Respond to this post with a positive response :

Ask a probing question, substantiated with additional background information, evidence or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Use  references

                                                     Initial Post

                                                 Improving Quality

The IOM recommends that policy makers, health care leaders, clinicians, regulators, purchasers, and others are urged to adopt a shared vision for health care that focuses on closing the quality gap between what we know to be good health care and the health care that people actually receive. The report recommends a redesign of the American health care system by providing six “Aims for Improvement”:   Of the six aims, Drug diversion is best categorized by the “aims” is safety and is defined by avoiding injuries to patients from the care that is intended to help them. Drug diversion is defined by the use of prescription medications that are acquired or ingested illegally.  In recent years, the problem of opioid addiction has reached epidemic proportions and has been one of the largest contributors to the rise in diversion incidents.  Diversion involving healthcare providers can result in a various types of patient harm. Diversion poses substantial risk not only to the individual who is diverting the drugs but also to patients, co-workers, and employers. The president of Pharmaceutical Diversion Education estimates that there are approximately 37,000 incidents of drug diversion throughout the heath care system and can result in several types of patient harm including; substandard care due to having an impaired provider, tampering with medication administration – especially, those for pain, and increased risk of infection. The CDC, state, and local health departments have combined efforts to investigate the incidents of infection stemming from drug diversion activities that involved healthcare providers who tampered with injectable drugs.  The findings showed Nearly 30,000 patients were potentially exposed to bloodborne pathogens and were referred for testing. However, no data is available that precisely defines the extent of every type of drug diversion in the health care workplace. Patient safety and professional safety all demand effective, reliable safeguards to maintain the integrity of prescription drugs and controlled substances. Improvements are needed in drug monitoring systems. Greater awareness and specialized training in the area of addiction can help to ameliorate drug diversion. There are many actions health care providers can take to ensure the safety of drug administration. One strategy being developed by the pharmaceutical industry is to reformulate frequently abused drugs into abuse-deterrent preparations. Additionally, The National Pharmaceutical Drug Misuse Framework for Action established a plan aimed at improving the quality use of medicines and reduce the potential for misuse. A goal of the Foundation, is to provide a medication monitoring system for prescribers and pharmacists with real-time access to information on prescriptions for controlled substances.  As nurses, educators, managers and co-workers, we can be more vigilant in our efforts to prevent, detect, and report any suspected diversion. Several key areas such as improved systems for medication management, greater support for prescribers and pharmacists, education and improvement of health literacy, harm reduction and improved regulation are all a part of the solution.

Reference 

Australian Government National Drug Strategy. National Pharmaceutical Drug Misuse Framework for Action (2012-2015). Canberra: NDS; 2013. www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/drug-mu-frm-action [cited 2015 Sep 7]

 

CDC (2013). Risks of Healthcare-associated Infections from Drug Diversion. Retrieved from https://www.cdc.gov/injectionsafety/drugdiversion/index.html

Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National

Inciardi JA, Surratt HL, Kurtz SP, Burke JJ. The diversion of prescription drugs by health care workers in Cincinnati, Ohio. Subst Use Misuse 2006;41:255-64. [PubMed]

Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.

 McGregor C, Gately N, Fleming J. Prescription drug use among detainees: Prevalence, sources and links to crime. Trends and issues in crime and criminal justice. No. 423. Canberra: Australian Institute of Criminology; 2011 Aug.

Pilgrim JL, Yafistham SP, Gaya S, Saar E, Drummer OH. An update on oxycodone: lessons for death investigators in Australia. Forensic Sci Med Pathol 2015;11:3-12. [PubMed]

 

Discuss the health education and health promotion information and strategy’s you will use when working with patients who have asthma. What is an Asthma Action Plan?  Where to Post Response:  You will post this response to the online Journal. However, please write your response in Word or another text tool and save your work. When you are ready to post, copy your response text and paste it into the online Journal. This approach will ensure that you have a backup of your work.  To access the Journal, click the Journal tab located in the upper right area of the screen.  Assignment Requirements:  As this assignment is a Journal entry and not a formal paper, it may at times be difficult to follow the organization, style, and formatting of the APA 6th Edition Manual. Despite this, your Journal assignment should: •clearly establish and maintain the viewpoint and purpose of the assignment; •follow the conventions of Standard American English (correct grammar, punctuation, etc.); •be well ordered, logical, and unified, as well as original and insightful; •display superior content, organization, style, and mechanics; and •use APA 6th edition format as outlined in the APA Progression Ladder.

Competency

Appraise the relationship between a heightened regulatory environment and corporate governance.

Instructions

ABC Bank officials view compliance with regulations as a necessity for the very survival of their business. The leadership team at ABC also understands the impact that banks have on the aggregate economy, particularly the ramifications of mismanaged risks within banks. ABC’s leadership team believes that a holistic understanding of the intricacies of risk management within banks as well as the impact of risk on the economy is necessary to drive the desired behavior. As a result, you have been hired to facilitate a presentation for ABC’s new hires. Your presentation should be composed in PowerPoint or Prezi and must be submitted to ABC’s HR department for approval by the end of the week. Along with the slides, you must also submit notes on what you will say during the presentation. You should use the Note feature at the bottom of the PowerPoint slide to submit the notes.

Your presentation and notes should include the following 8 slides min.

• Identify three ways that banks impact the economy. Include clear examples and well-defined reasons.
• Identify two regulations and describe their origin and role in managing risks within banks.
• What risk management standards did the banks employ as a result of the regulations?
• What are the consequences of failing to meet the standards outlined by the regulators?
• Would a firm be prudent to properly manage its leverage and liquidity levels if they are not regulated? Why or why not? What tools can organizations employ to manage the risks caused by inadequate levels?
• 1. Three ways that banks can impact the economy are described, and all include clear examples, well-defined reasons, and a thorough explanation of the economic impact.
• 2.Two applicable regulations are identified, and the origin and role in managing risks within banks are correctly described with a high level of detail for each.
• 3.For each regulation mentioned, appropriate risk management standards that were a result are listed and described.
• 4.Consequences of failure to meet the standards outlined by regulators are thoroughly described.
• 5.A response with specific examples and with appropriate reasoning on why a firm would or would not want to manage its level of leverage and liquidity if it were not regulated is given.
• 6.Appropriate tools for managing each risk associated with leverage and liquidity that is mentioned are included.

Peer replies

1-Alberto :

Polypharmacy is an area of concern for many patients, especially the elderly.  Elderly patients are at a greater risk for adverse drug reactions (ADRs) because of the reduced drug clearance associated with aging and because of metabolic changes (Boris, Cafiero & Smith, 2014).  Some risk factors associated with polypharmacy are potential of drug-drug interactions because it is further increased by use of multiple drugs.  Another risk factor is hip fractures, associated with adverse drug reactions and losing balance or fainting (Boris, Cafiero & Smith, 2014).  Polypharmacy may sometimes lead to “prescribing cascades.”4 Prescribing cascade is said when signs and symptoms (multiple and nonspecific) of an ADR is misinterpreted as a disease and a new treatment/drug therapy is further added to the earlier prescribed treatment to treat the condition (Piere & Farrell, 2012).

       In my practice working with the elderly population, to reduce the incidence of polypharmacy medication, patients are evaluated on a monthly basis.  Additionally, a single drug is be prescribed instead of multiple drugs for the treatment of a single condition, if possible.  Another strategy we use is staring medication with the lower drug dosage and slowly increasing as indicated.

           A strategy that seems to be effective, according to research, is prescribe drugs that can be given once or twice a day instead of prescribing drugs that require to be taken three times a day (Thomas, Liao, & McCliar, 2016).  The reasoning behind this is to lower the risk of forgetting to take the medication or taking the medication together with other drugs.  Another strategy that can be employed is that if the drug taken has no therapeutic beneficial effect or clinical indication it should be eliminated. Unessential drugs should be identified and eliminated prescribed by different health care providers for the same condition/disease (Thomas, Liao, & McCliar, 2016).

2-maceda 

Polypharmacy refers to the effects of taking multiple medications concurrently to manage coexisting health problems, such as diabetes and hypertension (Piere & Farrell, 2014).  Too often, polypharmacy becomes problematic, such as when patients are prescribed too many medications by multiple healthcare providers working independently of each other. Also, drug interactions can occur if no single healthcare provider knows the patient’s complete medication picture. Nurses have a unique opportunity to help identify patients at risk for inappropriate polypharmacy and to educate patients and families about risk reduction. Nurses can use strategies such as patient teaching and consistency in care plan (Piere & Farrell, 2014). 

Some of the risk factors of polypharmacy are age and chronic conditions.  The elderly are more sensitive to the effects of certain drugs, particularly those that affect the central nervous system.  As a consequence, drug classes such as benzodiazepines should be used with caution, and if absolutely necessary, then at a reduced dose to minimize the risk of falls and other adverse events (Thomas, Liao & McCliar, 2016). In addition, age is associated with decreased regulatory functions, therefore anti-hypertensives can more easily result in postural hypotension and opiates in respiratory depression.  Communication barriers often go undetected in health care settings and can have serious effects on the health and safety of patients. Limited literacy skills are one of the strongest predictors of poor health outcomes for patients (Thomas, Liao, & McCliar, 2016).  If the patient is deaf, can’t see or is illiterate there are various strategies the nurse can use for example, advise the patient to bring someone with them to the visit.  Nurses who are responsible for checking patients in should be friendly and helpful. The length and number of forms patients are asked to fill out should be limited.