Post a brief explanation of the QI initiative you selected, and why. Be specific. Explain how adverse events are handled in your healthcare organization or nursing practice, including an explanation of how this may impact both public and internal perspectives on healthcare quality. Then, briefly describe the error rate from the article you selected, and explain how this may relate to your healthcare organization or nursing practice. Be specific and provide examples. RE: initial Post Week 6

Post a brief explanation of the QI initiative you selected, and why. Be specific. Explain how adverse events are handled in your healthcare organization or nursing practice, including an explanation of how this may impact both public and internal perspectives on healthcare quality. Then, briefly describe the error rate from the article you selected, and explain how this may relate to your healthcare organization or nursing practice. Be specific and provide examples. RE: initial Post Week 6

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CMS has defined quality improvement (QI) as a systematic process used to improve and standardize care, identify and reduce variation, achieve predictable results, and to improve outcomes w

NURS 8302 Discussion Quality Improvement Initiative ANSWER

ithin the health care systems for patients and organizations (CMS, 2021). The QI project that I would like to initiate is a plan to reduce return to hospitalization (RTH).  The goal is to reduce RTH by 50% in 6 months.  The geriatric population is exceptionally vulnerable of undergoing an adverse event associated with frequent rehospitalization. Research has shown that RTH especially in the elderly community can adversely affect their overall quality of life. In an article by Admi et al. (2015) they discussed “hospitalization of the older adult is often followed by an irreversible decline in the functional status that affects their quality of life and well-being after care”(Admi et al., 2015). In the acute care setting elderly patients are more likely to be subjected to physical and chemical restraints, foley catheters insertion and restrictions in movement in the efforts to keep them safe. Some of these interventions are detrimental to the mindset of the dementia patients; and they often return confused, and withdrawn.

Currently we address adverse events based off the event that triggered the need for change. I have determined that most of the events on my facility are handled from a reactive point of view; meaning the adverse events usually take place and triggers a quality improvement initiative. As a Director of Nursing (DON) and a DNP prepared nurse my focus is to change the culture of this practice.  Being reactive and waiting for an adverse event to happen alters the perception of the physician, patient, families, and community understanding of the abilities and capabilities of staff in the long-term care setting.  Unfortunately, it leads individuals to believe that long-term care facilities are not capable of providing quality care.  As a DNP prepared nurse, I know this is where quality evidence-based practice comes into play.  By re-visiting policy and procedures, and incorporating new standards of care and algorithm; a re-education of old processes can be reintroduced.  Quality care must be addressed as an action and re-iterate into every day practice.

In an article by Hudali et al. (2017) they discussed how the utilized a transitional care model (TOC) to address and reduce the RTH rate of their project study.  It was determined that 10.6% RTH was noted within the study population, approximately 40 patients out of 378 (Hudali et al, 2017).  It was noted that this rate dropped to 3.8% with the use of TOC model.  I found this information imperative for two reasons: many times, new patients transition for acute care setting to short-term rehab/long-term and we often transition these patients back home.  The study TOC model provided insight on examples and ways to utilize this model appropriately in my current setting to reduce and prevent rehospitalization of my population setting.  Medication reconciliation is one of  the most imperative aspects of the program along with teaching effective disease management from the patient perspective.

Reference:

Admi, H., Shadmi, E., Baruch, H., & Zisberg, A. (2015). From research to reality: Minimizing the effects of hospitalization on older adults. Rambam Maimonides Medical Journal, 6(2). https://doi.org/10.5041/rmmj.10201