Assessing the Problem- Quality Safety and Cost Considerations

Assessing the Problem- Quality Safety and Cost Considerations

Part 1

Type 2 diabetes mellitus (DM) is a problem of concern. The disease manifests with polyuria, excessive thirst, and polyphagia (Alghamdi et al., 2021). In addition, its pathophysiology entails insulin resistance and impairment in the secretion of glucagon and insulin (Alghamdi et al., 2021). All stakeholders should work in concert to facilitate perpetual screening, timely diagnosing, and the formulation of evidence-based treatment plans. When the disease is managed poorly, its prognosis worsens and increases the risk of complications. As such, the disease impacts patient safety, treatment costs, and the quality of healthcare services.

Impact on the Quality of Care

Patients with type 2 DM should receive holistic care to promote their well-being. This disease accounts for about ninety percent of all DM cases (CDC.gov, 2022-a). When the disease is managed inadequately, its prognosis worsens. Notably, the risk of complications and emergencies increases when glycemic levels are not controlled tightly (Forouhi & Wareham, 2019). For example, patients are predisposed to acute complications such as a hyperosmolar hyperglycemic state when the disease is not managed adequately (Alghamdi et al., 2021). Furthermore, the likelihood of chronic complications such as peripheral artery disease and diabetic nephropathy increases when glycemic levels are not controlled tightly (Howland & Wakefield, 2022). To address this problem, all stakeholders in a healthcare facility should collaborate to achieve a continuum of care.

Key stakeholders involved in the management of these patients include nurses, laboratory technologists, dieticians, pharmacists, and physicians. These stakeholders should play an active role in providing individualized patient education. This should address the relevance of adhering to the treatment plan, possible adverse effects, and manifestations of acute and chronic complications (Appuswamy & Desimone, 2020). The team should collaborate in the clinical decision-making process to formulate evidence-based treatment plans. Notably, nurses should aim at minimizing medication administration errors, pharmacists should provide patient-centered dispensing services, and physicians should formulate holistic evidenced-based management plans.

Impact on Patient Safety

Inadequately managed type 2 DM predisposes to lower patient safety by increasing the risk of complications. Data indicate that both acute and chronic complications account for about seventeen million visits to the emergency department annually in the USA (CDC.gov, 2022-b). In 2018, more than 24,000 and 241,000 people suffered from the hyperosmolar hyperglycemic state (HHS) and hypoglycemia, respectively (CDC.gov, 2022-b). Furthermore, more than 222,000 people were hospitalized due to diabetic ketoacidosis (DKA) (CDC.gov, 2022-b). Approximately 23 percent of patients with hypoglycemia received inpatient services (CDC.gov, 2022-b). Approximately 86 percent of patients with HHS and DKA were hospitalized (CDC.gov, 2022-b). These complications accounted for about 0.1 percent mortality rates (CDC.gov, 2022-b). Additionally, data from 2019 reveals that DM was ranked seventh among the leading causes of mortalities in the USA (CDC.gov, 2022-b). Other than acute and chronic complications, patients are likely to be depressed or anxious about the disease. This is attributed to factors such as the fear of suffering from complications such as hypoglycemia.

Impact on Cost

The disease has direct and indirect cost implications. According to the American Diabetes Association (2022), the annual expense of treating the condition is over $327 billion in the USA. These direct costs entail aspects such as purchasing medication, hospital visits, and managing complications (The ADA, 2022). The average diabetic patient spends approximately $16,750 a year on medical treatment (The ADA, 2022). Indirect costs result from absenteeism from work and reduced productivity. Absenteeism accounts for about $3 billion, whereas reduced productivity at the workplace accounts for approximately $26 billion annually (The ADA, 2022). Mortalities reduce productivity by about $19 billion annually, whereas about $37 billion is lost when patients are incapacitated and unable to work (The ADA, 2022).

Organizational and Government Policies

Various organizations and governmental institutions have formulated policies that impact care delivery, patient safety, and treatment costs. Firstly, the American Nurses Association (ANA) emphasizes embracing the nursing process in patient care, upholding cultural congruence, collaborating with other stakeholders, and upholding healthcare ethics (ANA, n.d.). The nursing process ensures that patient-centered services are provided by advocating for patient follow-up through evaluation. Collaboration among various stakeholders achieves care coordination, evidence-based and a continuum of care (Schmutz et al., 2019). Cultural congruence optimizes access to healthcare services by creating an inclusive environment (Schmutz et al., 2019). As such, the provisions of ANA aim at increasing the quality of healthcare services.

Secondly, the National Clinical Care Commission Framework for Diabetes Prevention and Control (NCCCFDPC) influences the delivery of healthcare services. NCCCFDPC champions patient education to promote and achieve a better understanding of the disease process and adherence to the treatment plan (Schillinger et al., 2022). It also advocates for screening to detect diabetic complications (Schillinger et al., 2022). NCCCFDPC recommends improving access to care for all patients with diabetes mellitus. Access to quality care facilitates accurate diagnosis and the formulation of patient-centered treatment plans (Schillinger et al., 2022). By so doing, the quality of healthcare services delivered to diabetic patients is improved.

Thirdly, McIntyre and Song (2019) report that the Affordable Care Act (ACA) aims to provide more people with access to affordable healthcare, expand the Medicaid program, and encourage innovation in healthcare. The enactment of ACA increased healthcare coverage to more than twenty million people (McIntyre & Song, 2019). Furthermore, ACA improved access to healthcare services by eliminating discrimination against individuals who were comorbid with other conditions (McIntyre & Song, 2019). ACA played a significant role in lowering treatment costs by availing healthcare coverage. This benefitted patients with chronic conditions such as type 2 DM. Also, increased healthcare coverage requires healthcare providers to uphold interdisciplinary collaboration to achieve continuum care.

The ANA, ACA, and NCCCFDPC will enable me to provide quality, cost-effective, patient-centered care. The ANA will ensure that I embrace cultural congruence, collaborate with other stakeholders, and uphold ethics in my practice. NCCCFDPC will ensure that I provide periodic patient education, whereas the ACA will ensure that I advocate for healthcare coverage for diabetics.

Strategies for Improving the Quality of Care and Patient Safety

All stakeholders in the healthcare setting can adopt various strategies to optimize the quality of care and promote the safety of patients with type 2 DM. Firstly, members of the interdisciplinary team should conduct regular screening. Regular screening will enable healthcare providers to identify the onset of complications and evaluate the effectiveness of patients’ treatment plans (Chen et al., 2020). Screening should entail foot exams, eye examinations, monitoring random and fasting plasma glucose, and evaluating HbA1c (Chen et al., 2020). Findings from screening exercises will enable healthcare providers to modify treatment plans to achieve tight glycemic control and manage early complications.

Secondly, all stakeholders should be involved in patient education. Education enlightens patients on key facts to ensure that the disease is managed adequately (Chen et al., 2020). For example, patients should be educated on the importance of adhering to their designated treatment plans (Chen et al., 2020). Patients can use mobile health to improve compliance. Notably, features such as reminders and alarms will help them to achieve this (Appuswamy & Desimone, 2020). Patients should be educated on the manifestations of acute and chronic complications. For example, they should be able to recognize the presence of hypoglycemia and when to seek prompt medical help.

Thirdly, members of the interdisciplinary team should develop current evidence-based treatment plans. The plan should embrace both pharmaceutical and non-pharmaceutical approaches. Non-pharmaceutical techniques entail aspects such as modifying dietary habits and lifestyles (Howland & Wakefield, 2022). For example, the patient should engage in regular physical exercise and limited alcohol intake (Howland & Wakefield, 2022). Pharmaceutical approaches entail oral hypoglycemic agents and insulin (Howland & Wakefield, 2022). These evidence-based approaches should address the holistic needs of the patient (Howland & Wakefield, 2022). For example, depression and anxiety should be addressed by patient counseling or prescribing medication for severe cases.

Strategies for Reducing Costs

Two strategies can be used to minimize treatment costs for patients with diabetes. Nurses and interdisciplinary team members should develop and implement evidence-based treatment plans to achieve better outcomes. By so doing, the incidence of both acute and chronic complications will be reduced. Furthermore, the incidence of hospitalizations for diabetic patients will be reduced. As such, patients will not incur extra costs in managing DM. Secondly, all stakeholders should advocate for insurance coverage for patients with DM. Insurance coverage will enable patients to minimize out-of-pocket costs. Additionally, health coverage will ensure that patients access quality services at affordable costs.

Sources of Benchmark Data

The Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention (CDC) provide benchmark data on the management of DM. The AHRQ provides annual quality and disparity reports on the management of DM (AHRQ.gov, n.d.). These reports evaluate the quality of managing DM at the state and national levels. To accomplish this, it provides both national and state benchmark values (AHRQ.gov, n.d.). By so doing, a comparison of performance among various states is made. On the other hand, the CDC provides annual reports on the prevalence and incidence of DM nationally and in various states (CDC.gov, 2022-c).

Part 2

I interacted with a 65-year-old African-American female patient with type 2 DM. She has lived with the disease for the past twenty years. According to her family, she forgets to take her medication, which has significantly impacted her adherence to the treatment plan. Currently, she presents with altered mentation, sunken eyes, decreased skin turgor, and delayed capillary refill. Diagnostic values reveal a plasma glucose level of 610 mg/dl and serum osmolality of 330 mOsm/kg. These features suggest a hyperosmolar hyperglycemic state due to poor glycemic control. I spend five hours with the patient and her family. The patient and her family did not demonstrate adequate health literacy during our interaction. I used therapeutic communication techniques such as empathy and active listening when interacting with the patient to overcome this barrier. I emphasized adherence to the treatment during this session. The patient claimed that her forgetfulness contributes to the etiology of non-adherence. We agreed that her family members would be involved in medication administration. Additionally, we explored the use of reminders and alarms to enforce adherence.

I used online databases such as Google Scholar to get peer-reviewed journals. Furthermore, I sought information from credible organizational websites. I evaluated the credibility of the journal article by checking for currency, accuracy, and purpose. I chose articles published within the past five years. I learned that DM was ranked seventh among the leading causes of mortalities in the USA.

References

AHRQ.gov. (n.d.). National Healthcare Quality and Disparities Reports (NHQDR). https://datatools.ahrq.gov/nhqdr

Alghamdi, M. A., Muidh Alzahrani, A., Alshams, H. A., Himeed, M., Saif, A., Moafa, A. M., Alenzi, M. M., Seadawi, L. E., Kamel, A., Ali, A., Saleh, N., Hufayyan, A., & Mujallid, M. F. (2021). Hyperosmolar hyperglycemic state management in the emergency department; Literature review. Jubail General Hospital, Eastern Province, KSA. 5 General Practitioner, 12(1), 37–40.

Appuswamy, A. V., & Desimone, M. E. (2020). Managing Diabetes in Hard to Reach Populations: A Review of Telehealth Interventions. Current Diabetes Reports, 20(7). https://doi.org/10.1007/s11892-020-01310-2

CDC.gov. (2022-a). Prevalence of Diagnosed Diabetes. https://www.cdc.gov/diabetes/data/statistics-report/diagnosed-diabetes.html

CDC.gov. (2022-b). Coexisting Conditions and Complications. https://www.cdc.gov/diabetes/data/statistics-report/coexisting-conditions-complications.html

CDC.gov. (2022-c). National Diabetes Statistics Report. https://www.cdc.gov/diabetes/data/statistics-report/index.html

Chen, S., Qian, D., Burström, K., & Burström, B. (2020). Impact of an educational intervention in primary care on fasting blood glucose levels and diabetes knowledge among patients with type 2 diabetes mellitus in rural China. Patient Education and Counseling, 103(9), 1767–1773. https://doi.org/10.1016/j.pec.2020.03.010

Forouhi, N. G., & Wareham, N. J. (2019). Epidemiology of diabetes. Medicine (United Kingdom), 47(1), 22–27. https://doi.org/10.1016/j.mpmed.2018.10.004

Howland, C., & Wakefield, B. (2022). diabetes mellitus : An integrative review. 44(1), 92–110. https://doi.org/10.1002/nur.22077.Assessing

McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLoS Medicine, 16(2), 10–12. https://doi.org/10.1371/journal.pmed.1002752

Schillinger, D., Bullock, A., & Herman, H. W. (2022). An All-Of-Government Approach To Diabetes: The National Clinical Care Commission’s Report To Congress. https://www.healthaffairs.org/do/10.1377/forefront.20220111.855646/

Schmutz, J. B., Meier, L. L., & Manser, T. (2019). How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: A systematic review and meta-analysis. BMJ Open, 9(9), 1–16. https://doi.org/10.1136/bmjopen-2018-028280

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

---

Assessment 2 Instructions: Assessing the Problem: Quality, Safety, and Cost Considerations
PRINT

In a 5-7 page written assessment, assess the effect of the patient, family, or population problem you’ve previously defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend approximately 2 direct practicum hours exploring these aspects of the problem with the patient, family, or group you’ve chosen to work with and, if desired, consulting with the subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or groups in the Capella Academic Portal Volunteer Experience Form. Report on your experiences during your first two practicum hours.

Introduction
Organizational data, such as readmission rates, hospital-acquired infections, falls, medication errors, staff satisfaction, serious safety events, and patient experience can be used to prioritize time, resources, and finances. Healthcare organizations and government agencies use benchmark data to compare the quality of organizational services and report the status of patient safety. Professional nurses are key to comprehensive data collection, reporting, and monitoring of metrics to improve quality and patient safety.

Preparation
In this assessment, you’ll assess the effect of the health problem you’ve defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 direct practicum hours working with the same patient, family, or group. During this time, you may also choose to consult with subject matter and industry experts.

To prepare for the assessment:

Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete and how it will be assessed.
Conduct research on the scholarly and professional literature to inform your assessment and meet scholarly expectations for supporting evidence.
Review the Practicum Focus Sheet: Assessment 2 [PDF], which provides guidance for conducting this portion of your practicum.
Note: As you revise your writing, check out the resources listed on the Writing Center’s Writing Support page.

Instructions
Complete this assessment in two parts.

Part 1
Assess the effect of the patient, family, or population problem you defined in the previous assessment on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 practicum hours exploring these aspects of the problem with the patient, family, or group. During this time, you may also consult with subject matter and industry experts of your choice. Document the time spent (your practicum hours) with these individuals or groups in the Capella Academic Portal Volunteer Experience Form. Use the Practicum Focus Sheet: Assessment 2 [PDF] provided for this assessment to guide your work and interpersonal interactions.

Part 2
Report on your experiences during your first 2 practicum hours, including how you presented your ideas about the health problem to the patient, family, or group.

Who did you meet with?
What did you learn from them?
Comment on the evidence-based practice (EBP) documents or websites you reviewed.
What did you learn from that review?
Share the process and experience of exploring the influence of leadership, collaboration, communication, change management, and policy on the problem.
What barriers, if any, did you encounter when presenting the problem to the patient, family, or group?
Did the patient, family, or group agree with you about the presence of the problem and its significance and relevance?
What leadership, communication, collaboration, or change management skills did you employ during your interactions to overcome these barriers or change the patient’s, family’s, or group’s thinking about the problem (for example, creating a sense of urgency based on data or policy requirements)?
What changes, if any, did you make to your definition of the problem, based on your discussions?
What might you have done differently?
Capella Academic Portal
Update the total number of hours on the NURS-FPX4900 Volunteer Experience Form in the Capella Academic Portal.

Requirements
The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.

Explain how the patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
Cite evidence that supports the stated impact.
Note whether the supporting evidence is consistent with what you see in your nursing practice.
Explain how state board nursing practice standards and/or organizational or governmental policies can affect the problem’s impact on the quality of care, patient safety, and costs to the system and individual.
Describe research that has tested the effectiveness of these standards and/or policies in addressing care quality, patient safety, and costs to the system and individual.
Explain how these standards and/or policies will guide your actions in addressing care quality, patient safety, and costs to the system and individual.
Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of care quality, patient safety, and cost to the system and individual.
Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individuals.
Discuss research on the effectiveness of these strategies in addressing care quality, patient safety, and costs to the system and individuals.
Identify relevant and available sources of benchmark data on care quality, patient safety, and costs to the system and individual.
Document the time spent (your practicum hours) with these individuals or groups in the Capella Academic Portal Volunteer Experience Form.
Use paraphrasing and summarization to represent ideas from external sources.
Apply APA style and formatting to scholarly writing.
Additional Requirements
Format: Format your paper using APA style. APA Style Paper Tutorial [DOCX] is provided to help you in writing and formatting your paper. Be sure to include:
A title page and reference page. An abstract is not required.
Appropriate section headings.
Length: Your paper should be approximately 5–7 pages in length, not including the reference page.
Supporting evidence: Cite at least 5 sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old. Provide in-text citations and references in APA format.
Proofreading: Proofread your paper, before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on its substance.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

Competency 3: Transform processes to improve quality, enhance patient safety, and reduce the cost of care.
Explain how a patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual and document the practicum hours spent with these individuals or groups in the Capella Academic Portal Volunteer Experience Form.
Competency 5: Analyze the impact of health policy on quality and cost of care.
Explain how state board nursing practice standards and/or organizational or governmental policies can affect a patient, family, or population problem’s impact on the quality of care, patient safety, and costs to the system and individual.
Competency 8: Integrate professional standards and values into practice.
Use paraphrasing and summarization to represent ideas from external sources.
Apply APA style and formatting to scholarly writing.