Quality Improvement and Patient Safety Initiatives

The vice president of nursing, Dr. Sasha Mendez, has had a lot of complaints from patients and their families about the difficulties they experience navigating the system at her organization; e.g., going from the E.R. to admissions. Dr. Mendez’s nursing specialty area is psych/mental health. As such, she is very concerned about the stress this is causing the patients.

What are the macro systems that are affecting patient satisfaction at Dr. Mendez’s facility? What micro systems should she also analyze to look at how the patient moves through—from entry, to possible admission, to possible discharge? How do these systems relate? What impacts each system?

The concepts presented in Week 8 serve as a foundation for this week as you continue to look at factors within an organization’s environment that are barriers and facilitators for implementing change. In this Discussion, you examine the macro and micro systems within the organization (of your practicum setting) and identify changes that may need to take place to facilitate quality improvement and achievement of patient safety outcomes.

To prepare:

• Reflect on the issue you have been addressing      through your EBP Project.
• Identify the macro and micro systems that      influence the issue. Review the McClusky and Middleton (2010) article for      an example of this process (See attached file).
• Determine the desired outcomes of resolving the  EBP Project issue and how resolving it will improve quality and patient     safety. (Note: Next week you will evaluate these outcomes. You may      want to view the Week 10 Discussion as you prepare.)
• What procedures/processes would need to be      modified to achieve the desired outcomes?

Post your PowerPoint presentation

By tomorrow Tuesday 10/23/18, in APA format and include 3 scholarly references from the list of required readings below, develop a 5-slide Microsoft PowerPoint presentation for the business unit team and leadership within the organization, sharing your issue, strategies for resolving the issue, and how it will improve quality and patient safety. 

Note: The purpose of the presentation is to persuade the business unit team and leadership to accept your recommendations.

Required Readings

Brooks, P., Spillane, J.J., Dick, K., & Stuart-Shor, E. (2014). Developing a strategy to identify and treat older patients with postoperative delirium. AORN Journal, 99(2), 256-276. (see attached file).

Jarden, R.J. & Sutton, L.J. (2014). A practice change initiative to improve the provision of enteral nutrition to intensive care patients. British Association of Critical Care Nurses, 20(5), 242-254.

McCluskey, A. & Middleton, S. (2010). Delivering an evidence-based outdoor journey intervention to people with stroke: Barriers and enablers experienced by community rehabilitation teams. BMC Health Services Research, 10(18). doi: 10.1186/1472-6962-10-18. Retrieved from https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-10-18. (see attached file).

Murfet, G.O., Allen, P., & Hingston, T.J. (2014). Maternal and neonatal health outcomes following the implementation of an innovative model of nursepractitioner-led care for diabetes in pregnancy. Journal of Advanced Nursing, 70(5), 1150-1163 (see attached file).

PIICOT Question

In patients in extended intensive care within an urban acute care facility in Eastern United States, how does early mobilization as recommended by National Institute of Health and Care Excellence clinical guidelines on rehabilitation of patients after critical illness impact early transfers from intensive care as measured 6 months post-implementation when compared to the current standard of care including minimal mobilization of patients?

P: Adult patients 

I: in extended intensive care within an urban acute care facility

I: increased mobilization of the patients 

C: minimal mobilization of the patients

O: early transfers of the patients from intensive care

T: 6 months

Throughout this course you will be developing a formal, evidence-based practice proposal.

The proposal is the plan for an evidence-based practice project designed to address a problem, issue, or concern in the professional work setting. Although several types of evidence can be used to support a proposed solution, a sufficient and compelling base of support from valid research studies is required as the major component of that evidence. Proposals are submitted in a format suitable for obtaining formal approval in the work setting. Proposals will vary in length depending upon the problem or issue addressed; they can be between 3,500 and 5,000 words. The cover sheet, abstract, references page, and appendices are not included in the word limit.

Section headings and letters for each section component are required. Responses are addressed in narrative form in relation to that number. Evaluation of the proposal in all sections is based upon the extent to which the depth of content reflects graduate-level critical-thinking skills.

This project contains seven formal sections:

1. Section A: Organizational Culture and Readiness Assessment
2. Section B: Problem Description
3. Section C: Literature Support
4. Section D: Solution Description
5. Section E: Change Model
6. Section F: Implementation Plan
7. Section G: Evaluation of Process

Each section (A-G) will be submitted as separate assignments so your instructor can provide feedback (refer to applicable modules for further descriptions of each section).

The final paper will consist of the completed project (with revisions to all sections), title page, abstract, reference list, and appendices. Appendices will include a conceptual model for the project, handouts, data and evaluation collection tools, a budget, a timeline, resource lists, and approval forms.

Use the “NUR-699 EBP Implementation Plan Guide” and “NUR-699 Evidence-Based Practice Project Student Example” to assist you. Also refer to “NUR-699 Evidence-Based Practice Project Proposal Format.”

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

NUR699.R.Evidence-BasedPracticeProjectProposalFormat_student.docxNUR699.R.EBPStudentExample_Student.docxNUR699.R.EvidenceBasedPracticeProposalFinalPaperOverview_student.docxNUR699.R.EBPimplementationPlanGuide_student.docx

Review the story at the link below before posting to the discussion:

Rau, J. (2015). Half of nation’s hospitals fail again to escape Medicare’s readmission penalties. Kaiser Health News. Retrieved from http://khn.org/news/half-of-nations-hospitals-fail-again-to-escape-medicares-readmission-penalties/ (Links to an external site.)Links to an external site.

After you have finished, consider how you would respond to the following situation:

Your local hospital has received notice from CMS (Centers for Medicare and Medicaid) regarding their readmission rates.

1. As a BSN prepared nurse, you have been asked to serve as a consultant to suggest a new Quality (Performance) Improvement process for ONE of the areas of deficiency. Write some brief steps (suggestions) for improvement as you contemplate accepting the consulting opportunity.
2. Share practice improvements utilized from your own clinical nursing experiences that have led to enhanced patient outcomes.

Textbook:  

Finkelman, A., 2016 Leadership and Management for Nurses: Core Competencies for Quality Care (3rd Edition), Pearson Learning Solutions, Boston, MA 

& Two outside scholarly sources to be referenced within the last 10 years.

  

HOMEWORK :

The overall goal of the Session Long Project is to examine health care delivery in the United States from a strategic perspective.

The Patient Protection and Affordable Care Act, or in short Affordable Care Act, changed the landscape of the health care industry. For this assignment, read the article “Information asymmetries and risk management in healthcare markets: The U.S. Affordable Care Act (ACA) in retrospect” by Mendoza, and write a paper to respond to the following questions:

1. Discuss the “moral theory” contained in this article.

2. Explain whether you agree or disagree with the author that the ACA was an answer to health care accessibility.

3. Explain whether you believe or do not believe that ACA will improve patient care.

4. Discuss what you think President Trump should do with the ACA.

5. Discuss what strategies you would recommend to deal with economic realities of health care based on your own research.

Length: Submit a 3-page paper, not including the cover page and the reference list.