limit the variations of sound-alike/look-alike mishaps and streamline ordering processes (Rowcliffe, 2018). Next, the designation of dedicated medication preparation area, standardization of storage/handling of medications/vaccines – utilizing separation of meds by type, placed in bins with labels, and minimizing par inventory to help prevent errors (Yonder et al., 2015; Rowcliffe, 2018; Säfholm et al., 2019).

The clinics will be provided with a standardized medication/vaccine safety workflow that includes safe practices for verification of the order and medication/vaccine preparation and documentation safety steps to prevent errors. The clinics will be provided access to the state-based immunization registry (for vaccines only) and continue to be required to enter all doses into the electronic health record using barcode scanners (Misasi et al., 2019; Macias et al., 2018).

The QI project will be measured using review of internal taxonomy risk reporting database, barcode scanning reports – to measure compliance related to the use of barcode scanner, review of overall number of administrations compared to the number of medication errors. The data will breakdown the rationale for the errors to allow for continual education and changes to the standardized processes to continually improve patient safety.

Reference:

Macias, M., Bernabeu-Andreu, F. A., Arribas, I., Navarro, F., & Baldominos, G. (2018).

Impact of a Barcode Medication Administration System on Patient Safety. Oncology Nursing Forum, 45(1), E1–E13. https://doi-org.ezp.waldenulibrary.org/10.1188/18.ONF.E1-E13

Misasi, P., & Keebler, J. R. (2019). Medication safety in emergency medical services:

approaching an evidence-based method of verification to reduce errors. Therapeutic Advances in Drug Safety. https://doi.org/10.1177/2042098618821916

ROWCLIFFE, M. (2018). Let’s all stop making medication errors in kids. Contemporary

Pediatrics, 35(8), 6–8.

Säfholm, S. Bondesson, A., & Modig S. (2019). Medication errors in primary health care records; a cross-sectional study in Southern Sweden. BMC Family Practice, 20(1), 1–7. https://doi-org.ezp.waldenulibrary.org/10.1186/s12875-019-1001-0

Yoder, Mindy, DNP, RN, Schadewald, Diane, DNP, RN, FNP-BC, WHNP-BC & Dietrich, Kim.

(2015). The Effect of a Safe Zone on Nurse Interruptions, Distractions, and Medication Administration Errors. Journal of Infusion Nursing, 38, 140-151. https://doi.org/10.1097/NAN.0000000000000095

Allison Wright

RE: Group B Practice Experience Discussion – Week 5

COLLAPSE

Main Post

Severe hypoglycemia events in the hospital setting is the focus of this quality improvement (QI) project. Root cause analysis on all occurrences since January 1, 2020 show that nurses and patient care technicians are not consistently following evidence-based policies and/or protocols. The QI plan aimed at decreasing the rate of these never-events will start with the implementation of a mandatory M-learning module, including pre and post testing, for all bedside nurses and support staff working on progressive care and med-surg units. Supportive ISE will be delivered quarterly by the network Diabetes Care Coordinator based on the previous months data findings (Norushe et al., 2015).

Each progressive care and med-surg unit-based educator will be provided informational flyers for their employees. These will announce the purpose of the education, provide due date, include the QR code needed for smart-device access, and give directions for completion via computer. Staff are responsible for completing the learning and returning the pre/post test results to their educator. The tests will then be passed on to the DCC by expected due date. The tests will be analyzed and data on performance gaps placed on a Pareto chart. ISE will be focused on the “vital few” (Spath, 2018, p. 92). Gathering of this imperative information and teaching “in the moment” improves retention of education and contributes to improved practice compliance (Hypoglycemia Prevention in Hospital Patients: a Quality Improvement Project to Prevent Severe and Recurrent Hypoglycemia | Clinical Diabetes, 2016).

Success of the QI plan will be measured by results seen in the rate of severe hypoglycemia events. A decrease in rate, consistency in rates below hospital benchmark and monthly root cause analysis of events that show occurrences not caused at the bedside will deem this plan appropriate to share network wide.

References

Hypoglycemia prevention in hospital patients: A quality improvement project to prevent severe and recurrent hypoglycemia | clinical diabetes. (2016). American Diabetes Association. https://clinical.diabetesjournals.org/content/34/4/193

Norushe, T., Van Rooyen, D., & Strumpher, J. (2015). In-service education and training as experienced by registered nurses. Curationis, 27(4). https://doi.org/10.4102/curationis.v27i4.1022

Spath, P. (2018). Introduction to healthcare quality management, third edition. Health Administration Press.