Discuss appropriate techniques that you would use to improve quality in the nursing home.

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3-4 page paper excluding front and back matter (APA standards apply).
Instructions:
In this assignment, you will be researching dimensions of quality and safety in healthcare, specifically long- term care, and how various industries can apply these concepts to improve operations.

§  Using the Medicare Nursing Home Compare website, research one nursing home that displays a low level of quality as indicated by their Five Star Rating*

§  The nursing home should display a low level of quality (-2 star rating)

§  The nursing home should display a low level of safety

§  Provide a general overview of the nursing home (e.g., name, location, bed size, ownership, etc.)

§  Discuss the quality performance of the nursing home as evident by its most recent health care inspection (e.g., deficiencies, citations, financial penalties, etc.). This can be accomplished by thoroughly reading the nursing home’s statement of deficiencies and plan of action to correct quality deficiencies (CMS Form 2567).

§  Discuss the safety performance of the nursing home as evident by its most recent life safety inspection (e.g., life safety citations, financial penalties, etc.). This can be accomplished by thoroughly reading the nursing home’s life safety code statement of deficiencies and plan of action.

§  Discuss appropriate techniques that you would use to improve quality in the nursing home.

§  Discuss appropriate techniques that you would use to improve safety in the nursing home.

§  Be sure to include details about the deficiencies that you found.

Describe the patient’s presenting problem focusing on the pathophysiological issues.

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Formative Assessment Task 1= 40%, 1500 words (due week 4) Due Date – 08-Nov-2018
Students are required to submit a critical discussion paper related to the nursing management of Mr Ferguson’s
case study below:
The critical discussion paper should address the following issues:
1. Describe the patient’s presenting problem focusing on the pathophysiological issues.
2. Review and use of literature to explain the pharmacokinetics of the prescribed medications and their indications.
3. Discuss the nursing management appropriate for the patient including management of the adverse effects of the medication(s) using evidence-based literature.
4. Describe in detail the information you would share with the patient and how you will educate the patient about the interactions and long term effects of the medications prescribed in the ED?
Mr Ferguson is a 76 year old male who presented to your emergency department at 0800hrs complaining of a 2/24 history of chest heaviness. He has self administered x2 sprays of his glyceryl trinitrate pump spray totaling 800mcg with minimal relief. On arrival to your allocated bed Mr Ferguson appears pale, diaphoretic & short of breath.
Regular Medications Medications Prescribed Administered in ED
Aspirin 100mg PO, OD Aspirin 300mg Po
Metoprolol 50mg PO, OD Morphine sulphate IV 2.5mg administered on four (4) occasions PRN
Rosuvastatin 10mg, PO, OD Low molecular weight (LMW) heparin infusion
glyceryl trinitrate pump spray- PRN Fentanyl 50mcg IV, x2 STAT doses
Vitals Signs
Blood pressure 172/86
Heart rate 103bpm, irregular
Spo2 97% RA
Respiratory rate 24b/min
Temperature 36.8C tympanic
Glasgow Coma Scale 15/15 – E4V5M6
AMPLE
A llergies: Amiodarone
M edications: as stated above
P ast medical history: Angina
Non ST Elevated Myocardial Infarction (NSTEMI) (1998 & 2006) Hypertension
Hypercholesterolemia
Last time the patient ate and drank: toast and tea at 0630hrs
E vents preceding admission: chest heaviness 2/24
Table 1: Marking guide Formative Assessment Task – 40%
Criteria Available mark % Awarded mark % Comments
Introduction and conclusion
A clear introduction outlining the purpose
of the paper 5
Content
a. A very clear description of the
health issue, prescribed
medication, Drug interaction
and long term effect.
b. A clear presentation of
management plans from the
literature 5 5
Application of pharmacology to practice
a. Knowledge of pharmacokinetics and
management plan to prevent the
adverse events.
b. Evaluations of the therapeutic
management plans presented in the
literature.
5 5
Quality of Presentation/Writing
a. Logical and sequential arrangement
of arguments and discussions
based on literature findings
b. Grammar, syntax, expression,
spelling, style, presentation &
legibility 5 5
APA Referencing
a. Citations where appropriate
b. Accuracy of bibliographic details 2.5 2.5
Subtotal 40

You did such a great job of turning around the last facility you managed! Now you have been recruited to take the position as administrator of a retirement community called Midview, which is located in the mountains near Los Angeles.Midview has independent living, assisted living, and skilled nursing facilities.There is no designated separate area for people with dementia. Like your last facility, there are many issues to address, and you will have to rely on all of your knowledge about legal and regulatory issues in long-term care to solve them.

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You did such a great job of turning around the last facility you managed! Now you have been recruited to take the position as administrator of a retirement community called Midview, which is located in the mountains near Los Angeles.Midview has independent living, assisted living, and skilled nursing facilities.There is no designated separate area for people with dementia. Like your last facility, there are many issues to address, and you will have to rely on all of your knowledge about legal and regulatory issues in long-term care to solve them.

The independent living has 200 apartments and is 90% occupied.Your director of marketing tells you that occupation rates could be even higher, but you have had complaints from potential residents about all of the people in wheelchairs.She wants to start marketing the housing as “active seniors only” and use only pictures of healthy people playing tennis and golf in your ads.She would also like to have separate floors in the building for people of different ethnicities and nationalities, since she believes that residents will be more comfortable if they can be around those with similar backgrounds.Finally, she wants to have a firm “no pets” rule in order to keep the building quiet and clean.When you tour the building and review the files, you notice that there many requests from tenants for modifications to the apartments for things like installing grab bars or widening the doors to allow walkers or wheelchairs, but the facility has not responded.Your facilities director tells you that it is better not to respond, because maybe then those tenants will get frustrated and move out, so you won’t have to deal with their problems.

The assisted living (also called residential care facility) has 55 apartments and has a good occupancy level of 92%.There has been a recent elopement where the resident went outside, slipped and fell on the ice, and broke his leg.He was not discovered for some time, and also had frostbite from lying in the snow.He is currently in the skilled nursing facility undergoing rehabilitation.The family is very upset and complained to the state.The facility was issued a citation for lack of supervision as it was documented that this resident was confused and deemed a wander risk.The staff at this facility tells you that the best thing to do is refuse to take this resident back when he is discharged from the nursing home, since he is too difficult to care for.They also say that the family wants to meet with someone from the facility to talk about what happened, but the last manager recommended that you stonewall and say the facility did nothing wrong.Staff wants you to refuse to meet with the family, and to start eviction proceedings while the resident is in the nursing home.You decide to review his file, but cannot find a copy of an admission agreement signed by the resident.Staff tells you that they don’t bother with admission agreements since people in the mountains are so friendly and easy to get along with.They say that everything is done on a handshake.You also notice that there are many residents at the assisted living facility who have dementia.You are a little bit concerned because there are no door locks or monitors or systems of any kind to track where residents are in the facility.The facility has also been written up because of substandard fire and smoke alarms. Overall, this facility seems really low-technology!

The skilled nursing facility has sixty beds and has averaged 82% occupancy levels for the last year.The facility takes a mix of private pay, Medicaid, and Medicare patients.They received a poor survey where they had twenty four deficiencies.There are two pending lawsuits.One was based around a fall and the other was due to a death caused by aspiration.The Director of Nursing is new to the position as she worked in assisted living previously.She says they would like to start a quality assurance program, but have not gotten around to it yet.You ask to see the most recent inspections/state surveys, and they do not have any copies.Staff tells you that the last manager had them shred a bunch of files when the lawsuits were filed, and they think that the surveys were included by accident in the records that were destroyed.They tell you that they are also going to delete all of the e-mails relating to the lawsuits, but have not gotten around to it yet. You review the files that are available, and you notice that there are a number of complaints from residents and their families because they are not allowed to meet in groups at the facility.There are also a lot of complaints from families that residents with dementia are being restrained or drugged most of the time.When you check the files for these patients, you do not find any doctor orders for physical or chemical restraints.When you ask the Director of Nursing about this, she tells you not to worry about it, because you can just transfer or discharge the patients who complained to get rid of them.She offers to get them all out by the weekend, if that would help.She says that Wild Bill, one of the new aides, just got out of prison for dealing drugs and elder abuse, and he would be a great person to help get those patients out of the building.You notice that Wild Bill has a bag full of watches, rings and hearing aids and was seen earlier carting boxes of medication out to his car.

Your head is spinning from everything you have seen so far at Midview.But you need to come up with a plan to address all of the problems, and you need to start working on it right away.What steps will you take at each facility?What problems do you see, and what additional steps would you take to uncover problems that you don’t know about yet?What laws do you think the facilities may be breaking?How will you get the facilities into compliance?Are there areas where you can improve, even if the facility is technically in compliance with laws?How would you manage and mitigate the risk of current and future claims against the facilities?

You must citewhich laws and regulations apply, and what state and federal agencies would oversee your facilities or might become involved in complaints against your facilities. You must also include a list of references/works cited at the end of your paper, which can be listed inMLA or APA format at the end of your paper. YOU WILL EARN POINTS BASED ON SUCCESSFULLY IDENTIFYING ISSUES IN THE HYPOTHETICAL, SO BE SURE TO ADDRESS THE FACTS PRESENTED THOROUGHLY.

The paper should be 10 pages double-spaced or longer. The paper should be submitted through Blackboard no later than 10:00 a.m. PST on 12/01.Save your paper in the Microsoft Word format (.doc or .docx) with a title of the file set as your last name & “final” (e.g. smith_final.docx). Required format is 12 point font with one-inch margins.

APN Practice Improvement

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Use APA format

Identify a specific clinical practice problem that is relevant to clinical nursing practice (mine is FALL) use the PDSA ( Plan, Data, Study, Action) template to identify the problem and follow each segment to clearly describe how you will incorporate in all the subheadings of PDSA. I want you to be specific in each categories and include your strategies for improvement: What is the problem? Is this a Unit Specific or Facility Wide problem? Why is this a problem? What is your current rates or reports? How will you make changes ( your methodology to improve practice) How will you monitor? What are your indicators? How long will you monitor? Identify your desired outcomes or goals for these identified problems. Please include benchmarks ( National or Historical). How will this improve your practice, patient care/safety/satisfaction and your health facility fiscal revenue ( think reimbursements). Due to the focus on interprofessional collaborative approach, kindly include other disciplines who are involved in this project ie., Pharmacy, Infection Control etc. I recommend for you to review: The New York State Partnership for Patients ( NYSPFP); Greater New York Health Association and the Healthcare Association of New York State ( HANYS),. Look for NYS Partnership for Patients ( GNYHA) and click on the link you find past presentations on: NYS Partnership for Patients and several presentations on Infection Control ( 2018); GNYHA Conference Seeks to Prevent Falls in Hospitals ( October 29, 2018);

Rubric

ASSIGNMENTS

I. APN Practice Improvement Paper

The purpose of this paper is to facilitate role transition to an advanced nursing practice role by having the student identify a clinical problem that can be addressed with the skills and knowledge acquired by advanced practice nurses. Students will begin to think on a systems level to identify the problem, strategies for resolution, a plan for resolution, and outcome measures to determine the effectiveness of the strategic plan.

Identify a specific clinical practice problem that is relevant to clinical nursing practice (for example, sepsis, pressure ulcer detection, family presence during resuscitation, nursing staff shift report, nursing staff patient transfer report, etc.). Think in specific, narrow terms when identifying a problem and remember that many problems affecting clinical practice are too complex for you to resolve; they are addressed at a higher level of organizational leadership. For example, you probably cannot change the number of RNs working in a hospital, but you might be able to change the scheduling method for RNs on a specific unit if that might resolve the problem. You will use skills and knowledge from one or more of the advanced practice nursing competencies to design a strategy to address the problem. Discuss your topic with the professor if you are unsure whether it is appropriate.

Search the scholarly peer-reviewed literature for articles related to your topic. Also, search for evidence-based practice guidelines that address the problem. Include the following information in your paper:

Introduction (25%)

Discuss the following: a clear statement of the practice problem and documentation that supports the existence of the problem, an historical perspective of the issue, a brief literature review related to the significance of the issue, and the relevance of this issue to advanced practice nursing. It is recommended that you choose a real practice that you can directly influence with the PI project that you will develop.

Possible Strategies to Address the Problem (15%)

In this section you will discuss possible relevant strategies that could be used by an advanced practice nurse to resolve this situation. Be very specific. These should include strategies reported in the literature. Discuss the research evidence that supports the use of each strategy.

Strategic Focus (35%)

In this section you will elaborate on one of the strategies you have discussed in the previous section. Indicate its theoretical/conceptual basis, relevance to the clinical problem and how you would implement this strategy in your practice as an advanced practice nurse. Possible theoretical/conceptual bases include change theory or other theories specific to the type of problem. Develop a specific plan for implementation that includes a step-by-step description of how you will implement this change in a clinical practice environment. Indicate others who will be involved in this strategy and what their roles will be.

Outcome Evaluation Strategy (15%)

Describe how you will evaluate the effectiveness of your strategic focus strategy. Include the instruments or other outcome measures that you will use to evaluate outcomes. If the instruments have been published, include psychometric data. If the instruments are new, indicate how you will evaluate reliability and validity. This must be specific.

References (10%)

Your reference list will be evaluated for the inclusion of scholarly peer-reviewed literature and evidence-based practice guidelines (if available). You may use information from professional health-related web sites, such as the Centers for Disease Control and Prevention (CDC), Joint Commission, National Guideline Clearinghouse or other professional organizational web sites; just be sure to include them on your reference list.

Additional Instructions:

? Papers without section headings are unacceptable and will result in a loss of 10 points.

? Do not use your text as a source of information for this paper. You are expected to read recent scholarly peer-reviewed journal articles and practice guidelines (if available) related to the topic. Synthesize the information from these articles in your discussion. If you wish to include additional information from a web site, you may do so only if the information is relevant, you have appropriately paraphrased and cited the source, and the web site is a credible, scholarly source of information (i.e., from a professional organization, university or other credible site; refer to information in the References section above). Do not use sites such as Wikipedia, e-how, ask, all nurses, nurses together and similar sites.

? Use the library’s electronic databases to search for articles.

? Scholarly writing and adherence to scholarly format as described in the 6th edition of the APA Publication Manual is expected. You may write in first person in the Strategic Focus and Outcomes sections of the paper. Please pay particular attention to the appropriate use of heading levels, grammar, sentence structure, spelling and punctuation, consistency of font size and style, and reference citations. Be very careful to cite all of your sources correctly at the point in your paper where you discuss them. It is inadequate to include sources on your reference list that have not been cited in the body of your paper. Also inadequate is citing your references only at the end of a paragraph. If you wrote an entire paragraph that was paraphrased from another source, cite the source the first time to refer to it in your paragraph. Then use appropriate transition language so the reader knows you that what follows was from the same source. Avoid the use of direct quotes.

? Any plagiarism will result in a grade of 0 for your paper.

You will submit your paper through Blackboard using Turn- it- In (ASSIGNMENTS link). Save your paper in one of the following file formats: Word (.docx or .doc) or rich text file (.rtf). The file name should be: The Assignment Title – Do not use a cover page

Grading Rubric: APN Practice Improvement Paper

Criteria

Points Possible

Points Earned

Introduction

? Practice problem clearly stated

? Provides evidence to support existence of problem

? Discusses historical perspective

? Reviews pertinent literature

? States relevance of the issue to advanced nursing practice

25

Possible strategies

? Lists possible strategies to resolve problem

? Provides scientific evidence to support the strategy

15

Strategic focus

? Selects one strategy to address the problem

? Discusses the theoretical basis for the strategy

? Describes the relevance of the strategy to the problem

? Describes a step-by-step plan to implement the strategy

? Describes who will be involved in the implementation process and what their role(s) will be

35

Outcome evaluation

? Describes a specific plan to evaluate outcome achievement

? Describe the outcome variable, i.e., what are you measuring?

? Describe what data you will collect and how you will collect the data

? Describe any instruments that will be used to measure outcomes

? Discuss any known or anticipated limitations to your project

15

References

? Selects relevant references from scholarly, peer-reviewed journals or relevant professional and credible websites

10

Scholarly writing and APA format (a maximum of 10 points will be deducted for errors)

? Sentence structure and punctuation are correct

? Word choice is correct and words are spelled correctly

? Appropriate headings are used

? Synthesis of ideas is evident with appropriate transitions used where needed

? References and headings are formatted correctly, according to the APA Manual, 6th edition

? Paper is organized and ideas flow fluently and correctly

? Font size is 11 or 12 and style is one of the following: Cambria, Calibri, Arial, Times New Roman

? Paper is double-spaced (includes reference list) and formatted according to the APA Manual

Total 100