DISCUSSION REPLIES

respond to the four colleagues  by  critiquing the gap/opportunity/solution descriptions; by offering supporting ideas you believe your colleagues should address; or by offering alternative solutions to the issue or specific financial, budgetary, or other challenges you believe their approaches should address. Please provide at least 2 references each

Amber: Gaps in care refers to the discrepancy between the care provided to patients and the recommended best practices in healthcare. A significant gap within healthcare organizations is inadequate education for patients with low health literacy. The Institute of Medicine defines the construct as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Institute of Medicine (US) Committee on Health Literacy, Nielsen-Bohlman, Panzer, & Kindig, 2004). Low health literacy can lead patients to have “inappropriate medication use, risk of hospitalisation, inaccurate processing of health information, and lower uptake of preventive health services” (Smith, O'Conor, Curtis, Waite, Deary, Paasche-Orlow, & Wolf, 2019). By addressing this gap through the implementation of a comprehensive patient education program where we empower individuals to take charge of their health demonstrates a commitment improving not only patient outcomes but overall healthcare efficiency. With employing systems that consider various factors that influence patient understanding, we can design an education program that caters to diverse populations and empowers patients to manage their conditions effectively.In order to address this gap, we can implement a comprehensive patient education program that employs systems to promote the effective management of diseases. This program would include individualized educational materials and interventions along with the help of interdisciplinary collaboration between healthcare providers, educators, and IT specialists. It is important to recognize patients understanding of their conditions and how it can be influenced by a variety of factors such as cultural backgrounds, health literacy levels, and socioeconomic status. So this program would be simple to comprehend, accessible to everyone no matter how diverse their population, and sensitive to cultures. It would be able to provide this with the help of community organizations and patient advocacy valuable insights for customizing the educational program for each patient. This would be accessible through online platforms that will have interactive modules, videos, and virtual consultations to help educate them on their conditions, medication adherence, lifestyle changes, and symptom recognitions.

 Improved patient education results in better self-management, fewer hospital readmissions, and fewer complications, ultimately resulting in healthcare system cost savings. Utilizing technology for the dissemination of education can reach a greater number of patients at a lower cost. Financial investments would be required to implement a comprehensive patient education program, including the development of educational content, the creation of online platforms, and the training of everyone involved these things all outweighing the upfront costs.

 In conclusion, addressing the deficiency in patient education by implementing a comprehensive patient education program demonstrates our dedication to enhancing patient outcomes and overall healthcare efficiency. By employing systems that take into account various factors that influence patient comprehension, it is possible to design an education program that accommodates to diverse populations and equips patients to effectively manage their conditions.

Deanna: Chronic pain substantially impacts physical and mental functioning, productivity, quality of life, and family relationships. Chronic pain is often defined as pain lasting 3 months or longer or persisting past the normal time for tissue healing, though definitions vary. Chronic pain affects millions of adults in the United States, with an annual cost in personal and health system expenditures conservatively estimated at $560 billion to $635 billion (Skelley et al., 2020).

Although opioid analgesics provide important benefits for acute pain, their long-term use is speculated as a contributor to the increase in opioid analgesic misuse, opioid addiction, and overdose, often leading to death. Therefore, it is imperative that alternative pain relief strategies be integrated into routine practices to facilitate analgesia and reduce reliance solely on opioid analgesics. Responding to these adverse events, the Centers for Disease Control and Prevention (CDC) developed guidelines for the management of persistent noncancer pain to include the use of nonpharmacological strategies. According to Andrews-Cooper and Kozachik (2019) nonpharmacological modalities have been reported to have encouraging and notable results in persistent noncancer pain because they address pain from a multifaceted and patient-centered approach.

The patients are provided with physical and occupational therapies while they are being treated within the Community Living Center of the VA. I propose to fill the gap by offering them a choice of other nonpharmacological pain relief strategies. There is a gap in services, not all veterans want to take narcotic pain medication and want alternatives. This would also be beneficial +for the veterans who have a history of drug abuse. They cannot be prescribed narcotic pain medication and Acetaminophen alone does not control the pain. By offering them a choice of nonpharmacological methods of pain control they will feel like they have more choices and they see that we are aware of the struggles they are going through and are attempting to alleviate some of the pain and stress.

Start-up Cost: This is the most expensive part of the venture. An office would have to be cleared out and possibly remodeled for the storage of the supplies needed for the nonpharmacological methods to be provided for a 38-bed unit. The cost of the labor, clean up, and supplies would be part of the initial cost. Also included would be the initial purchase of aroma therapy equipment, radios, music, reusable heat/cold packs, massage table, towels, massage oils, and lotions. In addition to the cost of the supplies the labor of setting up the office and training the staff would be part of the cost as well as advertising the services and the day of opening.

Operating Cost: To continue having this service be a successful venture takes more money. Salaries of the employees, supplies need to be replaced as they are being used. (If this was an outside venture there would be rent and utilities. Within the VA, it would be included into the budget). Supplies would need to be replaced as they wear out and need to be repaired as needed. Refreshments would need to be made available to the veterans while they were receiving treatment to prevent dehydration.

Revenue/Cost Savings: The cost savings would be the decrease in the amount of pain medications administered. This method would enable some of the veterans to decrease the number of times they needed medication for pain. This could enable a decrease in length of needed therapy and length of stay.

Effective management of a patient’s pain is a vital nursing activity, and it needs a nurse’s adequate pain-related knowledge and a favorable attitude. As stated by Tekletsadik et al. (2021), ineffectively managed pain affects the patient’s quality of life negatively, which results in higher hospital readmission rate, more repeated outpatient visits, prolonged hospital stay, increased risk of nosocomial infection, and increased stress and anxiety for the patient as well as his family

Hannah: In 2012, the World Health Organization (WHO) published a mental health action plan noting that in low and middle-income countries, 76-85% of people with severe mental illness (SMI) do not receive treatment and could account for a 16.3 trillion-dollar profit loss between 2013 and 2030 (World Health Organization, 2021). Despite continued research, multiple barriers exist to being treated for mental illness, including lack of knowledge, limited access, stigma, perceived effectiveness of treatment, and believing it will go away on its own (Lien et al., 2023).

For this discussion, we will focus on limited access to care. The healthcare organization in which I am currently employed serves a total of nine counties in rural Mississippi. There are nine outpatient community mental health centers, a 16-bed crisis stabilization unit (CSU), an inpatient alcohol and drug program, a children and youth outpatient program, and several day programs. Despite all these programs, there still needs to be more access to care in the community. Most of the programs for this organization are in low-income counties, which presents an issue with access to care—for example, no transportation to appointments or to pick up prescribed medications. The organization has a program for ICORT, or Intensive Community Outreach and Recovery Team, which is only offered in some counties. This is a team of nurse practitioners, therapists, nurses, and social workers who go to the patients’ homes and see them. It would be very effective if the staff could see everyone through ICORT without transportation, but unfortunately, there is not enough staff for this, so some are just left to fend for themselves. This leads to the practice gap that I would like to address. The stakeholders of this organization have said hiring more therapists is “not in the budget,” but when looking at this from a system-wide standpoint, there is room for gain from this.  For instance, say we discharge a patient from the inpatient crisis unit, but they have no transportation and live in one of the counties where ICORT isn’t offered, so they do not follow up or refill their medications. They will likely have to be readmitted to the crisis unit for stabilization. Without transportation or community support services, this patient will become part of the revolving door phenomenon. Having frequent readmissions because of non-adherence due to lack of access is going to cost the system more in the end, as inpatient crisis unit admissions, except for the inpatient alcohol and drug program, is the costliest of all the programs.

My proposed solution for this problem is simple. If it is outside the budget to hire more staff, use our current team and rotate them throughout all nine counties weekly. To be more cost-effective, the nurse and nurse practitioner could visit together one day, then the therapists and social worker another day. This makes the visits less lengthy and allows the two teams to see patients simultaneously. This way, all nine counties could offer ICORT services, and readmissions could be prevented, saving the system undue expenses. Hiring more therapists and a rotating schedule would be presented to the stakeholders of this organization. Of course, there would need to be criteria for this, or the system could be easily overwhelmed. For example, have we involved the patient's family? Could they help with transportation to and from appointments? Have we checked to see if their plan covers transportation if they have Medicaid or Medicare? Also, we would need to look at why the patient does not have transportation. Have they had their license revoked due to legal issues? Do they not like to drive? Are they on medication that makes them unable to drive? Have substance abuse issues created a financial burden? These are important to consider when choosing who should receive ICORT services and who should not.

Two resources were selected to consult for financial planning. The first is the chief finance officer, who oversees the company's system-wide finances. The next is the CSU director, as inpatient readmission directly impacts their performance rates. Both will be assets in helping to adjust the budget to offset the extra cost related to this until the program is functioning at full potential and profit can be gained. Some anticipated beginning costs are increased gas usage while traveling to and from different counties and purchasing more company vehicles.

Monicah: Within our healthcare organization, a notable gap exists in the integration of technology to streamline patient communication and improve overall care coordination. Currently, there is a lack of a unified platform that facilitates seamless communication among healthcare providers, patients, and support staff. This gap hinders the efficient exchange of information, leading to potential delays in treatment, miscommunication, and suboptimal patient outcomes (Khatri et al., 2023). To address this gap, a possible solution is the implementation of a comprehensive Electronic Health Record (EHR) system that encompasses features for secure messaging, appointment scheduling, and real-time updates on patient progress. This system would enable healthcare providers to access and share patient information in a timely manner, fostering collaboration and informed decision-making. Patients, in turn, would benefit from improved communication channels, allowing them to actively engage in their care and stay informed about their treatment plans. The financial impact of implementing an EHR system would require a significant upfront investment. However, the long-term benefits in terms of improved efficiency, reduced errors, and enhanced patient satisfaction can contribute to cost savings over time. Additionally, the system can streamline administrative processes, reducing the workload on support staff and allowing them to focus on more value-added tasks.

Considering the budgetary implications, collaboration with the finance counselor is crucial to ensure a sustainable financial model. This may involve exploring potential government grants, incentives, or partnerships with technology vendors to offset implementation costs. Conducting a cost-benefit analysis that takes into account both short-term and long-term financial considerations is essential in making informed decisions about the investment in the EHR system (Rundio, 2021). By adopting a systems thinking approach, we recognize that the integration of technology is not just a standalone solution but a part of a larger interconnected healthcare ecosystem. It involves considering the perspectives of healthcare providers, patients, and support staff, as well as the broader financial and operational implications. This holistic approach ensures that the proposed solution addresses the root cause of the communication gap and contributes to an overall improvement in the quality of care provided by our organization.