Executive Summary of a Quality Improvement Initiative Program

Executive Summary of a Quality Improvement Initiative Program

Executive Summary of a Quality Improvement Initiative Program

Executive Summary of a Quality Improvement Initiative Program

Quality improvement is a structure that is employed to regularly improve the ways care is delivered to patients (Agency for healthcare, research and quality (AHRQ), n.d.)

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QI initiative in my institution

“Prevention of hospital acquired pressure injuries in the medical ICU”.  Hospital acquired pressure injuries (HAPIs) negatively impact the quality of life in patients in that it is painful, costly and is associated with other risks including death.  Development of stage 3 and stage 4 pressure ulcers denotes poor patient care by the Centers for Medicare and Medicaid Services (CMS) and institutions get to cover the costs of such ulcers and its complications (AHRQ, n.d.).  The financial burden on institutions and public report of poor patient outcomes in institutions have led to measures put in place to prevent the occurrences of HAPIs.

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Management of adverse events in my organization

Organizations have different channels of commands when adverse events occur. My organization handles hospital acquired pressure injuries (HAPIs) as follows: When HAPIs happen on a unit, data on the patient is sent by the nurse to PIRC which is data collection platform.  Such data is reviewed every Tuesday by the Unit Manager, Quality Controls personnel and the Manager of the Inpatient Wound care nurses. They look at patient’s comorbidities and preventive measures that were in place prior to HAPI occurring. They look for any gaps that would have led to the development of HAPIs. An educational tool is done from the collection of data and followed weekly. However, if this problem persists in a unit despite education, and changes in processes as deemed necessary, the CMO, Quality Controls personnel and other members of leadership are notified so that jointly they would come up with a sustainable plan.

Impact of HAPIs

The development of HAPIs, specifically stages 3 and 4 pressure ulcers is considered a “never event” according to Rondinelli et al. (2018).  When this happens, such event is report to the Centers for Medicare and Medicaid Services and this result in decrease in reimbursement (Rondinelli et al. 2018). Also, this data is made public and the reputation of the organization in providing safe care is at risk.  Thus, institutions are working hard to prevent these from occurring to avoid financial losses and also gain the confidence of the public in providing safe and quality care to patients entrusted in their care.

Literature review

Da Silva et al. (2016) provided a case study on a medication error and recommendations of how this can be avoided in healthcare settings.  This case involves a 71y/o female with a medical history that includes hypertension and was prescribed Norvasc 10mg to be taken twice a day.  The pharmacist accidentally filled Navane, an antipsychotic medication instead of Norvasc.  This patient took this medication for 3 months unnoticed, until the development of adverse effects including abnormal movements and a fall. During her 3 months of being on this medication, she was seen by multiple providers but this was not traced until her 3rd presentation to the hospital in which her medication bottles were reviewed.  Then, it was noted that she was actually taking Navane, not Norvasc for hypertension (da Silva et al. 2016). This patient was failed by multiple providers including pharmacists, hospitalist and nurses, subsequently leading to an adverse event (da Silva et al, 2016). Recommendations to avoid such medication errors in the future include reviewing of pill bottles during medication reconciliation, having electronic health records in the institutions with software that allows for detailed information on prescribed medications, having two step medication review by providers upon admission and discharge, recommendations against providing refills on discharge prescriptions unless where absolutely necessary and promoting a system where pharmacists and physicians work closely together to review patient medications, among others (da Silva et al, 2016). Many institutions now have electronic health records but this does not take the place of providers carefully reviewing patient’s home medications, including looking at their pill bottles if available. Providers should educate patients to always carry their medications with them to every appointment to ease the process of medication review and reconciliation so that such errors could be caught in a timely manner.

References

Agency for Healthcare, Research and Quality (AHRQ), (n.d.) Practice Facilitation Handbook. Module 4. Approaches to Quality Improvement. https://www.ahrq.gov/ncepcr/tools/pf-handbook/mod4.html

da Silva, B. A., & Krishnamurthy, M. (2016). The alarming reality of medication error: a patient case and review of Pennsylvania and National data. Journal of community hospital internal medicine perspectives6(4), 31758. https://doi.org/10.3402/jchimp.v6.31758

Rondinelli, J., Zuniga, S., Kipnis, P., Kawar, L. N., Liu, V., & Escobar, G. J. (2018). Hospital-Acquired Pressure Injury: Risk-Adjusted Comparisons in an Integrated Healthcare Delivery System. Nursing research67(1), 16–25. https://doi.org/10.1097/NNR.0000000000000258

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Quality improvements are frameworks used to systematically enhance how care is delivered to patients (Dixon-Woods & Martin, 2016). To use the frameworks, health professionals establish problems and areas of waste, develop and implement a plan for improvement, track the initiative over time and adjust it when necessary to achieve the set objectives. In doing so, health professionals become patient advocates since they make decisions that enhance the delivery of care. The purpose of this paper is to analyze a quality improvement initiative in a health care setting, evaluate the success of the initiative using recognized benchmarks and outcome measures, incorporate interprofessional perspectives on the QI functionality and outcomes and recommend additional indicators and protocols to improve and expand the quality outcomes of the QI.

Eliminating Discharge Delays

Managing the bed capacity in a hospital is a critical issue because increased inefficient discharges slow care, increase cost and impact patient flow (Khalifa, 2017). In the assessed hospital, the initial projects aimed at discharging a specific percentage of patients at a given time of day to free up beds. Nevertheless, system inefficiencies were still there and they contributed to delayed admissions and transfers. Patient flow was hampered by unpredictable discharges and length delays which increased the cost for everyone involved. The hospital had fragmented discharge planning, sub-optimal assessment of readiness for discharge, a breakdown in information transfer and communication between physicians and inadequate post-discharge care and follow-up (Khalifa, 2017). After an analysis of the available evidence, a project team came up with standard discharge criteria for eleven common inpatient diagnoses.

The information was then embedded in the electronic medical record and the new discharge process focused on patient needs first by ensuring that patients were discharged when medically ready.  The nurses could monitor and signal when patients met discharge goals and physicians could prioritize early rounding (Emes, Smith, Ward & Smith, 2019). The process also created a streamlined pharmacy prescription process which improved discharge efficiency. Additionally, there was consistent communication of patient needs between all care providers regardless of the time of day. Due to the process, 80% of eligible patients are released within two hours of meeting the discharge criteria. The project decreased waste linked to inefficient discharges and it saved money for families, hospitals and health plans. Equally, the process focused on patient needs and thus higher acuity patients benefited from the more existing bed. It also reduced the length of stay in line with the global aim of reducing the cost of care (Emes, Smith, Ward & Smith, 2019).

Benchmarks and Outcome Measures

The absence of a standardized process in the discharge planning system results in inconsistencies as well as poor patient outcomes like avoidable hospital re-admissions. The best way to analyze the project on eliminating discharge delays is through internal benchmarking since it identifies best practices within an organization, compares practice within the organization and compares practice over time (Davidson et al., 2017). The analysis looks at a hospital in terms of effectiveness, efficiency and customer satisfaction. To help in the analysis of the quality initiative, the Centers for Medicare and Medicaid Services (CMS) outcome measures were used. The first assessment looked at the mortality rates in the hospitals. The mortality rates reduced after the implementation of the project since it automated the discharge process. The automation increased workflow efficiency and staff productivity and it freed hospital resources which made it possible for the physicians to cater to more complicated cases. Automation also reduced clerical functions by 75% which offered staff more time to interact with patients and initiate interventions when needed (Davidson et al., 2017).

The second outcome measure assessed was readmissions. The number of readmissions decreased due to the effectiveness of discharge planning. It ensured that medications are prescribed and given correctly and the family members are prepared to take over the care of their loved ones. The discharge process covers patient education, medication reconciliation and follows up which has not only enhanced patient satisfaction but reduced rehospitalization (Davidson et al., 2017).  In terms of patient experience, decreasing the discharge delays has led to increased patient satisfaction especially because patients are only discharged when medically ready. The last outcome measured is the timeliness of care. In terms of access to care, reducing the discharge delays has increased the number of available bed which in turn has led to reduced overcrowding in the emergency department (Davidson et al., 2017). The number of patients who leave without being seen has reduced in the hospital. In overall, the project has enhanced patient flow and decreased cost since a 38% increase in patient discharged within two hours has been seen and the hospital has saved $5.9 million.

Interprofessional Perspectives

To get a better understanding of the quality improvement initiative, the interprofessional perspectives were taken. The nurses indicated that before the project, everyone was stressed due to delayed discharges. Among the reasons attributed to the stress were lengthened waiting list which created pressure for some patient to be discharged home (Pinelli, Stuckey & Gonzalo, 2017). The effect was frustration and guilt among health professionals who felt like patients were pressured to leave the hospital. The concern shifted from providing care to those in need to discharging patients to meet government targets. The overall effect was a negative experience among patients due to the delay and also a negative reaction from the staff. However, after the project was implemented, interprofessional communication and pre-discharge planning became effective eventually helping the health professionals meet the government targets while enhancing the patient experience. Patients were less depressed and bored. Patients are no longer rushed to free beds and can ask any questions making them engaged in discharge planning (Pinelli, Stuckey & Gonzalo, 2017).

The nurses noted that the new discharge system has reduced the number of stressed, bored and anxious inpatients. Additionally, it has reduced the lengths of time and thus other service users can access therapeutic interventions and care packages can be arranged effectively. The hospital previously felt overstretched and with insufficient staff but the streamlined system has enhanced care coordination (Pinelli, Stuckey & Gonzalo, 2017). The risk for serious incidents, self-harm, substance misuse, aggression and violence on the wards has reduced and the potential delays when admitting appropriate at-risk service users, as well as premature discharges, have reduced. The nurses also pointed out that the hospital had an inappropriate transfer of service users between services and wards which have changed. The patients also faced an increased risk of service user dependence on inpatient care and lost coping skills post-discharge while the staff morale, retention, and recruitment were affected (Pinelli, Stuckey & Gonzalo, 2017). The new system has tackled these issues since staff input was obtained when implementing the system.

Reducing Discharge Delays Further

To enhance the initiative further, the hospital should adopt a centralized billing system between various departments to facilitate easy real-time billing. A billing system will help in informing the patient about interim pending amount any time they enquire which will prevent discount requests at the wrong times (Stelfox et al., 2015). The hospital should also improve its information system in a way that various departments in the hospital have a central platform. The platform will ease communication among the department and clearance from the various department will be reduced. With a centralized platform, once a consultant triggers a discharge, the concerned departments are notified right away and they clear the patient automatically (Stelfox et al., 2015). The effect is reduced delays since final bill preparation can be done within the shortest time possible.

The hospital should also create a centralized bed management system. The system will indicate whether beds are available and make room and bed assignments to new patients more efficient. The system will also trigger bed cleaning notice during discharge reducing the number of hours needed to assign beds to new patients (Stelfox et al., 2015). Lastly, an automated inventory management system should be in place to ensure that discharge medication from the pharmacy reaches the ward as early as possible. The system will ensure that excess medication return to the pharmacy and discharge medication to the wards is completed ahead of time enhancing the discharge process.

Conclusion

Quality improvements initiatives enhance the care offered to patients. The analyzed healthcare facility had implemented an initiative that eliminated discharge delays. The hospital had started with a project that aimed at discharging a specific percentage of patients at a given time to free up beds but it resulted in system inefficiencies.  A team was set and analyzed the weakness and it came up with standard discharge criteria that were embedded in the electronic medical record. The initiative has enhanced care and analyzing healthcare outcomes reveals that mortality rates have reduced, readmissions have reduced, patient experience enhanced as well as timeliness of care.  Even the health professionals in the hospital outline a positive impact of the initiative which has enhanced morale and satisfaction. The system, however, can benefit from a centralized billing system, a central information system, centralized bed management system and an inventory management system.

References

Dixon-Woods, M., & Martin, G. P. (2016). Does quality improvement improve quality?. Future Hospital Journal, 3(3), 191-194.

Pinelli, V., Stuckey, H. L., & Gonzalo, J. D. (2017). Exploring challenges in the patient’s discharge process from the internal medicine service: A qualitative study of patients’ and providers’ perceptions. Journal of interprofessional care, 31(5), 566-574.

Emes, M., Smith, S., Ward, S., & Smith, A. (2019). Improving the patient discharge process: implementing actions derived from a soft systems methodology study. Health Systems, 8(2), 117-133.

Davidson, G. H., Austin, E., Thornblade, L., Simpson, L., Ong, T. D., Pan, H., & Flum, D. R. (2017). Improving transitions of care across the spectrum of healthcare delivery: A multidisciplinary approach to understanding variability in outcomes across hospitals and skilled nursing facilities. The American Journal of Surgery, 213(5), 910-914.

Ulin, K., Olsson, L. E., Wolf, A., & Ekman, I. (2016). Person-centered care–An approach that improves the discharge process. European Journal of Cardiovascular Nursing, 15(3), e19-e26.

Stelfox, H. T., Lane, D., Boyd, J. M., Taylor, S., Perrier, L., Straus, S., & Zuege, D. J. (2015). A scoping review of patient discharge from i

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Grand Canyon University’s RN to BSN program meets the requirements for clinical competencies as defined by the CCNE and AACN by utilizing non-traditional experiences for practicing nurses. 
These encounters take the form of direct and indirect care experiences in which licensed nursing students learn within the context of their hospital organization, specific care discipline, and local communities.
You will choose program, quality improvement initiative, or other project from your workplace for this assignment. 
Assume you are presenting this program to the board for funding approval. 
Write an 

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