Reducing Hospital Readmissions with Telephone Follow-ups

Chamberlain College of Nursing NR451 RN Capstone Course Capstone Project Milestone 1: Practice Issue and

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Evidence Summary Worksheets For Use July 2018 Student Name: Rosa Yanez Date: DIRECTIONS 1. 2. 3. 4. Refer to the guidelines for specific details on how to complete this assignment. Type your answers directly into the worksheets below. Submit to the Dropbox by the end of Week 3, Sunday at 11:59 p.m. MT. Post questions about this assignment to the Q & A Forum. You may also email questions to the instructor for a private response. Practice Issue Worksheet List the topic and include the citation for the systematic review you have selected from our approved list (optional: an additional scholarly source of support): Hospital Readmissions Leppin, A. L., Gionfriddo, M. R., Kessler, M., Brito, J. P., Mair, F. S., Gallacher, K., & … Montori, V. M. (2014). Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Internal Medicine, 174(7), 1095-1107. doi:10.1001/jamainternmed.2014.1608 What is the nursing practice issue you have identified related to the topic you have chosen? Are patients who receive adequate discharge planning, follow up appointments, medication reconciliation and home care services less likely to be re-admitted to the hospital within 30 days of discharge versus those who do not. Fully describe the scope of the practice issue: Readmission has been a problem in the healthcare fields for a long time and the level of readmission has increased in the recent years. This increase has led to the need to identify the ways and the factors that can be applied to help in the reduction of re-hospitalization. To this end, the provision of follow up appointments, home care services, medical reconciliation and others have been identified to help in the reduction of readmission. The issue will compare the use and the lack of use for patient to observe the outcome. NR451 W3 MS1 Practice Issue and Evidence Summary Worksheets 7/2018 DP 1 Chamberlain College of Nursing NR451 RN Capstone Course What is the practice area? _X_ Clinical ___ Education ___ Administration ___ Other (List): How was the practice issue identified? (check all that apply) ___ Difference between hospital and community practice _X__ Safety/risk management concerns ___ Clinical practice issue is a concern __X_ Unsatisfactory patient outcomes ___ Procedure or process is a time waster ___ Wide variations in practice ___ Clinical practice issue has no scientific base __X_ Significant financial concerns __ Other: Describe the rationale for your checked selections: Readmission covers a wide range of concerns and the checked concerns are the primary ones associated with this practice issue. For instance, the cost of readmissions to the health care system is substantial. Hospital are financially penalized for high rates of readmissions. Some readmissions are preventable, and that being readmitted is undesirable for most patients, reducing avoidable readmissions presents a potentially large opportunity to reduce cost, improve quality, and improve the patient experience simultaneously. What evidence must be gathered? (check all that apply) _X_ Literature search _X_ Clinical Expertise _X_ Guidelines ___ Financial Analysis ___ Expert Opinion _X_ Standards (Regulatory, professional, community) ___ Patient Preferences ___ Other NR451 W3 MS1 Practice Issue and Evidence Summary Worksheets 7/2018 DP 2 Chamberlain College of Nursing NR451 RN Capstone Course Describe the rationale for your checked selections: Literature research is essential in gathering data on the various trends that have been observed by other scholars in the rates of readmission on hospitals and specifically to certain diseases. Additionally, guidelines from scholars and approved manuals are important as they demonstrate what is considered the best practice in such cases. Expert opinion would be gathered from hospital management, nurses and doctors, it would be invaluable in giving a localized view of the issue at the hospital level. Experts are often at par with current research and have first hand experience in the field. Regulatory standards and legal provisions are paramount in this research since they show the direction that facilities are expected to turn in case of certain cases. They could demonstrate weakness in facility practices or they themselves could have fundamental flaws. The regulations that are relevant are those that pertain to hospital discharge procedures and cases of return patients. These regulations and procedures can be from the government or industrial bodies and policies. EVIDENCE SUMMARY WORKSHEET Directions: Please type your answers directly into the worksheet. Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms: The main problem is that the number of patients who were being readmitted after 30 days was increasing from 1990 to 2013. The situation was affecting the effectiveness of the treatment services which were being offered in hospitals. As a measure of the problem tested interventions were introduced in the process and it was found out that in 42 cases there was a drop of patient readmission by 1.6 times when the tested intervention was used as compared to a situation where no test was conducted. Type the complete APA reference for the systematic review article you chose from the list provided. It must be relevant to the practice issue you described above. Include the APA reference for any additional optional supplemental scholarly source related to the review you wish to use. Leppin, A. L., Gionfriddo, M. R., Kessler, M., Brito, J. P., Mair, F. S., Gallacher, K., & … Montori, V. M. (2014). Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Internal Medicine, 174(7), 1095-1107. doi:10.1001/jamainternmed.2014.1608 Identify the objectives of the article: NR451 W3 MS1 Practice Issue and Evidence Summary Worksheets 7/2018 DP 3 Chamberlain College of Nursing NR451 RN Capstone Course To synthesize the evidence of the efficacy of interventions to reduce early hospital readmissions and identify intervention features—including their impact on treatment burden and on patients’ capacity to enact post-discharge self-care—that might explain their varying effects. Provide a statement of the questions being addressed in the work and how these relate to your practice issue: Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes. The author suggests on the introduction of the tested interventions to improve the situation. In this case when patients come to hospital complete test should be conducted within 24 hours to identify the issue. From the test then the right treatment should be given to the patient. With the right treatment then it means that cases of readmission will be reduced at the end. The fact is right identification of the issue will mean that the problem in question can be handled on time and effectively making sure that the patient is not readmitted. Giving post discharge care becomes easy. The use of supportive discharge interventions aimed at avoiding readmissions. Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome. Consider the relevance to your project proposal for the Milestone 2 project paper. (If an optional supplemental source is also used, include a statement of relevance to it as well.) It was found out that after conducting the randomized trials there was positive and also effective responses as to the use of the tested intervention as it reduced risk of 30 day readmission. With this it was found out that with effective intervention it was easy to enact the post discharge care. As the main evidence and strength of the finding it aligns with CuCoM finding which argued that provision of comprehensive patient support reduce early hospital readmission. With this it aligns with the proposal which aims at reducing readmission cases. Outline evidence-based solutions that you will consider for your project. Post-acute care services Follow up appointments Medical reconciliation Home care services Discuss any limitations to the studies that you believe impacts your ability to utilize the research in your project. NR451 W3 MS1 Practice Issue and Evidence Summary Worksheets 7/2018 DP 4 Chamberlain College of Nursing NR451 RN Capstone Course The studies were conducted in single academic center which means the applicability is limited. A wide array of centers would have given better results as compared to single source. The scale used to measure the intervention is not very clear. It means that even the results can have a problem. NR451 W3 MS1 Practice Issue and Evidence Summary Worksheets 7/2018 DP 5 Running head: TYPE SHORT TITLE IN ALL CAPS Title Your Name Chamberlain College of Nursing NR451 RN Capstone Course Term and Year 1 TYPE SHORT TITLE IN ALL CAPS 2 Your title here This paragraph(s) is to introduce the paper. State the problem and potential solutions backed by evidence. Briefly, introduce the nursing focused plan. Remember this is a scholarly APA assignment so you cannot use first person. Remember also that you will keep all the bolded headings and just remove the non-bolded content when you start your paper. Change Model Overview In this first paragraph, provide an overview of the ACE Star model Evidence-Based Practice Process. Feel free to state why nurses should use this model as a guide to facilitate change. Under each of the second level headers listed below, you now link your identified topic to the ACE Star model EBP Process. Define the Scope of the EBP Restate your practice issue. Why is this a problem? Give statistics and information to back the scope of the problem at your facility/work area. How does this problem impact healthcare on a broader scale? Stakeholders You will be the leader of the team since this is your project. Who will you also include in your team? Make sure you choose relevant stakeholders. You should have no more than eight members. Do not list your team members by name but instead by position (pharmacists, charge nurse, etc.). Determine Responsibility of Team Members Why are the members chosen important to your project? What are their roles? Evidence TYPE SHORT TITLE IN ALL CAPS 3 Conduct internal/ external search for evidence. What type of evidence did you find in addition to you Evidence Summary? EBP guidelines? Quality improvement data? Position statements? Clinical Practice Guidelines? Briefly discuss the strength of this research. This is not where you describe the results of your studies. This is done in the following steps. Summarize the Evidence In this section, you need to synthesize the information from the systematic review article. What are some of the evidence-based interventions you discovered in your Evidence Summary that do you plan to use? Be sure and cite all of your references, in proper APA format, from any and all articles into this one paragraph. Develop Recommendations for Change Based on Evidence What is your recommendation based on the research? Ideally, you will have found enough support in your evidence to proceed with implementing your pilot program. Translation Action Plan You have not implemented your project yet, therefore, this section will be hypothetical. Develop your plan for implementation. What are the specific steps you will take to implement your pilot study? What is the timeline for your plan? Make sure you include a plan for evaluation of outcomes and method to report the results. Process, Outcomes Evaluation and Reporting What are the desired outcomes? How will they be measured? How will you report the results to the key stakeholders? Identify Next Steps TYPE SHORT TITLE IN ALL CAPS 4 How will you implement the plan on a larger scale? Will this be applicable to other units or the facility as a whole? What will you do to ensure that the implementation becomes permanent? Disseminate Findings How will you communicate your findings internally (within your organization) and externally (to others outside of your organization)? Conclusion Provide a clear and concise summary. Review the key aspects of the problem as well as the change model. Be sure to include important aspects of the five points of the ACE Star change model EBP process and ways to maintain the change plan. TYPE SHORT TITLE IN ALL CAPS 5 References
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