Consultative Change Recommendation Essentials of Advanced Nursing Practice Field Experience
Essentials of Advanced Nursing Practice Field
... [Show More] Experience 02/16/2020
Advanced practicing nurses (APN) have a responsibility to promote positive health outcomes. APN’s are leaders, which give them opportunities to be part of positive changes within their organizations. APN’s create positive changes by working with inter-professional teams and apply their knowledge to create positive changes.
Purpose of Consultation and Overview of the Consultation Process
In this scenario I am a nurse consultant that has been assigned a healthcare system to review and identify an improvement plan that is needed within the organization. For this process I utilized the Center for Medicare Services (CMS) website to review HCAHPS scores from my hospital and hospitals in the surrounding areas. On the CMS website I can compare the quantitative data collected for local hospital and compare them to the national average. The data will help to identify areas that need improvement. For this project, I have chosen heart failure readmissions to be the focus for my process improvement plan.
Organizational Analysis
Description of Organization
Mercy Health System is a non-profit organization with the primary and original location in Janesville, Wisconsin. The health care system continues to grow and is regional with over 85 facilities throughout southern Wisconsin and northern Illinois and employs over 8,000 people (Mercyhealth, n.d.). The average number of patients admitted to Mercy Hospital is 90-100. The organizational structure is vertical structure with top-down hierarchy. The facility follows a functional structure with each department grouped together by their specific purpose in the facility. For instance, the nursing department has nurse practice counsel where they will have gathered in meetings that help develop nursing practice and aspects that affect the nursing department. The Mercy Health Hospital and Trauma Center in Janesville Wisconsin is a level one
trauma center that has in-patient and out-patient surgery services, ER, ICU, medical/surgical, labor and delivery, and a small pediatric unit. The hospital also offers specialty services such as gastroenterology & GI surgery, geriatrics, nephrology, neurology & neurosurgery, orthopedics, pulmonology & lung surgery, and urology (Mercyhealth, n.d.). This hospital is one of two major facilities in Janesville and serves a large percentage of the approximate 64,000 residents for their healthcare needs.
Primary Needs of Organization’s Population
Mercy Hospital provides services for the approximate 64,000 residents in the city of Janesville, Wisconsin. The hospital is in the city of Janesville; however, it serves all the small surrounding areas in the county of Rock. It is one of two major hospitals in this city that have very similar services provided to the public. The Janesville population consists of primarily white residents at 92.37%. Black or African American is approximately 1.43&, and Asian 1.57% of the overall population. 55% of the residents are married, and 45% are families with children under the age of 18 (Areavibes, n.d.). The median household income in Janesville is $50,300, median earnings for males is $36,174, and females $23,428, with an unemployment rate of 4.4% and poverty rate of 14.7%.
With lower that the national average income levels, and high unemployment rates we can determine that a primary health risk for the residents of Rock County is obesity, heart disease and type II diabetes. The obesity rates are related to socioeconomical status (Center for Disease Control and Prevention, 2017). According to the county health rankings listed on the county website, Rock County is the second most obese county in the state of Wisconsin (Rock County Wisconsin, 2017). According to the Center for Disease Control and Prevention in 2015-2016, the leading cause of preventable deaths are related to heart disease, cardiovascular accidents, certain
types of cancers, and type II diabetes (Center for Disease Control, 2017). According to CMS, Mercy Hospital in Janesville has a high rate of heart failure patients with a high percentage of hospital readmission rates compared to other hospitals in the area. Mercy’s heart failure readmission rate is 21% with the other local hospital just a couple miles away at 20.6% (Center for Medicare Services, n.d.). The county having high obesity rate, which is a risk factor for heart disease, and a recorded high number of heart failure patients makes heart disease or heart failure primary risks for these residents.
Having a population at high risk for heart disease affects the cost of care provided from the hospital. A high volume of patients needing inpatient acute care services can make the hospital have bed shortages. The high volume of patients can lead to unstaffed units which causes high stress and burn out for the current staff. Having a population of high -risk individuals also puts a strain on the community. The community may need to reallocate resources to supply the resources needed for this population of patients. Readmission of heart failure patients also has a negative impact on hospital reimbursement rates. An estimated 90% of patients with heart failure that are readmitted into the hospitals are preventable (McClintock, et al., 2014). The readmission rates for heart failure patients not only cost the healthcare facility a sizeable amount of money, this also negatively effects patient satisfaction and quality of life. The purpose for an improved heart failure program is to reduce the readmission rate and increase patient satisfaction and quality of life (Al-Sutari, et al., 2017).
Nurse Leader Interview Summary
Role of the Nurse Leader
The nurse that I interviewed is the supervisor of the medical/surgical unit at Mercy Hospital. Per our discussion, her role consists of assisting the Chief Nursing Officer
(CNO) with overall coordination of the nursing department. She serves as a clinical resource to nursing staff and is responsible for the coordination and direction of the medical/surgical unit. She organizes and manages the duties of the nurses and coordinates educational opportunities for staff. She also assures the maintenance and quality of patient care and compliance with physician orders and hospital policy. Some of her informal responsibilities as a manager at the hospital are mentoring and succession planning, actively listening to staff to ensure their needs are being met and providing conflict resolution when needed. The nurse manager has an important influential role on the organization by promoting employee engagement and retention. This nurse managers role aligns with the roles defined by the American Association of Colleges of Nursing (AACN) by incorporating both formal and informal influences within the organization. According to the AACN, a master’s degree level nurse influences healthcare outcomes, and nurse interventions include indirect and direct components of care which are described as part of this nurse managers role (American Association of Colleges of Nursing, 2011).
Organizational Characteristics
Current Strengths
Magnet recognized. Participates in Nurse Practice Counsel. Provides tuition reimbursement. Follows patient-centered care models. Promotes patient advocacy. Promotes development and use of EBP in practice.
Culturally responsive. Promotes a culture of safety.
Current Weaknesses
With a large organization and a recent merge with Rockford, it is difficult to be transparent as to why decisions are being made. Difficult to create a consistent culture throughout the organization.
Current Evidenced-Based
Sepsis bundles are based on EBP. Fall committee looking at research and EBP to decrease falls. Use of EBP within our heart failure, chest pain and
Practice Activities stroke programs.
Quality Improvement Projects
In preparation for Joint Commission visit, they are currently working on documentation of care plans, assessment and reassessment of pain documentation. The current documentation has been lacking follow-up, so they in the process of developing documentation strategies to include the missing pieces.
Recommendation for Organizational Change
The recommended practice change is to implement a stronger heart failure program which includes a nurse educator being involved in the patients care, follow-up by the nurse after discharge, and providing additional education and resources. Primary prevention strategies of providing heart failure patients with additional support and education increase quality of life and will reduce heart failure patient hospital re-admission rates. The primary goal for the program is to provide improved care for this medically complex population. To prioritize patient- centeredness, the process change will include the patient in all steps of the program. The primary goal for the program is to improve patient quality of life. The plan, implementation of the plan, and the evaluation are all focused on patient satisfaction and improved quality of life.
The rationale for the process improvement project is that heart failure readmissions negatively impact the hospitals reimbursement rates and have a significant negative impact on patient satisfaction and quality of life. An estimated 90% of patients with heart failure that are readmitted into the hospitals are preventable (McClintock, et al., 2017). The readmission rates for heart failure patients not only cost the healthcare facility a sizeable amount of money, this also negatively effects patient satisfaction and quality of life. The purpose for an improved
heart failure program is to reduce the readmission rate and increase patient satisfaction and quality of life (Al-Sutari, et al., 2017).
Patients with heart failure have a high mortality rate, have multiple comorbidities, and have symptoms that are often difficult to manage. Implementing a program that will encourage patients to actively participate in their care and self-manage symptoms can have a significant impact on the patient’s quality of life as well as provide financial benefits for the healthcare system. Developing and implementing an improved heart failure program will decrease heart failure readmission rates which will have a positive impact on the patient and the system.
Heart failure patients will have improved quality of life with the program by having better managed symptoms and less hospitalizations. Hospitals are full of patients that have contagious illnesses and put acutely ill patients at risk for infection. Patients in the hospital are also at greater risk for delirium and sleeplessness from noises related to multiple patients and hospital staff. With an improved heart failure program, patients will be able to remain in their homes where they are most comfortable. The primary reason for the program is to improve patient outcomes.
Evaluation of Change Effectiveness
After a practice change is implemented, it is extremely important to evaluate the effectiveness of the change to determine if the expected outcome has been achieved. Measuring the improvement following the practice change would involve on-going tracking of heart failure readmission rates. Part of the process would include the implementation of an area for documentation within the electronic health record for the nurse educator to document the teaching provided and the patients understanding of the teaching. Monitoring of this would have to be on-going to ensure the education continues to be provided to the patient. Monitoring the
HCAHP scores and seeing a decrease in the readmission scores would be a good indicator that the process improvement plan was effective. Less hospital admissions are good indicators that the patient has better control of symptoms and able to self-manage symptoms without the hospital environment, and less hospitalizations are also an indicator of improved quality of life.
References
Al-Sutari, M., Ahmad, M., (2017). Effect of educational program on self-care behavior and health outcome among patients with heart failure: an experimental study (2017).
International Journal of Evidenced-Based Healthcare. 178-185. doi:10.1097/XEB0000000000000108
American Association of Colleges of Nursing. (2011). The essentials of master’s education in nursing. Available from http://www.aacnnursing.org/portals/42/publications/mastersessentials11.pdf
Areavibes, (n.d.). Janesville demographics profile. Retrieved from http://www.areavibes.com/janesville-wi/demographics/
Center for Disease Control and Prevention. (2017). Strategies to prevent obesity and other chronic diseases. Retrieved from https://www.cdc.gov/obesity/downloads/PA_2011_WEB.pdf
Center for Medicare services. (n.d.). CMS.gov. Retrieved from
https://www.medicare.gov/hospitalcompare/compare.html#cmprTab=1&vwgrph=1&cmp
rID=520066%2C520208&cmprDist=0.9%2C2.9&dist=50&loc=JANESVILLE%2C
%20WI&lat=42.6827885&lng=-89.0187222
McClintock, S., Mose, R., Smith, L., (2014). Strategies for Reducing the Hospital Readmission Rates of Heart Failure Patients. The Journal of Nurse Practitioners., 10 (6), 430-433.
Retrieved from http://dx.doi.org/10.1016/j.nurpra.2014.04.005
Mercyhealth. (n.d.). Retrieved from
https://mercyhealthsystem.org/location/mercyhealth-hospital-and-trauma-center-janesville/
Rock County Wisconsin. (2018, April 2). Retrieved from www.co.rock.wi.us/publichealth- familycommunity/publichealth-obesity-prevention [Show Less]