Discussion : Measures of Quality: NURS 8300 Week 3
NURS 8300 Week 3: Drivers of Quality Management in Healthcare
Discussion: Measures of Quality
Health care quality is a nationally recognized topic that is addressed through public policies, licensure, and accreditation standards for health care professionals and organizations. Throughout history, numerous organizations have been involved in developing health care quality and safety initiatives.
The Joint Commission and Centers for Medicare and Medicaid Services (CMS) developed quality and safety indicators for various health care systems. These indicators seek to establish accountability for health care organizations through a reporting system, which is available to the public. For this Discussion, explore various accrediting organizations and specific measures that pertain to quality. In your research on accrediting organizations, consider how these quality measures affect quality outcomes, support ethical principles, and influence the delivery of clinical services.
To prepare for Discussion : Measures of Quality:
- Select one specific quality indicator from the Week 2 Discussion and compare it with those outlined in this week’s Learning Resources.
- Review the accrediting body standards that pertain to your organization focusing on those standards that require your organization to define its quality management program.
- Consider regulatory requirements at the state or national level that affect quality outcomes in your organization.
- Ask yourself: How do the Centers for Medicare and Medicaid Services (CMS) restricted reimbursements affect quality management or improvement efforts at my organization? How do these standards and regulations influence or support ethical principles and influence patient care and nursing practice?
By Day 3, post a cohesive scholarly response on Discussion : Measures of Quality that addresses the following:
- Choose any measurement and explain the extent to which your chosen measure is affected by CMS driven incentives and disincentives. From a systems perspective, discuss how this measure affects quality outcomes, supports ethical principles, and influences patient care and nursing practice.
Read a selection of your colleagues’ responses.
By Day 7, respond to two of your colleagues posts on Discussion : Measures of Quality in one or more of the following ways:
- Ask a probing question, substantiated with additional background information, evidence, or research.
- Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
- Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
- Validate an idea with your own experience and additional research.
- Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
- Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Return to this Discussion : Measures of Quality in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.
Click on the Reply button below to post your response.
Discussion : Measures of Quality: SAMPLE APPROACH AND RESPONSE
The measure chosen for this week’s discussion from week two is that of pressure ulcers. This quality measure is affected by the Centers for Medicare and Medicaid Services (CMS) incentives through the prevalence of ulcers in the healthcare setting and long-term care centers. According to CMS, over 2.5 million people in the US develop pressure ulcers (AHRQ, 2017). CMS implemented an “On Time” training program for nursing home staff that has shown some positive results in the reduction of nursing home pressure ulcers (AHRQ, 2017). Through the utilization of electronic medical records and weekly reports that help staff and nursing home leadership identify at-risk resident’s interventions are implemented for residents to avoid the development of these adverse events (AHRQ, 2017).
Through some of the literature, it was identified that CMS would not reimburse for stage III and IV ulcers that have been determined to have been preventable (Bergquist-Beringer, Derganc & Dunton, 2009). Additional complications of pressure ulcers include increased hospitalization, increased pain, and overwhelming infection (Bergquist-Beringer et al., 2009). Additional complications of pressure ulcers include increased hospitalization, increased pain, and overwhelming infection (Bergquist-Beringer et al., 2009). Utilization of these identification systems and prevention measures is supported by CMS and reimbursed for, though ulcers that develop as a result of not implementing these systems is not supported and very costly to the families and facilities affected (Bergquist-Beringer et al., 2009). In addition to the “On Time” initiative, another implementation is the skin champions within the organization (Bergquist-Beringer, Derganc & Dunton, 2009). These skin specialists within nursing support the total skin assessment, education for staff, patients, families to ensure safe passage through the hospital and on into the home (Bergquist-Beringer, Derganc & Dunton, 2009).
Additionally, taking skin championship one step further, certified nurses in wound and ostomy within these care systems were shown to provide additional support and expertise for patients identified as high risk or who are currently developing skin breakdown (Bergquist-Beringer et al., 2009). Through training of staff and support of patients, these programs demonstrated significant decreases in the prevalence of ulcers, infections and subsequent increase in care needs, pain, cost, etcetera through their organizations. Through these important prevention efforts, skin remains intact and protects the rest of the body, preventing overwhelming infection and additional care needs, pain, the cost for the patient and caregivers (Bergquist-Beringer et al., 2009).
Discussion : Measures of Quality References
Agency for Healthcare Research and Quality (AHRQ) (2017). AHRQ’s Safety Program for Nursing Homes: On-Time Prevention. Agency for Healthcare Research and Quality. Retrieved from https://www.ahrq.gov/professionals/systems/long-term-care/resources/ontime/index.html
Bergquist-Beringer S, Davidson J, Agosto C, Linde NK, Abel M, Spurling K, … Christopher A. (2009). Evaluation of the National Database of Nursing Quality Indicators (NDNQI) training program on pressure ulcers. Journal of Continuing Education in Nursing, 40(6), 252–260. https://doi-org.ezp.waldenulibrary.org/10.3928/00220124-20090522-05
Bergquist-Beringer, S., Derganc, K., & Dunton, N. (2009). Embracing the use of skin care champions. Nursing Management, 40(12), 19–24. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=47271226&site=eds-live&scope=site
Boyle, D. K., Bergquist-Beringer, S., & Cramer, E. (2017). Relationship of Wound, Ostomy, and Continence Certified Nurses and Healthcare-Acquired Conditions in Acute Care Hospitals. Journal of Wound, Ostomy & Continence Nursing, 44(3), 283–292. https://doi-org.ezp.waldenulibrary.org/10.1097/WON.0000000000000327
RESPONSE TO THE DISCUSSION POST
Thank you for a very informative statement post. I agree with you. The Patient Safety Indicators, specifically the Pressure Ulcer Rate, is a tool(s) correctly assist in collecting data to allow predictive outcomes and identify modalities to prevent further complications (Agency for Healthcare Research and Quality [AHRQ], 2017), consequently allowing educational opportunities for staff in prevention and treatment.
Pressure ulcers can cause undue pain, tissue deformity, and idle, if not halt recovery of any co-morbidity during hospitalization along with the pressure injured tissue area itself (Bates-Jensen, 2001). When looking into this topic, most of what PSI is focused on is improving prevention methods, consequently developing educational opportunities for staff, patients, and families and improving patient outcomes. Building awareness of pressure ulcer incidence can be the first step in prevention.
When communicating with primary caregivers in a home setting, the added education in awareness, prevention and consequently treatment of pressure ulcers can aide in re-admissions due to ulcer complications.
Educating nursing staff in the hospital setting on proper assessment tools and techniques can also bring awareness to the growing incidence of pressure ulcers.
According to Ellis (2016), an estimated more than 2.5 million people will develop pressure
ulcers in the United States each year, and 60,000 U.S. hospital patients die from complications related to hospital-acquired pressure ulcers. Prevention is the goal of changing these statistics.
Ellis (2016) discusses several methods of prevention including frequent assessments of the skin, appropriate support such as hybrid mattresses made from air cells, foam or gel; microclimate support to the skin surface of the affected area, and frequent repositioning if patient unable to, to allow reperfusion of the affected tissue.
Several of these prevention methods are widely used in hospitals; however some are still in the process of being proven effective, therefore not as well known or utilized — several of these methods for prevention I use in my nursing practice as a Medical-Surgical nurse. Included methods are quality-nursing assessments, appliances, nutritional interventions, and individualized body support. Proper nursing assessments of skin, nutrition, and mobility are vital in recognizing any areas of concern on the patient’s skin. Once nursing assessments have been completed, they need to be followed by appropriate intervention, therefore, stopping the progression of or aid in the healing of any pressure ulcers found (Ellis, 2016). If there is an identification of assessed problem areas, interventions designated for the patient-specific issue must be included in their plan of care. Things such as proper skin hygiene, repositioning, nutritional support through supplementation and prophylactic use of dressings are everyday occurrences in our facility when we identify problem pressure areas.
Discussion : Measures of Quality Resources:
Bates-Jensen, B. M. (2001). Quality Indicators for Prevention and Management of Pressure Ulcers in Vulnerable Elders. Annals of Internal Medicine, Volume 135 (8) 744-751.
Ellis, M. (2016). Understanding the latest guidance on pressure ulcer prevention. Journal of Community Nursing. Aug/Sept 2016; 30(4), 29-36
Agency for Healthcare Research and Quality (2017). Patient Safety Indicators Overview. Retrieved from http://www.qualityindicators.ahrq.gov/Modules/psi_resources.aspx
Agency for Healthcare Research and Quality (2002). Measures of Patient Safety Based on Hospital Administrative Data The Patient Safety Indicators. Retrieved from http://www.ahrq.go
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