There is a high rate of patients’ readmission to health facilities soon after being discharged which is rather expensive. Avoiding unnecessary hospital readmissions is imperative for patients, payers, families, as well as health care providers. The proposal entails the use of Rosswurm and Larrabee’s Model for change. The proposal entails evaluating the need for change in practice; identification the problem, as well as connecting it to potential interventions; reviewing the literature; and formulating a case for practice improvement (Birk, 2012).
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This phase will entail assessing the need for the change in the practices of securing home monitoring devices for heart failure patients at the time of discharge in order to reduce the incidence of hospital re-admissions. Changing the procedures of securing home monitoring devices for heart patients at the time of discharge rather than after discharge was motivated while running reports on the number of pre-authorization of home health services.
The management was dissatisfied with the high re-admission rate that was present in the hospital and particularly among the Medicare group patients who were suffering from chronic heart failure. Over 30% of those patients who were discharged with a diagnosis of heart failure were readmitted at least once in three months with readmission rates fluctuating between 25-54% in 3-6 months.
Therefore, that is the reason why this writer felt responsible for providing accurate information to appropriate stakeholders pertaining to the high readmission rate that is associated with elderly patients suffering from chronic heart failure. There is a possibility that a multidisciplinary management approach and home-based intervention can reduce the high readmission rate, as well as the high hospital, stays in heart failure patients. This writer started the process by reviewing available literature pertaining to the issue, as well as consultations from relevant experts in this field, producers, and guidelines and concerning policy.
She unearthed enough support that home care monitoring for elderly people who are suffering from heart failure can considerably help in reducing hospital readmissions and particularly when they are secured at the time of discharge, rather than after discharge. The literature review will be followed by embarking on the process for pursuing the change in the process. This will entail meeting with various stakeholders and discussing about the visibility of the change process.
Some of the stakeholders scheduled to be invited to the meeting will include; hospital administrators, physicians, clinical leaders, pharmacy team, as well as staff nurses. At the meeting, the writer will avail a summary of her literature findings and a copy of the current policy used for regulating the administration of heart monitoring devices.
In case the proposal is overwhelmingly accepted and that it is established that the current procedure that is followed of securing the heart monitoring devices after the discharge rather than at discharge is the major cause of high readmission rates, the group will develop a committee to review the current policy and procedures being followed to come up with better ones in accordance to the evidence presented by the literature review (Hines, Yu & Randall, 2010).
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The second stage will involve connecting the problem with interventions and outcomes. Home care management can play an essential role in providing effective, as well as cost-efficient healthcare for heart failure patients. It is noted that the adoption of modern improved technology to monitor patients along with the support of a health care provider greatly improves heart failure management, as well as cuts down the costs of healthcare.
The failure to secure heart monitoring devices for heart failure patients at the time of discharge is the reason that is causing the current high incidences of hospital readmissions. The literature review conducted revealed that appropriate applications of home care monitoring devices of heart failure patients are a very effective strategy for reducing re-hospitalizations. The review of the literature showed that the chief objectives of the home care monitoring devices are; to bring improved outcomes, decrease hospitalizations as well as reduce readmissions rates. Home care monitoring devices enable the patients to become co-managers of their illness.
By implementing the devices, the health care providers are required to embark on developing strategies for effective management, as well as encouraging patients to embark on good health practices. The study validates a multidisciplinary method that encompasses inpatient education, outpatient home care and compliance monitoring is essential to patients in all health care settings.
The study reinforced the importance of tele-management. In order to find out the relevance of the information gathered from the literature, the writer engaged physicians who specialized in cardiac treatments in a conversation. From this conversation, she learned that the factors highlighted from the literature review resonated with the physicians’ arguments (Desai, 2012).
The third step will synthesize best evidence. The information received in step two enabled the writer to review the literature further in order for the researcher to synthesize the data presented and formulate a framework that will assess the strengths, weaknesses as well as the gap that exists in the literature. This research is then supplemented with clinical judgment and any relevant data to either adopt the change practice or reject it.
The next literature review was more focused and concentrated on reviewing the literature on the benefits associated with securing monitoring devices of heart failure patients at the time of discharge. The second research reinforced about patients safety and satisfaction. The outcome of the study indicated the need for securing heart monitoring devices for patients diagnosed with heart failure problems as a means of improving their quality of life, as well as avoiding unnecessary readmission (Louis, Turner, Gretton, Baksh& Cleland, 2003).
Step four entails designing a change practice. It involves synthesizing best evidence. In additional, relevant stakeholders should advocate for the changes and identify resources required in implementing the change process. Then the group will be disassembled and the project handled over to a specified group to develop new procedures that will reflect recommendations pointed by the group. Then the procedures written down will be reviewed by relevant stakeholders from the group to see whether it is written in accordance with the group recommendations (Silow-Carroll, Edwards &Lashbrook, 2011).
Step five entails implementing and evaluating the proposed procedures. A pilot study for the practice change will be implemented and assessed after a predetermined time frame, more adjustments and revisions will be made. Ultimately, the process will result either to the acceptance or rejection of the proposed practice.
If the outcomes from the pilot study support a change in practice, the new policy and procedures will be adopted in the hospitals with roll-out dates, as well as staff education. It is noted that continue education as well as staff-in service education will be administered and tailored in improving the success in the implementations of the new evidence-based practice (Stone & Hoffman, 2010).
The sixth step will involve integrating and maintaining the change process. The implementation of the proposed change process will be followed by integrating and maintaining the changes. The team that will oversee the change implementation should monitor the realization of the implemented change and incorporate appropriate amendments in order to maintain the change process.
The current high re-hospitalization of those people suffering from cardiac related illness has called for implementation of an effective strategy to arrest the situation. The researcher identified the need for the change in the practices of securing home monitoring devices for heart failure patients at the time of discharge rather than after the discharge.
The reviews of the literature, as well as discussion will relevant stakeholders regarding the proposed change indicated that securing of heart monitoring devices at the time of discharge can greatly assist in reducing the high rate of re-hospitalization and mainly for the Medicare group. Further reviews of the literature revealed that implementing the proposed changes will help in reducing the hospital readmissions, as well as improving the quality of life for the patients.
Designing an effective change process and getting approval from relevant stakeholders is imperative for the success of the project. Approval of the proposal will result to the project being assigned essential resources to support the implementation process. Then a pilot study will be conducted and if the study results to improved performance, the new procedures will be adopted in hospitals and the process monitored and appropriate amendments incorporated in order to maintain the change process.
Birk S. (2012). Reducing hospital readmissions. Healthcare Executive. 27(2), 17-24.
Desai, A. (2012). Home Monitoring Heart Failure Care Does Not Improve Patient. Journal of Circulation. 2(125), 820-827.
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Hines, P., Yu, K., & Randall, M. (2010). Preventing heart failure readmissions: is your organization prepared? Journal of Nursing Economics. 28(2), 74-86.
Louis, A., Turner, T., Gretton, M., Baksh, A., & Cleland, J. (2003). A systematic review of telemonitoring for the management of heart failure. The European Journal of Heart Failure, 5, 583–590.
Silow-Carroll, S., Edwards, J., &Lashbrook, A. (2011). Reducing Hospital Readmissions: Lessons from Top-Performing Hospitals. Synthesis Report. Web.
Stone, J., & Hoffman, G., (2010). Medicare Hospital Readmissions: Issues, Policy Options and PPACA. Congressional Research Service.
|Assignment Criteria||Outstanding or Highest Level of Performance |
|Very Good or High Level of Performance |
|Competent or Satisfactory Level of Performance |
|Poor, Failing or Unsatisfactory Level of Performance |
|Introduction||Introduction to the plan is nursing focused, with evidence-based problem identification and potential solutions clearly identified. |
|Introduction to the plan is nursing focused, with evidence to support the problem and potential solution identified but convincing areas are missing. |
|Introduction to the plan is provided; however, evidence to support the problem and potential solution is not convincing. |
|Introduction lacks evidence to support need for change and/or potential solution is not realistic. |
|Change Plan Overview |
|Activities to achieve the first three steps of change are fully described in detail and are based on the first three steps of the Rosswurm and Larabee six- step model: Assesses need for change, links problem-interventions-outcomes, and synthesizes best evidence (literature review) |
|Activities to achieve the first three steps of the change are described, not in detail, and are based on the first three steps of the Rosswurm and Larabee six-step model: Assess the need for change, links problem-interventions-outcomes, and synthesizes best evidence (literature review). |
|Activities to achieve the first three steps of the change are vague. The first three steps of Rosswurm and Larabee’s six-step model are not clearly identified. The literature review does not incorporate current literature supporting the need for change. |
|Activities to address and support change are not specifically addressed. The literature review is absent. Portions of the first three steps are missing or absent. |
|Change Plan Overview |
|Activities to achieve the last three steps of change are fully described in detail and are based on the last three steps of the Rosswurm and Larabee six- step model: Design practice change, implement and evaluate change (with measurable goals and a specified time frame), integrate and maintain change. |
|Activities to achieve the last three steps of the change are described, not in detail, and are based on the last three steps of the Rosswurm and Larabee six-step model. Design practice change, implement and evaluate change (with measurable goals and a specified time frame), integrate and maintain change. |
|Activities to achieve the last three steps of the change are vague. The last three steps of Rosswurm and Larabee’s six-step model are not clearly identified. The goals are not measurable or do not have specified time frames. |
|Activities to achieve the last three steps of change are not addressed. The last three steps of Rosswurm and Larabee’s six-step model are missing or absent. |
|Summary||Clear, solid summary summarizing the key points and six-steps of the change plan is included; ways to maintain the change plan are described. |
|A clear summary summarizing the key points and part of the six-steps of the change plan is provided; ways to maintain the change plan are mentioned, but not in detail. |
|A summary is present but is vague; parts of the six-steps of the change plan are highlighted; ways to maintain the change plan are not clear. |
|A summary is difficult to determine or absent. Key points of the change plan and six-steps are not recapped or are absent. |
|APA format 6thedition: third person, grammar, sentence structure, punctuation, and spelling; sources correctly cited and referenced; title page, headers, and page numbers||No errors to one error. |
|Two to three errors. |
|Four to five errors. |
|Multiple errors |