Evidence-Based Practice Project Proposal: Evaluation Plan Assignment

In 750-1,000 words, develop an evaluation plan to be included in your final evidence-based practice project proposal. You will use the evaluation plan in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal.

Provide the following criteria in the evaluation, making sure it is comprehensive and concise:

1. Discuss the expected outcomes for your evidence-based practice project proposal.
2. Review the various data collection tools associated with your selected research design and select one data collection tool that would be effective for your research design. Explain how this tool is valid, reliable, and applicable.
3. Select a statistical test for your project and explain why it is best suited for the tool you choose.
4. Describe what methods you will apply to your data collection tool and how the outcomes will be measured and evaluated based on the tool you selected.
5. Propose strategies that will be taken if outcomes do not provide positive or expected results.
6. Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation. Evidence-Based Practice Project Proposal: Evaluation Plan Assignment
   

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You are required to cite a minimum of five peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

APA style and formatting criteria and general guidelines for academic writing.

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

 

PICOT Final

Name_________________Daysha Polk____________________

 

Complete your PICOT using your approved proposed nursing practice problem. If they were approved, you may use the population and intervention developed in your Topic 1 assignment. Include any necessary revisions in this submission. Refer to the “Example PICOT” below as needed for guidance on how to complete the PICOT.

PICOT Question
P	Population	Patients experiencing decreasing satisfaction levels at ED
I	Intervention	Real-time location systems
C	Comparison	Manually entered status updates to track patients
O	Outcome	Decreased rate of Left Without Being Treated (LWBT) and raising revenue collection
T	Timeframe	Six months
PICOT Create a complete PICOT statement.	ED patients with decreasing levels of satisfaction (P), does the utilization of a real-time location systems (RTLS) in the hospital’s ED (I), compared to manually entered status updates to track patients (C), help to decrease the rate of LWBT and to raise revenue collection (O) within 6 months (T)? Evidence-Based Practice Project Proposal: Evaluation Plan Assignment
Problem Statement Create a problem statement for your PICOT. You will use this problem statement throughout your final written paper.	The current delays, long waits, leaving without being treated, decreased revenue collection from the ED unit, and reduced patient satisfaction scores have negatively portrayed the hospital’s reputation to the public. As a result, the daily patient visits have continued to decrease as people attribute the facility to poor emergency care services delivery. All these complications result from the use of combined data resources and manual entry status updates when tracking patient records. This manual tracking cannot meet the demand for many patients and leads to overcrowding due to and reduced patient flow in the ED. Therefore, there is a need to install an automatic patient tracking system to increase the flow.

 

References

 

Asheim , A., Nilsen, S. M., Carlsen, F., Næss-Pleym, L. E., Uleberg, O., Dale, J., Bache-Wiig Bjørnsen, L. P., & Bjørngaard, J. H. (2019, December 26). The effect of emergency department delays on 30-day mortality in Central Norway. European journal of emergency medicine : official journal of the European Society for Emergency Medicine. https://pubmed.ncbi.nlm.nih.gov/31135613/. 

Fudge, N., Sadler, E., Fisher, H. R., Maher, J., Wolfe, C. D. A., & McKevitt, C. (n.d.). Optimising Translational Research Opportunities: A Systematic Review and Narrative Synthesis of Basic and Clinician Scientists’ Perspectives of Factors Which Enable or Hinder Translational Research. PLOS ONE. https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0160475.

Morrison, L. E., & Joy, J. P. (2016, June 20). Secondary traumatic stress in the emergency department. Wiley Online Library. https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.13030.

Wand, T., Crawford, C., Bell, N., Murphy, M., White, K., & Wood, E. (2019, April 30). Documenting the pre-implementation phase for a multi-site translational research project to test a new model Emergency Department-based mental health nursing care. International Emergency Nursing. https://www.sciencedirect.com/science/article/abs/pii/S1755599X19300400?via%3Dihub.

Wang, H., Kline, J. A., Jackson, B. E., Robinson, R. D., Sullivan, M., Holmes, M., Watson, K. A., Cowden, C. D., Phillips, J. L., Schrader, C. D., Leuck, J. A., & Zenarosa, N. R. (2017, October 5). role of patient perception of crowding in the determination of real-time patient satisfaction at Emergency Department. OUP Academic. https://academic.oup.com/intqhc/article/29/5/722/4158405?login=true. Evidence-Based Practice Project Proposal: Evaluation Plan Assignment

 

Benchmark -Evidence-Based Practice Project: Literature Review

The purpose of this assignment is to write a review of the research articles you evaluated in your Topic 5 “Evidence-Based Practice Project: Evaluation of Literature” assignment.

A literature review provides a concise comparison of the literature for the reader and explains how the research demonstrates support for your PICOT.

In a paper of 1,250-1,500, select eight of the ten articles you evaluated that demonstrate clear support for your evidence-based practice and complete the following for each article:

1.  Introduction – Describe the clinical issue or problem you are addressing. Present your PICOT statement.

2.  Search methods – Describe your search strategy and the criteria that you used in choosing and searching for your articles.

3.  Synthesis of the literature – For each article, write a paragraph discussing the main components (subjects, methods, key findings) and provide rationale for how the article supports your PICOT.

4.  Comparison of articles – Compare the articles (similarities and differences, themes, methods, conclusions, limitations, controversies).

5.  Suggestions for future research: Based on your analysis of the literature, discuss identified gaps and which areas require further research.

6.  Conclusion – Provide a summary statement of what you found in the literature.

7.  Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as an appendix at the end of your paper. Benchmark -Evidence-Based Practice Project: Literature Review

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite eight peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not 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 LopesWrite

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Literature Evaluation Table

Student Name:

Change Topic (2-3 sentences): PICOT Analysis. Generally, a high level of patient satisfaction for the clients in the emergency department (ED) is vital, especially at this time when the healthcare system is shifting towards patient-centered care. Utilization of RTLS in the hospital’s ED, compared to manually-entered status updates to tract patients, help decrease the rate of LWBT and to raise revenue collection within 6 months, for ED patients with decreasing satisfaction levels with the provided healthcare services. This is as from the articles discussed below. Benchmark -Evidence-Based Practice Project: Literature Review

Criteria	Article 1	Article 2	Article 3	Article 4
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article	Asamrew, N., Endris, A. A., & Tadesse, M. https://www.hindawi.com/journals/jeph/2020/2473469/	sheim, A., Nilsen, S. M., Carlsen, F., Næss-Pleym, L. E., Uleberg, O., Dale, J., et al. https://pubmed.ncbi.nlm.nih.gov/31135613/	Boehm, L., & Petty, K. https://vocera.com/sites/default/files/resources/CXO_Survey_2016_Report_Vocera_Experience_Innovation_Network.pdf	Boulos, M. N., & Berry, G. https://ij-healthgeographics.biomedcentral.com/articles/10.1186/1476-072X-11-25
Article Title and Year Published	Level of Patient Satisfaction with Inpatient Services and Its Determinants: A Study of a Specialized Hospital in Ethiopia. (2020)	The Effect Of Emergency Department Delays On 30-Day Mortality in Central Norway. (2019)	The Rise of the Healthcare Chief Experience Officer. Vocera’s Experience Innovation Network. (2016)	Real-Time Locating Systems (RTLS) In Healthcare: A Condensed Primer. (2012)
Research Questions (Qualitative)/Hypothesis (Quantitative)	The level of patient satisfaction is a determinant for quality of care.	Is prolonged ED stay associated with increased risk of death?	Focus on human experience of care supports highest healing potential.	The article addresses RTLS application in healthcare.
Purposes/Aim of Study	Measuring the level of patient satisfaction and its determinants.	To assess whether prolonged length of stay in ED was associated with risk of death.	To examine whether the chief experience officer can enable humanized care delivery.	The paper evaluates if RTLS options, solutions, and deployment have benefits.
Design (Type of Quantitative, or Type of Qualitative)	Quantitative	Experimental	Mixed research	Qualitative research
Setting/Sample	In hospital	out of hospital	out of hospital	In hospital
Methods: Intervention/Instruments	Facility-related domain, general facility amenities, and provider interaction.	Indicators on risk of death, discharge, and hospitalization length.	Leader experience in achieving quality, safety, and performance.	RTLS components and technologies.
Analysis	Increasing needs and demands of the patients influence suitability of satisfaction levels. Assessing patient satisfaction through various inpatient services can lead to measurement of care quality. Increased engagements with the healthcare provider can shape perceptions impacting satisfaction.	Patients arriving and been admitted in hospitals ED have expectations of staying longer in the hospital after admission. This can have an impact on their satisfaction and confidence depending on the length of hospitalization.	Priorities established by the leader demonstrate commitment to excellence and patient care. The care entails safety through performance improvement. Experience improvement is based on patient and family involvement in care, staff support, and support technologies enabling satisfaction.	RTLS in healthcare tracks emergency first response by hospitals and providers. The technology exploits real-time location and status information of tracked entities. In the ED the technology provide timely responses to patients. Care providers would receive timely information on patients, rooms, their stay in hospital, and needs.
Key Findings	Determinants/ predictors used ought to create perceptions on satisfaction levels. Interactions with the care provider as well as facility amenities (toilet cleanliness, accommodation, and dietary service) are key predictors in satisfaction levels.	Prolonged stays in the ED were associated with discharges from the hospital. This reduced the association between increased risk of death and hospitalization.	Building a sense of community and satisfaction of all shareholders considers the experiences created. Patient care strategies are highly facilitated by humanized care leadership strategies enabling healing and satisfaction.	The technology can be integrated with other in-place technologies to communicate in real-time in providing quick responses. The solutions offered consider tagged locations with precision to locate rooms and needy patients.
Recommendations	Periodic assessments to be carried out. Improvement and job-training of health providers. Hospital reformation and modernization. Improvements in facility amenities. Improvements in client-patient interactions.	Improvements in care quality to shape patient perceptions.	Adopting new measures on healthcare humanity. Accepting advanced technology in hardwiring humanity. Patients setting course for experience improvements. Seamless patient journeys across the care continuum.	Improvements within the capabilities of the technology. Careful vendor selection in hardware and software support. Careful technology selection as per intended application.
Explanation of How the Article Supports EBP/Capstone Project	The article offers evidence on the need to establish variables as predictors to patient satisfaction.	The article supports the capstone project by articulating how quality care can influence satisfaction reducing risk of death.	The article offers evidence-based practice on experience and technology incorporation to facilitate patient satisfaction.	The article offer substantial evidence on RTLS technology.

 

Criteria	Article 5	Article 6	Article 7	Article 8
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article	Drazen, E., & Rhoads, J. https://www.chcf.org/publication/using-tracking-tools-to-improve-patient-flow-in-hospitals/	Heath, S. https://patientengagementhit.com/features/patient-satisfaction-and-hcahps-what-it-means-for-providers	Prakash, B. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047732/	Son, H., & Yom, Y.-H. https://onlinelibrary.wiley.com/doi/full/10.1111/jjns.12132
Article Title and Year Published	Using Tracking Tools to Improve Patient Flow in Hospitals. (2011)	Patient Satisfaction and HCAHPS: What It Means for Providers. (2016)	Patient Satisfaction. (2010)	Influencing Satisfaction With Emergency Department Medical Service: Patients’And Their Companions’Perspectives. (2017)
Research Questions (Qualitative)/Hypothesis (Quantitative)	Usage of tracking tools can be effective in improving patient flow in hospitals.	Understanding patient satisfaction through consumer assessment survey enabled in hospitals.	Patient satisfaction is an indicator of doctor or hospital performance.	Consumer satisfaction can be applied as a barometer for the improvement of service quality.
Purposes/Aim of Study	To examine tracking technologies and techniques available to hospitals.	To explore hospital quality and patient satisfaction through 27 questions to patient recent stay in hospital.	To evaluate if patient satisfaction can be used to measure quality of care.	To examine the individual determinants that influence satisfaction with services at the ED and compare factors that influence satisfaction compared with their companions.
Design (Type of Quantitative, or Type of Qualitative)	Qualitative	Experimental	Descriptive analysis	Cross-sectional study design
Setting/Sample	Out of hospital	out of hospital setting	Out hospital setting	Household setting
Methods: Intervention/Instruments	Tracking technologies and techniques	Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.	Patient satisfaction in practice building.	Individual factors influencing satisfaction.
Analysis	Hospitals are expected to meet growing patient volumes. This would enable providers to satisfy patients in various stages of treatment through technologies.	Client satisfaction information in the ED department can streamline workflow. While technology can be applied to enhance the satisfaction, providers are required to provide technical quality in care delivery.	Assessment of quality from a report published in 2001 showed how patient satisfaction can be used to shape healthcare practice. The doctor, patient, and organization are important factors in service excellence.	Through regression analysis, the results depicted predictors of satisfaction in the ED for patients and companions. Core domains in satisfaction entailed age, gender, and employment of the patient. Companions with lower education levels and visited due to patient illness were more satisfied.
Key Findings	Patient-tracking technologies help providers by providing real-time information on patients. The information is used to mould workflow enabling customization to fit patient and organization needs.  Benchmark -Evidence-Based Practice Project: Literature Review	Social rapport built creates both trust and satisfaction to the parties. However, providers should consider authentic engagement for deeper connections. This has regards to reduced computer usage.	Even if patient satisfaction is an attitude, it determines patient loyalty to the doctor and the hospital. Patient-focuses care provided is expected to meet expectations besides ensuring the organizations strives to provide better care. The satisfaction can act as an indicator to quality care.	Active communication between care providers and patients or companions can help in predicting patient satisfaction. Communication in the ED is important to keep visitors satisfied and cared for.
Recommendations	Technology benefits should fit organizational and patient needs to yield outcomes.	Face to face interaction in patient engagement. Create authentic engagements with patients.	Doctors and hospitals should strive to provide better care and exceed patient expectations.	Assessment of the waiting period as a determinant of patient satisfaction.
Explanation of How the Article Supports EBP/Capstone	The article will be utilized to educate how tracking technology integration can be used to promote best practices.	The article also emphasizes the efficiency provider-patient engagement for satisfaction.	The article evaluates patient satisfaction as an element in improving quality of care.	The article offers substantial information on patient satisfaction determinants across ED settings.

 

Criteria	Article 9	Article 10	Article 11
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article	Wand, T., Crawford, C., Bell, N., Murphy, M., White, K., & Wood, E. https://pubmed.ncbi.nlm.nih.gov/31047855/	Wang, H., Kline, J. A., Jackson, B. A., Robinson, R. D., Sullivan, M., Holmes, M., et al. https://pubmed.ncbi.nlm.nih.gov/31047855/	Xesfingi, S., & Vozikis, A. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1327-4
Article Title and Year Published	Documenting The Pre-Implementation Phase For A Multi-Site Translational Research Project To Test A New Model Emergency Department-Based Mental Health Nursing Care. (2019)	The Role Of Patient Perception Of Crowding In The Determination Of Real-Time Patient Satisfaction At Emergency Department (2017)	Patient Satisfaction With The Healthcare System: Assessing The Impact Of Socio-Economic And Healthcare Provision Factors. (2016)
Research Questions (Qualitative)/Hypothesis (Quantitative)	Reorientation of health services and resources can meet change in demand in ED for people with mental health, drug health, and behavioural problems.	Is overcrowding in the ED associated with lower real-time patient satisfaction?	Patient satisfaction is an important measure in healthcare quality.
Purposes/Aim of Study	To implement and evaluate an innovative model of mental health nursing care in three EDs across New South Wales Australia.	Evaluate the associations between real-time patient satisfaction and ED crowding as determined by patient perception and crowding estimation tool score in a high-volume ED.	To assess the degree of patient satisfaction and study the relationship between patient satisfaction of health system and set of socio-economic and healthcare provision indicators.
Design (Type of Quantitative, or Type of Qualitative)	Qualitative mixed methods design	Observational study design	Descriptive analysis
Setting/Sample	In hospital setting	In hospital setting	In hospital setting
Methods: Intervention/Instruments	Timeliness of consultations, documentation processes, delays in decisions, and lengthy assessment.	National emergency department overcrowding scale (NEDOCS) and Severely overcrowded not overcrowded Estimation tool (SONET).	Satisfaction index and healthcare provision indicators.
Analysis	Increased patients rates in EDs dealing with mental, drug, and behavioral problems are due to staff frustrations. Existing models on the practice constitute reasons leading to the frustrations.	Analysis of the observed data to create comparisons between overcrowded and not overcrowded associations with patient satisfaction.	Included data from Euro Health Consumer Powerhouse based on literature indicators. The information regarded the years 2007 to 2012 on hospital performance from patient perceptions.
Key Findings	Adopting and implementing new models of care can reduce frustrations and improve patient satisfaction. This would impact staff willingness to support change and corporate in the implementation of innovative practice models.	Higher degrees of crowding and overcrowding at the ED during patient admission lowered patient satisfaction levels.	Patient satisfaction levels and healthcare provision indicators have a strong association in the ED. In addition, socio-economic aspects shape patient satisfaction levels. Patients on public health expenditures and the elderly are observed to be more satisfied with the country’s healthcare system.
Recommendations	Adoption and implementation of new models with a consideration of applicability and suitability of the EDs.	Hospitals to reduce ED crowding to enhance client satisfaction.	Further evaluations on the construction of the satisfaction index. Focus on country-level analysis.
Explanation of How the Article Supports EBP/Capstone	The article will be utilized to educate on how innovative changes can be useful in the ED.	The article also emphasizes the efficiency patient satisfaction from reduced ED crowding. Benchmark -Evidence-Based Practice Project: Literature Review	The article evaluates the association between patient satisfaction and quality provision of healthcare as per current improvements in the system.

 

Evaluation And Management (E/M) Assignment

The Assignment

• Assign DSM-5 and ICD-10 codes to services based upon the patient case scenario.

Then, in 1–2 pages address the following. You may add your narrative answers to these questions to the bottom of the case scenario document and submit altogether as one document.

• Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.
• Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.
• Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.  Evaluation And Management (E/M) Assignment
  

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Instructions

Use the following case template to complete Week 2   Assignment 1. On page 5, assign DSM-5 and ICD-10 codes to   the services documented. You will add your narrative answers to the   assignment questions to the bottom of this template and submit altogether as   one document.

 

Identifying Information

Identification was verified by stating of their name and     date of birth.

Time spent for evaluation: 0900am-0957am

 

Chief Complaint

“My other provider retired. I don’t think I’m doing so     well.”

 

HPI

25 yo Russian female evaluated for psychiatric     evaluation referred from her retiring practitioner for PTSD, ADHD,     Stimulant Use Disorder, in remission. She is currently prescribed     fluoxetine 20mg po daily for PTSD, atomoxetine 80mg po daily for ADHD.
Today, client denied symptoms of depression, denied anergia, anhedonia,     amotivation, no anxiety, denied frequent worry, reports feeling     restlessness, no reported panic symptoms, no reported obsessive/compulsive     behaviors. Client denies active SI/HI ideations, plans or intent. There is     no evidence of psychosis or delusional thinking. Client denied past episodes of hypomania,     hyperactivity, erratic/excessive spending, involvement in dangerous     activities, self-inflated ego, grandiosity, or promiscuity. Client reports     increased irritability and easily frustrated, loses things easily, makes     mistakes, hard time focusing and concentrating, affecting her job. Has low     frustration tolerance, sleeping 5–6 hrs/24hrs reports nightmares of     previous rape, isolates, fearful to go outside, has missed several days of     work, appetite decreased. She has somatic concerns with GI upset and     headaches. Client denied any current     binging/purging behaviors, denied withholding food from self or engaging in     anorexic behaviors. No self-mutilation behaviors.  Evaluation And Management (E/M) Assignment

 

Diagnostic Screening Results

Screen of symptoms in the past 2 weeks:
PHQ 9 = 0 with symptoms rated as no difficulty in functioning
Interpretation of Total Score
Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression     10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe     depression
GAD 7 = 2 with symptoms rated as no difficulty in functioning
Interpreting the Total Score:
Total Score Interpretation ≥10 Possible diagnosis of GAD; confirm by     further evaluation 5 Mild Anxiety 10 Moderate anxiety 15 Severe     anxiety
MDQ screen negative
PCL-5 Screen 32

 

Past Psychiatric and Substance Use Treatment

· Entered mental health system when she was     age 19 after raped by a stranger during a house burglary.

· Previous Psychiatric     Hospitalizations:  denied

· Previous Detox/Residential treatments: one     for abuse of stimulants and cocaine in 2015

· Previous psychotropic medication trials:     sertraline (became suicidal), trazodone (worsened nightmares), bupropion     (became suicidal), Adderall (began abusing)

· Previous mental health diagnosis per     client/medical record: GAD, Unspecified Trauma, PTSD, Stimulant use     disorder, ADHD confirmed by school records. Evaluation And Management (E/M) Assignment

Substance Use History

Have you used/abused any of the     following (include frequency/amt/last use):

 

Substance

Y/N

Frequency/Last Use

 

Tobacco products

Y

½

 

ETOH

Y

last drink 2 weeks ago, reports drinks 1-2 times       monthly one drink socially

 

Cannabis

N

 

Cocaine

Y

last use 2015

 

Prescription stimulants

Y

last use 2015

 

Methamphetamine

N

 

Inhalants

N

 

Sedative/sleeping pills

N

 

Hallucinogens

N

 

Street Opioids

N

 

Prescription opioids

N

 

Other: specify (spice, K2, bath salts, etc.)

Y

reports one-time ecstasy use in 2015

Any history of substance     related:

· Blackouts: +

· Tremors:   –

· DUI: –

· D/T’s: –

· Seizures: –

Longest sobriety reported     since 2015—stayed sober maintaining sponsor, sober friends, and meetings

 

Psychosocial History

Client was raised     by adoptive parents since age 6; from Russian orphanage. She has unknown     siblings. She is single; has no children.

Employed at local     tanning bed salon

Education: High     School Diploma

Denied current     legal issues.

 

Suicide / HOmicide Risk Assessment

RISK FACTORS     FOR SUICIDE:

· Suicidal Ideas or plans – no

· Suicide gestures in past – no

· Psychiatric diagnosis – yes

· Physical Illness (chronic, medical) – no

· Childhood trauma – yes

· Cognition not intact – no

· Support system – yes

· Unemployment – no

· Stressful life events – yes

· Physical abuse – yes

· Sexual abuse – yes

· Family history of suicide – unknown

· Family history of mental illness – unknown

· Hopelessness – no

· Gender – female

· Marital status – single

· White race

· Access to means

· Substance abuse – in remission

PROTECTIVE     FACTORS FOR SUICIDE:

· Absence of psychosis – yes

· Access to adequate health care – yes

· Advice & help seeking – yes

· Resourcefulness/Survival skills – yes

· Children – no

· Sense of responsibility – yes

· Pregnancy – no; last menses one week ago,     has Norplant

· Spirituality – yes

· Life satisfaction – “fair amount”

· Positive coping skills – yes

· Positive social support – yes

· Positive therapeutic relationship – yes

· Future oriented – yes

Suicide Inquiry:     Denies active suicidal ideations, intentions, or plans. Denies recent     self-harm behavior. Talks futuristically. Denied history of     suicidal/homicidal ideation/gestures; denied history of self-mutilation     behaviors

Global Suicide     Risk Assessment: The client is found to be at low risk of suicide or     violence, however, risk of lethality increased under context of     drugs/alcohol.

No required     SAFETY PLAN related to low risk

 

Mental Status Examination

She is a 25 yo     Russian female who looks her stated age. She is cooperative with examiner.     She is neatly groomed and clean, dressed appropriately. There is mild     psychomotor restlessness. Her speech is clear, coherent, normal in volume     and tone, has strong cultural accent. Her thought process is ruminative.     There is no evidence of looseness of association or flight of ideas. Her     mood is anxious, mildly irritable, and her affect appropriate to her mood.     She was smiling at times in an appropriate manner. She denies any auditory     or visual hallucinations. There is no evidence of any delusional thinking.     She denies any current suicidal or homicidal ideation. Cognitively, She is     alert and oriented to all spheres. Her recent and remote memory is intact.     Her concentration is fair. Her insight is good.

 

Clinical Impression

Client is a 25 yo Russian female who presents with     history of treatment for PTSD, ADHD, Stimulant use Disorder, in remission.

Moods are anxious and irritable. She has ongoing     reported symptoms of re-experiencing, avoidance, and hyperarousal of her     past trauma experiences; ongoing subsyndromal symptoms related to her past     ADHD diagnosis and exacerbated by her PTSD diagnosis. She denied vegetative     symptoms of depression, no evident mania/hypomania, no psychosis, denied     anxiety symptoms. Denied current cravings for drugs/alcohol, exhibits no     withdrawal symptoms, has somatic concerns of GI upset and headaches.

At the time of     disposition, the client adamantly denies SI/HI ideations, plans or intent and     has the ability to determine right from wrong, and can anticipate the     potential consequences of behaviors and actions. She is a low risk for     self-harm based on her current clinical presentation and her risk and     protective factors.

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Diagnostic Impression

[Student to provide DSM-5 and ICD-10 coding]

Double click inside this text box to add/edit text.     Delete placeholder text when you add your answers. Evaluation And Management (E/M) Assignment

Treatment Plan

1) Medication:

· Increase fluoxetine 40mg po daily for PTSD     #30 1 RF

· Continue with atomoxetine 80mg po daily for     ADHD. #30 1 RF
Instructed to call and report any adverse reactions.
Future Plan: monitor for decrease re-experiencing, hyperarousal, and     avoidance symptoms; monitor for improved concentration, less mistakes, less     forgetful

2) Education: Risks and benefits of     medications are discussed including non-treatment. Potential side effects     of medications discussed. Verbal informed consent obtained.
Not to drive or operate dangerous machinery if feeling sedated.
Not to stop medication abruptly without discussing with providers.
Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs.     Instructed to avoid this practice. Praised and Encouraged ongoing     abstinence. Maintain support system, sponsors, and meetings.
Discussed how drugs/ETOH affects mental health, physical health, sleep     architecture.

3) Patient was educated about therapy and     services of the MHC including emergent care. Referral was sent via email to     therapy team for PET treatment.

4) Patient has emergency numbers: Emergency     Services 911, the national Crisis Line 800-273-TALK, the MHC Crisis Clinic.     Patient was instructed to go to nearest ER or call 911 if they become     actively suicidal and/or homicidal.

5) Time allowed for questions and answers provided.     Provided supportive listening. Patient appeared to understand discussion     and appears to have capacity for decision making via verbal conversation.

6) RTC in 30 days

7) Follow up with PCP for GI upset and     headaches, reviewed PCP history and physical dated one week ago and include     lab results

Patient     is amenable with this plan and agrees to follow treatment regimen as     discussed.  Evaluation And Management (E/M) Assignment

Narrative Answers

 

[In 1-2 pages, address the following:

· Explain   what pertinent information, generally, is required in documentation to   support DSM-5 and ICD-10 coding.

· Explain   what pertinent documentation is missing from the case scenario, and what   other information would be helpful to narrow your coding and billing options.

· Finally,   explain how to improve documentation to support coding and billing for   maximum reimbursement.]

Add your answers here. Delete instructions and placeholder   text when you add your answers. Evaluation And Management (E/M) Assignment

Quality Improvement Initiative Evaluation Assignment

Deliver to the interprofessional team a presentation (20 minutes; 12-15 slides) that analyzes an existing workplace quality improvement initiative related to a specific disease, condition, or public health issue of interest. The presentation’s purpose is to inform and get buy-in from the interprofessional team.

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Too often, discussions about quality health care, care costs, and outcome measures take place in isolation—various groups talking among themselves about results and enhancements. Nurses are critical to the delivery of high-quality, efficient health care. As a result, they must develop their skills in reviewing and evaluating performance reports. They also need to be able to communicate outcome measures related to quality initiatives effectively. Patient safety and positive institutional health care outcomes mandate collaboration among nursing staff members to ensure the integration of their perspectives in all quality care initiatives. Quality Improvement Initiative Evaluation Assignment

In this assessment, you will have the opportunity to analyze a quality improvement initiative in your workplace. You will then present your analysis to a group of nurses and other health care professionals. The purpose of your presentation is to inform and enlist support for the initiative from your audience.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies through the following assessment scoring guide criteria:

• Competency 2: Plan quality improvement initiatives in response to routine data surveillance.
  • Recommend additional indicators and protocols to improve and expand outcomes of a quality initiative.
• Competency 3: Evaluate quality improvement initiatives using sensitive and sound outcome measures.
  • Analyze a current quality improvement initiative in a health care or practice setting according to strategic organizational initiatives.
  • Evaluate the success of a current quality improvement initiative according to recognized national benchmarks.
• Competency 4: Integrate interprofessional perspectives to lead quality improvements in patient safety, cost-effectiveness, and work-life quality.
  • Incorporate interprofessional perspectives related to initiative functionality and outcomes.
• Competency 5: Apply effective communication strategies to promote quality improvement of interprofessional care.
  • Communicate the QI improvement initiative evaluation in a professional, effective manner that engages the interprofessional stakeholders to implement and sustain change.
  • Use correct grammar, punctuation, spelling, and APA style for scholarly citations and references. Quality Improvement Initiative Evaluation Assignment
    

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Preparation

Quality Initiative Selection

In this assessment you will deliver an analysis of an ongoing quality improvement initiative in your workplace. The initiative you analyze must relate to a specific disease, condition, or public health issue of personal or professional interest to you. The purpose of your analysis is to assess whether specific quality indicators point to improved patient safety, quality of care, cost and efficiency goals, and other desired metrics. Your audience consists of nurses and selected health care professionals with specializations or interest in your selected condition, disease, or issue. You hope to inform and garner support for the initiative from your audience. (*please include speaker notes)

• Instructions
  The optional QI Initiative Evaluation Presentation Template [PPTX] is provided to help you prepare your slides. If you choose to work without the template, consider referring to Guidelines for Effective PowerPoint Presentations [PPTX]. (attached)
  In your presentation, you will:
• Analyze a current quality improvement initiative in a health care or practice setting according to strategic organizational initiatives.
  • Explain the rationale behind the QI improvement initiative. What prompted the initiative?
  • Detail problems that were not addressed and any issues that arose from the initiative.
• Evaluate the success of a current quality improvement initiative according to recognized national benchmarks.
  • Analyze the benchmarks used to evaluate success. Which aspects of the initiative were most successful?  What outcome measures are missing or could be added?
  • Incorporate one appropriate supporting visual (such as a graph or chart) that showcases the most critical aspect of this presentation.
• Incorporate interprofessional perspectives related to initiative functionality and outcomes.
• Integrate the perspectives of interprofessional team members involved in the initiative. Who did you talk to? What are their professions?  How did their perspectives impact your analysis?
• Recommend additional indicators and protocols to improve and expand outcomes of a quality initiative.
  • Identify specific process or protocol changes as well as technologies that would improve quality outcomes.
• Communicate the QI initiative evaluation in a professional, effective manner that engages the interprofessional stakeholders to implement and sustain change.
• Use correct grammar, punctuation, spelling, and APA style for scholarly citations and references.
• Additional Requirements
• Presentation length: A maximum of 20 minutes.
• Number of slides: 12–15 slides. Balance text and visuals. Avoid text-heavy slides. Use speaker’s notes for additional content.
• Font and font size: Appropriate size and weight for presentation, generally 24–28 points for headings; no smaller than 18 points for bullet-point text. Use a suitable professional typeface such as Times or Arial throughout the presentation. Quality Improvement Initiative Evaluation Assignment
• Number of references: Cite a minimum of 7 current scholarly and/or authoritative sources to support your analysis. Current is defined as no older than 5 years unless a seminal work.
• APA formatting: Adhere to APA style and formatting guidelines for citations and references. Consult these resources for an APA refresher:
  • APA Style & Format.
  • APA Module.
  • American Psychological Association. (n.d.). APA style. Retrieved from https://www.apastyle.org/

Assignment: Controversy Associated With Dissociative Disorders

The DSM-5 is a diagnostic tool. It has evolved over the decades, as have the classifications and criteria within its pages. It is used not just for diagnosis, however, but also for billing, access to services, and legal cases. Not all practitioners are in agreement with the content and structure of the DSM-5, and dissociative disorders are one such area. These disorders can be difficult to distinguish and diagnose. There is also controversy in the field over the legitimacy of certain dissociative disorders, such as dissociative identity disorder, which was formerly called multiple personality disorder.

In this Assignment, you will examine the controversy surrounding dissociative disorders. You will also explore clinical, ethical, and legal considerations pertinent to working with patients with these disorders.

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The Assignment (2–3 pages)

• Explain the controversy that surrounds dissociative disorders.
• Explain your professional beliefs about dissociative disorders, supporting your rationale with at least three scholarly references from the literature.
• Explain strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.
• Finally, explain ethical and legal considerations related to dissociative disorders that you need to bring to your practice and why they are important. Assignment: Controversy Associated With Dissociative Disorders