Professional nurses rely on research findings to inform practice decisions; they use critical thinking to apply research di

The topic that is most concerning to me in my field and most relevant is that of compliance in the hospice patient.  Compliance with medication and interventions really does help manage symptoms and usually low live discharge rate occurs.  Live discharge occurs when they either want off service, go to the hospital, move out of area or are placed in the care of someone else  I am a hospice nurse of one year and see a terrible compliance issue with these patients.  Yes, they are at the “end of lifeâ€� in most cases but they should not have other issues/complication then their primary diagnosis. I believe a little back ground will be needed to describe my true setting.  Medicare (or insurance office that handle their money) will refer my company to take a look at them for admission (with great pressure to admit) to keep patients from coming back to the hospitals.  A trip to the ER, admission, treatment etc is big bucks that these insurance companies must pay out.  If they are placed on hospice, they pay a set amount monthly driving the cost down.  It is our job to keep the patients away from the hospital by managing their symptoms adequately and efficiently day or night. 

So they reason why I choose this because I believe we can do a better job with helping our patients with comfort measures at end life.  (they could work with regular hospital d/c as well). 

Write your clinical question in the PICO(T) format for your nursing practice problem

Population-(our LCD guidelines set by medicare) the non-compliant hospice patient, a patient with a terminal illness usually over the age of 65.  They can either be at home, in a facility, homeless, in the hospital etc. 

Intervention-The things that I believe would make a difference is simple things like pill box, writing what the medication is used for on each medication, setting timers on phone or alarm clock for medication administration, daily (or several times a day) wellness checks, speed dial set up on phones to reach nurses quickly, having medication and equipment needs anticipated and having a second nurse assess at least one time to have a second eye/opinion on patient needs.  I am full of ideas today 😊, I am modifying my list and coming up contracting or staffing paramedics that live in areas close to patients.  They are cheaper and can be trained to do what we do in case of a change of condition in the middle of the night or day while everyone is busy (only if billable by medicare).  Also setting up a tablet on a tripod where the patients medication usually is or where the patient using sits/lays would be a cheap and effective way to help with efficiency and compliance.  Also purchasing a b/p cuff, pulse ox, stethoscope and thermometer would greatly help each patient.  Yes some of these techniques may be invasive this is only for patients that are willing.  This can also be for the primary caregivers and they can be trained how to use the equipment. 

According to the American Journal of Health-system pharmacy, “While rounding is a long-established care delivery technique within inpatient settings, rounding is yet to be widely implemented outside of acute care settings.â€�  The article continues “a palliative care and hospice physician and a nurse practitioner, were enlisted to provide consultations with the CCM team as necessary. All practitioners on the team were instructed to provide patients with motivation to perform daily activities that promote positive reinforcement of lifestyle self-management and give patients a sense of ownership over their illness rather than feeling as if medical issues dictate their quality of life.â€� Yes, this is in place but so rare and the nurses in our company do the work. Furthermore the article states, “Per the request of the ACO corporate team to assist with transitions of care for patients being discharged from a hospital or skilled nursing facility, pharmacists were also involved with performing virtual medication consultations through use of medication lists provided to them by the CCM paramedic or medical assistant after an in-home visit.â€�

In 65+ and/or terminal illness hospice patients (P) does a 1-2x/week routine visit for head to toe assessment by one nurse and medication reconciliation (I)  compared to providing IDT visits, purchasing equipment (vitals sign tools, wed cams, pill boxes, writing what medication is for etc) ( C ) have less change of condition issues unrelated to primary diagnosis,( O ) over 6 months to one year. (T)

Population- 65+ terminal illness/hospice population

Intervention- 1-2x/week routine visit for head to toe assessment by one nurse and medication reconciliation

Comparison- providing IDT visits, purchasing equipment (vitals sign tools, wed cams, pill boxes, writing what medication is for etc)

Outcome- less change of condition issues unrelated to primary diagnosis,

Timeframe- 6 months to one year.

The reason why I care about this problem is because I see this all the time.  There must be a better infrastructure behind the healthcare setting.  We have the resources and the  knowledge, it’s the implementation of the process that we lack.  The general population overlooks our elderly and dying but we can do better for these people and they can use our help.  Our patients would benefit from finding the best evidence because they would be managed properly and more efficiently.  Like I said before this can also trickle down the line into other fields and help with readmission rates, yes its an upfront cost but in the in the long run I feel it will be cheaper (no research d/t not being my main topic).    

Reference(s):

(n.d.). Retrieved May 17, 2020, from https://eds-a-ebscohost- (Links to an external site.)        com.chamberlainuniversity.idm.oclc.org/eds/detail/detail?vid

,

The topic that is most concerning to me in my field and most relevant is that of compliance in the hospice patient.  Compliance with medication and interventions really does help manage symptoms and usually low live discharge rate occurs.  Live discharge occurs when they either want off service, go to the hospital, move out of area or are placed in the care of someone else  I am a hospice nurse of one year and see a terrible compliance issue with these patients.  Yes, they are at the “end of lifeâ€� in most cases but they should not have other issues/complication then their primary diagnosis. I believe a little back ground will be needed to describe my true setting.  Medicare (or insurance office that handle their money) will refer my company to take a look at them for admission (with great pressure to admit) to keep patients from coming back to the hospitals.  A trip to the ER, admission, treatment etc is big bucks that these insurance companies must pay out.  If they are placed on hospice, they pay a set amount monthly driving the cost down.  It is our job to keep the patients away from the hospital by managing their symptoms adequately and efficiently day or night. 

So they reason why I choose this because I believe we can do a better job with helping our patients with comfort measures at end life.  (they could work with regular hospital d/c as well). 

Write your clinical question in the PICO(T) format for your nursing practice problem

Population-(our LCD guidelines set by medicare) the non-compliant hospice patient, a patient with a terminal illness usually over the age of 65.  They can either be at home, in a facility, homeless, in the hospital etc. 

Intervention-The things that I believe would make a difference is simple things like pill box, writing what the medication is used for on each medication, setting timers on phone or alarm clock for medication administration, daily (or several times a day) wellness checks, speed dial set up on phones to reach nurses quickly, having medication and equipment needs anticipated and having a second nurse assess at least one time to have a second eye/opinion on patient needs.  I am full of ideas today 😊, I am modifying my list and coming up contracting or staffing paramedics that live in areas close to patients.  They are cheaper and can be trained to do what we do in case of a change of condition in the middle of the night or day while everyone is busy (only if billable by medicare).  Also setting up a tablet on a tripod where the patients medication usually is or where the patient using sits/lays would be a cheap and effective way to help with efficiency and compliance.  Also purchasing a b/p cuff, pulse ox, stethoscope and thermometer would greatly help each patient.  Yes some of these techniques may be invasive this is only for patients that are willing.  This can also be for the primary caregivers and they can be trained how to use the equipment. 

According to the American Journal of Health-system pharmacy, “While rounding is a long-established care delivery technique within inpatient settings, rounding is yet to be widely implemented outside of acute care settings.â€�  The article continues “a palliative care and hospice physician and a nurse practitioner, were enlisted to provide consultations with the CCM team as necessary. All practitioners on the team were instructed to provide patients with motivation to perform daily activities that promote positive reinforcement of lifestyle self-management and give patients a sense of ownership over their illness rather than feeling as if medical issues dictate their quality of life.â€� Yes, this is in place but so rare and the nurses in our company do the work. Furthermore the article states, “Per the request of the ACO corporate team to assist with transitions of care for patients being discharged from a hospital or skilled nursing facility, pharmacists were also involved with performing virtual medication consultations through use of medication lists provided to them by the CCM paramedic or medical assistant after an in-home visit.â€�

In 65+ and/or terminal illness hospice patients (P) does a 1-2x/week routine visit for head to toe assessment by one nurse and medication reconciliation (I)  compared to providing IDT visits, purchasing equipment (vitals sign tools, wed cams, pill boxes, writing what medication is for etc) ( C ) have less change of condition issues unrelated to primary diagnosis,( O ) over 6 months to one year. (T)

Population- 65+ terminal illness/hospice population

Intervention- 1-2x/week routine visit for head to toe assessment by one nurse and medication reconciliation

Comparison- providing IDT visits, purchasing equipment (vitals sign tools, wed cams, pill boxes, writing what medication is for etc)

Outcome- less change of condition issues unrelated to primary diagnosis,

Timeframe- 6 months to one year.

The reason why I care about this problem is because I see this all the time.  There must be a better infrastructure behind the healthcare setting.  We have the resources and the  knowledge, it’s the implementation of the process that we lack.  The general population overlooks our elderly and dying but we can do better for these people and they can use our help.  Our patients would benefit from finding the best evidence because they would be managed properly and more efficiently.  Like I said before this can also trickle down the line into other fields and help with readmission rates, yes its an upfront cost but in the in the long run I feel it will be cheaper (no research d/t not being my main topic).    

Reference(s):

(n.d.). Retrieved May 17, 2020, from https://eds-a-ebscohost- (Links to an external site.)        com.chamberlainuniversity.idm.oclc.org/eds/detail/detail?vid

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