Quality, Safety, and Cost Considerations
Approximately 116 million American adults have uncontrolled hypertension (CDC, 2020). This condition is one of the leading causes of death in the United States. Even though there is a high prevalence of hypertension globally and in the United States, it is still challenging to control this condition. This is despite the existence of evidence-based treatment strategies. Hypertension negatively affects healthcare quality, patient safety, and healthcare costs.
Quality of Care
Uncontrolled hypertension can result from a lack of early detection, unawareness of hypertension, poor control, and non-adherence to prescribed treatment plans (Zhou et al., 2018). Uncontrolled hypertension increases the risk of cardiovascular diseases and mortality in individuals. It is thus essential to evaluate the risk factors and variables in uncontrolled hypertension. These include hypertension awareness, pharmacotherapy, and non-pharmacological interventions. Regarding quality care, there are problems related to patients and healthcare professionals. Barriers to quality care can be found within the hospital system.
A study was done by Sany et al. (2020) to evaluate the barriers that impact the quality of care in hypertensive patients. Healthcare professionals acknowledged the Lack of knowledge on treating hypertension in specific populations. Most clinicians could not stay up to date with new clinical guidelines. They could not also conduct patient education and offer prehypertension care to patients at high risk of developing hypertension (Sany et al., 2020). The healthcare professionals had issues in identifying unhealthy behaviors and blood pressure regulation.
Even though they conducted regular blood pressure readings, the healthcare professionals found that social barriers and uncoordinated care were barriers to healthcare systems. In addition to this, they noted that healthcare systems were the most critical barrier to providing quality healthcare services (Sany et al., 2020). There were short consultation times, so the patient did not adhere to the treatment plans. This led to poor hypertension control. There were also patient barriers that negatively impacted the quality of care. Patients did not know that unhealthy behavior, such as unhealthy diet, salt consumption, and physical inactivity, could cause hypertension. The patient did not know how to interpret blood pressure readings (Sany et al., 2020). Patients did not know the healthcare dangers of hypertension.
Patients did not require antihypertensives since they exhibited no hypertension symptoms (Sany et al., 2020). They also felt that they were addicted to the drugs. The patients found it challenging to change their unhealthy behavior. They could not be able to prioritize their healthcare needs. The problems that patients cited were Lack of access to gym facilities, Lack of healthy meals, Lack of finances, Lack of insurance, and high treatment costs (Sany et al., 2020). These problems prevent them from accessing quality healthcare.
Improving Quality of Care
Improving the quality of care in hypertension is very important. The study by Sany et al. (2020) revealed that patients noted that Lack of clinical information and support negatively affected how they implemented lifestyle changes and adhered to the antihypertensive medication. Due to these challenges, middle-range nursing theories can enhance the quality of care provided by healthcare professionals. The middle-range framework can help nurses caring for hypertensive patients to provide quality care (Drevenhorn, 2018). Middle-range nursing theories include Oreom’s theory and Watson’s theory of caring. These theories integrate nursing care, patient-related concepts, and social support. Greenhorn (2018) noted the importance of patient consultation in enhancing the quality of hypertensive care. The clinician should assess a patient’s readiness and ability to implement lifestyle modifications. In addition, the clinician must establish the patients’ desired outcomes at the beginning of therapy.
To ensure the success of middle-range nursing theory in enhancing the quality of care in hypertension, nurses must be effective communicators. Additionally, they must promote multidisciplinary collaboration to enhance effective decision-making, educate individuals on healthy coping skills, promote patient self-care, and promote medication adherence (Drevenhorn, 2018). Managing patient expectations is critical in successfully applying middle-range nursing theories to improve hypertensive patients’ quality of care
Patient Safety
Poor hypertensive care and medical errors in hypertension are due to a lack of multidisciplinary collaboration (Rosen et al., 2018). Lack of coordination between healthcare professionals threatens the integrity of patient safety. Patients with hypertension most likely have multiple chronic conditions, and thus, they are managed by many doctors. Failure of these physicians to collaborate can threaten patient safety. Loss of coordination of physicians can result in medical errors that may endanger patient safety. Lack of patient education and poor communication between patients and healthcare professionals negatively affect patient safety (Wu & Busch, 2019). Hypertensive patients must be advised on appropriate lifestyle modifications, medication adherence, and follow-up visits. Non-adherence to treatment plans can negatively impact patient health and safety. If not effectively managed, hypertension can cause complications such as stroke, cardiovascular complications, and even death (Singh et al., 2017).
Improving Patient Safety
Patient safety can be achieved through patient and provider collaboration in the treatment process (Wu & Busch, 2019). Effective communication between the patient and provider is required to ensure safe hypertensive care. Non-adherence to medication is linked to poor communication. Healthcare professionals must thus implement good communication strategies to ensure the patients receive the instructions well. Good communication will reduce prescription errors, effective initiation of therapy, good patient follow-up, and informed decision-making. Good communication reduces the chances of hypertensive patients developing long-term complications. Effective communication also improves patient satisfaction, ensuring patient safety. Patient-centered care can enhance patient needs by ensuring patients are involved in the treatment plan (Jannick Kuipers et al., 2019). Care is also tailor-made to meet the needs of individual patients.
Cost Considerations
Kirkland et al. (2018) conducted a study among 224,920 participants with hypertension. The study results revealed that patients diagnosed with hypertension spend approximately 2000 USD more compared to those not diagnosed with hypertension. Patients diagnosed with hypertension spend 2.5 times more on hospitalizations and prescription medications than those without hypertension (Kirkland, 2018). On average, hypertensive patients spend 2 731 USD annually on hospitalization and 2 791 USD annually on patient care. Compared to patients without hypertension, who spend 4172 USD, hypertensive patients spend 9089 USD (Kirkland, 2018). This cost shows how hypertension is a highly costly condition to manage. It is costly to the patient, the government, and the healthcare delivery industry.
Improving Costs
The American Heart Association (AHA) suggests that clinicians enhance hypertension detection, prevention, evaluation, and management to reduce associated costs (Vise, 2019). Four principles can guide healthcare professionals to reduce the costs related to hypertension. The first principle is early intervention. Early hypertension intervention helps decrease damage to the heart and reduces the risk of developing cardiovascular complications like stroke (Vise, 2019). The second principle should ensure the patient’s blood pressure readings are within the normal range. By understanding the importance of blood pressure control, clinicians can closely monitor and communicate with their patients (Vise, 2019).
The third principle of reducing healthcare costs is implementing interdisciplinary collaboration and integrating community resources. Interdisciplinary collaboration will help promote effective communication and strategies to control hypertension (Vise, 2019). The final principle addresses the causes and barriers that negatively impact hypertension management. Healthcare professionals should promote medication adherence for patients of low socioeconomic status. They can improve adherence by enhancing access to healthcare, patient education, and providing social support (Vise, 2019). Lowering healthcare costs will ensure that patients adhere to the treatment plan.
Government Policy
The Affordable Care Act is a government policy that impacts the treatment of hypertension. Former President Barack Obama enacted this act in 2010. This act has increased access to healthcare services and reduced healthcare costs. Since its enactment, ACA has expanded Medicaid coverage and improved healthcare access to individuals of low income (Courtemanche et al., 2020). Since this act has expanded insurance coverage to individuals who did not have insurance, ACA directly impacts the management of hypertension. Individuals can now access healthcare services despite having preexisting medical conditions (Courtemanche et al., 2020). Affordable Care Act also promotes implementing preventive services such as patient education, which help manage hypertension.
Part 2
When I met Mr. Daniels for this practicum session, his family noted that the patient had experienced a safety issue because of hypertension. The patient recently suffered a stroke, which paralyzed his left side of the body. They say the cardiologist told them this happened due to non-medication adherence. The patient stated that he does not like taking his medications since they are many. He also likes his alcohol and cigarettes; hence, he finds it hard to quit using them. The family has gone to the emergency department three times because of this condition. They visited the emergency department two months ago when the patient suffered a massive stroke. The patient has only been hospitalized once because of hypertension. This was for three weeks because of the stroke he suffered. The patient was admitted to a rehabilitation facility. He has since been discharged but attends the facility twice weekly for speech therapy.
The patient is currently on four medications. Artovastatin 20mg, Junior Aspirin 75mg. Atenolol 10mg, and Enalapril 10mg. He claims that these medications are too much. I, however, advised him that they are essential. I was amazed that he had so much information on these drugs. He stated that he reads a lot about drugs, and he did not like them because of the side effects. The patient states that Medicare and private insurance pay for his medications. He rarely spends out-of-pocket to meet his medication needs. The patient stated that the drugs make him feel nauseous and sometimes give him a headache. These are some of the reasons that he does not like taking them. The patient goes to see his cardiologist once every month. He also goes for rehabilitation speech therapy after the stroke. He noted that his premium insurance covers all his hospital and rehabilitation visits.
Conclusion
Hypertension is a complex condition affecting millions of American American adults. It is linked with increased healthcare costs, healthcare quality, and patient safety. Healthcare professionals must implement effective strategies such as multidisciplinary collaboration, effective communication, and patient-centered care to enhance safety and quality and reduce the cost of care in hypertension.
References
CDC. (2020, September 8). Facts about hypertension. Centers for Disease Control and Prevention. https://www.cdc.gov/bloodpressure/facts.htm
Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2020). The impact of the Affordable Care Act on healthcare access and self‐assessed health in the Trump era (2017‐2018). Health Services Research, 55(S2), 841-850. https://doi.org/10.1111/1475-6773.13549
Drevenhorn, E. (2018). A proposed middle-range theory of nursing in hypertension care. International Journal of Hypertension, 2018, 1-11. https://doi.org/10.1155/2018/2858253
Jannick Kuipers, S., Murray Cramm, J., & Nieboer, A. P. (2019). The importance of patient-centered care and Co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. International Journal of Integrated Care, 19(4), 315. https://doi.org/10.5334/ijic.s3315
Kirkland, E. B. (2018, May 30). Adults with high blood pressure face higher healthcare costs. American Heart Association. https://newsroom.heart.org/news/adults-with-high-blood-pressure-face-higher-healthcare-costs
Rosen, M. A., Diaz-Granados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 73(4), 433-450. https://doi.org/10.1037/amp0000298
Sany, S. B., Behzhad, F., Ferns, G., & Peyman, N. (2020). Communication skills training for physicians improves health literacy and medical outcomes among patients with hypertension: A randomized controlled trial. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-4901-8
Singh, S., Shankar, R., & Singh, G. P. (2017). Prevalence and associated risk factors of hypertension: A cross-sectional study in urban Varanasi. International Journal of Hypertension, 2017, 1-10. https://doi.org/10.1155/2017/5491838
Wu, A. W., & Busch, I. M. (2019). Patient safety: a new basic science for professional education. GMS journal for medical education, 36(2). https://doi.org/10.3205/zma001229
Zhou, D., Xi, B., Zhao, M., Wang, L., & Veeranki, S. P. (2018). Uncontrolled hypertension increases risk of all-cause and cardiovascular disease mortality in US adults: The NHANES III linked mortality study. Scientific Reports, 8(1). https://doi.org/10.1038/s41598-018-27377-2
ORDER A PLAGIARISM-FREE PAPER HERE
We’ll write everything from scratch
Question 
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 two 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 Core Elms Volunteer Experience Form. Report on your experiences during your first two practicum hours.
Quality, Safety, and Cost Considerations
Introduction
Organizational data, such as readmission rates, hospital-acquired infections, falls, medication errors, staff satisfaction, serious safety events, and patient experience, can 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 critical 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 two direct practicum hours working with the same patient, family, or group. You may also consult with subject matter and industry experts during this time.
To prepare for the assessment:
Review the assessment instructions and scoring guide to ensure you understand the work you will be asked to complete and how it will be assessed.
Conduct scholarly and professional literature research to inform your assessment and meet scholarly expectations for supporting evidence.
Review the Practicum Focus Sheet: Assessment 2 [PDF], which guides conducting this portion of your practicum.
Note: Remember that you can submit all or a portion of your draft assessment to Smarthinking for feedback before you submit the final version. If you plan on using this free service, be mindful of the 24–48 hours turnaround time for receiving feedback.
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 two 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 Core Elms 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 two 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 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?
CORE ELMS
Update the number of hours on the NURS-FPX4900 Volunteer Experience Form in CORE ELMS.
Requirements
The assessment requirements below correspond to the scoring guide criteria, so 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, length, and 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 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 policies in addressing care quality, patient safety, and costs to the system and individual.
Explain how these standards and 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 benchmark data sources 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 Core Elms 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 write and format 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 long, not including the reference page.
Supporting evidence: Cite at least five 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 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 individuals. Document the practicum hours spent with these individuals or groups in the Core Elms 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 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.
Practicum Focus Sheet 2
Practicum Focus Sheet
Assessment 2
Note: Expect to spend at least 2 hours with the patient, family, or group you’ll be working with
during this portion of your practicum, exploring patient safety, quality, and costs
associated with the health problem you’ve defined. This includes time spent in consultation with
subject matter or industry experts. You’ll report on the results of this work as part of your following
assessment.
For this portion of your practicum, discuss how the problem will affect patient safety,
quality of care, and costs. Consider the following questions to help guide your exploration of
quality, safety, and costs and to make the most of your time:
• Has the patient, family, or group experienced any serious safety events because of the
problem?
• How often have they gone to the emergency department (ED)?
• How many times have they been hospitalized?
• What is the frequency of ED visits or hospitalizations?
• How many medications are needed to manage the problem?
• Does insurance pay for these medications?
• Have the medications caused any side effects?
• How often are doctors’ visits or other therapies needed?
• Does insurance pay for these visits or treatments?