This article provides a solution essay to Quality in Health Care.
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The purpose of this assignment is to apply the concepts you have learned in this course to a situation you have encountered. Choose one quality or patient safety concern with which you are familiar and that you have not yet discussed in this course. In a 1,250-1,500 word essay, reflect on what you have learned in this course by applying the concepts to the quality or patient safety concern you have selected. Include the following in your essay:
Solution
Overview of Quality in Health Care
Introduction
Quality in healthcare depends on so many factors, including how information is shared, stored, and interpreted, and how the risks of avoidable harm that patients are exposed to be addressed. A disconnect exists between the effort invested in collecting information when matched to the effort in improving, whether this is in the context of performance improvement or quality improvement( Dixon-Woods, 2019). Most importantly, the abovementioned scholar opines that more resources are needed to address many of these problems since there is no contestation about the preconditions needed for high quality, safe Care, namely funding training, buildings, equipment, and other infrastructure. Like in the rest of the world, many healthcare organization systems across the country continue to experience a myriad of issues like preventable medical errors, hospital-acquired infections, limited cash flows, clinical variations, and delayed patient discharge. As such, this essay shifts its focus to a nurse’s reflections on what the nurse has learned in the current course by applying the concepts to the quality improvement of optimizing sepsis care to enhance early recognition and outcomes in the context of a clinical quality improvement program dealing with sepsis.
Description of Sepsis Care and Associated Challenges
Healthcare experts recognize sepsis as the body’s reaction to an infection.
In a healthy person, it is the immune system’s function to fight an infection, but in some cases, this help is needed in the form of fluids, some treatments, and antibiotics to prevent sepsis from worsening. In sepsis severity, the course lessons emphasized that time to treatment is essential in combating the infection and preventing organ dysfunction. Research findings indicated that early sepsis identification and treatment through antibiotics and fluids could determine the patient’s morbidity and mortality (Nguyen et al., 2016). Nationally, sepsis is reported as a leading cause of mortality, where it is estimated that more than 50% of hospital deaths are attributable to the infection (Fleischmann et al., 2016). However, several challenges bedevil early sepsis care as the patient’s physical response may present as a syndrome of non-specific symptoms, which delays sepsis recognition and diagnosis, thereby increasing patients’ mortality rates.
How EBP, Research, and Performance Improvement (PI) Would Be Utilized
Having identified that early sepsis care encounters several challenges, implementation of evidence-based sepsis care bundles has facilitated early sepsis identification, and standardized treatments that include but are limited to addition of evidence based alerts and use of Mission Health gained insights into sepsis performance drive improvements. Nursing practice of the 2020s and beyond stress that EBP should remain the driving force behind establishing optimal clinical outcomes since most existing practices need to be updated with EBP. Like EBP practice programs, research on sepsis care would help identify the barriers and facilitators of sepsis care, leading to better sepsis care (Branco et al., 2020). Suffice it to say that while variations exist in terms of practice importance for each healthcare facility, introducing some practice changes is likely to lead to a better return on investment. Optimizing sepsis care directly affects improved performance at the clinical and hospital, leading to decreased healthcare costs and decreased mortality once outlier management and severe sepsis are addressed.
The QI Process the Nurse Would Apply To Optimize Sepsis Care
A nurse practitioner should appreciate the role that EBP projects, research, and performance improvement play in optimizing sepsis herein regarded as the continuum from initial infection or trauma to severe sepsis and septic shock. The nurse researcher would rely on Systemic Inflammatory Response Syndrome (SIRS) criteria in the proposed quality improvement process intervention. The parameter would be reinforced with a comprehensive screening tool that captures organ dysfunction signs besides two or more clinical responses like the patient’s body temperature and heart rate. The QI project is set to change how nurses in the Emergency Department triage screen patients seeking services for potential sepsis. The overarching purpose is to have nurses stationed at the ED screen all patients above 18 years for sepsis and get the point–of–care lactate levels to identify sepsis early enough. Since a suitable PICOT – framework question would have been formulated, a suitable theoretical change model like Kotter’s Change Model (KCM) would be used.
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Simultaneously, measures to achieve the proposed project outcomes would be updated continuously to meet the project coordinator’s needs, the facility’s administration, and the ED staff. The QI project’s selected site would be two EDs affiliated with a not-for-profit hospital in South East Maryland. The optimization of the Sepsis care project would then compare the pre-implementation to post-implementation data. The sepsis care issue and the proposed intervention were chosen because the latest data from Agency for Healthcare Research and Quality indicate that septicemia is one of the top ten most common causes of hospitalization in the USA (Paoli et al., 2018). In an AHRQ report released in 2012, the number of sepsis patients more than doubled since 1993, with an annual increase averaging 6% annually. The report further noted that septicemia rates were highest among elderly patients, where the average length of stay for a sepsis patient was 8.8 days and an average cost of more than $2300 daily.
Description of Data Sources, Including Outcome and Process Data
The project’s data sources will be from the healthcare facility selected as the QI site, namely a not for profit clinical facility located in South East Maryland that is an affiliate of 15 hospitals in Maryland. As stated elsewhere in this paper, the selected facility has two EDs within its hospital system, and data will be collected from its electronic health records (EHRs) database. Additionally, some data will be from relevant literature as the projects are PICOT- based. The primary outcomes of screening and compliance with the sepsis care bundle will be analyzed, while the treatment components that follow will also be analyzed to establish the timing and compliance with the policy. Moreover, a chi-square test of independence will be calculated to compare the frequency rates before and after the proposed policy implementation.
How the Data Will Be Captured and Disseminated
The project facilitator will collect the data using an EPIC computer reporting system to retrieve specific outcome measures to form the EHRs. To strengthen validity, only one person, the project facilitator, will collect the data and analyze using a consistent reporting program. Data will be obtained from electronic medical records from July 1, 2019, to October 1, 2019, to provide pre-implementation comparison information. On the other hand, post-implementation data will be collected daily using a particular computer report explicitly formulated for this project. The list will include i-stat lactate information for every patient triaged the day before besides the patient’s age, chief complaint, and sepsis screening information. Once the changes in outcomes are determined, the findings concerning the primary outcomes of screening in terms of percentage and adherence to the new sepsis care bundles policy components will be disseminated after the nurse researcher has drafted the research study and selected a suitable peer-reviewed journal to publish their findings (Milner, 2016).
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Organizational Culture Considerations Will Be Essential
Once the research study findings and conclusions have been written in a final draft in line with change communication, discussion, and implementation, the KCM’s last three steps will be crucial for the QI’s success. These steps are that the facility ensures the implemented change continues leading to more positive change and finally being incorporated into the organizational culture. Generation of short term will consolidate more gains and generate more change, and lastly, anchor the new sepsis care bundles policy in the ED triage unit as essential strategies to lasting and sustainable change.
Conclusion
In conclusion, this nurse reflection has determined that implementing a sepsis care policy is bound to positively impact screening of potentially septic patients within the ED setting. The proposed sepsis care bundle policy utilizes the best evidence available to identify and treat sepsis patients that correspond to the Surviving Sepsis campaign guidelines and recommendations. Registered nurses have the responsibility of promoting quality patient care. Synthesis of best practice evidence, effecting policy change, and having outcomes monitored and evaluated would positively impact sepsis care in patients.
References
Agency for Healthcare Research and Quality. (2012). Healthcare cost and utilization projection. Septicemia in US hospital, 2009
Branco, M. J. C., Lucas, A. P. M., Marques, R. M. D., & Sousa, P. P. (2020). The role of the nurse in caring for the critical patient with sepsis. Revista Brasileira de Enfermagem, 73(4).
Dixon-Woods, M. (2019). How to improve healthcare improvement—an essay by Mary Dixon-Woods. BMJ, 367.
Fleischmann, C., Scherag, A., Adhikari, N. K., Hartog, C. S., Tsaganos, T., Schlattmann, P., … & Reinhart, K. (2016). Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. American journal of respiratory and critical care medicine, 193(3), 259-272.
Kim, H. I., & Park, S. (2019). Sepsis: Early recognition and optimized treatment. Tuberculosis and respiratory diseases, 82(1), 6-14.
Milner, K. A. (2016). Sharing your knowledge: Getting your idea published. Journal of infusion nursing, 39(5), 297-305.
Nguyen, H. B., Jaehne, A. K., Jayaprakash, N., Semler, M. W., Hegab, S., Yataco, A. C., … & Gill, J. K. (2016). Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE: critical Care, 20(1), 160.
Paoli, C. J., Reynolds, M. A., Sinha, M., Gitlin, M., & Crouser, E. (2018). Epidemiology and costs of sepsis in the United States—an analysis based on diagnosis and severity level timing. Critical care medicine, 46(12), 1889.
Question – Quality in Health Care
The purpose of this assignment is to apply the concepts you have learned in this course to a situation you have encountered. Choose one quality or patient safety concern with which you are familiar and that you have not yet discussed in this course. In a 1,250-1,500 word essay, reflect on what you have learned in this course by applying the concepts to the quality or patient safety concern you have selected. Include the following in your essay:
- Briefly describe the issue and associated challenges.
- Explain how EBP, research, and PI would be utilized to address the issue.
- Explain the PI or QI process you would apply and discuss why you chose it.
- Describe your data sources, including outcome and process data.
- Explain how the data will be captured and disseminated.
- Discuss which organizational culture considerations will be essential to the success of your work.This assignment uses a rubric.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.