same

Scenario QI Data For You

From: Sienna Pope, Director of Medical Support Services

To: Manager Lisa

Hi! I heard through word of mouth that you were looking for some possible areas of improvement in the hospital. I’ve got some data from SAMC’s in-home hospice program that might be useful.

I realize that you may not be familiar with the hospice program, so I also set up some meetings with a few people with a stake in the program. I’m hoping they can give you some context for the data you’re looking at.

Let me know if you need anything!

Sienna Pope, Director of Medical Support Services

Hospice Data 2020-2021

Facility metrics related to four AHRQ reportable benchmarks.

Interviews with Stakeholders about the hospice program data

Streamlining Roger Goldenberg - Director of Hospice Services

What are the overall goals of the hospice program?

Roger : Well, given the unique mission of hospice, we take a different tack from other practices. Since we’re providing end-of-life care, our goal is comfort care, not urgent or life-saving care. That means we treat the symptoms, not the disease. Unlike other units, the patient is a recipient of care, but so is the family.

What is your approach to meeting those goals?

Roger : We use a holistic approach, in that we try to address not just physical, but also emotional, psychological, and spiritual needs. With each patient, there’s an interdisciplinary team that delivers care at home. When symptoms arise that need more aggressive management than home care can provide, we do temporary inpatient admissions.

Jackie Sandoval - Chief Nursing Officer

Roger Goldenberg mentioned that an interdisciplinary team is an important part of the hospice approach. Who do you consider to be part of that team?

Jackie: Many different roles, actually. Of course the nurse, a hospice physician, and a social worker are going to be involved. Often home health aides are part of the team, as well as the volunteer coordinator and the chaplain. Depending on the patient and their circumstances, sometimes music, art, or physical therapists are also engaged in the patient’s care.

What would you consider to be quality-related “red flags” as far as the data categories?

Jackie: One big problem we see in hospice is that patients are referred too late — that is, too close to their end of life. So they aren’t able to receive all of the benefits of being in the hospice program. So length of stay is something you’ll want to look at. Then, of course, the effectiveness of pain and symptom management.

How do hospice nurses document and communicate data between their on-site location and the rest of the team?

Jackie: All of our hospice nurses carry laptops so they can live-chart patient-related data, just like inpatient nurses on site use connected devices to update the EHR. In some homes, where wi-fi isn’t available, those nurses just take notes on their laptops on site and then chart later.

David Brooks - Quality Assurance Director

What are the processes that the hospice program uses to ensure safety?

David: We’ve got processes and procedures in place for managing movement for patients who are at risk of falls, for maintaining sanitary conditions, for managing medical waste (for example, if a patient has a catheter in place), and for safe storage of pain and other medications. And we have processes for pain assessment, which are also part of our protocol for assessing the need for an IPU admission.

What about quality?

David: That’s somewhat reflected in our adverse event reporting. Obviously, we’re not delivering quality care if all we do is prevent adverse events. But our processes are geared to prevent those events and make sure we’re helping the patient to face the end of life as comfortably as possible. So our nurses monitor pain levels, symptom levels, and the patient’s overall level of comfort, as well as that of the family and caregivers. They ask a lot of specific and general questions to get at the patient’s quality of life, from their own perspective and from that of their loved ones.

Owen Welch - CFO

What is the current state of the hospice program’s physical plant?

Owen: Well, the current technology — secure laptops with remote access to the EHR — is working, although I think there’s always something better out there. We’re thinking about experimenting with video conferencing to improve care on site; for example, when a physician isn’t available but another is available by video link, that’s an opportunity to improve care. I’ve heard of technology that pushes electronic alerts to hospice nurses so that they can coach caregivers to deliver better care. But of course, we can’t have everything.

Do you feel that the hospice program is resourced adequately?

Owen: Well, of course, as with any offsite program like this, you start to have staff issues when staff are stretched too thin. So are they having to spend too much time traveling to patient’s homes, or feeling that their patient census is too high to give each patient the care they really need? I like to think that we’ve balanced care loads among our hospice nurses pretty well. But we can’t know if we’re wrong — absent adverse events, which we really don’t want — unless our nurses tell us.

From: Sienna Pope, Director of Medical Support Services

To: Manager Lisa

I hope you got what you needed from Jackie, David, Roger, and Owen. Can you send me an email and let me know what your initial thoughts are? It doesn’t have to be anything formal, just your ideas about what the data suggest, and whether there are any QI initiatives that you would recommend based on what you’re seeing. If there are, make sure you explain how the initiatives you recommend might affect the different roles on the hospice team.

Thanks! — Sienna

MY RESPONSE -

My initial thoughts are:

Dignity and Respect: The increase from 78% to 80% suggests positive strides. However, maybe explore the factors contributing to the 20% who did not experience consistent dignity and respect.

Communication with Family Caregivers: There's a slight dip from 78% to 75%, understanding the reasons behind this decrease could be crucial. Improved communication training or resources may be beneficial.

Pain and Symptom Management: The increase from 65% to 68% is a positive sign. Maybe investigate further into specific pain management protocols and potential areas for enhancement.

Timely Help for Patients and Caregivers: A slight decrease from 70% to 68% may warrant a closer look. Look at obstacles to prompt assistance and restructuring processes could be key.

Recommendations:

Early Referral and Length of Stay: Addressing the issue raised by Jackie about late referrals is crucial. Initiatives focusing on earlier referrals may enhance the benefits of hospice care.

Pain and Symptom Management Training: Conduct targeted training sessions for the hospice team to ensure effective pain and symptom management, which aligns with David's emphasis on adverse event prevention.

Utilizing Technology: Owen mentioned experimenting with video conferencing and electronic alerts. Exploring these technologies could improve communication, especially in situations where on-site physicians are unavailable.

Staff Workload: Regular check-ins with hospice nurses to assess workload and travel time could help maintain a balanced care load, as mentioned by Owen.

Make a quality initiative proposal (7-10 PowerPoint slides) through a presentation, interpreting and communicating dashboard data to support the proposal.

Collapse All

Introduction

Health care providers are perpetually striving to improve care quality and patient safety. To accomplish enhanced care, outcomes need to be measured. Next, data measures must be validated. Measurement and validation of information support performance improvement. Health care providers must focus attention on evidence-based best practices to improve patient outcomes.

Health informatics, along with new and improved technologies and procedures, are at the core of  all quality improvement initiatives. Data analysis begins with provider documentation, researched process improvement models, and recognized quality benchmarks. All of these items work together to improve patient outcomes. Professional nurses must be able to interpret and communicate dashboard information that displays critical care metrics and outcomes along with data collected from the care delivery process.

Overview

A basic principle of quality measurement is: If you can't measure it, you can't improve it.

–Agency for Healthcare Research and Quality (2021)

In the previous assessment, you analyzed the effectiveness of an existing quality initiative. Now that you've done that, this assessment gives you experience interpreting and communicating dashboard data for the purpose of making a quality initiative proposal of your own. And you'll make your proposal through a PowerPoint presentation, including using speaker notes in the Notes section of the slides, much like you might in your health care setting.

Health care providers are on an endless quest to improve both care quality and patient safety. This unwavering commitment requires hospitals and care givers to increase their attention and adherence to treatment protocols to improve patient outcomes. Health informatics, along with new and improved technologies and procedures, are at the core of virtually all QI initiatives. The data gathered by providers, along with process improvement models and recognized quality benchmarks, are all part of a collaborative, continuing effort. As such, it is essential that professional nurses are able to correctly interpret and effectively communicate information revealed on dashboards that display critical care metrics.

Instructions

In this assessment, you will make a QI initiative proposal based on a health issue of professional interest to you. This proposal will be based on an analysis of dashboard metrics from a health care facility. You have two options:

Option 1

If you  have access to dashboard metrics related to a QI initiative proposal of interest to you:

· Analyze data from the health care facility to identify a health care issue or an area of concern. You will need access to reports and data related to care quality and patient safety. If you work in a hospital setting, contact the quality management department to obtain the data you need.

· You will need to identify basic information about the health care setting, size, and specific type of care delivery related to the topic that you identify. You are expected to abide by standards for compliance with the Health Insurance Portability and Accountability Act (HIPAA).

Option 2

If you  do not have access to a dashboard or metrics related to a QI initiative proposal:

· You may use the hospital data set provided in the Vila Health: Data Analysis media piece to identify a health care issue or an area of concern.

· You will follow the same instructions and provide the same deliverables as your peers who select Option 1.

Complete the following steps for your proposal:

· Analyze data to identify a health care issue or an area of concern as it relates to a state, national, or accreditation benchmark requirement relevant to your professional setting.

· Evaluate the quality of the data.

· Outline a QI initiative proposal based on the selected health issue or area of concern and supporting data analysis to improve identified dashboard metric. The interactive activity Designing a Quality Improvement Initiative can get you going on the first steps of a QI process and your assessment.

· Identify the target areas of improvement and outcome measures.

· Include the QI model that will be utilized.

· Specify evidence-based strategies that will be utilized.

· Integrate interprofessional perspectives and actions to lead quality improvements in patient safety, cost-effectiveness, and work-life quality.

· Specify roles and responsibilities.

· Apply effective collaboration strategies to promote QI of interprofessional care.

· Include specific communication tools.

· Deliver a persuasive, coherent, and effective audiovisual presentation. Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

Be sure that your proposal, at minimum, addresses each of the bullet points. You may also want to read the Data Analysis and Quality Improvement Initiative Proposal Scoring Guide to better understand the performance levels that relate to each grading criterion. Additionally, be sure to review the  Guiding Questions: Data Analysis and Quality Improvement Initiative Proposal [DOCX]  document for additional clarification about things to consider when creating your assessment.

Recording Your Presentation

Before starting to record your presentation make sure you have:

· Set up and tested your microphone and headset using the installation instructions provided by the manufacturer. You only need to use the headset if your audio is not clear or high quality when captured by the microphone.

· Practice using the equipment to ensure the audio quality is sufficient.

· Consult  Using Kaltura  for guidance on how to record your presentation and upload it in the courseroom.

· Microsoft PowerPoint also allows you to record your narration with your slides. If you choose this option, simply submit your presentation to the appropriate area of the courseroom. Your narration will be included with your slides.

· Remember to practice delivering and recording your presentation multiple times to ensure effective delivery.

Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact Disability Services at  [email protected]  to request accommodations.

Additional Requirements

Your assessment should also meet the following requirements:

· Length of submission: 7–10 PowerPoint slides, with speaker's notes, not including title slide and attached reference list. Balance text with visuals. Avoid text-heavy slides. Use speaker's notes for additional content.

· Length of presentation: No more than 10 minutes.

· Number of references: Cite a minimum of five sources (no older than seven years, unless a seminal work) of scholarly or professional evidence to support your evaluation, recommendations, and plans. Review the  Nursing Master's Program (MSN) Library Guide  for guidance.

· APA formatting: Resources and citations are formatted according to current APA style. Review the  Evidence and APA  section of the Writing Center for guidance.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

· Competency 2: Plan quality improvement initiatives in response to routine data surveillance.

· Analyze data to identify a health care issue or area of concern as it relates to a state, national, or accreditation benchmark requirement.

· Outline a quality improvement initiative proposal based on a selected health care issue or area of concern and supporting data analysis to improve identified dashboard metrics.

· Competency 4: Integrate interprofessional perspectives to lead quality improvements in patient safety, cost-effectiveness, and work-life quality.

· Integrate interprofessional perspectives and specify actions to lead quality improvements in patient safety, cost-effectiveness, and work-life quality.

· Competency 5: Apply effective communication strategies to promote quality improvement of interprofessional care.

· Apply effective collaboration strategies to promote quality improvement of interprofessional care.

· Create a persuasive, coherent, and effective audiovisual presentation. Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

Reference

Agency for Healthcare Research and Quality. (2021).  Preventing falls in hospitals. https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html

Scenario QI Data For You

From: Sienna Pope, Director of Medical Support Services

To: Manager Lisa

Hi! I heard through word of mouth that you were looking for some possible areas of improvement in the hospital. I’ve got some data from SAMC’s in-home hospice program that might be useful.

I realize that you may not be familiar with the hospice program, so I also set up some meetings with a few people with a stake in the program. I’m hoping they can give you some context for the data you’re looking at.

Let me know if you need anything!

Sienna Pope, Director of Medical Support Services

Hospice Data 2020-2021

Facility metrics related to four AHRQ reportable benchmarks.

Interviews with Stakeholders about the hospice program data

Streamlining Roger Goldenberg - Director of Hospice Services

What are the overall goals of the hospice program?

Roger : Well, given the unique mission of hospice, we take a different tack from other practices. Since we’re providing end-of-life care, our goal is comfort care, not urgent or life-saving care. That means we treat the symptoms, not the disease. Unlike other units, the patient is a recipient of care, but so is the family.

What is your approach to meeting those goals?

Roger : We use a holistic approach, in that we try to address not just physical, but also emotional, psychological, and spiritual needs. With each patient, there’s an interdisciplinary team that delivers care at home. When symptoms arise that need more aggressive management than home care can provide, we do temporary inpatient admissions.

Jackie Sandoval - Chief Nursing Officer

Roger Goldenberg mentioned that an interdisciplinary team is an important part of the hospice approach. Who do you consider to be part of that team?

Jackie: Many different roles, actually. Of course the nurse, a hospice physician, and a social worker are going to be involved. Often home health aides are part of the team, as well as the volunteer coordinator and the chaplain. Depending on the patient and their circumstances, sometimes music, art, or physical therapists are also engaged in the patient’s care.

What would you consider to be quality-related “red flags” as far as the data categories?

Jackie: One big problem we see in hospice is that patients are referred too late — that is, too close to their end of life. So they aren’t able to receive all of the benefits of being in the hospice program. So length of stay is something you’ll want to look at. Then, of course, the effectiveness of pain and symptom management.

How do hospice nurses document and communicate data between their on-site location and the rest of the team?

Jackie: All of our hospice nurses carry laptops so they can live-chart patient-related data, just like inpatient nurses on site use connected devices to update the EHR. In some homes, where wi-fi isn’t available, those nurses just take notes on their laptops on site and then chart later.

David Brooks - Quality Assurance Director

What are the processes that the hospice program uses to ensure safety?

David: We’ve got processes and procedures in place for managing movement for patients who are at risk of falls, for maintaining sanitary conditions, for managing medical waste (for example, if a patient has a catheter in place), and for safe storage of pain and other medications. And we have processes for pain assessment, which are also part of our protocol for assessing the need for an IPU admission.

What about quality?

David: That’s somewhat reflected in our adverse event reporting. Obviously, we’re not delivering quality care if all we do is prevent adverse events. But our processes are geared to prevent those events and make sure we’re helping the patient to face the end of life as comfortably as possible. So our nurses monitor pain levels, symptom levels, and the patient’s overall level of comfort, as well as that of the family and caregivers. They ask a lot of specific and general questions to get at the patient’s quality of life, from their own perspective and from that of their loved ones.

Owen Welch - CFO

What is the current state of the hospice program’s physical plant?

Owen: Well, the current technology — secure laptops with remote access to the EHR — is working, although I think there’s always something better out there. We’re thinking about experimenting with video conferencing to improve care on site; for example, when a physician isn’t available but another is available by video link, that’s an opportunity to improve care. I’ve heard of technology that pushes electronic alerts to hospice nurses so that they can coach caregivers to deliver better care. But of course, we can’t have everything.

Do you feel that the hospice program is resourced adequately?

Owen: Well, of course, as with any offsite program like this, you start to have staff issues when staff are stretched too thin. So are they having to spend too much time traveling to patient’s homes, or feeling that their patient census is too high to give each patient the care they really need? I like to think that we’ve balanced care loads among our hospice nurses pretty well. But we can’t know if we’re wrong — absent adverse events, which we really don’t want — unless our nurses tell us.

From: Sienna Pope, Director of Medical Support Services

To: Manager Lisa

I hope you got what you needed from Jackie, David, Roger, and Owen. Can you send me an email and let me know what your initial thoughts are? It doesn’t have to be anything formal, just your ideas about what the data suggest, and whether there are any QI initiatives that you would recommend based on what you’re seeing. If there are, make sure you explain how the initiatives you recommend might affect the different roles on the hospice team.

Thanks! — Sienna

MY RESPONSE -

My initial thoughts are:

Dignity and Respect: The increase from 78% to 80% suggests positive strides. However, maybe explore the factors contributing to the 20% who did not experience consistent dignity and respect.

Communication with Family Caregivers: There's a slight dip from 78% to 75%, understanding the reasons behind this decrease could be crucial. Improved communication training or resources may be beneficial.

Pain and Symptom Management: The increase from 65% to 68% is a positive sign. Maybe investigate further into specific pain management protocols and potential areas for enhancement.

Timely Help for Patients and Caregivers: A slight decrease from 70% to 68% may warrant a closer look. Look at obstacles to prompt assistance and restructuring processes could be key.

Recommendations:

Early Referral and Length of Stay: Addressing the issue raised by Jackie about late referrals is crucial. Initiatives focusing on earlier referrals may enhance the benefits of hospice care.

Pain and Symptom Management Training: Conduct targeted training sessions for the hospice team to ensure effective pain and symptom management, which aligns with David's emphasis on adverse event prevention.

Utilizing Technology: Owen mentioned experimenting with video conferencing and electronic alerts. Exploring these technologies could improve communication, especially in situations where on-site physicians are unavailable.

Staff Workload: Regular check-ins with hospice nurses to assess workload and travel time could help maintain a balanced care load, as mentioned by Owen.