Process Improvement Initiative: Improving Patient Care

Methadone maintenance therapy is the primary go to source for addicts looking to quit the street drug, heroin. Methadone on it's own has its own number of controversies within society. However add on the fact that a number of patients that attend the meth clinic that is pregnant, well this can add additional controversy and raise ethical implications as well. Ultimately the child is better off when not being subjected to harmful substances such as drugs an alcohol. However when given the choice of heroin or methadone, we will examine what the benefits of methadone maintenance therapy can provide the mother, and the fetus. Methadone clinics provide a safe form of the drug with clean needles which helps cut the spread of HIV/AIDS among the population. While the client is at the clinic it is a good time to reach out and provide the future mother with resources that may help her once her child is born. Clinicians can also take advantage of this meeting time to reach out to the mother and inform her on the benefits of attending a treatment facility to help achieve sobriety.

In today’s health care organizations, Continuous Quality Improvement is a structured organizational process created to improve the quality of health care. The CQI system uses data collected to make positive changes and to recognize trends even before a problem exist. I had the opportunity to administer a “one on one” interview with one of University Medical Center‘s Epic Application Coordinators. Debra Lewis is Senior Analyst whose job entails building systems or designs in the Electronic Medical Record (EMR) department for end users. The Health Information and Compliance Departments are her clients within the hospital. Debra usually deals with the Health Information Modular (HIM) to create applications request which consist of release of information and identity, deficiency tracking, and hospital coding. If the client recognized that the current application needs improvement to be more efficient, they can send a request to see if a system can be built to a specific model for a particular provision. Her educational training has enabled her to perform at an advanced level throughout her professional career. Debra received her A.A.S degree in Health Information Technology, a Bachelors and M.B.A. in Business Administration, and also received credentialing as a Registered Health Information Administrator (RHIA). With over 25 years of healthcare experience, she is no stranger to Continuous Quality

Two types of data were collected through surveys, both before and after implementation of the combined approach (Sand-Jecklin and Sherman,2014). The first data was on nurses’ point of view with regards reporting process, and the second on patients view regrading nursing care. The baseline survey included 233 patients and 148 nurses, while the survey three months into the implementation period included 157 patients and 98 nurses. The final survey, 13 months into the impanation, was completed by 154 patients and 54 nurses. The patient survey also included responses from patient families. These were 70, 72, and 53 responses for baseline survey, three-month postimplementation surveys, and 13-month postimplementation surveys.

(2010) explains that although methadone is used for opioid exposure especially during pregnancy, but also is linked to NAS when a fetus is exposed to methadone. With their focus of the effects of NAS on the central nervous system hyperirritability and autonomic nervous system dysfunction Jones et al. also focused on the different effects of methadone versus those of buprenorphine, which has less substantial research. The points of study included number of newborns requiring treatment for NAS, peak score on a NAS scale, amount of morphine given through out treatment, length of hospital stay and the head circumference. Overall they only found significant differences in outcomes for the total morphine required as well as the length of the neonates hospital stay. When exposed to buprenorphine prenatally the newborns required 89% less morphine during treatment and 43% less time in the hospital than those exposed to methadone (Jones et al.,

The problem was discovered by Ashley Kilpatrick, NNP, Project Manager of this process improvement initiative. Ashley saw the opportunity to improve patient care by standardizing the care of the infants by decreasing the variation in care. I was made aware of the problem in weekly discharge rounds that occur every Tuesday in RNICU/CCN with the nurse managers, assistant nurse managers, social services, utilization management, UAB Police and the discharge coordinator to talk about any financial or social barriers to discharge. During discharge rounds, we discussed infants whose mother was addicted to drugs, whether prescription, illegal, or opioid substitutions. We also discuss whether the infants are having withdrawals and receiving Methadone. There would always be questions about weaning the Methadone, what day of weaning were the infants on so they could be discharged. There would be questions whether we were monitoring 3 -5-7 days off Methadone to send the infant home. This could ultimately be a safety and quality issue for the organization.

In the Care About Your Care video discussion one of the transitional care implementations was a nurse visit after leaving the hospital. In the article, Transitional Care Interventions Prevent Hospital Readmissions for Adults with Chronic Illnesses, the author’s identified that same intervention of a nurse visit, but stipulated that the visit should be within three days of discharge and be performed by a registered nurse or advanced-practice nurse, along with other interventions such as, “care coordination by a nurse and communication between the primary care provider and the hospital” (Verhaegh, MacNeil-Vroomen, Eslami, Geerlings, Rooij & Buurman, 2014). During the nurse visit it would be beneficial to perform a drug reconciliation to reduce

Healthcare is a complex industry that is consistently changing to meet the demand of improving quality patient care. As a member of the healthcare team, we are obligated to provide safe patient-centered care. However, patient care within the facility this nurse is employed is not as effective as it should be. The organization currently utilizes three different charting systems, two electronic health information systems and a paper chart. Each with its own purpose of use. To make matters worse, not all healthcare providers have access to both electronic health information system. Depending on the individuals professional role within the organization, access would be limited to one or the other. Nurses are the only one

The problems at hand that the SIMARRA Act bill is proposing to address, involves child welfare issues, women’s health concerns, and a lack of protection and healthcare needs for these women and their unborn children within the criminal justice system. According to the bill, it has been propositioned to enhance the welfare and public health for incarcerated pregnant women and mothers by improving the effectiveness and efficiency of the Federal prison system, by establishing a pilot program of critical-stage, developmental nurseries in Federal prisons for children born to inmates, with risk needs assessments, and risk and recidivism reduction (H.R.5130, 2016). The bill is intended to focus and alleviate the lack thereof adequate care, stress, and hazardous health practices that incarcerated mothers are experiencing with their infant babies, while also monitoring the health of these women. Both the mothers and infants are affected in these situations because the health of the mother has substantial

Information obtained for this project included researching hospital scores from the Centers for Medicare & Medicaid Services (CMS) hospital consumer assessment of healthcare providers and systems (HCAHPS), The Leapfrog Group, American Hospital Directory, an interview with the Vice President/Chief Nursing Officer (VP/CNO) of the facility, a letter from the President/Chief Administrative Officer (CAO) of the facility, Covenant Health websites, Medicare website, the Joint Commission website, national practice standards, as well as personal knowledge gained while working in the facility.

Quality improvement is defined by Kelly (2012) as “a systematic process of organization wide participation and partnership in planning and implementing continuous improvement methods to understand, meet, or exceed customer needs and expectations and improve patient outcomes” (p.477). The women’ unit can receive thirty patients from age eighteen to late adulthood. The unit is a receiving facility for everyone Baker acted in the state of Florida. Like any other organization, change is always happening in the women’s unit. One of the areas that need improvement on the unit is a reduction in the number of seclusion and restraint that we do every month. Patients that are violent and present a danger to either

According to Lowe (2017), “…across the United States, a woman presents every 3 minutes to an emergency department for opioid misuse or abuse” (p.657). With the significant increase in the misuse of opioids over the last thirty years in the US, it has become a serious public health concern. With the most dramatic rise in opioid use being of childbearing age women, it is a very important issue in maternal health care (Keough & Fantasia, 2017). It is imperative that nurses are informed and have efficient knowledge of the potential risks, effects, treatment, and prevention of opioid dependence during pregnancy.

In the United States alone there are 98,000 deaths per year caused by low quality health care (Ignatavicius & Workman, 2013, pg. 2). This statistic is disturbing because the errors that resulted in death were errors that were preventable. The intent of this chapter is to bring awareness to health care providers that are able to make a change in the quality of health care. In current practice patients are subjected to medication errors, preventable hospitalizations, premature death, and poor care provided due to racial, ethical, or low-income factors.

The premise of this paper is to identify deficiencies in daily managerial processes by using systematic statistical process controls and make the necessary improvements. The paper will employ various examples and calculations along with supporting data to explain control limits and its importance to the statistical process control. The effects of seasonal factors and its relevance to a process will also be highlighted and how confidence intervals are important in giving insights into data sets that improve the entire statistical process control.

It is this writer’s belief that these babies should be cared for by another family member or child welfare agency until the mother can prove that she is responsible. This would be measured by the mother attending counseling sessions where she learns about the dangers of drug abuse and she would also undergo random drug testing to assure the child will be safe in her care.

The Quality Improvement nursing process that I have chosen to research is patient safety. I have chosen to focus specifically on the topic of catheter associated urinary tract infections (CAUTI’s) during hospitalization and their preventions. It is estimated that 15-25% of hospitalized patients receive a urinary catheter throughout their stay, whether or not they need it. A large 80% of all patients diagnosed with a urinary tract infection (UTI) can be attributed to a catheter (Bernard, Hunter, and Moore, 2012). The bacteria may gain entry into the bladder during insertion of the catheter, during manipulation of the catheter or drainage system, around the catheter, and after removal.