Assessing the Problem: Quality, Safety, and Cost Consideration Essay
Assessing the Problem: Quality, Safety, and Cost Consideration
Assessing the Problem: Quality, Safety, and Cost Consideration
Quality in healthcare refers to various issues such as access, outcomes, affordability, safety, and equity. Population problems in clinical and non-clinical settings cause significant quality, safety, and cost issues that should be addressed. In the previous assignment, we identified a problem to focus on in the capstone project. Catheter-acquired urinary tract infections are a significant problem in critical care settings, affecting many hospitalized patients. Evidence-based strategies such as clinician and patient education and checklists have been used to drive change and reduce the CAUTIs burden. Nurse-driven protocols are significant models used successfully to prevent these infections. This essay evaluates the quality, safety, and costs associated with the clinical problem and proposes strategies to improve the quality and safety and reduce costs to the system and individuals.
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Effects of the Problem on the Caren Quality, Safety, and Costs
CAUTI affects the quality of care, patient safety, and care costs to the individuals and the system. Individuals who develop CAUTIs experience significant pain and require more treatment interventions than others. Complications such as pyelonephritis, recurrent encrustation and blockage, urinary stones, and increased bladder cancer risk can also arise (Odoemene & Adril, 2019). Such problems negatively affect patients self-reported healthcare experiences and satisfaction scores, important care quality indicators. Thus, these infections significantly affect care quality. CAUTIs increase the risk of bacteremia in patients. Patients can acquire systemic infections, which significantly affects patient safety. They have an average mortality rate of 10%, which is significant for patient safety (Clarke et al., 2022). High CAUTIs are also an indicator of poor quality and safe care, according to the AHRQ. Hospital-acquired infections are monitored in hospitals, and high levels indicate poor quality care in facilities. CAUTIs also affect the cost of care significantly. They prolong the hospital stay, which increases the cost of care. Individuals who acquire them at home are hospitalized hence high costs of care. Catheter-acquired urinary tract infections’ average cost of care is $1000, which can skyrocket to about $10000 when systemic infection arises, and the cumulative costs are approximately $ 340-450 million annually (AHRQ, n.d.). Thus, CAUTIs significantly affect quality, patient safety, and care costs.
State Board Nursing Practice Standards/Organizational/Governmental Policies in Addressing Care Quality, Patient Safety, and Costs to the System and Individual
Government policies require institutions to monitor, report and intervene in CAUTI prevention. The agency for healthcare research and quality policies in CAUTI prevention requires care providers to monitor and report catheter indication, catheterization rate, CAUTI rate, complications, mortality rate, and reinfection rates (AHRQ, n.d). According to Blackmore et al. (2019), monitoring the CAUTIs related indicators helps facilities determine the effectiveness of their efforts in preventing and managing CAUTIs. Monitoring also provides data necessary at the national and state levels to inform policies necessary for preventing and managing these infections. The Institute of Healthcare Improvement has developed structured processes at the national level that can be used to prevent CAUTIs. The policies, CAUTI prevention bundles, focus on two areas which are reducing unnecessary catheterizations and prompt catheter removal.
According to Atkins et al. (2020), national policies and efforts are integral to leading change, and these policies have increased CAUTI monitoring and prevention. However, more effort is required to reduce CAUTIs or eradicate them. Other policies in are in care delivery are those involving care reimbursement. Since October 2008, the Center for Medicare and Medicaid Services stopped reimbursing healthcare costs related to CAUTIs (AHRQ, n.d.). This policy means that individuals and facilities pay for these costs. The policy can significantly affect the cost of patients and the institution and thus management, stimulating organizational efforts in their prevention and management. Most Institutions have thus implemented programs. These policies demonstrate how policies can affect care quality, patient safety, and care costs.
The standards of practice outline the scope and expected professional standards for nurses when implementing care intervention. The above policies will guide actions addressing care quality, patient safety, and care costs. The CMS policy will stimulate nursing actions to prevent CAUTIs. In addition, these policies also outline areas of interest for corrective actions. Following these policies, I will ensure that interventions are aimed at monitoring and reporting CAUTIs, ensuring correct catheter indications, aseptic care, and prompt removal of these catheters (AHRQ, n.d.). The policies will also help leverage actions and gain buy-in from all stakeholders by showcasing the significance of CAUTI prevention on healthcare costs, care quality, and patient safety to the healthcare team. Thus, the policies will guide action development, presentation, gathering support, and implementation in the healthcare facility.
The nurses’ scope of practice is regulated by local, state, and federal policies. Policies can limit or facilitate nurses’ roles and scope of practice in enhancing the quality of care, safety, and healthcare costs. They dictate and regulate what nurses can and cannot do to address these problems. The federal policies above advocate for practice within the scope of practice stipulated by the state board nursing practice act. These activities include monitoring, reporting, and intervening to ensure quality and safe care delivery while eliminating unnecessary healthcare costs (Russel & Watters, 2019). Nurses must also participate in care teams as active team members to enhance care delivery. They promote quality patient outcomes emphasizing the nurses’ scope and what they can do to prevent CAUTIs. These policies also attach national obligations besides the stipulations of the NPA, and thus, they are integral to regulating the practice and ensuring quality care, patient safety, and costs to the system and individuals.
Strategies to Improve Quality of Care, Enhance Patient Safety, and Reduce Care Costs
Various strategies can be implemented to improve care quality, patient safety, and cost reduction. One of the crucial strategies is using safety checklists to minimize unnecessary catheterization and ensure prompt catheter removal. It follows the recommendations by the Institute of Healthcare Improvement, which recommends interventions to reduce unnecessary catheterization and prompt the removal of catheters (Russel & Watter, 2019). In addition, it can be accompanied by other strategies, such as staff education, to increase the use of the technologies and thus enhance their success. Research shows that checklists are effective interventions, and implementation of checklists reduces unnecessary catheterization and eliminates catheterization for more than ten days (Hernandez et al., 2019). Hernandez et al. (2019) note that checklists help improve accuracy in catheter indications and remind nurses to remove catheters to prevent prolonged catheter use, which carries high risks for CAUTIs. The checklists serve as reminders that improve care providers’ diligence and prompt care delivery. They will ensure prompt removal and correct indications hence quality care, prevention of CAUTIs, and the avoidance of unnecessary costs.
Staff education on CAUTI and its prevention is also significant. The education ensures that staff understands the importance and strategies to prevent CAUTI. Education programs enhance staff vigilance, confidence, and promptness of care delivery, improving the safety and promptness of care delivered. Menegueti et al. (2019) evaluated staff education programs and checklists’ effects on care quality and patient safety. The study aimed to develop a long-term intervention to prevent CAUTIs in intensive care units. The study’s results showed that staff education and checklists significantly reduced CAUTIs and their related complications and unnecessary catheterizations and enhanced prompt removal of these catheters (Menegueti et al., 2019). The study results are supported by Shadle et al. (2021), who show that checklists alongside patient education reduce cumulative catheter days and CAUTIs. Reducing CAUTI prevalence and complications reduces the healthcare costs to the system and individuals hence the significance of these strategies in promoting care quality, enhancing patient safety, and reducing costs to the system and individuals.
Reliable Sources of Benchmark Data
Reliable sources of Benchmarking data include government databases, hospital health records, and data from other institutions. Healthcare institutions generate and store data that can be borrowed and used by other institutions to compare performance. The agency for healthcare research and quality keeps data from all healthcare institutions. They set their standards/indicators based on the best-performing healthcare facilities’ data and thus provide the best benchmark data to evaluate organizational performance. The agency for healthcare research and quality also produces a yearly report that focuses on the national benchmarks and is a vital source of benchmark data to determine how the institution is performing in the various indicators. The national health disparities and quality research reports show the changes in these health indicators and set national benchmarks for specific healthcare indicators (AHRQ, n.d.). The NHDQR reports will thus be vital, reliable benchmark data sources for this problem and its management interventions.
Conclusion
Nurses are the frontline in ensuring quality and safe care delivery and reducing care costs to the individual and the healthcare system. Problems such as CAUTIs affect the care quality and patient safety due to the consequences to which they expose patients, such as bladder cancer and pyelonephritis. Government and organizational policies and the state boards standards of nursing practice are vital to facilitating or inhibiting nursing actions and the scope of nursing practices to prevent CAUTIs. xx Hospital-acquired infections are not reimbursed by Medicare and Medicaid, leading to high healthcare costs to the individual and the system hence the need to address this problem. Checklists help care providers avoid unnecessary catheterizations that expose patients to CAUTIs. Staff education is also vital to help sensitize individuals to the significance of CAUTI and their prevention interventions. The information gathered in this stage will help develop the capstone project further.
References
Atkins, L., Sallis, A., Chadborn, T., Shaw, K., Schneider, A., Hopkins, S., Bunten, A., Michie, S., & Lorencatto, F. (2020). Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioral analysis of interventions. Implementation Science, 15, 1–22. https://doi.org/10.1186/s13012-020-01001-2
Blackmore, A. R., Leonard, J., Madayag, R., & Bourg, P. W. (2019). Using the trauma quality improvement program metrics data to enhance clinical practice. Journal of Trauma Nursing| JTN, 26(3), 121–127. https://doi.org/10.1097/JTN.0000000000000436
Clarke, K., Hall, C. L., Wiley, Z., Tejedor, S. C., Kim, J. S., Reif, L., Witt, L., & Jacob, J. T. (2020). Catheter‐Associated Urinary Tract Infections in Adults: Diagnosis, Treatment, and Prevention. Journal of Hospital Medicine, 15(9), 552-556. https://doi.org/10.12788/jhm.3292
Hernandez, M., King, A., & Stewart, L. (2019). Catheter-associated urinary tract infection (CAUTI) prevention and nurses’ checklist documentation of their indwelling catheter management practices. Nursing Praxis in New Zealand, 35(1). https://doi.org/10.36951/NgPxNZ.2019.004
Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., da Silva Canini, S. R. M., Basile-Filho, A., & Laus, A. M. (2019). Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: A quasi-experimental study. Medicine, 98(8). https://doi.org/10.1097/MD.0000000000014417
Odoemene, C. A., & Adiri, C. O. (2019). Catheter-associated urinary tract infection offending pathogens, antimicrobial sensitivity, and complications. Nigerian Journal of Surgical Sciences, 29(1), 6. https://doi.org/10.4103/njss.njss_6_20
Russell, J. A., & Watters, R. (2019). Implementation of a nurse-driven CAUTI prevention algorithm. Nursing Clinics, 54(1), 81–96. https://doi.org/10.1016/j.cnur.2018.11.001
Shadle, H. N., Sabol, V., Smith, A., Stafford, H., Thompson, J. A., & Bowers, M. (2021). A bundle-based approach to prevent catheter-associated urinary tract infections in the intensive care unit. Critical Care Nurse, 41(2), 62–71. https://doi.org/10.4037/ccn2021934
The Agency for Healthcare Research and Quality (n.d.). Healthcare-Associated Infections Program: Toolkit for Reducing CAUTI in Hospitals. Retrieved 8th March 2023 from https://www.ahrq.gov/hai/tools/cauti-hospitals/index.html
The Agency for Healthcare Research and Quality (n.d.). Toolkit for Reducing Catheter-Associated Urinary Tract Infections in Hospital Units: Implementation Guide. Retrieved 8th March 2023 from https://www.ahrq.gov/hai/cauti-tools/guides/implguide-pt1.html
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In a 5-7 page written assessment, assess the effect of the patient, family, or population problem you’ve previously defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend approximately 2 direct practicum hours exploring these aspects of the problem with the patient, family, or group you’ve chosen to work with and, if desired, consulting with subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form. Report on your experiences during your first two practicum hours.
Competency 3: Transform processes to improve quality, enhance patient safety, and reduce the cost of care.
Explain how a patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual and document the practicum hours spent with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
Competency 5: Analyze the impact of health policy on quality and cost of care.
Explain how state board nursing practice standards and/or organizational or governmental policies can affect a patient, family, or population problem’s impact on the quality of care, patient safety, and costs to the system and individual.
Competency 8: Integrate professional standards and values into practice
Use paraphrasing and summarization to represent ideas from external sources.
Apply APA style and formatting to scholarly writing.
Introduction
Organizational data, such as readmission rates, hospital-acquired infections, falls, medication errors, staff satisfaction, serious safety events, and patient experience can be used to prioritize time, resources, and finances. Health care organizations and government agencies use benchmark data to compare the quality of organizational services and report the status of patient safety. Professional nurses are key to comprehensive data collection, reporting, and monitoring of metrics to improve quality and patient safety.
Preparation
In this assessment, you’ll assess the effect of the health problem you’ve defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 direct practicum hours working with the same patient, family, or group. During this time, you may also choose to consult with subject matter and industry experts.
To prepare for the assessment:
Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete and how it will be assessed.
Conduct research of the scholarly and professional literature to inform your assessment and meet scholarly expectations for supporting evidence.
Review the Practicum Focus Sheet: Assessment 2 [PDF], which provides guidance for conducting this portion of your practicum.
Note: As you revise your writing, check out the resources listed on the Writing Center’s Writing Support page.
Instructions
Complete this assessment in two parts.
Part 1Assess the effect of the patient, family, or population problem you defined in the previous assessment on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 practicum hours exploring these aspects of the problem with the patient, family, or group. During this time, you may also consult with subject matter and industry experts of your choice. Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form. Use the Practicum Focus Sheet: Assessment 2 [PDF] provided for this assessment to guide your work and interpersonal interactions.
Part 2
Report on your experiences during your first 2 practicum hours, including how you presented your ideas about the health problem to the patient, family, or group.
Whom did you meet with?
What did you learn from them?
Comment on the evidence-based practice (EBP) documents or websites you reviewed.
What did you learn from that review?
Share the process and experience of exploring the influence of leadership, collaboration, communication, change management, and policy on the problem.
What barriers, if any, did you encounter when presenting the problem to the patient, family, or group?
Did the patient, family, or group agree with you about the presence of the problem and its significance and relevance?
What leadership, communication, collaboration, or change management skills did you employ during your interactions to overcome these barriers or change the patient’s, family’s, or group’s thinking about the problem (for example, creating a sense of urgency based on data or policy requirements)?
What changes, if any, did you make to your definition of the problem, based on your discussions?
What might you have done differently?
Capella Academic Portal
Update the total number of hours on the NURS-FPX4900 Volunteer Experience Form in Capella Academic Portal.
The BSN Capstone Course (NURS-FPX4900 ) requires the completion and documentation of nine (9) practicum hours. All hours must be recorded in the Capella Academic Portal. Please review the BSN Practicum Campus page for more information and instructions on how to log your hours.
Requirements
The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.
Explain how the patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
Cite evidence that supports the stated impact.
Note whether the supporting evidence is consistent with what you see in your nursing practice.
Explain how state board nursing practice standards and/or organizational or governmental policies can affect the problem’s impact on the quality of care, patient safety, and costs to the system and individual.
Describe research that has tested the effectiveness of these standards and/or policies in addressing care quality, patient safety, and costs to the system and individual.Explain how these standards and/or policies will guide your actions in addressing care quality, patient safety, and costs to the system and individual.
Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of care quality, patient safety, and cost to the system and individual.
Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual.
Discuss research on the effectiveness of these strategies in addressing care quality, patient safety, and costs to the system and individual.
Identify relevant and available sources of benchmark data on care quality, patient safety, and costs to the system and individual.
Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
Use paraphrasing and summarization to represent ideas from external sources.
Apply APA style and formatting to scholarly writing.
Additional Requirements
Format: Format your paper using APA style. APA Style Paper Tutorial [DOCX] is provided to help you in writing and formatting your paper. Be sure to include:
A title page and reference page. An abstract is not required.
Appropriate section headings.
Length: Your paper should be approximately 5–7 pages in length, not including the reference page.
Supporting evidence: Cite at least 5 sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old. Provide in-text citations and references in APA format.
Proofreading: Proofread your paper, before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on its substance.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
