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Quality and Sustainability Measures in Nursing

Introduction

To evaluate the practical implications of quality outcomes and safety measures, it is essential to possess the experience of analyzing and benchmarking them. For this assignment, the author will create a health care entity and evaluate its quality and safety measures. The facility in question will be a nursing home that houses a number of senior patients and provides them with care. It accommodates both short- and long-term patients, but it mostly focuses on the second category. Patients in nursing homes are subject to a variety of conditions as well as the risk of falls, and it is the task of the staff to ensure that their health is excellent. To that end, this paper will highlight some quality and safety measures, evaluate them against the benchmark, and discuss improvement opportunities and barriers.

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Health Care Entity Description

The facility used in this paper is a nursing home located in Miami, Florida. There are twenty-five beds, which are served by five licensed nurses and ten certified nursing assistants. Twenty-three of these beds are currently occupied, with twenty being taken up by long-term patients and the other three being in use by short-term ones. No long-term patients have arrived at the home or departed from it in the last year, but it has treated another ten patients for short-stay care. The facility is for-profit, though it is not part of any chain. It has been in operation for the last fifteen years, and the author has been working there for the past two years. However, there may be deficiencies in its performance that are not immediately apparent, which should be addressed, as well.

Quality and Safety Measure Benchmark

The author has evaluated several quality and safety measures for current patients as well as people who have stayed at the facility over the past year. Namely, the statistics that they have analyzed include:

  • Percentage of long-term residents who have lost weight excessively;
  • Percentage of long-term residents who have started experiencing more difficulty with independent movement;
  • Percentage of short-term residents with moderate or severe pain;
  • Percentage of long-term residents who have suffered a significant injury as a result of a fall.

The measures described here were compared to the nationwide quality measures described in Quality measures compared to achievable benchmarks (n.d.). It should be noted that, due to the small sample size of the nursing home, exact comparisons may be challenging because of the variance that can result (Lock et al., 2018). Nevertheless, substantial differences in the statistics can highlight notable successes and failures.

The percentage of long-term residents who have lost excessive amounts of weight was 5%, which is generally consistent with the benchmark that was used. 10% of the long-term patients have started having movement difficulties, which is indicative of performance above that set by the reference. However, 23% of the short-term patients who stayed at the home experienced moderate to severe pain, which is considerably higher than the corresponding nationwide value. Lastly, there was one fall incident that resulted in a significant injury throughout the last year, which is markedly higher than the benchmark at 5% against 0.4%. The benchmark’s value is extremely low, and it is challenging to compare the two directly. However, the existence of the fall implies that there is an opportunity for improvement, as very few nursing home residents experience falls otherwise.

Safety Area Improvement

Falls present a safety issue, as they involve harm to patients that occurs within the nursing home. For this paper, the author will focus on them, though they acknowledge the existence of other issues. The nursing home currently uses measures such as fall detection alarms, but the prevention and protection measures that are used may be inadequate. In terms of prevention, the author recommends evaluating different patients for their risk of a fall and assigning interventions where they are necessary. Hsiao (2016) suggests the usage of several short triage scales that were developed by the Joint Commission for the purpose. Based on the results, training, medication, and vitamin D supplementation adjustments can be used to mitigate the risk (Michel et al., 2018). Other measures that are currently in use at the Center may also be applied to successful effect.

However, as it is impossible to eliminate the risk of a fall in a patient, it is also essential to consider protection measures. Michel et al. (2018) suggest the usage of hip protectors for patients identified as most at risk for a fall to reduce the potential damage. However, Boltz et al. (2016) describe the effectiveness of such a measure, as well as low-rise beds and hip protectors, as uncertain, with evidence both for their success and against it. DeCarlo and Bradley (2019) recommend the usage of assistive devices such as canes and walkers, though they also highlight a lack of evidence of their effectiveness and recommend extensive training in their usage. Overall, the author recommends the multifactorial usage of all of these protection tools as necessary, with specific measures applied based on the risk analysis.

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Potential Obstacles

The first significant obstacle to the implementation of the new measures would be an economic one. The equipment that will be involved in the intervention is likely to cost the nursing home a considerable amount, and management may be opposed to its purchase as a result. They are expected to argue that the safety improvement does not justify the cost, as there was only one fall throughout the year, which may have been an accident. Moreover, the various assessments and adjustments that are part of individual patient evaluations will constitute added labor, which will also require compensation for the workers. The facility’s leadership may be unwilling to accommodate these expenses for the same reasons as those for the equipment. As such, it will be necessary to overcome the resistance by providing valid financial arguments.

The resistance of other nurses who work at the facility may be another barrier that the author will need to address. Schmidt and Brown (2019) claim that nurses tend to be resistant to change, even if it is supported by evidence. The reason is likely that they are uncomfortable with adjusting the routines that they are used to, considering them adequate. As such, nurses will see attempts to improve their performance as suggestions that their performance is inadequate and respond negatively. In particular, they may disregard the available evidence and argue against the implementation of the intervention. However, in general, since the responses that are proposed by the author aim to increase the safety of the patients and are supported by quality and safety measures, the resistance from the nurses should not be powerful.

Collaborative Groups and Entities

Due to the nature of the changes that are proposed by the author, the collaboration of the home’s management will be necessary. Christenbery (2017) identifies a need to form a leadership coalition for a change initiative to succeed. Moreover, as most of the interventions used to require the use of new equipment and approaches, the more often-used change models may not apply. Multiple workers will generally treat the same patient throughout the day and week, which makes cooperation necessary for the implementation of the interventions such as training and vitamin D supplementation. Moreover, due to the lack of equipment, a management commitment to its purchase will be necessary. As such, the author will try to convince the leadership to purchase new equipment and introduce enhanced fall prevention practices. With their cooperation, the process of change should conclude quickly and efficiently.

Conclusion

Overall, falls appear to be the most significant issue at the nursing center, though more details regarding the incident that has resulted in the injury could contradict this claim. The national statistics represent the initiative to minimize the number of fall-related injuries to as low a value as possible. Nevertheless, it is vital to address the problems that have led to the emergence of the issue through both preventative and protective measures. While there are some interventions designed to minimize the incidence of harmful falls at the facility, evidence suggests the existence of additional modalities that can be added. With that said, the costs and the alterations in general practices that are required for the purpose are likely to be barriers to the success of the initiative. The author will seek the assistance of the company’s leadership in the implementation of the change.

References

Boltz, M., Capezuti, E., Fulmer, T., & Zwicker, D. (eds.). (2016). Evidence-based geriatric nursing protocols for best practice (5th ed.). Springer Publishing Company.

Christenbery, T. L. (ed.). (2017). Evidence-based practice in nursing: Foundations, skills, and roles. Springer Publishing Company.

DeCarlo, K., & Bradley, S. M. (2019). Falls screening, differential diagnosis, evaluation, and treatment. In A. Chun (Ed.), Geriatric practice: A competency based approach to caring for older adults (pp. 321-334). Springer International Publishing.

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Hsiao, H. (ed.). (2016). Fall prevention and protection: Principles, guidelines, and practices. CRC Press.

Lock, R. H., Lock, P. F., Lock, K. M., Lock, E. F., & Lock, D. F. (2018). Statistics: Unlocking the power of data (2nd ed.). Wiley.

Michel, J., Beattie, B. L., Martin, F. C., & Walston, J. D. (eds.) (2018). Oxford textbook of geriatric medicine (3rd ed.). Oxford University Press.

Quality measures compared to achievable benchmarks. (n.d.). Agency for Healthcare Research and Quality.

Schmidt, N. A., & Brown, J. M. (2019). Evidence-based practice for nurses (4th ed.). Jones & Bartlett Learning.

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