The purpose of this assignment is to apply the concepts you have learned in this course to a situation you have encountered. Choose one quality or patient safety concern with which you are familiar and that you have not yet discussed in this course. In a 1,250-1,500 word essay, reflect on what you have learned in this course by applying the concepts to the quality or patient safety concern you have selected. Include the following in your essay:
Briefly describe the issue and associated challenges.
Explain how EBP, research, and PI would be utilized to address the issue.
Explain the PI or QI process you would apply and discuss why you chose it.
Describe your data sources, including outcome and process data.
Explain how the data will be captured and disseminated.
Discuss which organizational culture considerations will be essential to the success of your work.This assignment uses a rubric.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. Overview of Quality in Healthcare Essay Paper
Overview of Quality in Healthcare: Accidental Patient Falls
The issue of quality in healthcare has recently become a central consideration of regulatory authorities when it comes to accreditation and certification. This is especially so because of the fact that reimbursement after passage of the Patient Protection and Affordable Care Act of 2010 (ACA 2010) is dependent on value rather than volume (Kominski et al., 2017). This is the pay for performance policy that has now become the norm for all healthcare providers (Holmström, 2017). Initially, providers only concentrated on volume, but this was found to encourage the delivery of healthcare services whose quality was below par. But n a healthcare setting, quality or performance is also regarded or measured by what is lacking instead of what is delivered. For this, there are several quality and performance measures or metrics that are looked at. One of these quality/ performance measures is the rate of accidental patient falls. It is a known fact through scholarly scientific evidence from literature that patients aged 65 years and above are susceptible to accidental falls within healthcare institutions. Particularly, these are healthcare settings such as nursing homes and rehabilitation centers for the old (McCarthy, 2016). The purpose of this paper is to describe accidental patient falls as a quality issue and to discuss how research, evidence-based practice (EBP), quality improvement (QI) processes, and performance improvement (PI) processes can be used to mitigate it.
A Description of the Issue and Associated Challenges
The issue of accidental patient falls among elderly patients in United States hospitals is a major QI and PI issue impacting care. To illustrate this, the Centers for Medicare and Medicaid Services or CMS as payers have since the year 2008 stopped reimbursing facilities for care given to patients who are victims of falls (Fehlberg et al., 2017). The rationale behind this decision was that accidental falls in healthcare facilities are preventable and are therefore occurring as a result of failures in quality and performance in terms of the nursing services offered. Falls among the elderly in the hospitals and other healthcare settings are responsible for significant morbidity and even mortality in this population of concern. After a fall, some of the injuries suffered include concussion, fractures, and abrasions. In an old person who is already frail and probably also suffering from cognitive impairment, these injuries easily undergo complications such as infections and lead to preventable mortality (Kenny et al., 2017). Reported annual fall rates in US hospitals is reported to be between 3.3 and 11.5 patient falls per 1,000 patient stays (Bouldin et al., 2013). This can be compared to the national benchmark or average rate of patient falls which is estimated to be 3.44 falls per 1,000 hospital stays (Venema et al., 2019).
The associated challenges to this issue of accidental patient falls include that there is frequently a shortage of nurses in these nursing homes and rehabilitation centers. This makes it difficult to effectively monitor these patients and ensure that they are completely safe. Also, most of these elderly patients suffer from neurocognitive disorders (NCD) such as dementia and Alzheimer’s disease (APA, 2013). This makes it very difficult for nurses alone to monitor them round the clock and they may therefore suffer a fall within a very short moment of confusion leading them to want to leave their beds. Extra caregivers may therefore be required, but this also means that the cost of care is going to increase.
How EBP, Research, and PI would be used to address the Matter of Patient Falls
Evidence-based practice (EBP) is the current norm for all nursing practice. It is the practice that places preference on the utilization of interventions that have been proved to be safe, effective, efficient, and patient-centered. The evidence for this efficacy comes from scholarly peer-reviewed scientific literature. To get this evidence, however, one must engage in the clinical process known as clinical inquiry. This is how EBP will be used to address the issue of accidental patient falls among the elderly (Melnyk & Fineout-Overholt, 2019). First, a question will be formed using the PICOT model. This question identifies the patient population of interest as the elderly above 65 years of age (P), the intervention of choice (I), the comparison intervention or what is currently being commonly practiced (C), the outcome that is expected (O) and the timeframe envisioned for the implementation of the preferred intervention (T). It is this PICOT statement that will then be used to derive search terms and embark on a systematic search of scholarly evidence. This search is conducted in reputable research databases such as CINAHL, PubMed, ProQuest, and Cochrane amongst others. The evidence that will be found will then guide the kind of interventions that will be used to prevent accidental patient falls. This will be done in the context of performance improvement (PI) within the organization, as undertaken by the QI committee. Overview of Quality in Healthcare Essay Paper
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The PI or QI Process that Would be Applied in this Case
The QI process that would be applied in this case would entail the following steps:
- A review of the data providing evidence of the presence of the practice problem
- An analysis of the data to deduce trends and causality
- An EBP search for effective preventive interventions
- Training and education
- Implementation of the strategies
- Evaluation of the implemented strategies
A review of the present data on patient falls will entail looking at the recorded and reported incidences of patient falls for a given period of time. This could be for instance a period of 12 months or six months. This could be done as a routine organizational practice, or it may be prompted by inspection carried out by regulatory agencies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The data is then analyzed for trends and causality. What this means is that comparisons are made with previous periods and differences noted. Also, the associated incidents or what are recorded to have been the possible causes of the falls are analyzed. In this task, the nurse informaticist will be instrumental in that she is the one who will retrieve this data from the organization’s electronic health record (EHR) dashboard. An EBP search is then conducted after formulating a PICOT question and interventions with evidence of efficacy are retrieved from scholarly peer-reviewed literature. These then inform training and education of the nurses on the identification and handling of fall risks. The EBP interventions are then implemented and later evaluated for effectiveness after the stated period of time or the “T” in the PICOT statement.
Data Sources, How Data Will Be Captured and Disseminated, and Organizational Culture Considerations
The data sources in this case will be the dashboard metrics for quality and performance (quality and performance measures) that are stored in the organization’s EHR system. Outcome data will show the exact number of patient falls entered into the system over the given period of time. Process data will show what was done when these events occurred. This is what is entered as the interventions the nurses took at the time that the events occurred. This process data is informed by the organization’s policies, procedures, and practices. This data will be captured through retrieval from the EHR database and this will be facilitated by the nurse informaticist. Dissemination of the data would take several forms, including podium presentations and posters (Brownson et al., 2018; Williams & Cullen, 2016).
The organizational culture considerations that will be essential for the success of this work will definitely be about change readiness and preparedness. An organization that has a culture of change is easier to accept change than one in which change is an alien concept. Therefore, organizational readiness for change and favorable change policies and procedures will determine whether this project succeeds or fails.
References
American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Author.
Bouldin, E.D., Andresen, E.M., Dunton, N.E., Simon, M., Waters, T.M., Liu, M…. & Shorr, R.I. (2013). Falls among adult patients hospitalized in the United States: Prevalence and trends. Journal of Patient Safety, 9(1), 13–17. https://doi.org/10.1097/PTS.0b013e3182699b64
Brownson, R.C., Eyler, A.A., Harris, J.K., Moore, J.B., & Tabak, R.G. (2018). Getting the word out: New approaches for disseminating public health science. Journal of Public Health Management and Practice, 24(2), 102–111. https://doi.org/10.1097/PHH.0000000000000673
Fehlberg, E.A., Lucero, R.J., Weaver, M.T., McDaniel, A.M., Chandler, M., Richey, P.A., Mion, L.C., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3), 1-7. http://dx.doi.org/10.1093/geroni/igx036
Holmström, B. (2017). Pay for performance and beyond. American Economic Review, 107(7), 1753–1777. https://doi.org/10.1257/aer.107.7.1753
Kenny, R., Romero-Ortuno, R., & Kumar, P. (2017). Falls in older adults. Medicine, 45(1), 28-33. https://doi.org/10.1016/j.mpmed.2016.10.007
Kominski, G.F., Nonzee, N.J. & Sorensen, A. (2017). The Affordable Care Act’s impacts on access to insurance and health care for low-income populations. Annual Review of Public Health, 38. https://doi.org/10.1146/annurev-publhealth-031816-044555
McCarthy, M. (2016). Falls are leading cause of injury deaths among older people, US study finds. BMJ, 354 (i5190). https://doi.org/10.1136/bmj.i5190
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.
Venema, D.M., Skinner, A.M., Nailon, R., Conley, D., High, R., & Jones, K.J. (2019). Patient and system factors associated with unassisted and injurious falls in hospitals: An observational study. BMC Geriatrics, 19(348), 1-10. https://doi.org/10.1186/s12877-019-1368-8
Williams, J.L., & Cullen, L. (2016). Evidence into practice: Disseminating an evidence-based practice project as a poster. Journal of PeriAnesthesia Nursing, 31(5), 440–444. https://doi.org/10.1016/j.jopan.2016.07.002 . Overview of Quality in Healthcare Essay Paper