C157Consultative Change RecommendationWestern Governors Univ, Lecture notes of Accounting

Download C157Consultative Change RecommendationWestern Governors Univ and more Lecture notes Accounting in PDF only on Docsity! Running head: CONSULTATIVE CHANGE RECOMMENDATION C157 Consultative Change Recommendation Western Governors University College of Health Professions Essentials of Advanced Nursing Practice Consultative Change Recommendations Healthcare is rapidly changing as more emphasis is being placed on the experience of the consumer and better patient outcomes. For an organization to remain viable today and in the future, hospitals must provide care that is not only based on the most current research but must also meet the demands of the consumer. This may require change of a current practice and change is never easy. Purpose of Consultation and Overview of the Consultation Process The purpose of this consultation was to interview one of the nurse leaders at PHCMC, evaluate the organization’s weaknesses and strengths and propose a change based on the feedback from the nurse leader. The individual interviewed on September 24, 2020 was Kelly Galbo, Executive Director of Acute Care Services. As part of the consultation process, Kelly was asked about her role as a nurse leader in the organization and duties she is responsible for. Next, questions were asked pertaining to the organization itself, including strengths and weaknesses, opportunities, and systems and processes in place to promote patient safety. Lastly, Kelly shared what quality improvement projects and Evidence-based practice activities are currently in place CONSULTATIVE CHANGE RECOMMENDATION 2 and which ones she has been involved in. Kelly was able to align her role as a leader with the organization’s core values of compassion, dignity, justice, excellence, and integrity. Prior to the interview, the organization’s mission statement, vision statement and core values were reviewed on the PHCMC website; as well as the organization statistic data. The Community Health Improvement Plan for 2020-2022 was obtained from the website and reviewed to obtain demographic data and needs assessment for the community. The identified organization weakness was the below benchmark HCAHPS result of ‘my nurse treated me with courtesy and respect’. The current data for nursing communication, which includes three questions specific to nursing (including the courtesy and respect question) was retrieved from the Medicare.gov Hospital Compare website. Additionally, the director of Patient Relations and the Magnet Director were contacted as they are the departments that collect and disseminate this information hospital wide. Year to date monthly HCAHPS data for each of the questions was received, as well as the historical data from the previous three years. Of the 1,546 patients that have returned the surveys for 2020, only 49% of the responses stated that the nurse ALWAYS treated me with courtesy and respect. Organizational Analysis Description of Organization Providence Holy Cross Medical Center (PHCMC) is a 377-bed acute care medical center located in Mission Hills, Southern California and provides services to the San Fernando Valley. It is a not for profit organization that was founded in 1961; five years ago, Providence joined with St. Joseph Health making the organization one of the largest medical systems in the area. PHCMC is a level two trauma center, a Certified Primary Plus Stroke Center, a STEMI Receiving Center, and has a Cancer Center on site. In addition, the campus includes a skilled CONSULTATIVE CHANGE RECOMMENDATION 5 Indian, and African American/Black. Age demographics show most of the population as being between 10 and 39 years old; with adults over 65 making up only 14% of the population. The population is described in the Providence San Fernando Valley Medical Centers 2020-2022 Community Health Improvement Plan as having “adverse social determinants of health (which) include low-income status, food insecurity, housing affordability, poor access to medical care challenges, high rates of health risk behaviors, low educational achievement, and low English language proficiency” (p. 4). Research has shown that these social determinants of health are directly correlated to poorer health outcomes in a community. The top four health concerns identified for this community is diabetes, hypertension, hyperlipidemia and obesity. These all contribute to the risk of developing a stroke or cardiovascular disease. Preventative care and management of these chronic diseases are essential for the health of this community and unfortunately are not being managed properly due to the previously identified social determinants of health. A community can be negatively impacted by these chronic disease process because they increase an individual’s risk for stroke and cardiovascular events leading to increased disability and death. Individuals with chronic hypertension that lead to renal failure requiring dialysis affects a community also as the need for dialysis centers increase and needed appointment times are difficult to schedule. PHCMC is both a comprehensive stroke center and a STEMI receiving center, which is appropriate for the community that it serves. The organization is affected by increased hospitalizations due to these events. Several times a day, we admit patients who are fluid overloaded because they missed their scheduled dialysis appointment and were unable to get it rescheduled in a timely manner. This negatively affects PHCMC as the bed is now being used for a routine dialysis treatment instead of a patient that is truly sick. Routinely the CONSULTATIVE CHANGE RECOMMENDATION 6 Emergency Room (ER) at PHCMC is being closed to saturation and the ER is holding patients with admitting orders until an inpatient bed becomes available. Nurse Leader Interview Summary Role of the Nurse Leader An interview with Kelly Galbo, Executive Director of Acute Care Services, was conducted on September 24, 2020. Kelly has her MSN in Leadership through WGU. Kelly has worked at PHCMC for ten years; she started as a House Supervisor, transitioned to the Manager of Nursing Administration, then to the Director of Nursing Administration, and recently to Executive Director of Acute Care Services. All of Kelly’s roles at PHCMC have been as a formal leader, as is her current role as Executive Director of Acute Care Services. One of Kelly’s primary roles is to oversee and support the leadership for each of the departments that she oversees: sub-acute and acute rehabilitation, nursing administration, three telemetry departments, oncology services, two medical surgical departments, wound care, and manages the dialysis program and their nurses. She advocates for her team members when needed. Essential III in Essentials of Master’s Education in Nursing (American Association of Colleges of Nursing, 2011) states that the MSN prepared nurse is involved in quality improvement and safety and needs to be “prepared to apply quality principles within an organization to be an effective leader and change agent” (p. 13). Kelly has a broad reach in the organization and is highly active in most of the committees that make decisions regarding quality and safety. In the past she has chaired the monthly Medication Safety Interdisciplinary Committee and been the advisor for the Quality and Safety Council. Because Kelly initially started as a house supervisor and worked her way up to her current position, she has become the ‘go-to’ person at PHCMC and knows most of processes in place. CONSULTATIVE CHANGE RECOMMENDATION 7 Essential VII in Essentials of Master’s Education in Nursing (American Association of Colleges of Nursing, 2011) states that the MSN prepared nurse participates in interprofessional collaboration in order to improve patient outcomes. Not only is Kelly an advocate for her caregivers, but she is also a patient advocate and her values and beliefs are in alignment with this core competency. Kelly plays a significant role on many of the interprofessional teams in the organization both at a local and regional level. For example, since the beginning of March, Kelly has been one of the key members of the COVID-19 interprofessional team that meets to discuss and put processes in place for caregivers, patients, and the community. Kelly states that her MSN in Leadership has prepared her for her leadership roles at PHCMC and her nursing practice as a nursing leader has been in alignment with the expectation of master prepared nurses. Essential IX in Essentials of Master’s Education in Nursing (American Association of Colleges of Nursing, 2011) states that the expectation of a master’s prepared nurse is that their nursing practice reflect that master’s level education and that the master’s prepared nurse participate in strategies to “implement safe, quality care in a variety of settings and roles” (p. 26). Although Kelly has always been in formal leader role at PHCMC, she also excels as an informal leader. Kelly pays attention to details and makes a point of developing relationships with her direct reports and caregivers throughout the organization. She goes above and beyond to make a connection with the leadership in her departments and lives out the core values of this organization. Organization’s Characteristics Current strengths. CONSULTATIVE CHANGE RECOMMENDATION 10 Two current quality improvement projects at PHCMC that have been extremely successful is the management of hypoglycemia and sepsis. Both of these quality improvements projects have been implemented in the last two years and have been able to be sustained. Quality improvements seem to come and go in the healthcare industry and sometimes the biggest hurdle to overcome is the sustainability of the quality improvement project. The quality department at PHCMC has been tracking hypoglycemic episodes with the purpose of ultimately reducing the number of hypoglycemic events that patients experience while in the hospital. These hypoglycemic episodes are tracked daily and a running tally for the month is shared Monday through Friday at our morning safety huddle and written on our safety huddle board. A report is run each morning for any patients who had glucose levels below 70 md/dL in the previous 24 hours. These patient records are reviewed to see if the current hypoglycemia protocol were followed for the glucose recheck 15 minutes after treatment and then at one hour. It is also determined if the event was avoidable or not. The hypoglycemic report is shared with leadership and managers are expected to follow up with their caregivers in real time as much as possible. Caregivers are continually educated to look at the glucose trends, pay attention to percentage of meal eaten, ask clarifying questions to their patients about the glucose management routine at home, and encouraged to speak up with any concerns to the physician. Root Cause Analysis (RCA’s) are requested on patients that have had more than one episode or if it was determined to have been an avoidable hypoglycemic event. This quality improvement project has significantly reduced our numbers of hypoglycemic events and has led to improved care for our patients. Prior to implementing this quality initiative, our patients were experiencing between 75 to 100 hypoglycemic events per month. Currently, for the month of September there have been 19 events which is significantly reduced from the baseline. CONSULTATIVE CHANGE RECOMMENDATION 11 In the last several years, there has been national attention regarding sepsis and patient outcomes related to sepsis. According to the CDC (2020), each year 1.7 million adults in the United States are diagnosed with sepsis and almost 270,000 of these individuals expire each year. At the beginning of 2019, it was noted that our mortality rate for sepsis was constantly around 9.8% with an observed-to-expected (O/E) mortality rate of 0.90. The target O/E mortality rate is 0.85. In April 2019, we hired a designated full time Sepsis RN to implement a plan to improve our outcomes for this patient population. The Sepsis RN would identify sepsis patients in the electronic health record, round and assess those patients, communicate with the physicians, and educate the primary nurse. To provide consistent care to this patient population, a sepsis bundle was added into the electronic medical record, along with a sepsis checklist so that no steps would be missed. In addition, a sepsis unit was created where sepsis patients were admitted, and those nurses received education specific for that patient population. By the end of 2019, we had decreased our mortality rate to 7.8% with an O/E mortality rate of 0.74, which was well below the 0.85 target. When sepsis patients were admitted to the sepsis unit, there was an overall decreased length of stay for patients. Recommendation for Organization Change Recommendation Due to below benchmark results for HCAHPS questions ‘my nurse treated me with courtesy and respect’, the recommended organizational change is implementing a quality improvement project that will increase this score hospital wide to meet or exceed benchmark within six months of implementation. In a qualitative study conducted by Mayfield et al (2020) patients perspective of courtesy and respect was broken into six categories: attentiveness of nurses, empathetic support from nurses, culture and beliefs taken into consideration and honored, CONSULTATIVE CHANGE RECOMMENDATION 12 recognition of family, honoring the patient’s person space, and recognition the personhood of each patient (p. 171). Just as each culture and belief system is individualized, so are the perceptions of respect and courtesy. Caregivers need to understand that each patient may perceive courtesy and respect differently than they do and should have a self-awareness of how they are perceived. The following outline is the plan for implementing this quality improvement project: 1. Identify key stakeholders and enlist their support. Identify caregivers that would be willing to be SuperUsers for quality improvement project. 2. Evaluate potential barriers such as nursing resistance, leadership resistance, and overall cost of quality improvement project. 3. Collect applicable research and collaborate with Stakeholders and SuperUsers to develop a strategy to improve patient perception of courtesy and respect. 4. Implement quality improvement program which consists of: a. Survey sampling of nurses regarding their perception of courtesy and respect. b. Develop education for all caregivers to complete on the educational platform, Health Stream, that is used at PHCMC. This education will include the six themes of patient’s perception identified in the study completed by Mayfield et al. (2020) mentioned previously. c. Roll out education house wide for all caregivers to identify themselves and their role when they enter a patient room (patients are not easily able to identify who the nurse is when caregivers from all departments are in scrubs). d. During daily nurse leader rounding of patients, incorporate questions specific to courtesy and respect. Service recovery can be completed in real time if patients