Grand Canyon University Quali

Please make me a two-page Reflection journal for this week for my project: Initiative to improve the quality of nursing documentation. Including references. APA 7th edition format.

It must include all of these:

1.The week’s goals- 14 points

Explanation:

  1. Evaluation of the project:      Initiative to improve the quality of nursing documentation. The project      was a success in terms of buy-in from the management and the staff. The      most important goal that was achieved was the promotion of compliance in      nursing documentation. 

2.Activities and events that happened this week, including accomplishments and disappointments- 14 points

Explanation: After the project’s intervention of educating the staff on documenting the EKG interpretation, on pain assessment, and reassessment, and on the unit’s documentation guidelines, the project’s findings were shared with the target audience, the staff nurses. The findings were very positive that the chart audits came back 100 % complete in all aspects. The most significant disappointment this week is that the nurse educator who will do the chart audit monthly from August until December was detailed to another unit and that left me to ask my nurse colleagues to take on the responsibility. A very enthusiastic coworker eagerly wanted to do it.

3.Hurdles and barriers- 14 points

Explanation:  It’s a challenge for me to train my coworker to do the audit because in our department, nurses have numerous non-nursing roles, which denied both of us the time to do the training. It remains the source of disappointment for this week. The non-nursing roles are: We make appointments for the patients when the clerks go home at 3 pm. We get disrupted with too many phone calls unrelated to PACU and direct them to the areas they need to connect to. Most of the time, we transport patients. Nurses get the patients dressed when they are ready to go home, and most of the time, we transport patients.

Other barriers to the training are staff shortages (we have one nurse on orientation), and another one is starting in August., inconvenient places/times (Our unit opens at 5:30 am and closes at 8:00 pm if there is no admission from the recovery room) Monday to Friday, fatigue/inability to concentrate after working (We work 12-hour shifts), and family/personal commitments.

4.Project revisions or adjustments- 14 points

Explanation: It is a great milestone to have a nursing documentation project in our unit and this created a mark in the hospital.

5.Next week’s goals-

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Grand Canyon University Quali

reply with 200-300 words each. 

Isabel:

For this assignment, I would like to use the quantitative design to collect data and evaluate the effectiveness of the practice project proposal.   Pilot (2017) states that quantitative data comes from measurements of research variables. These measurements yield data for research in the expression of numeric form or simple binary values (e.g., 1=yes, 2=no). The other data is qualitative, which are in narrative form, or in the form of words rather than numbers. Researchers collecting qualitative data tend to have a flexible, unstructured approach rather than more formal data collection (Polit, 2017). Meadows-Oliver (2019, p. 193) stated, qualitative evidence answers clinical questions about the human experience, such as how one perceives an experience. This type of data is more applicable for evaluating readiness and overall perception of the organization. With this perception of readiness for change revealed, barriers and/or support for the project proposal can be identified.   When support and barriers are revealed, this will also allow alignment with other supports in different leadership roles to further the proposal project. 

References

Meadows-Oliver, M. (2019). Critically Appraising Qualitative Evidence for Clinical Decision Making. In B. M. Melnyk, & E. Fineout-Overholt, Evidence-Based Practice in Nursing & Healthcare; A Guide to Best Practice (4 ed., p. 193). Philadelphia, PA: Wolters Kluwer.

Polit, D. F. (2017). Data Collection Methods. In J. Fitzpatrick, Encyclopedia of nursing research (4th ed.). Springer Publishing Company. Retrieved from Credo Reference: https://lopes.idm.oclc.org/login?url=https://searc…

Michelle:

Quantitative research is objective form of data collection; expressed in numbers and graphs. It is used to test or confirm theories and assumptions and establish generalized facts about a subject (Streefkerk, 2019). With quantitative research, the evidence in my evidence-based practice (EBP) proposal is proven effective. The data is straight forward and can be determined if a practice is effective or not. Diabetic foot ulcer (DFU) is a major health care concern and can lead to serious complications in diabetic patients (Tan, et. al., 2019). The goal of my EBP project is to decrease amputations in Native American patients by increasing training and education on proper diabetic foot care, thus preventing an ulcer in the first place. 

Quantitative evidence provides the knowledge necessary for practice. It supports personal and experimental knowing through participant’s words and stories that is applied to nursing care practices. Common quantitative methods include experiments, observations recorded as numbers, and surveys with closed-ended questions (Streefkerk, 2019). Most nursing research involves the collection of new data through self-report, observation, biophysiological implementation, or performance tests, some research involves the analysis of previous data (Polit, 2017). For my EBP project, direct patient engagement and clinical records would be a primary source for data collection. 

Quantitative research design is the best for my EBP project because it generates and summarizes the evidence to my question. Quantitative research will be able to show how valid and effective the project is by taking previous data (numbers) and post data regarding if there are less diabetic foot ulcers and another if people are more informed on the topic as a primary prevention. This methodology requires critical appraisal of primary studies, data extraction in a reliable and repeatable way, and examination for validity of the results (Oh, 2016). 

References

Oh, E. (2016). Synthesizing quantitative evidence for evidence-based nursing: Systemic review. Asian Nursing Research, 10(2). https://doi.org/10.1016/j.anr.2016.05.001

Polit, D. F. (2017). Data Collection methods. Encyclopedia of nursing research (4th ed.). https://lopes.idm.oclc.org/login?url=https://searc…

Streefkerk, R. (2019). Qualitative vs. quantitative research. https://www.scribbr.com/methodology/qualitative-quantitative-research/

Karla:

For my EBP project of implementing for self-care strategies for increase resiliency to decrease turnover, burnout, improve mood, compassion, the best data would be a use of both quantitative and qualitative data. However, when assessing the topic of the project and how the intervention is based more on feelings and thoughts and resulting data can be based on both quantitative data and qualitive data so if I am choosing just one, qualitative data would be the best option. I think focusing on self-reporting data methods would be most successful for this topic. Questionnaires like the ProQOL-V have been used with great success and it is a validated tool that would be helpful in assessment of findings using the scale. There are additional metrics like turnover intention and absenteeism that would need to be measures. This could be done by surveys to measure turnover intention and ths would be another self-reporting qualitative method that would best for determining outcomes. Additionally, qualitative methods like observational tools like attendance records to assess absenteeism and turnover that has occurred with the staff members on the respective pilot units would be a good fit for the project (Polit, 2017).

References:

Polit, D. F. (2017). Data Collection methods. In J. Fitzpatrick (Ed.), Encyclopedia of nursing research (4th ed.). Springer Publishing Company. Credo Reference: https://lopes.idm.oclc.org/login?url=https://searc… 

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please reply to each 

Mycha: 

Hello All,

CMS Quality Measures are designed to ensure that high-quality healthcare and best practices are adhered to across participating healthcare systems.  As discussed by CMS (2020), “Data on quality measures are collected or reported in a variety of ways, such as claims, assessment instruments, chart abstraction and registries” (para. 1). In hospital systems, electronic specifications gather information from the Electronic Health Record systems. E-specifications are a relatively easy method of obtaining information once proper coding systems are in place. More difficult measures to obtain are gathering information from patients and families related to their outcomes and patient satisfaction.  As discussed by (Deshpande & Schellhase (2015):

  • To make patient safety metrics and their presentation more meaningful, cross-sector input from patients, families, providers, and payers should be actively sought.  Patient-reported outcome measures may prove better metrics for patient safety and quality than any currently in use. (p. 295)

Measures related to outcomes and patient satisfaction are likely more difficult to attain due to stakeholders’ information regarding these measures is not captured within the EHR system.

References:

CMS. (2020, February 11). Quality Measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures.

CMS. (2020, February 11). Electronic specifications for clinical quality measures. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Electronic_Reporting_Spec.

Deshpande, J.K., Green, A. & Schellhase, D.E. Measuring What Really Matters in Patient Safety. Curr Treat Options Peds 1, 286–297 (2015). https://doi.org/10.1007/s40746-015-0036-2

Paula:

The CMS Quality Measures Inventory compiles data for a number of specific conditions provided in a variety patient care settings (CMS.gov).  The measures address outpatient, inpatient and private office practices for specific conditions with data submission standards developed with the National Quality Forum (NQF). There are different aspects to consider for the ease or difficulty in collection of data for the quality measures.

The easiest data to collect is the concrete data such as length of admission for a specific disease process, particularly since this can easily be generated by the EHR. Data is more easily collected in an inpatient or outpatient setting of a healthcare institution secondary to available resources for data collection.

Data based upon patient actions can be more difficult to collect particularly if subjective such as perceived functional improvement post laminectomy or mental health screenings. Additionally, small private offices may lack the resources to generate electronic data or to send the quality measures data to the program. Quality measures based in these areas are more difficult to collect and the validity of the subjective data needs to be considered. 

Centers for Medicare & Medicaid Services (n.d.) Core Measures. https://www.cms.gov/Medicare/Quality-Initiatives-P…

Andrew:

The Centers for Medicare and Medicaid Services (CMS) core measures are designed to guide healthcare facilities and assure due diligence is done on behalf of the patient. Health care facilities that are in compliance with the CMS measures are provided funds for services rendered. While healthcare facilities not in compliance due to not receive funds for services rendered. The easiest compliance measure to collect is hospital readmissions. When it comes to patient discharges and readmission there is very little gray area. Patient readmittance can either be scheduled or not. Verifying as to why the patient was readmitted is more difficult and challenging. The most difficult standard to collect is admitting time for ED patients. In El Paso facilities it is not uncommon to admit non-citizen patients for emergency services.

Unfortunately when non-citizens are brought from border patrol services often the process is not entirely medical. Often admittance depends on Border patrol providing a sitter or guardian to oversee and watch the patient as well as a translator. These additional steps can often impede physicians from directly admitting a patient until service is verified with border patrol. Often the collection of numerical data is the easiest to collect however when admissions are based a multiple factors beyond simple acuity of illness, Numerical data can often be misleading or inaccurate.

Reference 

The CMS Measure Inventory Tool (CMIT)  retrieved August 7th, 2019  from https://cmit.cms.gov/CMIT_public/ListMeasures

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