Purpose  The purpose of student discussions is to provide the opportunity for a deeper understanding of polypharmacy  Activity Learning Outcomes  Through this discussion, the student will demonstrate the ability to: 

1. Summarize the different polypharmacy definitions found within the literature.      (WO1.5) (CO1)  
2. Discuss polypharmacy risk factors (WO1.5) (CO1)   
3. Explain  the actions steps for polypharmacy prevention (WO1.5) (CO1,      7)     
4. Provide an example of how your clinical preceptors have addressed polypharmacy.  

Please READ the RUBRIC. The paper must be in accordance with my instructor requests in the rubric. 

Anemia Case Study

A 21-year-old Greek female presents to her PCP for establishment of care. She reports 3 months of progressive fatigue but has no other complaints. Family history is notable for anemia in her mother and older sister. Past medical history is positive for mild persistent asthma.

Her CBC collected in the office reveals the following:

WBC 6.8 k/cu mm
Hgb 8.9 g/dl
Hct 28 %
MCV 76 fL
RDW 20.5 %
Platelets 483 k/cu mm

Question answers should be based on evidence found in readings and from peer-reviewed literature. At least two sources must be used and cited in APA format for each question. Only one source can be a textbook. Resources should generally be within 5 years unless you are explaining the pathophysiology of a disease or providing pertinent background information

Discussion Questions:

1. What would be the next set of labs you would expect to see ordered to determine the etiology of the anemia and why? Support with evidence from the literature.
2. Compare microcytic, normocytic, and macrocytic anemia and explain which of these is consistent with the labs above. Support with evidence.
3. Explain the physiology of how anemias impact oxygen transport and ways in which anemia patients compensate for decreased oxygen carrying capacity. Support with evidence.

1. Discuss the roles of the ARNPs or APNs employed by health care organization related to quality improvement activities in your communities. 
   1. Are the ARNPs and other APNs the leaders of quality improvement teams?
   2. What significant contributions have occurred as a result of the ARNPs or APNs involvement in Q I teams? What are your thought on it?

Using your knowledge of pathophysiology and research, you will need to present a differential of three disorders that could account for your patient’s symptoms. 2 pages APA

Patient Scenario

35-year-old man with a history of anxiety, chronic marijuana use, and chronic back pain. No current medications or other history, but he has been consistently complaining of back pain since joining the Thursday night league volleyball team. Single, lives alone, and works at a fast food restaurant. Heterosexual and consistent use of protection (barrier).

· Offer three differential diagnoses for what might be troubling your patient.

· Provide rationale with citations for each of your differential diagnoses.

· What would be your first course of action for your patient?

· What safety issues, if any, did you recognize for your patient?

· Summarize the scenario and what you chose as your final diagnosis for your patient and why.

· Make sure that you address psychosocial issues/concerns/contributors, along with content related to substance abuse, should this be appropriate.

 

This Performance Task Assessment is based on a case study set in Brooklyn Presbyterian Hospital, in the Park Slope neighborhood of Brooklyn, New York, as the hospital confronts the new quality standards set by the Patient Protection and Affordable Care Act (PPACA) for Medicare patients. To complete this Assessment, read the scenario below, and then complete Parts I and II that follow. You will use information from the scenario, along with the supporting documents, to demonstrate your ability to adapt internal policies and practices to align with changes to healthcare laws and regulations.

Professional Skills: Written Communication, Technology, and Critical Thinking and Problem Solving are assessed in this Competency.

Your response to this Assessment should:

• Download the Academic Writing Expectations Checklist to use as a guide when completing your Assessment. Responses that do not meet the expectations of scholarly writing will be returned without scoring. Properly formatted APA citations and references must be provided, where appropriate.
• Be sure to use scholarly academic resources as specified in the rubric. This means using Walden Library databases to obtain peer reviewed articles. Additionally, .gov (government expert sources) are a quality resource option. Note: Internet and .com sources do not meet this requirement. Contact your coach or SME for guidance on using Library Databases.
• Carefully review the rubric for the Assessment as part of your preparation to complete your Assessment work.

Assessment requires submission of one (1) document (Part I) and one (1) PowerPoint presentation (Part II). Save the Word document as LE003_PartI_firstinitial_lastname (for example, LE003_PartI_J_Smith). Save the PowerPoint Presentation as LE003_PartII_firstinitial_lastname. When you are ready to upload your completed Assessment, use the Assessment tab on the top navigation menu. 

Instructions

Before submitting your Assessment, carefully review the rubric. This is the same rubric the assessor will use to evaluate your submission and it provides detailed criteria describing how to achieve or master the Competency. Many students find that understanding the requirements of the Assessment and the rubric criteria help them direct their focus and use their time most productively.

Rubric

Imagine you are an administrator at Brooklyn Presbyterian Hospital in Brooklyn. One day you arrive at work to find an urgent memo from your CEO: Medicare has released its data on unplanned 30-day hospital readmission rates, and your hospital is being penalized at the maximum rate for having an exceptionally high rate of unplanned 30-day readmissions. Alarmed by these statistics, your CEO gives you a special project, outlined in Part I and Part II below.

Access the following to complete this Assessment:

• Brooklyn Presbyterian Hospital Acute Inpatient Hospital Admissions Payment Policy
• Brooklyn Presbyterian Hospital—Unplanned Readmission Rates (from Medicare Hospital Compare)
• James, J. (2013). Medicare Hospital Readmissions Reduction Program. Retrieved from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=102

This assessment has two-parts.  Click each of the items below to complete this assessment.

Part I: Analyzing HRRP Policy and Evaluating Hospital Performance

Read the Health Affairs Policy Brief on the “Medicare Hospital Readmissions Reduction Program.” Then, analyze the document “Brooklyn Presbyterian Hospital—Unplanned Readmission Rates,” which presents statistics on the unplanned readmission rates at the hospital and how they compare to the national averages. Also, review the current, “Acute Inpatient Hospital Admissions Payment Policy” document.

Use these resources to develop a report (4–5 pages) to the CEO that completes the following:

• Describe the key elements of the Medicare Hospital Readmissions Reduction Program (HRRP) established in the Affordable Care Act (ACA).
• Identify two factors at Brooklyn Presbyterian Hospital based on the current policy that contribute to the risk of failing to meet HRRP criteria.
• Explain how current internal practices and the changes in policy might positively impact alignment to current and future healthcare laws.
• Suggest one revision to the current policy to help Brooklyn Presbyterian Hospital meet HRRP criteria.
• Suggest one change in current practice across the hospital’s organization in order to help Brooklyn Presbyterian Hospital meet changes in Medicare reimbursement. Include 2–3 sentences explaining the importance of adapting internal policies and practices to align with changes in healthcare laws and regulations.
• Describe at least three key elements needed in a new program to earn the maximum reimbursement under HRRP by reducing readmission rates.
• Create five goals for Brooklyn Presbyterian Hospital for earning the maximum reimbursement by following the HRRP criteria. These goals may focus on processes or outcomes.

Part II: Developing an Action Plan to Maximize Reimbursements and Adapt to Change

Political pressure will result in changes to Centers for Medicare and Medicaid Services (CMS) policy and reimbursements. Develop a 10- to 12-slide presentation, to senior management, proposing strategies for executing a plan for earning maximum reimbursement under HRRP, specifically by changing the behavior of providers and patients. Your goal is to secure resources to put your plan into action. In this presentation, explain your approach, your plan for implementation, at least two ways you will prepare and monitor for change in CMS policy, and your education plan for staff.