C157-Essentials of Advanced Nursing Practice Task 1

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C157-Essentials of Advanced Nursing Practice Task 1

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Christina Bishop-C157-Essentials of Advanced Nursing Practice Task 1
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Running head: CONSULTATIVE CHANGE RECOMMENDATIONS

Consultative Change Recommendation Christina Bishop Western Governors University College of Health Professions C 157 February 22, 2020

Consultative Change Recommendations While all changes do not lead to improvement, all improvement requires change. The ability to develop, test, and implement changes is essential for any individual, group, or organization that wants to continuously improve. Change is never easy, but it is necessary to grow and thrive, especially in the healthcare industry. Purpose of Consultation and Overview of the Consultation Process The purpose of this paper was to interview a nurse leader at a health care organization, examine the health care organization, identify an organizational weakness and to propose an organizational change. The nurse leader I chose to interview was Heather Wheat. She is the PCU Department Manager at Redmond Regional Medical Center located in Rome, Georgia. We met in her office and she was asked various questions including her role and its scope, what organizational goals she supports, who are the stakeholders that she serves, and what she is responsible for delivering and to whom. She was then asked what the mission of her organization was, is the mission published, and available to staff and public, how does the organization operationalize its mission, how doe sit guide or direct organization policies, leader interactions, roles and day-to-day operations. She was asked to identify one strength and one weakness of the organization, and what are the major opportunities for improvement facing the organization? She was also asked what systems have been put in place to support patient safety, like electronic health records, employee education, and development programs, barcode scanning, and handoff reports? She was asked to what extent does your role participate in quality improvement efforts, in what ways does your organization incorporate evidence-based practice into care delivery systems, and does your organization educate staff about National Patient Safety Goals?

Chief Nursing Officer, Missy Ragland, Ethics and Compliance Officer, Patsy Adams, HR Director, Wendy Young, Education Director, Shelly Proctor, Risk Manager, and Susan Fisher Infection Control Officer.

Primary Needs of Organization’s Population

Floyd County, where Redmond Regional Medical Center is located, compromises at least 3 different zip codes. The total population is around 97,927. The demographics are 70% White, 14% Black or African, and 11% Hispanic or Latino. There are 20% persons living in poverty. Persons age 65 years and over are 16%. Females account for 51% pf the population (US Census Bureau, n.). The primary needs of this population are identified, including the primary health risks in the service area. The primary needs found were access to medical care and prevention services, cardiovascular disease, mental and behavioral health, and nutrition (Community Health Assessment, 2019). A community is impacted in many ways by each of these needs. If a patient lacks proper access to medical care and prevention services, then there are problems with preventing and managing disease, reducing unnecessary disability and premature death. A community can be impacted negatively also by increased incidence of cardiovascular disease. Cardiovascular diseases are the leading causes of death in the United States and in Floyd County. According to the CDC, coronary heart disease is the most common type of heart disease, causing nearly 630,000 deaths per year and costing over $200 billion overall in health services, medication, and lost productivity. This makes members of the community less productive. The patients are sicker, require more frequent medical and hospital visits, and possibly loss of work. Mental Health and lack of resources are another community need. This need can range from stress and depression to attention deficit disorders and schizophrenia. Psychological distress can affect all

aspects of our lives. It is important to recognize and address potential psychological issues before they become critical. When a person is depressed or having some type of chemical imbalance, that are not as productive in the community. This may cause loss of wages, and even may cause the patients to become homeless, placing and even larger burden on the community. A lack of proper nutrition or a lack of access to proper nutrition was another community issue. A lack of access to healthy foods is often a significant barrier to healthy eating habits. Low-income and underserved areas often have limited numbers of stores that sell healthy foods. People living farther away from grocery stores are less likely to access healthy food options on a regular basis, and thus, more likely to consume foods that are readily available at convenience stores and fast- food outlets. Food insecurity, defined as limited availability or uncertain ability to access nutritionally adequate foods, is associated with chronic health problems including diabetes, heart disease, high blood pressure, hyperlipidemia, obesity and mental health issues including major depression (Community Health Assessment, 2019). All the community needs listed, impacts Redmond Regional Medical Center as well. A lack of these resources leads to more frequent medical office visits, and more frequent hospitalizations. It also maxes out resources available in hospitals. Many times, during flu season the hospital runs out of beds to even place patients. These extra community needs places an even larger strain on the healthcare resources available for those truly in need.

Nurse Leader Interview Summary An interview with Nikki Wheat, Manager of PCU was conducted. She is a department manager, thus making her a formal leader. She was hired and assigned to this position by other directors and managers. Her job is to organize and direct her team members to meet the goals of

employees. There is a decreased incidence in in bed sores, patient falls and injuries. There is effective leadership to prevent errors. There is a safe reporting system when accidents or near misses do occur. Current weaknesses They have weaknesses in the areas of hospital acquired urinary tract infections. There tends to be areas with poor communication about medications and discharge orders between nursing and physicians. There is a lack of specially trained physicians to specifically care for ICU patients. There are also poor patient satisfaction scores on after discharge surveys in certain areas like nurse communication, understanding discharge instructions and there is a lack of patients returning or answering to the surveys. Evidence-based practice activities One of the evidence-based practice activities currently being used at Redmond Regional is bedside shift reporting. The nurses must physically go to the bedside of the patient and provide a report of the patient’s condition including the patient in the report. It has been proven to increase patient safety, and lead to nurse and patient satisfaction (McAllen, Stephens, Swanson-Bierman, Kerr & Whiteman, 2018). Another evidence-based practice is fall risk assessments on admission, every shift, and anytime a patient is transferred from one department to another. There are a series of screening questions in the computer system used to screen patients to determine who is at risk. Once a patient is determined to be a risk, they receive a yellow arm band, they must wear yellow socks, and they have a fall risk magnet placed outside their doors. They may also need to be placed in a camera room or have a 24-hour sitter as well. Falls have been found to be the number one reason

for injury related deaths in patient that are 65 and older. Injuries from falls have been found to cost as much as 30 billion annually (Phelan, Aerts, Dowler, Eckstrom & Casey, 2016). Quality improvement projects There are several quality improvements projects currently in place, but two of the main ones are control of hyperglycemia and hypoglycemia in all hospitalized patients within the unit to help reduce morbidity and mortality. To help with this, all patients have their glucose levels monitored every six hours for the first three days. Another quality improvement project is providing complete discharge instructions to the patients upon discharge. This was developed from poor patient satisfaction scores when it came to the question of whether patients understood the discharge instructions they were given. This also led to an improvement project of having the patients complete their satisfaction surveys before they left the hospital, but after all instructions were given. This includes, a list of all medications given, the last time they were administered, printed education on any and all diagnosis they have, and all follow up appointments scheduled upon discharge or the following business day. These all lead to improvements in patient care, and improved compliance with treatment plan and decreased readmissions. Recommendation for Organization Change Recommendation A recommended organizational change addressed in this interview was to increase the return and participation of the patient satisfaction scores, in hopes that the overall scores will improve. This is a very important national benchmark that is mandated by Medicare services. The plan is testing a process of giving out satisfaction surveys and getting them filled out and back to us before being discharged. Patient-centeredness is measured by surveys of patient-

patient satisfaction rise, then our scores should reflect that change. Our scores are unbiased ways to receive feedback on our patient experiences (Centers for Medicare and Medicaid, n.). Conclusion There were several areas of weakness discussed during my interview with Mrs. Wheat. We however, agreed that one of the most important ones to focus on at this time was improving our patient satisfaction scores, thus why we chose to propose a plan of change in this area. By increasing the scores, patients are better cared for and the hospital received appropriate reimbursement that is needed to provide access of care to the community of Floyd County, Georgia. As I said before, change is never easy but is needed.

References American Association of Colleges of Nursing (2011). The essentials of master’s education in nursing. Retrieved from aacnnursing/Portals/42/Publications/MastersEssentials11.pdf Bjertnaes, O., Iversen, H. H., Holmboe, O., Danielsen, K., & Garratt, A. (2016). The Universal Patient Centeredness Questionnaire: reliability and validity of a one-page questionnaire following surveys in three patient populations. Patient related outcome measures, 7 , 55– 62. doi/10.2147/PROM.S Centers for Medicare and Medicaid. Find and compare information about Hospitals: Hospital Compare. (n.). Retrieved March 2, 2020, from medicare/hospitalcompare/search.html McAllen, E., Stephens, K., Swanson-Biearman, B., Kerr, K., Whiteman, K (April 9, 2018) “Moving Shift Report to the Bedside: An Evidence-Based Quality Improvement Project” OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 2. Phelan, E. A., Aerts, S., Dowler, D., Eckstrom, E., & Casey, C. M. (2016). Adoption of Evidence-Based Fall Prevention Practices in Primary Care for Older Adults with a History of Falls. Frontiers in public health, 4 , 190. doi/10.3389/fpubh.2016. Services | Redmond Regional Medical Center. (n.). Retrieved February 10, 20AD, from redmondregional/services/

Straight to the Point Blog-Community Health Assessment. (2019). Retrieved from
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CONSULTATIVE CHANGE RECOMMENDATIONS 2
Consultative Change Recommendations
While all changes do not lead to improvement, all improvement requires change. The
ability to develop, test, and implement changes is essential for any individual, group, or
organization that wants to continuously improve. Change is never easy, but it is necessary to
grow and thrive, especially in the healthcare industry.
Purpose of Consultation and Overview of the Consultation Process
The purpose of this paper was to interview a nurse leader at a health care organization,
examine the health care organization, identify an organizational weakness and to propose an
organizational change. The nurse leader I chose to interview was Heather Wheat. She is the PCU
Department Manager at Redmond Regional Medical Center located in Rome, Georgia.
We met in her office and she was asked various questions including her role and its scope, what
organizational goals she supports, who are the stakeholders that she serves, and what she is
responsible for delivering and to whom. She was then asked what the mission of her
organization was, is the mission published, and available to staff and public, how does the
organization operationalize its mission, how doe sit guide or direct organization policies, leader
interactions, roles and day-to-day operations. She was asked to identify one strength and one
weakness of the organization, and what are the major opportunities for improvement facing the
organization? She was also asked what systems have been put in place to support patient safety,
like electronic health records, employee education, and development programs, barcode
scanning, and handoff reports? She was asked to what extent does your role participate in
quality improvement efforts, in what ways does your organization incorporate evidence-based
practice into care delivery systems, and does your organization educate staff about National
Patient Safety Goals?
CONSULTATIVE CHANGE RECOMMENDATIONS 3
I then performed research using various other avenues, after the face to face interview of
Mrs. Wheat was completed. I collected data in the beginning by reading and researching the
Redmond Regional Medical Center Intranet page. This is where I was able to find out more in-
depth information on the hospital mission statements, vision statements, and values. I researched
the United States Census Bureau website to learn information about age and sex in the
population served. I researched hospital information on the American Hospital Directory and
learned information on the total patient revenues, total patient days, services offered, and top
three zip codes served. I also found lots of information from a Community Health Assessment
prepared by a neighboring hospital in the same county (US Census Bureau, n.d.).
Organizational Analysis
Description of Organization
Redmond Regional Medical Center has been offering a high level of healthcare services
in Rome, Georgia since 1972. It is a private healthcare system that consists of compassionate
caregivers, doctors, therapists, and nurses. It is one of the largest employers in Floyd County
with a staff of 1200 and over 250 affiliated doctors. Redmond is a 230-bed medical surgical and
rehab unit serving Rome, Floyd County, and surrounding counties. It is known as the hospital
for Northwest Georgia. Redmond offers cardiac services and is the only dedicated chest pain
center in Northwest Georgia. Other services offered are cardiology, emergency care,
orthopedics, vascular care, oncology, and inpatient rehab. It has approximately 74, 900 visits
annually (Redmond Regional Medical Center, n.d.).
The leadership organization for Redmond Regional Medical Center begins with John
Quinlivan, Chief Executive Officer, Brad Stockton, Chief Operating Officer, Ken Metleauer,
Chief Financial Officer, Stephanie Jones, Chief Nursing Officer, Martine Osselaer, Assistant
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CONSULTATIVE CHANGE RECOMMENDATIONS 4
Chief Nursing Officer, Missy Ragland, Ethics and Compliance Officer, Patsy Adams, HR
Director, Wendy Young, Education Director, Shelly Proctor, Risk Manager, and Susan Fisher
Infection Control Officer.
Primary Needs of Organization’s Population
Floyd County, where Redmond Regional Medical Center is located, compromises at least
3 different zip codes. The total population is around 97,927. The demographics are 70.9%
White, 14.9% Black or African, and 11.3% Hispanic or Latino. There are 20.7% persons living
in poverty. Persons age 65 years and over are 16.7%. Females account for 51.7% pf the
population (US Census Bureau, n.d.). The primary needs of this population are identified,
including the primary health risks in the service area. The primary needs found were access to
medical care and prevention services, cardiovascular disease, mental and behavioral health, and
nutrition (Community Health Assessment, 2019).
A community is impacted in many ways by each of these needs. If a patient lacks proper
access to medical care and prevention services, then there are problems with preventing and
managing disease, reducing unnecessary disability and premature death. A community can be
impacted negatively also by increased incidence of cardiovascular disease. Cardiovascular
diseases are the leading causes of death in the United States and in Floyd County. According to
the CDC, coronary heart disease is the most common type of heart disease, causing nearly
630,000 deaths per year and costing over $200 billion overall in health services, medication, and
lost productivity. This makes members of the community less productive. The patients are
sicker, require more frequent medical and hospital visits, and possibly loss of work. Mental
Health and lack of resources are another community need. This need can range from stress and
depression to attention deficit disorders and schizophrenia. Psychological distress can affect all
CONSULTATIVE CHANGE RECOMMENDATIONS 5
aspects of our lives. It is important to recognize and address potential psychological issues before
they become critical. When a person is depressed or having some type of chemical imbalance,
that are not as productive in the community. This may cause loss of wages, and even may cause
the patients to become homeless, placing and even larger burden on the community. A lack of
proper nutrition or a lack of access to proper nutrition was another community issue. A lack of
access to healthy foods is often a significant barrier to healthy eating habits. Low-income and
underserved areas often have limited numbers of stores that sell healthy foods. People living
farther away from grocery stores are less likely to access healthy food options on a regular basis,
and thus, more likely to consume foods that are readily available at convenience stores and fast-
food outlets. Food insecurity, defined as limited availability or uncertain ability to access
nutritionally adequate foods, is associated with chronic health problems including diabetes, heart
disease, high blood pressure, hyperlipidemia, obesity and mental health issues including major
depression (Community Health Assessment, 2019).
All the community needs listed, impacts Redmond Regional Medical Center as well. A
lack of these resources leads to more frequent medical office visits, and more frequent
hospitalizations. It also maxes out resources available in hospitals. Many times, during flu
season the hospital runs out of beds to even place patients. These extra community needs places
an even larger strain on the healthcare resources available for those truly in need.
Nurse Leader Interview Summary
An interview with Nikki Wheat, Manager of PCU was conducted. She is a department
manager, thus making her a formal leader. She was hired and assigned to this position by other
directors and managers. Her job is to organize and direct her team members to meet the goals of
CONSULTATIVE CHANGE RECOMMENDATIONS 6
the company. She loves her job, and she is loyal to Redmond Regional Medical Center. Her
role aligns with certain Essentials of Master’s Education in Nursing. Essential number three
describes how the nurse leader promotes quality improvement and safety. Ms. Wheat
exemplifies essential three in that she is actively involved in several QI projects including
optimizing early recognition of sepsis, and how care is improved along with better outcomes
when signs and symptoms are recognized earlier. There are scores given to patients based upon
their vital sign changes, and lab value changes. Any patient with a score of 2 or more must be
assessed and charted on within 20 minutes. This has provided a reduction in rates of sepsis,
leading to a change in hospital policy on the screening process. This change improves patient
outcomes. Essential seven describes, interprofessional collaboration for improving patient and
population health outcomes. This is accomplished by the daily team meetings at 1:30pm every
weekday. Each day she has the nurses, physicians, Chaplin, case manager, and physical therapy
department meet at the nurse station and give updates on each patient’s status. Essential nine
describes the master level nursing practice by the end of the completion of the program. She
aligns her unit with this essential by enforcing patient centered care. This is done through
requiring bedside reporting and including the patient in the reporting process. This places the
patient at the center of what is taking place, as well as allowing their input (AACN, 2011).
Organization’s Characteristics
Current strengths
The strengths for Redmond Regional Medical are many. The best service they are known
for is cardiac services. They are strong in areas that prevent errors such as doctors ordering
medications through a computer, and safe medication administration. They are great in infection
prevention of MRSA, C Diff, and surgical site infections. There is great at teamwork among
CONSULTATIVE CHANGE RECOMMENDATIONS 7
employees. There is a decreased incidence in in bed sores, patient falls and injuries. There is
effective leadership to prevent errors. There is a safe reporting system when accidents or near
misses do occur.
Current weaknesses
They have weaknesses in the areas of hospital acquired urinary tract infections. There
tends to be areas with poor communication about medications and discharge orders between
nursing and physicians. There is a lack of specially trained physicians to specifically care for
ICU patients. There are also poor patient satisfaction scores on after discharge surveys in certain
areas like nurse communication, understanding discharge instructions and there is a lack of
patients returning or answering to the surveys.
Evidence-based practice activities
One of the evidence-based practice activities currently being used at Redmond Regional
is bedside shift reporting. The nurses must physically go to the bedside of the patient and
provide a report of the patient’s condition including the patient in the report. It has been proven
to increase patient safety, and lead to nurse and patient satisfaction (McAllen, Stephens,
Swanson-Bierman, Kerr & Whiteman, 2018).
Another evidence-based practice is fall risk assessments on admission, every shift, and
anytime a patient is transferred from one department to another. There are a series of screening
questions in the computer system used to screen patients to determine who is at risk. Once a
patient is determined to be a risk, they receive a yellow arm band, they must wear yellow socks,
and they have a fall risk magnet placed outside their doors. They may also need to be placed in a
camera room or have a 24-hour sitter as well. Falls have been found to be the number one reason
CONSULTATIVE CHANGE RECOMMENDATIONS 8
for injury related deaths in patient that are 65 and older. Injuries from falls have been found to
cost as much as 30 billion annually (Phelan, Aerts, Dowler, Eckstrom & Casey, 2016).
Quality improvement projects
There are several quality improvements projects currently in place, but two of the main
ones are control of hyperglycemia and hypoglycemia in all hospitalized patients within the unit
to help reduce morbidity and mortality. To help with this, all patients have their glucose levels
monitored every six hours for the first three days. Another quality improvement project is
providing complete discharge instructions to the patients upon discharge. This was developed
from poor patient satisfaction scores when it came to the question of whether patients understood
the discharge instructions they were given. This also led to an improvement project of having
the patients complete their satisfaction surveys before they left the hospital, but after all
instructions were given. This includes, a list of all medications given, the last time they were
administered, printed education on any and all diagnosis they have, and all follow up
appointments scheduled upon discharge or the following business day. These all lead to
improvements in patient care, and improved compliance with treatment plan and decreased
readmissions.
Recommendation for Organization Change
Recommendation
A recommended organizational change addressed in this interview was to increase the
return and participation of the patient satisfaction scores, in hopes that the overall scores will
improve. This is a very important national benchmark that is mandated by Medicare services.
The plan is testing a process of giving out satisfaction surveys and getting them filled out and
back to us before being discharged. Patient-centeredness is measured by surveys of patient-
CONSULTATIVE CHANGE RECOMMENDATIONS 9
reported experiences. These surveys include questions on nonmedical aspects of health care
such as information, communication, organization, and physical environment. Patient-
centeredness is addressed by understanding the respect, values and preference values of the
patients (Bjertnaes, Iverson, Holmboe, Danielson & Garratt, 2016).
Rationale for Recommended Change
The weakness found during the interview was responsiveness to patient satisfaction
surveys, thus leading to low scores. The plan is to physically hand a paper survey to each patient
and have them complete the survey right before leaving the hospital. This way staff will be
available to make sure it is completed, and that all questions were understood. This will address
the weakness of poor responsiveness in hopes of increasing patient satisfaction scores. By
improving scores and learning what the needs and desires of the patients are. This allows for the
hospital to see what areas need improving to better serve the needs of the community. It allows
for gaps in care to be met and improves the quality of care. It will increase the use of the hospital
by the community, thus increasing revenue. It will increase HCAPP scores and improve care in
the community. According to the Medicare website, Redmond Regional ranks equal in
comparison with the other hospital in Floyd County. They both rank 3 out of 5 stars in overall
quality of care received on patient satisfaction surveys (Centers for Medicare and Medicaid,
n.d.).
Evaluation of Change Effectiveness
Currently Redmond is at 3 out of 5 stars on overall patient experience. I will use the data
from HCAHPS surveys provided by the Centers for Medicare and Medicaid Services, to
determine if our scores have improved after implanting the on-sire satisfaction surveys. If our
CONSULTATIVE CHANGE RECOMMENDATIONS 10
patient satisfaction rise, then our scores should reflect that change. Our scores are unbiased ways
to receive feedback on our patient experiences (Centers for Medicare and Medicaid, n.d.).
Conclusion
There were several areas of weakness discussed during my interview with Mrs. Wheat.
We however, agreed that one of the most important ones to focus on at this time was improving
our patient satisfaction scores, thus why we chose to propose a plan of change in this area. By
increasing the scores, patients are better cared for and the hospital received appropriate
reimbursement that is needed to provide access of care to the community of Floyd County,
Georgia. As I said before, change is never easy but is needed.
CONSULTATIVE CHANGE RECOMMENDATIONS 11
References
American Association of Colleges of Nursing (2011). The essentials of master’s education in
nursing. Retrieved from
http://www.aacnnursing.org/Portals/42/Publications/MastersEssentials11.pdf
Bjertnaes, O., Iversen, H. H., Holmboe, O., Danielsen, K., & Garratt, A. (2016). The Universal
Patient Centeredness Questionnaire: reliability and validity of a one-page questionnaire
following surveys in three patient populations. Patient related outcome measures, 7, 55–

62. https://doi.org/10.2147/PROM.S102732
    Centers for Medicare and Medicaid. Find and compare information about Hospitals: Hospital
    Compare. (n.d.). Retrieved March 2,
    2020, from https://www.medicare.gov/hospitalcompare/search.html
    McAllen, E.R., Stephens, K., Swanson-Biearman, B., Kerr, K., Whiteman, K (April 9, 2018)
    “Moving Shift Report to the Bedside: An Evidence-Based Quality Improvement
    Project” OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 2.
    Phelan, E. A., Aerts, S., Dowler, D., Eckstrom, E., & Casey, C. M. (2016). Adoption of
    Evidence-Based Fall Prevention Practices in Primary Care for Older Adults with a
    History of Falls. Frontiers in public health, 4, 190.
    https://doi.org/10.3389/fpubh.2016.00190
    Services | Redmond Regional Medical Center. (n.d.). Retrieved February 10, 20AD, from
    https://redmondregional.com/services/
    Straight to the Point Blog-Community Health Assessment. (2019). Retrieved from
    CONSULTATIVE CHANGE RECOMMENDATIONS 12
    https://floydstraightforward.org/
    US Census Bureau. (n.d.). Census.gov. Retrieved February 2, 20AD, from
    https://www.census.gov/

C157-Essentials of Advanced Nursing Practice Task 1