Category: Hospital

Accreditation compliance is an essential topic in contemporary healthcare management since it is crucial for organizations to continue operating and providing high-quality medical services to populations. To facilitate compliance, managers should evaluate the status of their institutions regularly and make corrections to make the accreditation process easier and avoid issues. The Joint Commission is an excellent resource for organizations wishing to improve and maintain compliance since they publish relevant documentation that can be used for self-assessments and compliance checks. The present paper will seek to evaluate the current compliance status of the Nightingale Community Hospital, examine negative trends, and develop a plan for improving staffing levels that would help the organization to meet the required standards.

Current Compliance Status

The eighteen standards of the Joint Commission that apply to the case are

• Accreditation Participation Requirements  Compliant, as the medical institution, timely submitted the required data, provided accurate information throughout the accreditation process, and allowed the Joint Commission to use the reports from publicly recognized organizations.
• Emergency Management  Compliant due to the available Emergency Operations Plan containing the communicative strategy and managing the resources and assets, as well as the safety and security policies in the case of an emergency.
• Environment of Care  Non-compliant due to the insufficient adherence to the safety standards, which was proven by the smoke wall penetrations on the 1^st and the 4^th floors and inappropriate life safety measures testing.
• Human Resources  Compliant. The audit has shown that the hospital defined and verified staff qualifications, hence, determining the way and the manner the medical personnel functioned within the organization.
• Infection Control  Compliant, as the institution has proven its responsibility in identifying the risks of transmitting infections, as well as providing the experienced employees and the needed resources to maintain the standards of the infection prevention and control program.
• Information Management- Non-compliant, as the audit has shown that the progress and nursing notes, as well as physician orders, contained inappropriate and not standardized abbreviations, which could, subsequently, lead to misinterpreting the information provided.
• Leadership- Non-compliant; the lack of administering control resulted in the inappropriateness of documenting the necessary information, thus, leading to excessive workload. Non-compliance with the leadership standard showed the importance of restaffing in the medical institution.
• Life Safety- Non-compliant. Observations during the PPR rounds have revealed the issues concerning life security. These include clutters in hallways and inadequate fire drill processes, with their frequency not meeting the standards of life safety for an organization providing people with medical services.
• Medical Staff- Non-compliant, as the summary of the ongoing data collected to evaluate the medical staffs competence does not meet the standards of the OPPE policy.
• Medication Management- Non-compliant proven by the inadequate processes of following the range order and range dose policies, as well as by the presence of unlabeled medical equipment.
• Nursing  Non-compliant. Lack of nursing staff and, subsequently, the excessive workload, as well as the insufficient nurse-to-patient ratio, lead to ineffective providing the patients with medical services.
• Performance Improvement  Compliant because the data intended to control the organizations performance is collected and thoroughly analyzed.
• Provision of Care  Non-compliant, the absence of the day of Procedure Reassessment has been found in numerous cases throughout the auditing process.
• Record of Care  Non-compliant, as the chart reviews during the PPR rounds and the PI audit, displayed that verbal orders were not authenticated within 48 hours.
• Rights and Responsibilities  Compliant, proven by the fact that patients rights are respected, protected, and promoted.
• National Patient Safety Goals  Non-compliant, as the observed unlabeled basins together with the prelabeled syringes in cataract packs from external suppliers do not correspond to the NPSG policy.
• Transplant Safety  Compliant due to the fact that the hospital strictly adheres to the policies and procedures for safe organ and tissue donation, procurement, and transplantation.
• Waived Testing  Compliant. The established and approved policies for waived tests allow the medical organization to meet the waived testing standards.

The aspects of the facility that comply with the Joint Commission standards are emergency management, human resources, performance improvement, rights and responsibilities, transplant safety, and waived testing. The rest of the areas show some evidence of non-compliance, which should be addressed as part of the quality improvement initiative.

Trends

The first trend evident is the uneven application of care standards, which affects the organizations adherence to standards of records of care, provision of care, medication management, and environment of care. For example, the internal assessment has identified breaches in the use of unacceptable abbreviations and the authentication of verbal orders. Additionally, nurses did not follow range order policy and failed to record the day of procedure reassessment in case documentation as required. Failure to enhance compliance in these areas can lead to difficulties with accreditation. Furthermore, these problems could contribute to the incidence of medical errors, wrong patient or wrong site treatments, and other related issues that threaten patient safety and decrease the overall quality of care provided in the hospital. Thus, the organization should address these trends promptly to avoid negative consequences.

Another trend that was found during the investigation is problems with nursing practice and management. For example, the OPPE process did not meet relevant standards, and nurses failed to maintain consistent documentation due to being too busy. The latter fact suggests that the workload of nurses is too high, preventing them from following process requirements and standards correctly. This can also be connected to the issues relating to information management, treatment, and environment of care. For example, clutter in hallways could be due to nurses being overworked and busy with patients. Similarly, the lack of adherence to documentation standards and record-making procedures could also be linked to a high workload. The fact that nurses claim to forget some of the requirements due to their workload also indicates that there might be issues with staffing levels. If the organization does not have enough nurses per patient, this could cause further problems, such as decreased patient safety and satisfaction. This possibility necessitates a further inquiry into nurse staffing levels.

The third trend discovered as part of the assessment was that some aspects of the environment did not meet safety standards, thus threatening compliance with emergency management, life safety, and environment of care standards. For example, smoke wall penetrations were reported in various units, appropriate ILSM was not initiated during three construction projects, and the fire drill process was inaccurate. In case of an emergency, these problems can pose a threat to the safety of patients and care providers operating in the institution. Therefore, the organization should make sure that all relevant safety standards and regulations are addressed as part of its quality improvement processes. This will help to avoid issues related to accreditation while also protecting the health and safety of workers and patients who are being treated in the facility.

Overall, there are some organizational processes and practice areas that lack compliance with critical standards established by the Joint Commission. Some of the problems identified as part of the review could be connected to one another, such as the issues relating to misdocumentation and nurses workload. Other problems, however, require the specific attention of responsible persons as they relate to maintenance and emergency management. Fixing the issues identified in the review is essential to ensure the organizations compliance with all eighteen accreditation standards.

Staffing Patterns

For the organization to improve on some of the aspects identified in the previous section, it is essential to evaluate current staffing patterns. The report on staffing effectiveness defines two key groups of indicators used in the hospital to assess staffing: clinical indicators and human resource indicators. The clinical indicators vary depending on the unit, but human resource indicators are the same throughout the hospital and include nursing care hours and overtime. The use of these indicators is justified by the impact that nurse staffing levels have on patient safety and clinical outcomes (Kim, Kim, Park, & Lee, 2019; Needleman et al., 2002; Spetz, Donaldson, Aydin, & Brown, 2008). Therefore, the practices related to the organizations assessment of staffing patterns are correct.

The data provided by the hospital reveal various relationships between nurse hours and clinical indicators. In Oncology, the linear graph shows a slow increase in the number of falls that matches a decrease in nursing care hours over the same time. Similarly, the rate of pressure ulcers is negatively correlated with nursing care hours per day, as indicated by the graphs. In 4-East, the overall trends are the opposite, with falls and pressure ulcer rates increasing along with nursing care hours. This could be due to various factors, such as nurses burnout, lower qualifications, or decreased experience, as well as because of patient population characteristics, including age and severity of illness. Finally, the Intensive Care Unit showed no correlation between nursing care hours and falls or ventilator-associated pneumonia. Based on the results of the assessment, it is important to address staffing levels in Oncology, as this would help to improve patient outcomes and reduce the incidence of falls and pressure ulcers.

Staffing Plan

Addressing the issue of falls in the hospital is critical because they threaten patient health and treatment outcomes. The injuries that patients suffer as a result of falls can prolong their hospital stay, increase medical expenses, and lead to legal consequences for the institution (King, Pecanac, Krupp, Liebzeit, & Mahoney, 2018; Slade, Carey, Hill, & Morris, 2017). Hence, it is essential to support a meaningful improvement in staffing levels that would result in falls prevention.

The main nursing specialization that would be of interest in the present case is Certified Nursing Assistants. CNAs work more closely with patients than other nursing specialties while also being able to perform a wide array of duties that could relieve the workload of Registered Nurses and other care personnel. By seeking patients several times daily and helping them with various tasks, CNAs can contribute to the prevention of falls by assisting with movement or removing clutter in patient wards. Thus, it is likely that hiring more CNAs will help to reduce fall rates in the hospital.

Table 1. Proposed staffing chart.

The proposed staffing chart to help in solving the falls issue can be found in Table 1. Based on this chart, the number of registered nurses would be sufficient to provide patients with key medical services. At the same time, LPNs will be able to support the units operations by performing supplementary tasks, and CNAs will always be available to assist patients to minimize fall risk. The support of CNAs is particularly important at night since patients might need assistance moving around in the dark, which is why more CNAs are required during this time than other nurses. It is anticipated that the proposed staffing plan will help the hospital to improve patient outcomes and reduce patient safety risks.

Conclusion

Overall, the review of the case has helped to identify some gaps with respect to standard compliance. Specifically, the negative trends included policy non-compliance, staff issues, and environmental safety problems. These can have a negative effect on the organization, its patients, and accreditation. Staffing patterns were also analyzed, revealing a correlation between nurse hours and patient falls in one of the units. The proposed staffing plan takes this issue into account, suggesting a way to improve the situation through staffing. Consequently, implementing this plan will help the hospital to address patient safety concerns and improve compliance with accreditation standards.

References

Kim, J., Kim, S., Park, J., & Lee, E. (2019). Multilevel factors influencing falls of patients in hospital: The impact of nurse staffing. Journal of Nursing Management, 27(5), 1011-1019.

King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2018). Impact of fall prevention on nurses and care of fall risk patients. The Gerontologist, 58(2), 331-340.

Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K. (2002). Nurse-staffing levels and the quality of care in hospitals. New England Journal of Medicine, 346(22), 1715-1722.

Slade, S. C., Carey, D. L., Hill, A. M., & Morris, M. E. (2017). Effects of falls prevention interventions on falls outcomes for hospitalised adults: Protocol for a systematic review with meta-analysis. BMJ Open, 7(11), e017864.

Spetz, J., Donaldson, N., Aydin, C., & Brown, D. S. (2008). How many nurses per patient? Measurements of nurse staffing in health services research. Health Services Research, 43(5p1), 1674-1692.

Introduction

Performance outcomes primarily reflect the effect of hospital services on patient experience areas, clinical processes, and financial viability. The measures indicate the organizations progress made in patient safety and quality care. They also enable a hospital to determine the changes needed to improve employee engagement and performance  finances or customer satisfaction. The management uses outcome measures to identify priority areas for improvement and related drivers to achieve desired performance levels. This paper aims to develop a performance data scorecard and explore ways of improving outcomes that are below national benchmarks as a nurse leader.

Patient Population

The population served are post-op spine and joint (knee and shoulder) surgical patients on the Orthopedic and Spine floor unit at Abbott NorthWestern Hospital (ANWH), Minneapolis, Minnesota. ANWH is a 668-bed teaching hospital founded in 1882 and currently serving over 200,000 post-op patients in Twin Cities and nearby areas (Allina Health, 2020). It is a part of the Allina Health healthcare system and provides varied specialty services, including mental health and addiction treatment, Minneapolis Heart Institute, Orthopedic Institute, and Surgical Services. ANWHs mission is to serve communities through high-quality care, prevention, and restorative health. The population addressed includes patients with post-surgical needs at the unit. The aim is to provide safe, quality care that reflects empathy, respect, and dignity.

Outcome Measures

Necessary Processes

Performance

Effective initiatives to reduce readmissions after a knee or shoulder surgery will be help drive the units performance outcome. As a nurse leader, the first necessary processes for achieving this goal is a root-cause analysis to identify risk factors for readmitting patients at the facility based on hospital data. Subsequent collaboration with facility management will ensure a stronger policy to address those predisposing variables, including medical comorbidities (diabetes and obesity), patient age, type of procedure, pain, and infection. These issues account for a majority of post-surgical readmissions and must be minimized.

The necessary process is creating new protocols for better post-operative pain and infection control. Again, partnership with specialists  orthopedic surgeons and neurosurgeons  can help implement measures to minimize the risk. Physician buy-in for the initiatives will be gained by revealing the cost data related to post-op readmissions. Subsequently, readmission rates will be captured to track performance improvements due to the change. Readmissions are losses under the pay-for-performance model, and therefore, root-cause analysis and new protocols addressing risk factors are necessary processes for the performance goal. Finally, the results will be revealed to hospital management and third-party payers to enhance support for the initiatives.

Quality

The goal for this indicator is to decrease surgical-site infection rates, improving the inpatient experience. The nurse leader will include baseline screening as a pre-op routine or intervention to identify patients with a history of difficult-to-treat infections, such as methicillin-resistant Staphylococcus aureus. Positive cases will be referred to specialized preoperative treatment before surgery. Additionally, the pre-op admitting nurse will be required to care for the patient throughout the inpatient stay. Minimizing the number of contacts through this isolated treatment fashion can dramatically reduce infection. Hand hygiene protocols and stricter policies at the post-op unit will be necessary for achieving the quality goal. Patient/family education on wound care, including dressing and measures to prevent infection of the surgical site and post-operative pain, will also be implemented. The goal is to foster the patients experience and self-care capacity upon discharge.

Patient Safety

The goal is to reduce the risk of post-op pressure injuries (PIs) and fall rates. The nurse leader will take several interventions to achieve this outcome. Safety protocols for positioning patients or the flip process will be adopted to reduce friction or skin injury during turning. A minimum of two nurses will be involved in patient transfer and changing position in bed to avoid PIs. Additionally, prescribed exercises for post-op patients, including walking, will involve an assistive device or a physical therapist to reduce the fall risk. Based on assessed needs, a rehabilitation nurse will make arrangements for follow-up upon discharge from the unit.

Employee Engagement

Ensuring that nurses are optimally engaged in their roles will enhance organizational outcomes. The nurse leader will undertake three actions to drive employee engagement at the post-surgical unit. The first intervention is setting measurable goals that reflect individual performance metrics. Goals for HICAHPS scores will indicate to a nurse his or her contribution to the patient experience. As a result, the staff will feel motivated and obligated to meet them. Another intervention is investing in the professional growth and development of employees. Individual goals based on specific practice roles at the unit will help develop the required skills. Lastly, a reward system will be adopted to appreciate and motivate high performers in quality, safety, and patient experience.

Additional Indicators

The complexity of healthcare demands the use of many indicators to measure processes and identify opportunities for advancement. An additional indicator that will help drive outcomes in the scorecard is the staffing level. The high risk of re-injury during positioning and exercise will require well-staffed multidisciplinary teams. The nurse leader will need to monitor staffing regularly to ensure that the safety protocols for the flip process are implemented to reduce PIs and falls (a safety outcome measure) at the unit. Another indicator is patient-rated pain, which could indicate post-operative complications. Monitoring pain is important for the nurse leader to implement patient/family-centered care to improve inpatient experience (a quality outcome measure) at the unit.

Advantages

A balanced scorecard (BSC) is an innovative tool for improving an organizations competitive position. In healthcare, the BSCs customer-centric approach can enable hospitals to create value for patients, staff, and payers. A key advantage of this tool is that it gives structure to organizational strategy (Mehralian et al., 2018). It aligns the entity with a customer-focused approach to the market, supporting adjustment to regulatory and industry changes and measuring specific metrics. Fot instance, monitoring and evaluation of employee performance for reward and recognition can be accomplished with this tool. The alignment of departments and divisions is another advantage of BSC. It supports communication and collaboration in monitoring and assessing the strategic goals of the organization.

A third potential benefit of using the BSC tool is that it helps employees understand how individual goals contribute to organizational strategy. By assigning accountability to each individual at every level, BSC enhances communication quality and reduces the lead time to care delivery, improving the inpatient experience (Soysa et al., 2019). Another advantage is that it supports continual measurement and evaluation of initiatives against industry standards. Thus, it allows managers to quantify short-term financial gains in order to create long-term value for clients.

Current Trends

Employee engagement is critical to creating a motivated and productive workforce to drive organizational goals. Organizations must employ effective strategies to improve morale in the workplace, job satisfaction, and retention in the current competitive environment. A major trend in the healthcare industry is the use of attractive health benefits. Flexible, incentive-based wellness plans are provided to help employees with chronic illnesses attain a better health status (Gibson et al., 2017). For example, most employers may offer onsite behavioral and lifestyle programs, including weight loss and smoking cessation programs based on staff characteristics  disease risk and healthcare spending. High rates of engagement are achieved when employees can develop individual health goals, and incentive points are awarded (Gibson et al., 2017). The health promotion initiatives are meant to boost staff morale, enhance productivity, and reduce healthcare spending.

Given the complex and evolving nature of healthcare, a contemporary trend is availing opportunities for educational enhancements. Nurses require lifelong learning to gain new knowledge in order to practice competently. According to Gibson et al. (2017), employers facilitate or finance educational opportunities for staff, such as on-the-job training, specialty certification, conferences, workshops, and participation in quality committees as an engagement strategy. The goal is to equip employees with up-to-date clinical and leadership skills, which makes them more satisfied and confident in their roles, reducing the intention to leave the organization. Profit-sharing through bonuses and rewards for those meeting specified performance standards is an extrinsic engagement strategy. In this case, quality indicators are used to recognize and celebrate exceptional individuals.

Relationship

Employee engagement is a significant driver of quality outcomes in hospitals. Highly engaged teams involved in the Orthopedic and Spine unit will enhance patient care by participating in the quality and patient safety committee. Their active participation in the interdisciplinary group will ensure the alignment of clinical activities with institutional priorities and standards (Carthon et al., 2019). Consistent surveillance involving the employees will ensure early detection and treatment of complications or surgical site infections in post-op patients.

Additionally, the nurses educational enhancement through professional workshops and on-the-job training will enable staff to practice efficiently and effectively. As a result, patient outcomes, such as reduced fall rate and PIs and lower readmissions, will be obtained at the unit. For example, providing competent care will lead to fewer medical errors and wound infections, which will enhance the inpatient experience, contributing to more favorable ratings of the facility. Additionally, a patient safety culture will be created at the unit due to nurse-led interventions related to employee engagement in lifelong learning.

Current Tools

Employee job satisfaction can predict process, quality, and patient outcomes. ANWH does not use any tools to measure employee engagement internally, but the Allina health engagement surveys completed annually rated the hospital at 59% (Gesensway, 2016). Several instruments for measuring how well the staff is engaged or disengaged are available. A suggested tool for ANWH is the National Database of Nursing Quality Indicators (NDNQI) that collects data for 14 different outcome measures (Dempsey & Reilly, 2016). It measures quality indicators, such as fall rates and PIs, and staff mix. The RN satisfaction survey is a critical component of the NDNQI that helps nurse leaders to assess the nursing environment to promote their engagement and retention efforts (Dempsey & Reilly, 2016). Hospital data collected in each quarter are submitted electronically to the NDNQI database. Quality checks are conducted, and quarterly reports are generated for a facility desegregated at the unit level, allowing employers to identify performance and satisfaction levels. Thus, the RN satisfaction survey can provide the nurse leader with adequate data for employee engagement efforts.

Another viable engagement tool is the Great Places to Work Survey  a confidential web-based solution that can be used to measure corporate culture and staff morale levels. Using this tool, employers can create customized surveys and obtain feedback by unit, department, or site (Great Places to Work Institute, 2020). It captures and analyzes employee comments, empowering managers to make data-driven decisions. Therefore, this tool can provide the nurse leader with adequate data on employee engagement efforts at the Orthopedic and Spine unit.

Improving Employee Engagement

A plan to improve employee engagement based on the performance data scorecard developed in section A2 includes goals, strategies, evaluation, and timelines.

Goals

• To increase the number of Medical-Surgical Nursing certified RNs.
• To raise the population of orthopedic-certified nurses at the unit.

Strategies

• Provide a flexible shift-specific education or training for eligible nurses at the unit.
• Consulting staff nurses and supporting them meet personal development goals.

Evaluation

• Quarterly turnover at the unit compared to the overall organizational rates.
• The number of staff completing the training modules at the unit.
• Participant surveys to measure nurse satisfaction with the education plan.

Timelines.

Leadership Best Practices

Ensuring that workers feel supported and valued is an important human resource function of leaders. Available opportunities to enhance employee engagement range from wellness programs to recognition. Fostering trust and supporting teamwork are best practices in this area (Dempsey & Reilly, 2016). Accountability and empowerment through career growth opportunities create trust-based relationships based on respect. Multidisciplinary teams that work collaboratively to meet patient needs exhibit higher engagement levels than individuals operating alone. Other best practices include promoting communication and transparency of information or data on quality and acknowledging high performers through tangible rewards and genuine praises (Dempsey & Reilly, 2016). Supporting a proper work/life balance through flexible schedules is also critical in creating a highly engaged workforce to drive the outcome measures set for the organization, department, or unit.

References

Allina Health. (2020).About us. Web.

Carthon, J. M. B., Hatfield, L., Plover, C., Dierkes, A., Davis, L., Hedgeland, T., Sanders, A.

M., Visco, F., Holland, S., Ballinghoff, J., Del Guidice, M., & Aiken, L. H. (2019). Association of nurse Engagement and nurse staffing on patient safety.Journal of nursing care quality, 34(1), 4046. Web.

Dempsey, C., & Reilly, B. (2016). Nurse engagement: What are the contributing factors for success?OJIN: The Online Journal of Issues in Nursing, 21(1), 28. Web.

Gesensway, D. (2016). Building camaraderie: How social connectedness in hospitalist groups pays off. TodaysHospitalist. Web.

Gibson, T. B., Maclean, J. R., Carls, G. S., Moore, B. J., Ehrlich, E. D., Fener, V., Goldberg, J., Mechanic, E., & Baigel, C. (2017). Engagement in health and wellness: An online incentive-based program.Preventive Medicine Reports, 7, 8690. Web.

Great Places to Work Institute. (2020). Employee surveys you can trust. Web.

Mehralian, G., Nazari, J. A., & Ghasemzadeh, P. (2018). The effects of knowledge creation process on organizational performance using the BSC approach: The mediating role of intellectual capital.Journal of Knowledge Management, 22(4), 802823. Web.

Soysa, I. B., Jayamaha, N. P., & Grigg, N. P. (2019). Validating the balanced scorecard framework for nonprofit organisations: An empirical study involving Australasian healthcare.Total Quality Management & Business Excellence, 30(9-10), 10051025. Web.

Introduction

One thing that most prosperous organizations have in common is a vibrant culture. Regarding cultural priorities, there is general agreement that the organization and its objectives, rather than particular people, should take precedence. Nursing practice intervention is the particular procedure and action taken to help implement a patients care plan. It involves nurses utilizing their expertise and critical thinking abilities to choose the most appropriate care plan for the patient, given their medical requirements.

The Challenges Affecting the Implementation of the Nursing Practice Intervention

EBP gives nurses a way to apply critically evaluated and scientifically validated data when providing high-quality healthcare services to patients. Inadequate time to search and read through research articles at work is the primary challenge affecting the adoption of EBP at Memorial Regional Hospital in the Hollywood, FL area. Nurses are under more pressure to apply compelling evidence to specific patient scenarios as a consequence of the EBP implementation by searching for relevant evidence, utilizing clinical decision-making, and taking patients values and resources into consideration (Alkhatib et al., 2021). Other challenges of implementing EBP include unverified proof, a lack of training and expertise, poor time management, and poor motivation.

A Strategic Plan for the Implementation of Evidence-Based Practice

Helping to improve nurses perceptions of EBP can help them execute it more effectively. Belief is defined as the perception of the importance and advantages of EBP as well as the perceived self-assurance in ones EBP understanding and expertise. EBP is used more often by nurses who have a strong belief in it compared to those who have a weaker belief (Abu-Baker et al., 2021). Offering EBP training programs is a crucial step in improving EBP implementation. Accordingly, it is crucial to include EBP in the nursing curriculum to advance nursing science and improve nursing care for aspiring nurses. When it comes to hiring, managers may include EBP training among the requirements for employment.

Conclusion

In conclusion, EBP is a very crucial nursing practice that every nurse should be able to carry out with ease. Using evidence-based practice is crucial for nurses everywhere. Having a strong opinion of EBP and the advantages it offers does not necessarily guarantee that the practice will be used frequently. However, offering EBP training is a crucial step in improving EBP implementation. Teaching nursing and medical students the value of EBP information and how to access, evaluate, and properly apply it when necessary is equally crucial.

References

Abu-Baker, N. N., AbuAlrub, S., Obeidat, R. F., & Assmairan, K. (2021). Evidence-based practice beliefs and implementations: A cross-sectional study among undergraduate nursing students. BMC Nursing, 20(1), 1-8. DOI: 10.1186/s12912-020-00522-x

Alkhatib, A. H., Ibrahim, E. A., Ameenuddin, M., & Ibrahim, I. A. (2021). Nurses knowledge, perception, and attitude towards evidence-based practice at King Abdullah Medical City Saudi Arabia. American Journal of Nursing Research, 9(1), 1-7. DOI: 10.12691/ajnr-9-1-1

This essay discusses the key distinctions between PPO and HMO health plans. HMOs are a type of managed care organization that offer healthcare services to members using a network of participating providers. Usually, HMOs will require members to pick a primary care physician (PCP) from the organizations network of providers (Barnett et al., 2021). The PCP will be responsible for coordinating the members health care and making referrals to specialists within the HMOs network as needed.

A PPO is a type of managed care organization that does not require members to select a primary care physician. Instead, members can see any provider within the PPOs network without a referral. PPOs usually have higher premiums than HMOs, but offer more flexibility in terms of which providers members can see (Barnett et al., 2021). HMOs typically have narrower networks of providers and require referrals for specialist care.

Another key difference is that HMOs require members to receive care from in-network providers, while PPOs typically allow members to see out-of-network providers which can include higher out-of-pocket costs for doing so. HMOs use gatekeepers such as primary care physicians to help control costs by managing utilization (Bai & Anderson, 2018). In contrast, PPOs do not use gatekeepers and instead allow members to see any provider within their network.

Finally, HMOs and PPOs differ in how they handle prescription drugs. HMOs often require that members use specific pharmacies and mail-order services for their prescriptions. They may have their formularies or lists of approved drugs. PPOs do not usually have these restrictions and members can use any pharmacy they want. Besides, HMO plans require a person to receive care from doctors within the HMO network and will not cover out-of-network care except in an emergency (Barnett et al., 2021). A referral from the primary care doctor to see a specialist in an HMO coverage setting.

In conclusion, each health care plan has its unique advantages and shortcomings that influence the choices people make while considering a health coverage plan. Some people may prefer the lower premiums and greater control over utilization that an HMO offers, while others may prefer the flexibility and freedom to see any provider that a PPO offers. Ultimately, it is important to evaluate both types of plans before making a decision.

References

Bai, G., & Anderson, G. F. (2018). Market power: Price variation among commercial insurers for hospital services.Health Affairs, 37(10), 16151622.

Barnett, M. L., Bitton, A., Souza, J., & Landon, B. E. (2021). Trends in outpatient care for Medicare beneficiaries and implications for primary care, 2000 to 2019.Annals of Internal Medicine, 174(12), 16581665.

Mission Statement

The primary mission of the rural hospital is to provide individuals with chronic mental illness, including those with low social status, with quality medical care and rehabilitation services. A secondary mission of the hospital is to improve the lives of the whole community through competent organization and timely psychological, social, and adaptive support. We are convinced that social status is not an obstacle to receiving quality medical care.

Explanation

Social service organizations critically need a strong and powerful mission statement. The development of the statement and it was influenced by the Saint Rock Haiti Foundations, which stated primary and secondary missions (Social service mission statements, n.d.). The view of Loudoun Habitat For Humanity was an inspiring example and pointed out that the personal opinion of the company is critical to the mission statement (Social service mission statements, n.d.). It was helpful to read about how to shape the mission statement: for example, the advice about simple words (Wallace, 2004). Simplicity attracts people by letting them know the sincerity of the organizations intentions. The mission was built on the hospitals goal of providing care based on equality, respect, and support (McNamara, 2022). Everyone is worthy of help, and for those with chronic mental illness, it is essential to respond promptly to changes in their condition. The hospital, in the example, has the resources to provide community outreach programs, and the mission results from a deliberate decision to empower staff. It will bring the community together, improve social well-being and make the population healthier.

References

McNamara, C. (2022). Basics of developing mission, vision and values statements. Management Library. Web.

Social service mission statements. (n.d.). Mission Statements. Web.

Wallace, L. K. (2004). Writing a mission statement. In Libraries, mission & marketing: Writing mission statements that work. American Library Association.

St. James Hospital is a small commercial geriatric hospital serving elderly patients with chronic illness, injury, and aging symptoms. The hospital does not have an oncology and psychiatric department. The hospital has 80 beds and a small staff of nurses, physicians, surgeons, anesthesiologists, and other specialists who are required to serve the patients. However, while there are enough doctors to perform operations and prescribe treatments, the hospital faces a shortage of nurses who can care for patients. This disadvantage is felt especially acutely, since elderly patients are often unable to move independently and take care of themselves; thus, they need constant care and support.

The main problem of the hospital is the re-admission of patients less than 30 days after discharge. According to the Hospital Readmission Reduction Program, frequent patient re-admissions are a reason for funding cuts, which in the small St. James hospitals case leads to a lack of funds and an even greater shortage of staff. However, patients and their caregivers education, as well as follow-up calls and nursing visits to patients after discharge, reduce the likelihood of re-admission by 50% (Vernon et al., 2019; Coffey et al., 2019). Follow-up calls and checks allow nurses to propose changes in treatment on time that prevent health deterioration.

Hence, the main goal for St. James is to reduce re-admission by 50%, which includes such objectives as improving patient education and creating a system and schedule for nurses follow-up call patients and review of their health condition.

The goal of reducing patient re-admission is long-term as it takes time to implement and evaluate results. For this reason, the deadline for a 50% reduction in patient re-administration within 30 days after discharge is twelve months. In addition, the hospital will conduct interim assessments after six and nine months of project implementation start. Developing of nurses follow-up call system should take no more than one month, as well as scheduling for additional patient education. This period is necessary to agree and coordinate the working hours of nurses and other staff and determine the payment system for extra hours of work. However, a 20% improvement in patient education will be achieved in 3 months. The evaluation will be carried out by interviewing patients upon admission and after discharge.

This project requires almost no material costs, but a significant part of the budget must be spent on paying additional working hours for nurses. Some of the extra time will be spent on calls and some on patient education. In addition, funds could be spent on hiring one or two staff members who provide education to patients, since this decision can reduce other nurses working hours. Thus, the project will be built in-house, since all the goals set are within the competence of the nurses, although they are limited in time.

This approach will also reduce costs, which is necessary with a limited budget of St. James Hospital. Responsible for organizing the project will be Mr. Coal, Senior Healthcare Manager, who will coordinate physicians and nurses, identify means of communication with discharged patients, assess progress, and decide on recruiting additional staff. Ms. Violet, Senior Nurse Manager, will be responsible for scheduling and organizing nurses. Other nurses will be responsible for patient care and their direct responsibilities. Thus, all staff will be involved in implementing the project, since coordination and time planning are key for a small hospital with limited resources.

References

Coffey, A., Leahy-Warren, P., Savage, E., Hegarty, J., Cornally, N., Day, M. R., Sahm, L., OConnor, K., ODoherty, J., Liew, A., Sezgin, D., & OCaoimh, R. (2019). Interventions to promote early discharge and avoid inappropriate hospital (re)admission: A systematic review. International Journal of Environmental Eesearch and Public Health, 16(14), 2457. Web.

Vernon, D., Brown, J. E., Griffiths, E., Nevill, A. M., & Pinkney, M. (2019). Reducing readmission rates through a discharge follow-up service. Future Healthcare Journal, 6(2), 114117. Web.

The case of Anywhere Hospitals HIM department focuses on the use of functions in EHR, which makes the physicians work easier and increases their productivity. The case identified that overuse of the copy and paste function could result in mistakes in patients health records. The issue presents a common problem in the healthcare system, and there are different opinions on the topic, with some prioritizing the efficiency of the function.

Considering the requirements or prohibitions of using the function in EHR, the American Health Information Management Association (AHIMA) points to the possibility of errors in documentation with misuse of the function. Thus, while the function is not prohibited, its use is discouraged by AHIMAs regulatory requirements because it can result in redundant, erroneous, and/or incomprehensible health record documentation (as cited in Boyle, 2018). The current EHR system was implemented in Anywhere Hospital six months ago. While the system is designed to assist physicians and make their work easier, the current functionality detracts from the quality of the departments documentation. Furthermore, the systems copy and paste function negatively influence physicians attention to documentation, giving the process a routine character. Thus, by preferring to complete the documentation through copying and pasting information, the system does not provide additional assistance to specialists and imposes risks to the integrity of health records documentation.

Furthermore, there are different alternatives for the copy and paste function, which also increases the documentations efficiency but utilizes better organizational processes. For example, some companies offer software solutions that allow the implementation of voice commands for patient records entry in EHR. The solution addresses the problem of the routine nature of filling the data and increases physicians attention, improving documentation accuracy. Lastly, considering the standards that Anywhere Hospitals facility can implement in organizational documentation, the leadership can provide technical assistance to physicians in the documentation process. Alternatively, the leadership can require physicians to indicate the source of the copied data in patients records.

Reference

Boyle, E. L. (2018). Copying and pasting in EHRs. DukeHealth.

Introduction

Pressure Ulcers (PU) or bed ulcers is a significant issue affecting nursing care that causes 60,000 deaths out of 2.5 million patients in hospitalization globally. PUs also contribute to the hiking medical care cost and poor patient outcomes. PU essentially interferes with patients quality of life and can be prevented with appropriate nursing care. King Fahad Hospital in Riyadh, Saudi Arabia, is one of the largest growing complexes in the Middle East, with a capacity of 1200 beds incentivizing appropriate care to reduce incidences of bed ulcers. The National Pressure Ulcer Advisory Panel (NPUAP) gives PU specific recommendations and guidelines that health care workers can leverage in PU management. NPUAP also provides staging procedures to determine the severity of PU. Symptoms of PU are partial skin discoloration, itchiness, swelling, and unusual skin texture. PU is a hospital-acquired condition affecting long-term hospitalized patients and influences the quality of care whose management largely relies on nursing practice.

PU Affecting Nursing Practice And Nursing Administration at King Fahad Hospital

A pressure ulcer is a skin and underlying tissue condition associated with extended hospitalization. Critically ill patients and children with less mobility are most likely affected by PU. PU is a predictable condition that can be averted by improving nursing care in health care facilities. The risk factors for PU are advanced age, stillness, incontinence, neurological complications, multiple commodities, and poor nutrition. King Fahad Hospital has set up policies aimed at curtailing incidences of PU with a critical focus on health workers training. Many patients in the vulnerable categories are confined to hospital beds with the inability to move the body. High-risk patients also have a fragile immune system and skin that can easily be affected. Without proper treatment and care, PU is pernicious, developing deep in the skin and potentially resulting in death.

Reasons Why PU Exist at King Fahad Hospital

Being the largest medical facility in the Middle East, King Fahad Hospital admits patients with the most challenging conditions most vulnerable to PU. The high number of patients admission also makes it challenging to monitor individual patients affairs. According to Delmore et al. (2019), lack of education programs to train health workers on UP prevention is the primary cause of the challenge. The high patient burden utilize holistic assessment to determine patients vulnerable to PU in the prevention procedure. Lack of fragmented care potentially increases the risk of contaminating bed ulcers at King Fahad Hospital. In facilities with many admitted patients pose a challenging task of identifying patients at high risk of contaminating PU.

Uncensored patient hygiene, health, and nutrition also contribute to PU at King Fahad Hospital. Eating non-balanced food and poor fluid intake magnify the risk of PU. A sufficient supply of nutrients and water is needed to ensure proper blood flow for healthy skin. Insufficient fluid intake limits blood circulation elemental for skin replenishment. Bad hygiene makes patients more prone to bedsores and increases the infection severity on contaminated patients. High ill patients who need intensive care, if not adequately cleaned, build up sweat and dirt that poses a significant danger to skin health. Substandard patient administration, hygiene, and health are why PU exists at King Fahad Hospital.

Impacts of PU On Key Performance Indicators (KPIs)

The Key KPIs at King Fahad Hospital are patients outcomes, satisfaction, admission, and readmission rate. High rates of PU cause patient dissatisfaction, poor patient outcome, and low admission and readmission rates. Quality assurance in health care to guarantee patient safety is a significant factor affecting the KPIs. High cases of PU significantly involve the quality of preventive care provided, and they are often used to measure the quality of nursing care in a hospital (Delmore et al., 2019). Improving patient care to control bed ulcers at King Fahad Hospital will positively impact patient satisfaction, patient outcome, admission, and readmission rates.

Quality Model Of Solving PU

The most appropriate model of curtailing PU is through the education and training of nurses. A survey on staff knowledge in PU prevention and management at King Fahad Hospital indicated a deficiency in PU awareness and bad attitudes among health care practitioners (Kaddourah et al., 2016). Categorizing long-stay patients according to their care needs, age, and illness are elemental for intensive PU care. Detailed patient information is essential to identify at-risk persons and implement specific intervention measures. King Fahad hospital should make education and training intervention programs for health care providers to limit PU incidence. The educational programs should be engineered to influence PU risk identification, response, and behavior change among healthcare professionals.

How Health Workers Training Program Help Manage PU

The education and training program should pivot on preventive measures and management of PU. Improving patient mobility by turning them and changing their resting position are some of the preventative methods of PU. Nurses at King Fahad hospital should do regular follow-ups of patient repositioning and ensure the head elevation of the patient bed is safe (Kadourah et al., 2016). Oral nutritional supplements such as protein and vitamin to improve diet is also necessary to minimize the risk of PU. Incidences of the ulcers should also be recorded with high precision, such as size, location, and stage of development (Delmore et al., 2019). Nurses can record the progress of PU infection and response to treatment to help prevent the result of the wound to tertiary stages. Maintaining good hygiene standards is a critical PU management practice to minimize the risk of contamination. The overall staff should overlook and contribute to their corresponding duties to improve the quality of care provided. Managing PU is a multi-disciplinary task that requires training and cooperation between the general staff at King Fahad Hospital.

Data Collected Continuously To Monitor Improvement In Quality Of Healthcare Delivered

Patient satisfaction, outcome, admission, and readmission rate are the KPIs that should be evaluated continuously to monitor the improvement of healthcare delivery. Since there is no established tool for evaluating patient satisfaction, interviews, and questionnaires on discharged patients can monitor patient satisfaction. Patient outcome is integral to surveil the progress in PU cases reported and the severity implicated (Delmore et al., 2019). With continuous improvement in the quality of nursing care, the admission and readmission rates should improve. Collecting data and analyzing data relevant to PU solution will empower King Fahad Hospital to improve healthcare service delivery.

Conclusion

A bed ulcer is a skin condition caused by tissue damage due to pressure limiting blood supply on parts of the skin. Hospitalized and wheelchair-mounted patients are the most vulnerable people to PU. Poor nursing practice and administration are the significant attributes of PU at King Fahad Hospital. High PU prevalence affects patient outcome, satisfaction, admission, and readmission rates. Proper training and education of health care practitioners is the ultimate strategy of solving PU at King Fahad. Practices to monitor and enhance patient mobility, hygiene and outcome are critical in PU prevention and management. Individualized assessment of patients during admission also helps identify PU infection risk for better prevention strategies. Data for patient outcome, satisfaction admission, and readmission will continuously be collected and evaluated after strategy implementation to measure progress.

References

Kaddourah, B., Abu-Shaheen, A. K., & Al-Tannir, M. (2016). Knowledge and attitudes of health professionals towards pressure ulcers at a rehabilitation hospital: A cross-sectional study. BMC Nursing, 15(1). Web.

Delmore, B., Deppisch, M., Sylvia, C., Luna-Anderson, C., & Nie, A. M. (2019). Pressure injuries in the pediatric population: a national pressure ulcer advisory panel white paper. Advances in Skin & Wound Care, 32(9), 394-408. Web.

The article Infection Control at Massachusetts General Hospital written by Huckman and Trichakis gives an overview of the Massachusetts General Hospital (MGH) and its fight on controlling infections. The introductory part explains the unfortunate encounters of Benjamin Orcutt, assistant director of admissions at Massachusetts General Hospital (MGH). Orcutt issued a Code Help to alert all hospital departments to the impending bed shortage when operational occupancy for the hospitals inpatient beds reached about 100% (Huckman & Trichakis, 2014). Orcutt notified Dr. Paul Biddinger, head of the Division of Emergency Preparedness and the operational medical director at the Emergency Department (ED) on the issue.

MGH was established in Boston in 1811 and is dedicated to conducting cutting-edge research that covers the whole field of medicine. With a budget of more than $750 million annually, MGH was the largest receiver of money from the National Institutes of Health in 2011 and managed the countrys most extensive hospital-based research program. Additionally, it was a well-known supplier of clinical treatment. MGH managed almost 1.5 million patients in 2011 (Huckman & Trichakis, 2014). MGH Admitting Services would handle the admission of inpatients to the institution and allocate them a bed in a particular ward. One of the four patient access managers (PAMs) managed the accompanying requisition based on the services an inpatient required.

Orcutt and the four PAMs would gather at the beginning of each day to discuss the present bed occupancy and the projected allocation of beds throughout the day based on planned or potential discharges. The operational occupancy of beds across the hospital served as a gauge of Orcutts team efficiency in admitting patients. The MGH administration carefully monitored operational occupancy, and the general hospitals mean patient wait times. The MGH administration supported projects for process improvement that would simplify processes, lessen variability, and standardize practices to increase resource efficiency and service quality.

The techniques utilized to treat patients with present or past colonization or infection underwent numerous modifications because of MGH adopting the CDCs advised approach to contact precautions. An expanding body of research has shown that CP is linked to poorer patient care, involving reduced patient-provider engagement and more avoidable adverse events. The majority of patients receiving care under CP at MGH merely had a history of infection or colonization with methicillin-resistant Staphylococcus aureus (MRSA).

The patients might not have needed CP because they were no more colonized as a result. With the invention of Polymerase Chain Reaction (PCR) used in clinical microbiology by the late 2000s, a change had already started (Huckman & Trichakis, 2014). With the discovery of PCR assays that could be run on nasal samples, this breakthrough in MRSA screening became possible and promised to boost detection sensitivity while drastically cutting processing time to about two hours.

Shenoy and Hooper started reworking MGHs screening procedures for the test program in 2011 when improvements to RICAS were nearly finished, and the PCR device was up and running. Shenoy and Hooper had to find other solutions since, despite their mistakes, they still believed that PCR screening should be implemented in the ED. The first alternative they thought of was to request a new, full-time physician assistant (PA) for the emergency department (ED), who would be in charge of organizing the MRSA inspection in the ED. The second option was to entrust one of the EDs clinical research directors (CRCs) with organizing the screening.

Reference

Huckman, R., & Trichakis, N. (2014). Infection control at Massachusetts General Hospital.Havard Business School, 1-17. Web.

Introduction

Motivational Interviewing (MI) represents an antidote to something intended to fulfill a need. It is mostly a form of good guidance representing modern refinement. The approach can be helpful in behavioral change as it promotes offering guidance and helping people to appreciate what is in it for us (Stephen Rollnick, 2013). It involves using skills to support people to make decisions for themselves instead of only providing solutions to people, which breeds engagement such that the doer understands why an action is being taken.

Discussion

Additionally, MI thrives in a community of practice with different cultural values and an environment that supports easy implementation of change. The professor provides a contrast between two instances in a hospital. In both cases, the services are provided on different riders: Next please and Who would you like to see. The second case emerges better in supporting service delivery since nurses feel less stressed and engage better with the patients (Stephen Rollnick, 2013). The illustration underpins the value of putting systems around people, not people around systems, representing a big and significant cultural shift. While referring to the second case of teen mothers, an interesting observation about MI emerges. MI is seen not as a solution but as a powerful ingredient to drive good practice.

Conclusion

The presentation emphasizes the need to trust people as they know what is best for them. Their ideas can be sourced by structuring a purpose and supportive activity, such as a conversation. The key lesson is to appreciate that MI can be learned through five conceptual stages. The process begins by unlearning a persons clever strategies and other ideas, then slowly implementing a new approach (Stephen Rollnick, 2013). During the process, it is critical to remain bold, brave, and humble, believe that people have answers to their problems, and use the appropriate language to impart change.

Reference

Stephen Rollnick. (2013). [YouTube Video]. In YouTube. Web.