discussion replies for transforming and leading class week 6

WEEK 6 Transforming REPLIES

respond to the colleagues and Expand upon your colleague’s posting or offer an alternative perspective on the use of digital health. Include 2 references each

MOM TEONA:

Digital Health

In today’s healthcare sector wearable digital devices have revolutionized the way patients, their families and healthcare providers monitor patient care. These devices have saved lives and will continue to enhance patient outcomes. There are many wearable devices specifically designed to cater to a patient’s healthcare needs.  

One such device is the Holter monitor. This device is a type of portable electrocardiogram (ECG). It records the electrical activity of the heart over a 24-hour period or longer while the patient is away from their healthcare provider's office. Usually, a physician would order this device to detect abnormal heart rhythm that would occur due to specific situations such as stress or activity (Ateeq Mubarik & Arshad Muhammad Iqbal, 2019). Some Holter monitors also have an event monitor feature that allows the patient to activate it when they notice symptoms. Holter monitors record every heartbeat and can give information on the minimum, maximum, and average heart rate ( Holter Monitor, 2019). 

Opportunities and Challenges of Adopting a Wearable Device 

During my career as an emergency room nurse, patients would present with syncope, palpitations and abnormal cardiac enzymes and need further monitoring at home to detect any abnormal cardiac activity with a Holter monitor. This device has many benefits to both the providers and patients. Holter monitors allow for extended monitoring of a patient’s cardiac activity outside of the hospital, providing valuable data on heart rhythm and potential abnormalities. This monitor can also enable early detection of cardiac issues or arrhythmias, allowing for timely intervention and potentially preventing more serious complications (Hassani et al., 2024). Patients can go about their daily routine while wearing the Holter monitor, providing a more accurate picture of their heart function in real-world settings. Healthcare providers can remotely monitor patients’ heart activity, reducing the need for frequent hospital visits and allowing for more efficient use of resources. 

However, some challenges of using this wearable device are that some patients may find wearing the Holter monitor uncomfortable or inconvenient, leading to non-compliance or incomplete data collection (Carrington et al., 2022). Furthermore, healthcare providers need to interpret the large volume of data generated by the monitor accurately distinguishing between normal variations and clinically significant abnormalities. Also, Holter monitoring data needs to be seamlessly integrated into electronic health records and clinical workflows to facilitate timely communication and decision making among healthcare providers and this can be challenging (Freund et al., 2023). 

As a nurse, some issues may also arise for patients who are not technologically savvy or new graduates unfamiliar with the proper application of the device.  

In essence, while the Holter monitor offers valuable insights into patients’ cardiac health outside of the hospital setting, their adoption poses various challenges related to patient comfort, data interpretation, integration with healthcare systems, staff and patient training. Addressing these challenges can help maximize the benefits of Holter monitoring for patients leaving the emergency department. Furthermore, the doctoral prepared nurse must be cognizant of the role, challenges and benefits of incorporating wearable devices in healthcare settings and their impact on patient outcomes. 

MOM ALTHEA:

Wearable Devices

Wearable devices are now being recognized as valuable assets in the field of healthcare, providing ongoing monitoring and tailored insights for both patients and clinicians. Wearable devices can seamlessly integrate into patients' daily routines, allowing for remote monitoring, early detection of health problems, and proactive management of chronic conditions Devi et al., (2023). In addition, these tools enable individuals to actively manage their health by fostering self-awareness and supporting behavior modification through tailored feedback and reminders. Due to technological advancements and the increasing need for remote care solutions, wearable devices are expected to have a greater impact on healthcare outcomes and patient engagement.

The development of wearable Accu-Chek blood sugar glucose monitoring devices signifies a notable breakthrough in the field of diabetes care. These devices provide patients with diabetes with a simple and non-invasive means of monitoring their blood glucose levels in real-time. Wearable devices commonly comprise a compact sensor that is donned on the human body, frequently on the arm or belly, and is designed to consistently monitor glucose levels within the interstitial fluid. The sensor transmits the gathered data wirelessly to a smartphone or other suitable device, enabling users to monitor their glucose levels for the whole day without the necessity of regular fingerstick tests. According to Wu et al., (2020), the ability to continuously monitor glucose levels offers patients significant insights into their glucose patterns, empowering them to make well-informed decisions pertaining to insulin dosage, food selections, and physical exercise.

Challenges and Opportunities

One issue is making sure that digital technologies can be easily added to clinical processes and systems that are already in place. To do this, a lot of money needs to be spent on education and training staff, managing change, and improving infrastructure so that new digital tools can be used. To keep private medical information safe, it is also very important to follow data security and privacy rules when using digital solutions where challenges encompass regulatory obstacles and the reluctance to embrace change within the healthcare organization (Lupton and Maslen, 2020). Integrating data from wearable devices with preexisting healthcare information systems is an obstacle. Moreover, wearable devices capture personal health information, there are also security and privacy issues to consider. Given the seriousness of the threats associated with data breaches and illegal access, it is of the utmost importance to safeguard patient privacy and keep all data secure. Conversely, the trustworthiness and precision of data collected by wearable devices is considered a major obstacle, along with the dependability of data, which can be compromised due to calibration difficulties, sensor errors, and differences in device performance. This might result in misunderstanding or wrong diagnosis (Lupton and Maslen, 2020). Furthermore, wearable technology also has the potential to be difficult to use for some patient demographics, including the elderly and those with physical impairments.

Moreover, research has shown that wearable Accu-Chek blood sugar glucose monitoring devices are effective in improving glycemic control and reducing the risk of hypoglycemia in individuals with diabetes. A study conducted by Heinemann et al., (2020) revealed that the use of wearable devices for continuous glucose monitoring (CGM) resulted in notable enhancements in the amount of time spent within the desired glucose range and reductions in HbA1c levels when compared to conventional fingerstick testing. In addition, wearable CGM devices have been demonstrated to improve patient satisfaction and quality of life. They offer increased flexibility and freedom in diabetes management, while reducing the need for frequent glucose monitoring. The ongoing development and increasing availability of these devices have the potential to greatly transform diabetes care, enabling individuals with diabetes to effectively manage their condition and improve their overall well-being.

Ultimately, using wearable technology in healthcare may improve health outcomes, strengthen patient-centered care, and promote evidence-based practice as a DNP prepared nurse.

DEM-Sylvia:

Digital health refers to the use of information and communications technologies in medicine and other health professions to manage illnesses and health risks and to promote wellness (Ronquillo et al. 2023). Digital health has a broad scope and includes the use of wearable devices, mobile health, telehealth, health information technology, and telemedicine.  Digital Health has been gaining momentum because it is envisioned to: Improve access to healthcare, Reduce any inefficiencies in the healthcare system, Improve the quality of care, Lower the cost of healthcare, and Provide more personalized health care for patients (Ronquillo et al. 2023).  For this discussion I will be focusing on telehealth and the impact it has had in my facility.The terms telehealth and telemedicine are often used interchangeably. Telehealth is a subset of e-health and is the use of telecommunications technology in health care delivery, information, and education according to the Health Resources and Services Administration (Gajarawala & Pelkowski, 2021). Increasingly, telehealth technologies are being adopted and implemented as an efficient and cost-effective means for delivering and accessing quality health care services and outcomes. Telemedicine has the potential to reduce American health care spending by decreasing problems like medication misuse, unnecessary emergency department visits, and prolonged hospitalizations (Gajawala & Pelkowski, 2021).

working in a psych facility, we see patients who have been on the waitlist for a year or two because they can't fine outpatient  providers to continue with their care. Nowadays telehealth is helping in bridging that gap by providing patient care via video calls. Providers at my facility are able to provide patients with both inpatient and outpatient care as they now have access to telehealth. This is very crucial especially in psych where have many patient with drug addiction and overdosing everyday and we also have patients who struggle with suicide thoughts on a daily. Having a team they can reach wherever the are when they are going through crisis, to assess if meds are working, to refill meds and check in patients in general.Telehealth provides access to resources and care for patients in rural areas or areas with provider shortages, improves efficiency without higher net costs, reduces patient travel and wait times, and allows for comparable or improved quality of care.  Better access to care, convenience, and reduced stress with telehealth use also can increase patient satisfaction (Gajawala & Pelkowski, 2021). In light of the current opioid epidemic in the United States, telemedicine can provide a newer and quicker avenue for crisis intervention, which is being recognized by payor groups. For example, Connecticut had previously prohibited prescription of controlled substances through telemedicine, but as of 2018 the state has made an exception for the prescription of drugs that treat opioid use disorder or substance use disorder

DEM-Chidinma:

Virtually every facet of human effort has undergone transformation in the last several decades due to the rapid growth and advancement of digital technology. Population-wide health plans, integrated real-time development of new knowledge and insights, and dramatic advancements in individual health and medical care have all been made possible by the application of mechanical and digital recording and capture of physical status, experiences, and narratives (Abernethy et al., 2022). 

Telehealth

        The term "digital health" describes how information and communications technology are used in medicine and other health-related fields to control diseases and health risks and to advance wellbeing (Ronquillo et al., 2023). Wearable technology, telehealth, and digital devices are all included in the wide category of digital health.

         Telehealth is the use of telecommunications technology for health care delivery, information sharing, and education (Gajarawala & Pelkowski, 2021). It includes health care services provided using audio and video technology. When utilized properly, it is far more than just an inexpensive digital imitation of in-person care and can actually save expenses and enhance patient health. Additionally, it improves equity and accessibility of treatment for the 78% of adults worldwide and the 89% of adults in the United States who own a smartphone, including those living in underserved medical communities (Pearl & Wayling, 2022).

Challenges that have arisen in my healthcare organization

        Technical difficulties- These included poor internet connectivity, poor visual and/or audio quality. During video visits, we have experienced glitches with connectivity which in many occasions were not resolved resulting in an abrupt end to the video visit. In some cases, the video visit did not even start because of connectivity issues while attempting to start the video. It is to be noted that this challenge was sometimes from the patient’s end. Patients have called in after a video visit ended abruptly stating that their internet connection was the problem.

        Technologically challenged patients- Patients who are not technology savvy or skilled have experienced problems with setting up and joining in to their video visits. This was especially true for our older patients. 

       Limitations in conducting comprehensive physical examination- One of the challenges of telehealth is performing exams such as blood pressure (BP) checks, palpation, and auscultation. Although some organizations have set up BP checks in a way that patients home BP can be synced to their electronic records, my organization has not adopted that, therefore patients still have to come in to the clinic for their BP check

Leading week 6 replies

 respond to the colleagues  by expanding upon your colleague’s post or offering an alternative interpretation of the error rate described by your colleague. Include 2 references each

Natalia:

 To select a quality improvement initiative, it is beneficial to include the performance improvement team to help determine the best approach to any quality improvement initiative. The performance improvement team’s responsibility is to improve healthcare delivery through the focus on patient care outcomes, cost reduction, while decreasing risk and liabilities (Buljac-Samardzic (2020). Additionally, the Centers for Disease Control and Prevention (CDC) has acknowledged and stresses the issue of increasing resistance of microorganisms (Carrico, 2018). Partnerships between the CDC, ANA, and other professional nursing organization resulted in the development of the Nursing Infection Control Education (NICE) Network. The premise of this initiative is to improve adherence to infection prevention practices (Carrico, 2018).

            According to Zheng (2021), a total of 8,471,051 patients have been diagnosed with cancer between 1975 and 2016 and were identified during a retrospective surveillance, epidemiology, and end results (SEER) program. The results of the study revealed a mortality rate of fatal infections was 260.1/100,000 person-years which is three times more than the general population. The highest incidence was noted among cancer patients suffering from Kaposi sarcoma, liver cancer, acute lymphocytic leukemia, acute myeloid leukemia with an age range of 20-39 years old and those >80 years old the mortality rate rapidly increased and became the highest approximately 3 years post cancer diagnosis (Zheng, 2021). The conclusion of the study recommended that the age population with a cancer diagnosis including those receiving chemotherapy, should be sensitized to the risk of fatal infections. Fatal infections noted were pneumonia, influenza, and septicemia. The sample size of the study conducted by Zheng (2020) is 8,471,051 with 134,526 deaths observed with a rate of 260.1 the SMR 95% CI of 2.92 among all cancer anatomical sites. This information is very relevant to the cancer institute and the organization in total to the healthcare organization I currently support as in infection preventionist.

            Due to the increased mortality rate in the cancer population, the quality improvement (QI) initiative selected is to  improve infection prevention practices among nurses working in a cancer center (institute). Therefore, it is important to address how the organization I work for handles adverse events including nursing practices. When an adverse event occurs, a multidisciplinary team comes together to discuss the case and to go over the details of what transpired. The team members that may be involved are risk management, infection prevention and control, unit leader, senior and executive leadership, performance improvement, nursing house supervisor, chief nursing officer, and safety). Risk managers may choose to use the fishbone diagram to determine the cause of the event. Once the cause has been determined then performance improvement may choose to use the failure mode and effective analysis (FMEA) tool to assess and prioritize areas of risks in clinical practices. The infection prevention and control team may decide to do a risk assessment to understand the infection prevention practices and determine the gaps by performing a gap analysis to determine where the organization is at and where should the organization be from an infection prevention and control perspective. After these assessments take place, a strategy is created to improve practices, address adverse events, and prevent them from happening in the future. It is important to address adverse effects or any negative patient outcome immediately and be transparent across the organization to instill confidence in the staff and patients that may weigh in the pros and cons of the organizations they choose to receive care from. It takes seconds to lose trust that takes years of excellency to build, when an adverse event happens it may be demoralizing to the organization and staff members. While in the public may choose to receive their care in another organization they perceive as being safer and better. For this reason, it is important to have quality measures, quality improvement initiatives to prevent events that may destroy the perception of the public and the employees.

Julius:

The QI initiative in my organization is the Patient and Family Engagement Program, which is aimed at improving patient-centered care for psychiatric patients. The initiative seeks to involve patients and their families in their healthcare journey by furnishing them with information, resources, and prospects to participate in care decisions. I chose this initiative due to its significance in patient care. The involvement of patients in clinical decision-making is critical in improving the quality of care because patient preferences are considered. For example, some patients might require a specific gender to provide treatment.

My healthcare organization systematically handles adverse events. There are incident reporting systems that identify and report adverse events. The staff, patients, and healthcare providers use it to report adverse events. After an adverse event has been reported, a comprehensive analysis and investigation are carried out to comprehend the root causes, risk factors, and underlying system impacts that resulted from the event. This encompasses reviewing medical records and conducting interviews (Schwendimann et al., 2018). This approach positively impacts public perspectives by improving trust and confidence in the quality of care.

The selected article is by Robertson and Long (2018) and explores the impact of medical errors on healthcare providers. Medical errors have significant impacts on healthcare providers because they undermine their integrity and competence in providing quality healthcare. Medical errors have also been a significant issue in my healthcare organization. For example, my organization has reported increased cases of medication errors involving administering the wrong medication, incorrect dosage, and failing to administer medication as required. As a result, they have to incur additional healthcare costs due to long stays at the hospital (Elliott et al., 2020).

Brytnee:

Providing mental health services to incarcerated individuals is crucial for their well-being and the safety of the correctional staff and other inmates. Mental health (MH) issues such as depression, post-traumatic stress disorder (PTSD), antisocial personality disorder (APD), and substance abuse are common among inmates, and addressing these issues can reduce the likelihood of recidivism (Kopak et al., 2024). Correctional medicine involves providing healthcare services to inmates, including medical and psychiatric care. Patients who have an MH diagnosis are disproportionately at risk for potential suicide, and suicide attempts are a common challenge faced in a correctional organization (Obegi, 2024). Suicide rates can be exceptionally elevated in the confinement setting, with Carson (2021b)(as cited in Obegi, 2024) stating they occur at a rate of 25 in every 100,000 individuals compared to 13.9 per 100,000 in the general community. Therefore, with the high incidence of MH and the potential for suicide in a correctional setting, the quality improvement initiative is to decrease the number of suicides within correctional settings and improve the collaboration of services in the penal system through release back into the community.  

One of the challenges faced in correctional medicine is the potential for adverse occurrences, such as in any healthcare field, which can include suicide events. Unfavorable events can have severe consequences for the health and well-being of inmates, and addressing and preventing these events is critical for ensuring the delivery of safe and effective healthcare services in correctional facilities. Within my organization, after a severe adverse event like an inmate's death, every aspect of interaction from all staff and care is examined. Then, the review of processes, policies, and procedures concerning the adverse event occurs, and potential adjustments in these guidelines are constructed. These modifications come from collaboration amongst all the specialties residing within the facility, such as medical, mental health, and corrections. Quality improvement (QI) initiatives can focus on improving mental health services, screenings, and collaboration with healthcare providers within the penitentiary system and the community from these partnerships within the jail. These QI improvements are achieved through implementing regular training and education for healthcare providers and staff to promote more appropriate and positive health outcomes. From these adjustments, individuals within the judicial system can be seen by MH staff quickly, obtain vital medications that can better manage their symptoms and emotions, and thereby reduce their risk and chance of suicide. Additionally, these adjustments can help patients during their release into the community. When patients are released, now stable on medications, resources can be provided to them to continue their treatment, further reducing suicide risk and recidivism chance while increasing positive outcomes and community health. 

As mentioned, correctional medicine has its own unforeseen and unwanted adverse events. According to Obegi (2024), the error rate for suicide is 25 patients out of every 100,000 within the criminal justice system. Along the same lines, approximately a fifth of incarcerated individuals have tried suicide in the past (Scott et al., 2023). Thankfully, while I have had more experience with suicide attempts, with and without success, than I care to admit, suicide within the organizations where I have worked is rare. Still, knowing the rates of suicide and the influencing factors are staggering and are something that should be understood and managed. A QI initiative that targets education for staff on MH and substance abuse and to recognize signs or symptoms of potential suicide more readily can have significant positive impacts on patients. Likewise, targeting collaboration with outside resources (treatment centers or healthcare providers) to continue treatments initiated within a confinement setting can further positively influence patient health outcomes. By implementing QI initiatives, we can make a meaningful impact in reducing adverse events like suicide in jail settings and improving access to MH treatments within the judicial system, creating a safer and healthier community for everyone. 

Marc:

At my organization we have a quality initiative program around improving barcode medication administration (BCMA) rates. BCMA helps protect patients by acting as a second validator for the nurse administering medications. When done correctly, the BCMA system will allow for the seven rights of medication administration. While increasing the overall compliance rate is one of the goals, the performance improvement (PI) team are also looking at reasons medication were given at different time than ordered or why they were not given at all.

At my organization we attempt to look at adverse event situations in a non-punitive manner. Instead of blaming the individual, we try to find faults in the system that allowed the event to occur. This practice aligns with the Joint Commission’s practice of a culture of safety, in which staff are not fearful of reporting incidents in an attempt to prevent future occurrences (The Joint Commission, 2018). Our practice of root cause analysis (RCA) after an incident is used to understand how the event occurred and actions we can take to reduce the risk of reoccurrence. We try our best not to have education be the single change made as we are aware that this is the least effective method of prevention.

Medication issues are a big deal in healthcare. They have the ability to significantly impractical the quality of life or even cause death. A single medication issue can cause worldwide negative attention of the organization and foster a concern of safety and quality in the public eye. The RaDonda Vaughn medication incident in 2017 sent shockwaves throughout both the public and medical communities. Ms. Vaughn was a nurse who administered the wrong medication that resulted in the death of a patient under her care. She admitted to being rushed, overwhelmed, and failing to follow policies, yet she did self report the incident to prevent this from happening to another nurse (Timms, 2022). Although, Ms Vaughn voluntarily reported the incidents under the tenants of a just culture of non-punitive process, this was not the case in her situation. She was fired from her job, had her nursing license revoked, and was criminally prosecuted.

The RaDonda Vaughn incident is destined to occur again at anyone of hospitals in the United States without significant focus on removing barriers to safe administration of medications. While still not completely immune to errors, BCMA is one way to make this process safer. We will all need to work much harder on promoting a just culture of non-punitive when incidents occur. It will take years to rebuild the confidence of staff nurses that reporting incidents will not result in criminal prosecution.