Discussion
Leading Organizations for Quality Improvement Initiatives
Discussion response
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding on your colleague’s post and explaining how the quality indicators selected by your colleague may influence your practice setting.
PEER #1
Main Post Discussion Question 1
Quality Indicator 1 Hospital Readmissions:
In the acute hospital centers, re-admission are costly to both health care centers and insurance providers. They also inflict negative occurrences for both families and patients. Health care system re-admissions are a result of several reasons. Among them are failure of patients to fully understand their disease process and treatment modalities, lack of support and communication from staff, patients being discharged too soon, and lack of understanding of discharge instructions. Congruency regarding goal setting between the health care team and the patient needs to be established. Other factors may originate from lack of community and family support place patients at higher risk for readmission. As a perinatal case manager, I follow workflows that include ongoing assessments during the pregnancy and postpartum to assess the patients’ needs, and to identify gaps in care delivery.The appropriate resources are shared with the patients and families. The patients are given my direct contact information to contact me PRN.
The US congress came up with a plan in 2012 to reduce hospital admissions. They would penalize hospital for having unplanned readmissions within 30 days. Even though health care systems have improved the re-admission reduction rates that have been significant, improvements are still needed.
The Study
The Intensive case management (ICM) program is currently utilized in health care systems to provide services to patients that have complex medical and social needs. The services include frequent, scheduled contact between patient and case manager to address these needs. ICM is also strategically involved with assessing needs for discharge planning, and ensures that the patient and family has access to treatment modalities post discharge. Patient education and advocacy play an important role for active participation in health care treatment. An assessment of social determinants of health will reveal in barriers that exist, to direct the case manager to the appropriate resources. ICM is essential to decrease the incidence of health care readmissions.
Quality Indicator 2
Fall Prevention
The incidence of falls that occur in health care facilities are alarming. Among the elderly the fall rate is high at 40% within six months of discharge(Fehlberg et al 2020). Some will experience serious injuries that may include major fractures, damage to organs or lacerations. This places significant financial burden and liabilities on health care systems. The potential for these organizations to reduce the incidence of falls and harmful outcomes can be significantly reduced. This can be accomplished by implementing steps, policies and procedures, or workflows that lead to fall prevention.
The Study
The value of bed alarms are proven to be valuable, and most health care facilities are utilizing beds with alarms. The study concludes that staff should respond to bed alarms regardless if the patient is a fall risk or not (Fehlberg et al, 2020). This action could prevent a fall, or provide time for the staff to respond to injuries almost immediately. This should be the unit’s expectation of their staff. The principle and thoughts behind the use of bed alarms is that it that i warns staff and is some cases patients that there is a risk of falling out of bed. Even though they serve to lower fall risk, they can’t be classified and restraints, and do not serve that purpose; therefore bed alarms are warnings that should not be ignored.
when I worked in labor and delivery, patients that had epidurals for pain management were considered fall risks as they did not have complete function of their lower extremities. All bed had alarms, and the policy and procedure stated that all available staff are to respond.
References
Shade, K.Hidalgo, P., Arteaga, M., Rowland, J.,Huang, W. (2023) Intensive Case Management to Reduce Hospital Readmissions: A Pilot Quality Improvement Project.
Professional Case Management 28 (6), 271–279
Fehlberg, E.,Cook, Christa L., Bjarnadottir, R,. McDaniel, A,. Shorr, R.I.,Lucero, Robert J. (2020) Fall Prevention Decision Making of Acute Care Registered Nurses. JONA:
The Journal of Nursing Administration Volume 50(9), September 2020, 442-448
PEER #2
Chikita Domonique Smith
Quality Indicator 1 – Pressure Ulcer Prevalence and Incidence
Nurses pay attention to pressure ulcers or bedsores. A pressure ulcer is a tiny skin and/or tissue damage caused by pressure, shear, or both. Pressure ulcer incidence and prevalence are essential for assessing prevention strategies and nursing treatment. Pressure ulcer indicators were influenced by the Donabedian model and other early quality improvement theories that evaluated healthcare structure, method, and outcomes (Chen, Liao, & Zhou, 2023). This pressure ulcer prevention paradigm prioritizes outcomes, which patients need.
Influence of Early Quality Improvement Theories:
Pressure ulcer indicators are shaped by the Donabedian approach, which emphasizes comprehensive quality evaluation. Structures (such as resources and staff), processes (such as preventative measures), and results (such as pressure ulcer prevalence and incidence) are examined. As part of a complete pressure ulcer prevention strategy, the model emphasizes how these factors interact and affect patient outcomes.
Nursing Research Article:
Taylor, Mulligan, and McGraw’s article “Barriers and enablers to the implementation of Evidence-based Practice in pressure ulcer prevention and management in an integrated community care setting” (2021) explores factors affecting the adoption of evidence-based practices in pressure ulcer prevention. This research is relevant to my profession since it sheds light on pressure ulcer prevention challenges and opportunities. The study’s findings could help my company enhance quality by revealing issues like finances and personnel education.
Quality Indicator 2 – Patient Falls
Nurses also include patient falls when assessing nursing care quality and safety. Falls can cause injuries and impact patient outcomes. Fall indicators are influenced by Deming’s PDSA cycle, which emphasizes repeating cycles of planning, doing, studying, and acting to enhance quality (Brandrud, 2019).
Influence of Early Quality Improvement Theories:
The PDSA cycle has advanced fall indicators by promoting a deliberate and iterative quality improvement technique. Continuous outcome evaluation allows nursing interventions to be implemented, evaluated, and adjusted to avoid falls. Constant improvement and adaptability increase nursing care and patient safety.
Nursing Research Article:
The study “Quality Indicators for the care and Outcomes of adults with atrial fibrillation” by Arbelo et al. (2021) highlights quality indicators in patient care, but not specifically in falls. It shows how quality indicators are used in healthcare. This and similar studies can inspire interdisciplinary teams to establish comprehensive quality improvement initiatives to prevent patient falls in my practice using proven strategies from other areas.
To summarize, the creation of nurse-sensitive indicators necessitates comprehension and use of early quality improvement ideas. The selected papers provide valuable insights into the challenges and opportunities for improving patient care and preventing pressure ulcers. These criteria are essential for guiding quality improvement programs to ensure that patients receive high-quality nursing care.
Reference:
Arbelo, E., (Chair), Aktaa, S., Bollmann, A., D’Avila, A., Drossart, I., … & Martins Oliveira, M. (2021). Quality indicators for the care and outcomes of adults with atrial fibrillation: task force for the development of quality indicators in atrial fibrillation of the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC): developed in collaboration with the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin-American Heart Rhythm Society (LAHRS). EP Europace, 23(4), 494-495.
Brandrud, A. S. (2019). Learning about the conditions for improvement and excellent care from high performing clinical networks.
Chen, X., Liao, P., & Zhou, Y. (2023). Construction of nursing-sensitive quality indicators for the care of patients with prone position ventilation using the Delphi method. BMC nursing, 22(1), 336.
Evangelou, E., Middleton, N., Kyprianou, T., Kouta, C., Merkouris, A., Raftopoulos, V., … & Lambrinou, E. (2021). Nursing quality indicators for adult intensive care: a consensus study. Nursing in Critical Care, 26(4), 234-243.
Taylor, C., Mulligan, K., & McGraw, C. (2021). Barriers and enablers to the implementation of evidence‐based practice in pressure ulcer prevention and management in an integrated community care setting: A qualitative study informed by the theoretical domains framework. Health & Social Care in the Community, 29(3), 766-779.
