Evaluating and Sustaining Improvement

 The downfall of many quality improvement initiatives is the inability to sustain improvements. Last week, you considered the use of evidence-based practice models as a method for sustaining practice changes to improve quality. This week’s Discussion builds on those concepts of sustainability. You evaluate measurement mechanisms and explore strategies that leadership and improvement teams can use to sustain improvement efforts.
 

To prepare:

• Review      the evaluation tools presented in the Learning Resources and how the tools      can be used to promote sustainability.
• Select      a measurement mechanism that can be used to evaluate your quality      improvement initiative. You may wish to conduct additional research on the      use of measurement mechanisms to sustain outcomes of improvement      initiatives.
• Consider      the influence of leadership and improvement teams in sustaining      improvement efforts. Ask yourself: What specific strategies can leaders      and my improvement team use to sustain our improvement initiative?

By tomorrow Wednesday February 7, 2018 by 12 noon, post a minimum of 550 words essay in APA format with at least 2 references from the list below. Include the levels one headings as numbered below:

post a cohesive scholarly response that addresses the following:

1) Evaluate the influence of leadership and improvement teams in sustaining improvement efforts. 

2) Present a succinct analysis of three or more strategies leaders and teams can use in your response.

Required Readings

Richardson, A., & Storr, J. (2010). Patient safety: A literative review on the impact of nursing empowerment, leadership and collaboration [corrected] [published erratum appears in INT NURS REV 2010 Mar;57(1):158]. International Nursing Review, 57(1), 12–21. doi:10.1111/j.1466-7657.2009.00757.x 

This article analyzes how nurses can improve patient safety. It identifies certain knowledge gaps that inhibit nurses’ ability to improve patient safety that must be addressed before they can effectively make contributions.

Bigelow, L., Wolkowski, C., Baskin, L., & Gorko, M. (2010). Lean Six Sigma: Sustaining the gains in a hospital laboratory. Clinical Leadership & Management Review, 24(3), 1–14.

In this article, a health care organization uses Lean Six Sigma to improve performance, but it does not initially achieve the desired results. It then utilizes an Operational Performance Improvement office from within the organization to receive better training in Lean Six Sigma and it is finally able to improve performance.

Murphree, P., Vath, R. R., & Daigle, L. (2011). Sustaining Lean Six Sigma projects in health care. Physician Executive, 37(1), 44–48. 

The authors of this article consider ways to keep Lean Six Sigma projects operating instead of closing them. They distinguish between closing and controlling, the latter being the last phase in Lean Six Sigma. According to the authors, many organizations close Lean Six Sigma projects when they should be controlling them.

Required Media

Laureate Education, Inc. (Executive Producer). (2011). Organizational and systems leadership for quality improvement: Organizational change. Baltimore: Author.

Note: The approximate length of this media piece is 10 minutes.

This video examines factors that enhance and impede organizational change. Dr. Wooden and Dr. Freshman discuss change models that can be used to manage the change process and to assist individuals through the transition period 

Similarity less than 10%    

Use APA 6th Edition Format and support your work with at  least 3  peer-reviewed references within 5 years of publication.  Remember that  you need a cover page and a reference page. All  paragraphs need to be  cited properly. All responses must be in a  narrative format and each  paragraph must have at least 4 sentences. Lastly, you must have at least 2 pages of content, no greater than 3 pages, excluding cover page and reference page. 

Case Study is Due 2/2/2020 by 12 Midnight. If Any questions, please do not hesitate to contact me.

Case Study

L.L. is a 67-year-old male who has been diagnosed with BPH. He is   having difficulty with urination. He is currently on Cozaar 100 mg for   HTN and his BP is well controlled. He is taking no other medications.   The doctor has recommended medication for his BPH, but he would like to   try a herbal supplement before taking a prescription medication.

1. Would you recommend a herbal supplement in L.L’s case?

2. If so, what herbal supplement would he take?

3. What is the recommended dosage?

4. What are possible side effects of the herbal supplement?

5. What warnings should you give L.L. before he starts the herbal supplement.

Case Study

A 60 year old woman with a 10 year history of Type II diabetes presents with multiple complications including retinopathy, peripheral neuropathy and declining renal function.

She has not had the urge to eat as of recently she feels “full” after a few bites. The incidence of nausea and feeling bloated occurs at least twice a day and even after a glass of water she feels bloated. She also complains of fatigue and not been able to keep up with daily chores.

A radiographic gastric emptying study shows a prolonged gastric emptying time.

Assignment Questions

1. What is the typical diagnosis for a patient who presents with this clinical picture?
2. What is the likely pathophysiologic process responsible for the presenting symptom? Support your response with a credible source.
3. What is the class of the drug used to treat the pathophysiolog?. Discuss the pharmacologic management plan for this patient.
4. Outline the mechanism of action and any possible contraindications of the pharmacologic management plan that you identified for the patient.

Instructions

• Prepare and submit a 3-4 page paper [total] in length (not including APA format).
• Answer all the questions above.
• Support your position with examples.
• Please review the rubric to ensure that your assignment meets criteria.
• Submit the following documents to the Submit Assignments/Assessments area:
  • Case Study: Gastrointestinal

Discussion Prompt

Post your answers to the 6 questions corresponding to this week’s content on primary care medication management. Provide your responses and rationales. Support your rationales with high-level evidence. (See Post Expectations)

A 70-year-old woman is in your office complaining of recently having trouble maintaining her balance after taking diazepam (valium). She occasionally takes diazepam when she feels anxious and has trouble sleeping. She has a 15-year history of taking diazepam.

Q1. Explain the cause of this patient’s difficulty in maintaining her balance?

Q2. Diazepam experiences a significant first-pass effect. What is the first-pass effect, and how can first-pass metabolism be circumvented?

A 75-year-old woman develops symptoms of a cold and buys an over-the-counter cold medication at the grocery store. The medication contains diphenhydramine, acetaminophen, and phenylephrine. She takes the recommended adult dose but soon after taking the medication she becomes very confused and disoriented.

Q3. What is likely causing the signs of confusion?

A 26-year-old woman who has never been pregnant is seeking preconception care as she is planning to pursue pregnancy in a couple of months. Currently, she has no symptoms to report and on review of body systems, there were no concerns. Her past medical history is significant for a history of rheumatic fever as a child. She subsequently underwent valve replacement with a mechanical heart valve. She is followed by a cardiologist who has already evaluated her cardiac function and she has received clearance from her cardiologist to pursue pregnancy. Records from her cardiologist include a recent cardiac echocardiography report that reveals a normal ejection fraction indicating normal cardiac function.

She has no alterations in her daily activities related to her heart. She has no other significant medical or surgical history. She is a non-smoker, drinks occasionally but has stopped as she is attempting to conceive, and does not use any non-prescription drugs.

Current Medications: Her current medications include only prenatal vitamins, which she has begun in anticipation of pregnancy, and warfarin. She has no known drug allergies.

Vital Signs: On examination, her pulse is 80 beats per minute, blood pressure is 115/70 mm Hg, respiratory rate is 18 breaths per minute, and she is afebrile.

Measurements: Weight = 152 pounds, Height = 5′5 ″, BMI= 25.29

Q4. How is warfarin metabolized? Does warfarin cross the placental barrier?

Q5. Explain the hepatic drug metabolism of children 1 year and older. How do they compare with the hepatic drug metabolism of infants and adults?

Q6. Explain protein binding in the neonate.

PLEASE PROVIDE A HIGH LEVEL OF EXPLANATION FOR EACH QUESTION

Course Scenario

Chaparral Regional Hospital is a small, urban hospital of approximately 60 beds, and offers the following:

• Emergency room services
• Intensive care
• Surgical care
• Obstetrics
• Diagnostic services
• Some rehabilitation therapies
• Inpatient pharmacy services
• Geriatric services
• Consumer physician referral services

Recently, the CEO has been hearing complaints from both patients and staff, varying from long wait times to rude physicians. You have been hired to design and implement a Quality Improvement Plan to help uncover quality problems and to satisfactorily resolve them.

Instructions

The CEO has received some resistance from the Board on undertaking a QI program. She has asked you to develop a set of talking points on the pros and cons of common measurement techniques used in healthcare that she can use the next time she runs into a Board member. 

Talking points are used to quickly explain something by condensing it into a compelling, but easily digestible, list. If the goal is to increase support for a QI program, the talking points must provide the ideas she needs to convey in order to achieve the goal.

Your talking points should be submitted in a Word document. Your talking points should include the pros and cons of implementing a QI program.

Upon completion of your talking points, please prepare a PowerPoint presentation (or other shareable Webware/software you prefer) with narration where you will explain each talking point to the CEO so they clearly understand and can answer questions from the Board.

APA formatting for the talking points, and proper grammar, punctuation, and form are required.  

1. Length of PowerPoint is secondary to the quality of the presentation as a whole.
2. Highlight specific pros and cons of QI programs.
3. Use the Notes area on each slide as needed to expand on the key points.

 Your audio presentation should include an introduction, a concise discussion of each slide, and a conclusion. Make sure to use audience-specific language and tone in your PowerPoint. Remember, you would be presenting this to the CEO of your facility. The presentation will be assessed on your overall knowledge of the content, clarity of your voice, pronunciation of words, organization of your presentation, proper recording of your presentation, overall aesthetics and professionalism, and general clarity of your presentation.