Cornell University Assessing the Problem Quality Safety and Cost Considerations Paper

Assessing the Problem: Quality, Safety, and Cost Considerations

Learning Goal: I’m working on a literature question and need an explanation and answer to help me learn.

• In a 7 page written assessment, assess the effect of the patient, family, or population problem you’ve previously defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend approximately 2 direct practicum hours exploring these aspects of the problem with the patient, family, or group you’ve chosen to work with and, if desired, consulting with subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form. Report on your experiences during your first two practicum hours.INTRODUCTION
  Organizational data, such as readmission rates, hospital-acquired infections, falls, medication errors, staff satisfaction, serious safety events, and patient experience can be used to prioritize time, resources, and finances. Cornell University Assessing the Problem Quality Safety and Cost Considerations Paper. Health care organizations and government agencies use benchmark data to compare the quality of organizational services and report the status of patient safety. Professional nurses are key to comprehensive data collection, reporting, and monitoring of metrics to improve quality and patient safety.PREPARATION
  In this assessment, you’ll assess the effect of the health problem you’ve defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 direct practicum hours working with the same patient, family, or group. During this time, you may also choose to consult with subject matter and industry experts.To prepare for the assessment:
  • Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete and how it will be assessed.
  • Conduct research of the scholarly and professional literature to inform your assessment and meet scholarly expectations for supporting evidence.
  • Review the Practicum Focus Sheet: Assessment 2 [PDF], which provides guidance for conducting this portion of your practicum.
• Note: Remember that you can submit all, or a portion of, your draft assessment to Smarthinking for feedback, before you submit the final version. If you plan on using this free service, be mindful of the turnaround time of 24-48 hours for receiving feedback.INSTRUCTIONS
  Complete this assessment in two parts.Part 1

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• Assess the effect of the patient, family, or population problem you defined in the previous assessment on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 practicum hours exploring these aspects of the problem with the patient, family, or group. During this time, you may also consult with subject matter and industry experts of your choice. Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form. Use the Practicum Focus Sheet: Assessment 2 [PDF] provided for this assessment to guide your work and interpersonal interactions.Part 2

  Report on your experiences during your first 2 practicum hours, including how you presented your ideas about the health problem to the patient, family, or group.

  • Whom did you meet with?
    • What did you learn from them?
  • Comment on the evidence-based practice (EBP) documents or websites you reviewed.
    • What did you learn from that review?
  • Share the process and experience of exploring the influence of leadership, collaboration, communication, change management, and policy on the problem.
    • What barriers, if any, did you encounter when presenting the problem to the patient, family, or group?
      • Did the patient, family, or group agree with you about the presence of the problem and its significance and relevance? Cornell University Assessing the Problem Quality Safety and Cost Considerations Paper
      • What leadership, communication, collaboration, or change management skills did you employ during your interactions to overcome these barriers or change the patient’s, family’s, or group’s thinking about the problem (for example, creating a sense of urgency based on data or policy requirements)?
    • What changes, if any, did you make to your definition of the problem, based on your discussions?
    • What might you have done differently?
• CORE ELMS
  Update the total number of hours on the NURS-FPX4900 Volunteer Experience Form in CORE ELMS.REQUIREMENTS
  The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.
  • Explain how the patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
    • Cite evidence that supports the stated impact.
    • Note whether the supporting evidence is consistent with what you see in your nursing practice.
  • Explain how state board nursing practice standards and/or organizational or governmental policies can affect the problem’s impact on the quality of care, patient safety, and costs to the system and individual.
    • Describe research that has tested the effectiveness of these standards and/or policies in addressing care quality, patient safety, and costs to the system and individual.
    • Explain how these standards and/or policies will guide your actions in addressing care quality, patient safety, and costs to the system and individual.
    • Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of care quality, patient safety, and cost to the system and individual.
  • Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual.
    • Discuss research on the effectiveness of these strategies in addressing care quality, patient safety, and costs to the system and individual.
    • Identify relevant and available sources of benchmark data on care quality, patient safety, and costs to the system and individual.
    • Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form. Cornell University Assessing the Problem Quality Safety and Cost Considerations Paper

 

Assessing the Problem

 

Student’s Name

Affiliation

Course

Instructor

Date

 

 

Assessing the Problem

Introduction

While ventilation provides oxygenation and better outcomes in patients with breathing difficulties, it can also escalate the risks of pneumonia. Ventilator-associated pneumonia (VAP) adds a burden to the care of critically ill patients. The problem is among the leading causes of morbidities and mortalities in ICU. Nurses play a crucial role in patients care. Their role resonates with the institutional, state, and federal policies to provide patient-centered quality outcomes. For instance, evidence implies that head elevation is a feasible procedure to minimize VAP risks. However, nurses’ actions depend on the leadership from the institutional to the state and federal levels. The administration manages the resources available to support patients’ clinical outcomes. The leadership can seek ways to increase the supply of medically-necessary equipment and beds that facilitate recovery. The state also defines the nursing scope of practice. Although nurses can have sufficient skills to enable the outcomes, the scope of practice definition can limit the exercise of their full potential. However, nurses need to liaison with the other staff and management to improve communication and collaboration to promote safety and quality outcomes. The leadership skills allow the nurses to be dynamic in ever-changing patients’ needs. Besides, change management is a complex approach that requires strategies such as training to reduce resistance and compliance with the best practices. This paper will explore the VAP from the context of the nurses, equipment, leadership, state and federal guidelines that promote safety.

Patient Health Problem Relevant to My Practice

Ventilation is among the leading ICU interventions to manage critically ill patients who require oxygenation. This procedure is medically necessary for patients experiencing breathing difficulties, chest pain, and lung dysfunction that compromise breathing patterns. This intervention’s conditions necessitate asthma, pneumonia, chronic obstructive pulmonary disease, pulmonary hypertension, and Covid 19. While ventilation is a necessary procedure, it increases the patients’ susceptibility to VAP. According to Seth (2020), VAP develops within two days, 48 hours among patients with endotracheal intubation. In this problem, the patients experience aspiration. The aspiration of gram-negative bacteria and bacilli can increase the vulnerability to the risks of pneumonia. The problem mainly manifests with fever. It can compromise the general patients’ outcomes, such as worsening oxygenation. Accordingly, VAP can increase the mortality and morbidity of ICU patients. The problem adds a burden to healthcare spending. For instance, the pandemic has increased healthcare demands. While many patients require ventilation, VAP can double the risks of hospital stays, denying others patients from accessing the resources needed. It also adds the total reimbursement for the treatment. Besides the condition during admission, VAP adds another state that requires more attention and resources. Cornell University Assessing the Problem Quality Safety and Cost Considerations Paper

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Population for the Practicum

This practicum will focus on ICU patients who require intubation within 48 hours in a local hospital in New York City. The population for this study is the patients manifesting with labored breathing on admission and diagnosed with conditions such as COPD, pneumonia, pulmonary hypertension. These patients have impaired lung functions, making ventilation medically necessary to improve outcomes. Seth (2020) affirms that critically-ill patients are more susceptible to aspiration. These patients are likely to be colonized with gram-negative bacteria in their oropharynx. When endotracheal intubation is indicated among these patients, the procedure needs to follow the guidelines that help prevent aspiration. Endotracheal intubation weakens airway defense which increases the risks of micro-aspiration. This problem can affect intubated patients for up to ten days. VAP is a concern in healthcare since Seth’s (2020) report affects approximately 27% of the patients on mechanical ventilation. Approaches that solve this issue can potentially reduce the healthcare burden and spending among critically ill patients.

Relevance of the Problem in My Practice

As a baccalaureate-prepared nurse, my main objective is to offer patient-centered nursing care to facilitate quality outcomes. The ANA has defined the code of ethics for practice. For instance, I need to promote safe care promoting patients’ holistic recovery. This strategy is in line with the providence of nonmaleficence practice. Still, the care needs to benefit the patients. While ventilation remains the primary intervention in the ICU, it is inherent with challenges such as VAP. Nothing is more frustrating in practice that implementing an intervention that worsens the patient’s condition. Poor outcomes affect the patients and healthcare at large, and it also lowers the nurses’ motivation for quality outcomes. Nurses have a huge workload from the pressure related to the pandemic and the burden of other diseases. VAP adds a burden, especially on the resources. Ventilators are among the limited resources in healthcare. When a patient takes a long time on this resource, it compromises care delivery to other patients who require the same resource. The limitation can compromise justice as the ethical requirement since the resource is unavailable for all people. Extended hospital stays also increase the workload. Nursing care can cause burnout amid the increased needs. So, this problem has an economic, labor force, and quality burden.

Nursing Actions to Address VAP from the Literature

Evidence has supported that nurses can implement upright positioning as a feasible intervention to prevent VAP. Farsi, Butler & Zareiyan (2020) performed a Retrospective Clinical Trial (RCT) to compare the effectiveness of upright positioning versus recumbent positioning in minimizing the risks of aspiration among critically ill patients. The results indicated that upright positioning, which involves the head elevation of between 30 to 45 degrees, can significantly lower the risks of VAP to up to 50%. This evidence suggests that nurses need to implement appropriate head elevation of the intubated patients to limit the chances of aspiration. However, this study has some limitations. For instance, head elevation alone cannot effectively resolve the issue. Other factors such as patients’ disease severity, clinical status, and colonization by bacteria and bacilli influence the outcomes. The study fails to acknowledge another confounding variable that influences the results. While exploring other alternatives using the double-blind clinical trial, Barani et al. (2018) assessed the VAP among inpatient patients. The study investigated the effectiveness of the selective oropharynx decontamination approach in eliminating bacteria colonies. This study seemed to provide quality evidence in addressing the VAP since the process helped nurses eliminate bacteria using topical gentamicin. However, this study is still controversial in its application in nursing practice. For instance, the increased prevalence of antimicrobial-resistant bacteria can be limited. These resistant strains of bacteria do not decrease exposure to antibiotics. So, the procedure has evidence of reducing VAP with little support on mortality. From these two pieces of evidence, nurses can mix both methods to improve outcomes. Besides head elevation, the care needs to decontaminate the oropharynx and entire digestive system to promote safety.

Reputability of Data

I will know reputable data from unreputable data by evaluating the evidence. I utilize peer-reviewed research work from reputable databases such as PubMed. This database stocks articles approved to form the evidence in practice. I also critically appraised the sources by evaluating the authorship, currency, methodology, ethics, statistical, and clinically significant. For instance, systematic reviews and randomized control trials provide primary information with the highest level of evidence. The two studies used in this work, systematic review and randomized control trial, make them reputable for this study.

Nurses in Policymaking and Nursing Theory

The dynamic healthcare needs require nurses to participate in policymaking actively. This role requires nurses to transform their actions from the bedside to the boardroom. Often, nurses are the implementors of the policies. Since they understand the patients from the grassroots, nurses can formulate effective patient-centered policies. Ha, et al. (2019) provided evidence on the effectiveness of nurses in policymaking. The results indicated that policies championed by nurses are most effective in promoting patients’ safety. Primarily, this perception happens because the nurses understand the patients’ conditions holistically. Other studies indicate that facilities with more nurses in the administration have lower hospital readmission rates.

Watson’s theory of human caring will shape my entire practicum experience. This theory suggests that patients have diverse needs. Accordingly, nurses play integral roles in meeting the physical, emotional, and spiritual needs to enhance recovery. The problem of VAP can potentially lower the quality of care. As a nurse practicing in ICU, I need to abide by interdisciplinary care to offer patient-centered care which meets the patients’ needs. I also need to rely on evidence and clinical guidelines to improve collaboration and provide safe ventilation to prevent readmission. Cornell University Assessing the Problem Quality Safety and Cost Considerations Paper

State Board Nursing Practice Standard

New York State has implemented the hospital bed guidelines. The guideline drafted in 2009 and updated in 2019 provides the institutions’ approach to abide by best bed practices for safety. The guidelines define different bed categories which are medically necessary. The fixed height bed is height nonadjustable with manual leg and head adjustments. The variable height manually adjusts the height, led, and head. Besides, the electronic ones have automatic height, leg, and head elevation adjustments. This policy will penalize the facilities which use ordinary beds, that is, solid furniture, among the patients who require head, leg, or height adjustments. Overwhelming literature supports this policy. Farsi, Butler & Zareiyan (2020) affirmed that head elevation of between 30 to 45 degrees lowers the aspiration rates to up to 60% among patients on ventilators. Hence, this guideline reduces the risks of VAP and improves the quality of care. This policy informs my decisions and nursing scope of practice. I need to adhere to the stipulated procedures, such as head elevation among ventilated patients, to reduce the risks of aspiration. The guidelines allow collaboration with the interdisciplinary team and leadership for safety outcomes. In providing holistic care, I need to supplement my bedside practice stipulated in the scope of nursing with critical thinking and collaboration to promote patients’ safety outcomes.

Leadership Strategy

Inclusivity of the nurses in decision making is among the effective leadership strategies that help in the early detection of the problem, allocation of resources, and facilitating collaboration in patients’ care. Nurses possess vital experience on patients’ issues that affect outcomes. They also understand the resources and burden of matching healthcare resources with the demands. The leadership can integrate approaches that collect the nurses’ views, feedback, feelings, and responses about different procedures and resources in healthcare. This collaborative decision-making approach improves the facility’s ability to meet the holistic needs of patients. Nebbelink and Brewer (2018) researched this leadership strategy and concluded that facilities that actively include nurses in decision-making have lower hospital readmission rates. This strategy can also facilitate best bed practices in healthcare. In response, leadership needs to respond to the State board bed safety requirements by providing resources that meet the required standards. For instance, the facility needs to provide beds that facilitate head adjustments in ICU to prevent VAP. Besides, leadership also needs to listen to the nurses’ concerns on equitable resource allocation.

Collaboration, Communication, and Change Management

The facility needs to engage all the nurses in decision-making. This approach fosters effective communication between the patients, providers, and management. One of the best strategies to facilitate this collaboration is an organization of open discussions through face-to-face and virtual meetings. These meetings need to allow the nurses to express their feelings and views on improving patients’ care environment. The coloration will also enhance the s4eamless information flow and relationship between the employees and management. Suppose the facility needs to implement change that facilitates patients’ safety. In that case, the administration needs to implement training such as simulation that equips the staff with skills to manage the patients’ demands. Evidence suggests that limited knowledge of the change process is the leading cause of resistance.

 

References

Barani, M., Tabatabaei, S. M., Sarani, H., Dahmardeh, A. R., & Keykhah, A. (2018). Investigating the Effect of Selective Oropharyngeal Decontamination Using Topical Antibiotics on Oropharyngeal and Tracheal Colonization in Trauma Patients Admitted to the Intensive Care Units of Zahedan, Iran: A Clinical Trial Study. Medical-Surgical Nursing Journal, 7(3), e86895. https://doi.org/10.5812/msnj.86895

Farsi, Z., Butler, S., & Zareiyan, A. (2020). The Effect of Semirecumbent and Right Lateral Positions on the Gastric Residual Volume of Mechanically Ventilated, Critically Ill Patients. Journal of Nursing Research, 28(4), e108. https://doi.org/10.1097/jnr.0000000000000377

Ha, D. R., Forte, M. B., Olans, R. D., OYong, K., Olans, R. N., Gluckstein, D. P., … & McKinnell, J. A. (2019). A multidisciplinary approach to incorporate bedside nurses into antimicrobial stewardship and infection prevention. The Joint Commission Journal on Quality and Patient Safety, 45(9), 600-605. https://doi.org/10.1016/j.jcjq.2019.03.003

Nibbelink, C. W., & Brewer, B. B. (2018). Decision-making in nursing practice: An integrative literature review. Journal of clinical nursing, 27(5-6), 917–928. https://doi.org/10.1111/jocn.14151

Seth, S., (December 2020). Ventilator-Associated Pneumonia. MSD and the MSD Manuals. University at Buffalo, Jacobs School of Medicine and Biomedical Sciences. Retrieved March 28, 2022, from https://www.msdmanuals.com/professional/pulmonary-disorders/pneumonia/ventilator-associated-pneumonia. Cornell University Assessing the Problem Quality Safety and Cost Considerations Paper