NURS 4020 : Leadership Competencies In Nursing And Healthcare
Question:
You are a staff nurse working in a private primary care practice. It is a small practice with 2 MDs (internists), 2 nurses, 1 medical assistant, and an office staff for billing. There are approximately 1,000 patients in the practice. You have had no EHR until the last year, but all charts are manual, historically. Your physicians are starting to inquire about quality incentives, particularly regarding patients with diabetes.
2. Imagine that, for about a year, your nursing unit has been involved in an intensive campaign to improve patient satisfaction scores with pain management. You are getting good data from your patients, as the length of stay on this inpatient geriatric medical nursing unit is only about 6 days. Your hospital does 100% survey to inpatients, and the response rate is about 25%, which is higher than it has been. This notwithstanding, the percent of “patient very satisfied” (top box), with a score of 5, has been in the low 70s. The national benchmark for medical surgical units like yours is about 85% very satisfied. Of all the units in your hospital, your unit is the lowest scoring on this HCAPHS survey. But as your unit is the only geriatric medical nursing unit in the hospital, you’d always thought it was the nature of the patient population.
Based on the scenario, explain what was done successfully and where improvement was needed in the quality improvement process. Identify the performance improvement tools, and explain how they contributed to the outcome.
Support your response with references from the Resources and professional nursing literature. Your posts need to be written at the capstone level (see checklist).
Answer:
Scenario 1
The Healthcare Effectiveness Data and Information Set (HEDIS) is a key tool in assessing the availability of quality care to the patients.
Comprehensive Diabetes Care is important as high blood glucose if not addressed in an appropriate manner can lead to various other diseases related to heart, kidney, eyes, nervous system and premature death is a strong possibility (National diabetes statistics report,2017). To give comprehensive care and deciding patient centric care program, we documented the medical records which comprises mainly of following:
Results of ophthalmoscopic exam conducted by eye care professional with date of procedure which reveals if there are any abnormalities in retina etc.
Nephropathy screening and urine test results for detection of diabetic nephropathy, renal diseases, renal deficiencies and dysfunction, protein/creatinine ratio with a note of any prescriptions if received by the patients earlier (Murphy D et al., 2016).
HbA1c Testing results of patients along with date and control value. This assessment is for patients of age group 18-75 with diabetes (Type 1 and Type 2) (Mayer et al., 2012).
- HbA1c Control (<8%)
- HbA1c Control (<7%) (For some selected patients based on other medical conditions).
- HbA1c Poor Control (>9%)
Records of Blood pressure of the patients measured at regular intervals, taking the recent BP level to see if it is compliant with the standards.
Based on the patient’s progress and response to the treatment, revision in diagnosis is done and documented for further use.
Documentation of each patient includes reason for the encounter and relevant history, physical examination findings and prior diagnostics reports. Based on medical charts, we have designed care plan for the patients.
Applying Performance Improvement Tools
Scenario 2
Strategies and interventions tried in our unit were partially effective in creating a sustainable change in the unit. The leadership is confident that the trend of improvement will continue in future and therefore decided to celebrate the outcomes to create a positive environment for all of us.
To improve healthcare quality and provide affordable services to the patients in our nursing home, essentials such as adaptive leadership, culture, governance, analytics, evidence and consensus-based practices, adoption and financial alignment were taken in consideration.
Adaptive leadership – Staff may have the ability to make continuous improvements, but individual efforts require the support of leadership and adaptive learning culture to make changes as per the changing technology.
Analytics are important to keep a track of improvement outcomes. In the lifecycle of improvement process where our nursing unit stands and what has been done should be measured to ensure we are moving in right direction.
Evidence and Consensus based practices should be made the foundation of the initiatives to improve further, automated ways are required to measure the outcomes and make changes in the strategies accordingly.
Adoption of new strategies by nursing unit is important and for this purpose we need to train our staff to make them understand why we are doing this and what are their responsibilities to ensure the required outcome is achieved.
Financial alignment of all the departments in the nursing unit is necessary to ensure minimal wastage, no clinical variations and smooth operational efficiency.
Implementation of the improved programs required efforts and lack of guidance to certain extent made the success rate a little lower than expected. With better implementation strategies, we can predict a better result in future.
Quality management of improved programs included:
Patient-centric care plan – Plan to take care of patient completely depends on individual preferences, needs and values.
Effective services based on scientific knowledge are being provided in our nursing unit to the patients who are in need and not to those who could not be benefitted by it. We can say underuse and misuse both are being refrained.
By keeping an account of the progress of the patient because of the treatment and care plan, we are ensuring any possible harm or side effect could be avoided (Tschannen et al., 2008).
We need to streamline our departments in a better way to further improve the timeliness of attending the patients and reducing the wait time of processes.
Incentives are given to the staff so that they can feel motivated in providing high quality services.
We can improve further by providing medicine consultation online or through telephonic conversation once the person is discharged.
System cannot reap the benefits of tools like flow diagrams, run charts, Gantt charts, scatter plots without skilled resources, training people and designing a framework for establishing the practices.
The end goal of our nursing unit is to improve patient health and experiences and we believe in making efforts to transform the industry into one dedicated to quality.
References:
Centers for Disease Control and Prevention (CDC). 2017. “National diabetes statistics report:
estimates of diabetes and its burden in the United States, 2017.” Atlanta, GA: U.S.
Department of Health and Human Services. Retrieved from
https://www.cdc.gov/diabetes/data/statistics-report/index.html
Mayer-Davis EJ, Lawrence JM, Dabelea D, Divers J….Wagenknecht L. Incidence trends of type
1 and type 2 diabetes among youths, 2002–2012. N Engl J Med. 2017; 376:1419–1429.
Murphy D, McCulloch CE, Lin F, Banerjee T, Bragg-Gresham, Eberhardt MS…Hsu CY. Trends
in prevalence of chronic kidney disease in the United States. Ann Intern Med. 2016; 165:473–481.
Tschannen D, Keenan G, Yakel E, Mandeville M. HANDS: A Nursing-Oriented Standard for
Documenting and Communicating the Interdisciplinary Plan of Care in the EHR to Improve Safety, 2008.
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