Medicare/Medicaid
PREPARATION
Consider the hospital-acquired conditions that are not reimbursed for under Medicare/Medicaid. Among these conditions are specific safety issues such as infections, falls, medication errors, and other safety concerns that could have been prevented or alleviated with the use of evidence-based guidelines. Hospital Safety Score, an independent nonprofit organization, uses national performance measures to determine the safety score for hospitals in the United States. The Hospital Safety Score Web site and other online resources provide hospital safety scores to the public.
Read the scenario below:
Scenario
As the manager of a unit, you have been advised by the patient safety office of an alarming increase in the hospital safety score for your unit. This is a very serious public relations matter because patient safety data is public information. It is also a financial crisis because the organization stands to lose a significant amount of reimbursement money from Medicare and Medicaid unless the source of the problem can be identified and corrected. You are required to submit a safety score improvement plan to the organization’s leadership and the patient safety office.
Select a specific patient safety goal that has been identified by an organization, or one that is widely regarded in the nursing profession as relevant to quality patient care delivery, such as patient falls, infection rates, catheter-induced urinary infections, IV infections, et cetera.
DELIVERABLE: SAFETY SCORE IMPROVEMENT PLAN
Develop a 3–5 page safety score improvement plan.
Identify the health care setting and nursing unit of your choice in the title of the mitigation plan. For example, “Safety Score Improvement Plan for XYZ Rehabilitation Center.”
You may choose to use information on a patient safety issue for the organization in which you currently work, or search for information from a setting you are familiar with, perhaps from your clinical work.
Demonstrate systems theory and systems thinking as you develop your recommendations.
Organize your report with these headings:
Study of Factors
Identify a patient safety issue.
Describe the influence of nursing leadership in driving the needed changes.
Apply systems thinking to explain how current policies and procedures may affect a safety issue.
Recommendations
Recommend an evidence-based strategy to improve the safety issue.
Explain a strategy to collect information about the safety concern.
How would you determine the sources of the problem?
Explain a plan to implement a recommendation and monitor outcomes.
What quality indicators will you use?
How will you monitor outcomes?
Will policies or procedures need to be changed?
Will nursing staff need training?
What tools will you need to do this?
Additional Requirements
Written communication: Written communication should be free of errors that detract from the overall message.
APA formatting: Resources and in-text citations should be formatted according to current APA style and formatting.
Length: The plan should be 3–5 pages.
Font and font size: Times New Roman, 12 point, double-spaced.
Number of resources: Use a minimum of three peer-reviewed resources.
Write a 3–5 page safety score improvement plan for mitigating concerns, addressing a specific patient-safety goal that is relevant to quality patient care. Determine what a best evidence-based practice is and design a plan for resolving issues resulting from not maintaining patient safety.Quality improvement and patient safety are health care industry imperatives (Institute of Medicine’s Committee on Quality of Health Care in America, 2001). Effective quality improvement results in system and organizational change. This ultimately contributes to the creation of a patient safety culture
Context
Quality improvement and patient safety are health care industry imperatives (Institute of Medicine’s Committee on Quality of Health Care in America, 2001). Effective quality improvement results in system and organizational change. This ultimately contributes to the creation of a patient safety culture. Quality improvement and patient safety are central to the nursing leadership role. They are analyzed from many perspectives. Types of quality improvement and patient safety programs may range from internal, organization-based quality improvement team reports to external benchmarks from The Joint Commission, the Agency for Healthcare Research and Quality (AHRQ), Magnet, and numerous other organizations.A landmark publication by the Institute of Medicine’s Committee on Quality of Health Care in America (2001) identified the imperative to focus on quality care and patient safety. The initiative to create cultures of patient safety and quality care remain at the forefront of the health care leadership landscape. Nursing leadership sub-competencies include the understanding of components and use of effective tools for successful quality improvement programs within the practice setting.For a more recent snapshot of progress in the arena of patient safety, you may review a recent executive summary database report on safety cultures from the U.S. Department of Health & Human Services (n.d.). Lessons learned and tools presented within the directed readings provide a rich set of resources from which to draw for improved nurse leadership in the area of patient safety.References
Institute of Medicine’s Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.U.S. Department of Health & Human Services. (n.d.). HHS.Gov. Retrieved from http://www.hhs.gov/
QUESTIONS TO CONSIDER
To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of the health care community.Consider a performance measurement criteria or best practice guideline used in your work setting (or one that you are familiar with).
How was this criterion or guideline implemented?
Has it been successful?
Is it used consistently?
What evidence-based practices were used in developing the criteria or guideline?
How was nursing involved in the criteria or guideline development?
RESOURCES
Internet Resources
Access the following resources by clicking the links provided. Please note that URLs change frequently. Permissions for the following links have been either granted or deemed appropriate for educational use at the time of course publication.
Hospital Safety Score. (n.d.). What is patient safety? Retrieved from http://www.hospitalsafetyscore.org/what-is-patient…
Agency for Healthcare Research and Quality. (n.d.). AHRQ. Retrieved from http://www.ahrq.gov
National Academy of Medicine. (n.d.). Retrieved from http://nam.edu
Centers for Medicare & Medicaid Services. (n.d.). Hospital-acquired conditions. Retrieved from https://www.cms.gov/medicare/medicare-fee-for-serv…
American Nursing Informatics Association. (n.d.). ANIA. Retrieved from https://www.ania.org/
HIMSS. (n.d.). Nursing informatics. Retrieved from http://www.himss.org/ASP/topics_nursingInformatics…
Chao, S., Anderson, K., & Hernandez, l. (2009). Toward health equity and patient-centeredness: Integrating health literacy, disparities reduction, and quality improvement: Workshop Summary (2009). Washington, DC: The National Academies Press. Retrieved from http://www.nap.edu/catalog.php?record_id=12502
The Joint Commission. (n.d.). National patient safety goals. Retrieved from http://www.jointcommission.org/standards_informati…
AHRQ. (n.d.). Quality and patient safety. Retrieved from http://www.ahrq.gov/professionals/quality-patient-…
AONE. (n.d.). Retrieved from http://www.aone.org/
National Academies: Health and Medicine Division. http://www.nationalacademies.org/hmd/
American Nurses Association. (n.d.). NursingWorld. Retrieved from http://nursingworld.org/
American College of Healthcare Executives. (n.d.). Retrieved from http://www.ache.org/
Institute for Healthcare Improvement. (n.d.). Retrieved from http://www.ihi.org/Pages/default.aspx
U.S. Department of Health & Human Services. (n.d.). HHS.Gov. Retrieved from http://www.hhs.gov/
National Institutes of Health. (n.d.) Retrieved from http://www.nih.gov/
NCQA. (n.d.) Retrieved from http://www.ncqa.org/
QSEN Institute. (n.d.). Retrieved from http://www.qsen.org/
Agency for Healthcare Research and Quality. (2009). Hospital survey on safety culture: 2009 comparative database report.
