NR 451 Week 3: Capstone Project: Milestone 1: Practice Issue and Evidence Summary Worksheet (graded)

Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes. The authors have presented that the intervention for minimizing readmissions on the healthcare organization is the provision of an effective plan that will help the patients in the transition after discharge. In this regard, the elderly patients are provided with a discharge plan from the time of their admission. The authors deduce that the availability of an early plan for the patients in comparison with the usual care helps in reducing the cases of readmission of the elderly patients. This is attributed to the fact that the there is an improvement in the quality of life of the patients who have had a discharge plan from the time of their admission.

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. The findings indicate that many studies have indicated that an early discharge planning is crucial at the time that the patients are in an acute state for the reduction of readmission. Specifically, the findings are applicable for old patients and are performed by the nurses within the first 24 hours before the patient is discharged. Along these lines, the patient does not get enough information on the ways of managing their condition. The discharged plans that have been identified to be supported by a variety of researchers include the assessment of the needs of the elderly patients while at home. Moreover, the other discharge plans include the provision of education to the patients o the necessary adjustments that could help in reducing the cases or readmission and the transfer of information to the community health provided on the management of the care of the elderly patients. Additionally, the proposal of the follow-up plans is adduced to be of help in reducing the cases of readmission. The results indicate that the reviews indicated that the follow-up method that is identifiable include the use of telephone calls or a mobile phone application that could provide a report on the patient conditions.

Outline evidence-based solutions that you will consider for your project. Due to the intensity of the cases of readmission, the evidence based solution that will be proposed for the project is the education of the patients on the ways of managing their conditions before discharge. Along these lines, the patient should receive care from the nurses from the time of their admission to help in ensuring that there is enough information on the possible challenges that will be faced after their discharge. In addition, the patients should be educated on the effects of readmission on the psychological well-being and the cost of hospitalization. Moreover, the patients are trained on the use of technological devices such as the mobile application that reports the vital signs of the elderly patient or a regular basis. This will help the healthcare providers in monitoring the health of the patient. Discuss any limitations to the studies performed that you believe impacts your ability to utilize the research in your project. One of the limitations of the review is that there are limited study methods for the research topic. This is attributed to the fact that only nine studies have been used. The precision is as well influenced by the sample size and the conclusion made by the researchers may be affected by the fact that there is no heterogeneity. This will have an impact on the utilization of the article since it can be asserted that the issue at hand may not have had enough research studies in the past.  As such, the process of discharge planning may receive a measurable amount of resistance during the implementation.     

NR 451 Week 4: Evaluating Quality Patient Outcomes Discussion 

How can data provide information to evaluate quality patient outcomes? 

The data provided to evaluate quality patient outcomes can be beneficial to see if an intervention and plan of care was adequate and appropriate for that particular patient; reviewing some of the problems that are discussed in our discussion and course such as early hospital readmissions and skin to skin are examples to evaluate if the discharge intervention and planning provided a successful patient outcome that were effective enough, and compared to similar other cases, preventing further complications or even death. 

Give an example of data that can reflect poor quality in care. 

Hospitals and/or facilities use collected data such as early hospital readmissions, deaths, chronic illnesses, cost, and length of stay. Many hospitals are graded and information ratings are public, if I noticed a frequency of readmissions, and deaths, it would make me think, what are they doing, are they caring for the patient or worrying about cost, discharging patient too soon, not listening and communicating effectively can pose big issues and even death, this scares me, and what are they doing for the women that are addicted to drugs or alcohol and having babies that have symptoms and  there is no bonding between mother and baby, are there any resources provided and available to help this mom, so she can have the skin to skin bonding that is needed for a positive outcome. 

“Work groups such as those in the IOM have attempted to define quality of health care in terms of standards. Initially, the IOM defined quality as the “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.  This led to a definition of quality that appeared to be listings of quality indicators, which are expressions of the standards. These standards are not necessarily in terms of the possibilities or conceptual clusters for these indicators. Further, most clusters of quality indicators were and often continue to be comprised of the 5Ds—death, disease, disability, discomfort, and dissatisfaction5—rather than more positive components of quality.” The most recent IOM work to identify the components of quality care for the 21st century is centered on the conceptual components of quality rather than the measured indicators: quality care is safe, effective, patient centered, timely, efficient, and equitable. Thus safety is the foundation upon which all other aspects of quality care are built.” (Mitchell, 2008). 

How can quality improvement be a daily task in patient care? 

After assessing, planning, implementing, and evaluating goals and patient outcomes on a day to day basis to see if patient health is improving and making positive progression by the education and interventions that were put into place are understood and followed as instructed. If the patient has not made any improvements, then the plan and intervention should be reevaluated to make the appropriate adjustments that are needed for a successful outcome. 

“Patient safety is the cornerstone of high-quality health care. Much of the work defining patient safety and practices that prevent harm have focused on negative outcomes of care, such as mortality and morbidity. Nurses are critical to the surveillance and coordination that reduce such adverse outcomes. Much work remains to be done in evaluating the impact of nursing care on positive quality indicators, such as appropriate self-care and other measures of improved health status.’ (Mitchell, 2008). 

 Why does continuous quality improvement need to be associated with change? 

When a nurse and/or physician is planning a patients centered care, staff members must remember , the plan is an individual basis, that must fit that patient in order for the plan to be implemented and to be an successful outcome. Each patient is different even if they have the same diagnosis, such has copd, because it has to do with age, culture, learning capabilities, history, and financial means, and other factors that may play in the patients plan of care. 

“While all changes do not lead to improvement, all improvement requires change. The ability to develop, test, and implement changes is essential for any individual, group, or organization that wants to continuously improve.” (www.IHI.orgLinks to an external site.). 

Reference: 

American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author. 

Mitchell PH. Defining Patient Safety and Quality Care. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 1. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2681/Links to an external site. 

www.IHI.orgLinks to an external site.