Assignment: QI Project Impact of Residents Presentation

Assignment: QI Project Impact of Residents Presentation ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: QI Project Impact of Residents Presentation Please refer to 5 attachments. 1) I have attached a sample PP presentation “Sample QI Antipsychotics” of anti-psychotic drugs. Use this PP to guide yourself on what our PP should contain. Assignment: QI Project Impact of Residents Presentation 2) I have begun the presentation “QI Project” (the grey colored slides) (continue using that template), but will need you to finish it. 3) The presentation must be approximately 30-40 slides if possible. You will find a word document “QI Checklist” with some instructions as well. 4) You will also find 1 pp slide template “Sample QI Project Graph” with a graph. Be sure to include that slide in our presentation. 5) Also refer to ” Stats QI Proposal” proposal you did for me about 2 weeks ago. You may incorporate this info into this PP. Let me know if you have any questions. Thank you! stats_qi_proposal_wk_4.doc sample_qi_lh_pp_antipsychotics___cardiometabolic_monitoring.pptx qi_lh_checklist_instructtions.docx sample_qi_project_graph_template.pptx qi_project_lh_pp.pptx Running head: QUALITY IMPROVEMENT PROPOSAL Quality Improvement Proposal for Insufficient Incident Reporting Grand Canyon University 1 QUALITY IMPROVEMENT PROPOSAL 2 Proposed Improvement Initiative Problem Overview and the Setting the Problem Occurs The current demands in the healthcare systems mean hospitals should prioritize developing a patient safety culture. The international health community recommends hospitals to keep their patients safe by installing an appropriate incident reporting system. Recent researches have highlighted strong examples of serious patient safety incidents due to failure to report incidences. The major disasters in the healthcare setting have revealed the failures in understanding and responding to reported incidents (Carlfjord, Ohrn, & Gunnarson, 2018). Prioritizing patient safety has seen most healthcare institutions improve their healthcare delivery to have satisfied patients. However, challenges persist in the healthcare sector stemming from failures in the incident reporting system. Even though errors are inevitable in the health system, they are multidimensional and form a significant threat to patient safety. The contributing factors to healthcare errors are a combination of sociocultural features, human behavior, system weaknesses, and technical aspects of a system (Engeda, 2016). Developing a comprehensive incident reporting system helps health professionals learn from errors. Incident reporting’s’ primary purpose is to identify safety hazards and develop the interventions to reduce and mitigate the hazards. The hospital can alleviate the problems it has been facing, by installing an effective incident reporting system, to catch the hospital’s incidents. Assignment: QI Project Impact of Residents Presentation The high rate of errors and reports of patient dissatisfaction raises questions about developing an incident reporting system. Incident reporting within the healthcare setting would change the hospital’s culture to encourage quality improvement and reduce blame and personal responsibility when growing towards better patient safety. Reasons for the Quality Improvement Initiative Improving patient safety is a priority that requires immediate action and developing measures to curb the growing problem. Installing appropriate incident reporting is central to QUALITY IMPROVEMENT PROPOSAL 3 patient safety measures. Healthcare institutions can improve with a system that encourages identifying problems and mishaps in hospitals. The hospital can investigate and address the identified problems. The hospital can also learn from them, share with the other staff, and implement it. The primary reason for the proposed quality improvement initiative is encouraging a learning culture in the healthcare setting. Developing an inclusive approach to incident reporting is central to quality improvement since it forms the basis for healthcare personnel to learn from errors within the setup (Wahlin, Kvarnstrom, Ohrn, & Nilsing Strid, 2020). Healthcare institutions can use the records to trace some of the hospital’s errors, discuss them, and preventive design mechanisms. The importance of incident reporting cannot be overstated because it enables medical personnel to disclose near misses and unintended injuries. Making mistakes is part of being human. Medical personnel can make mistakes that could lead to several problems in healthcare. Even though health professionals make mistakes, one person does not cause critical incidents. However, the traditional response to such mistakes is blaming the involved individuals and failing to establish a system to avoid making similar errors and problems in the future. Failing to capture the errors has seen healthcare institutions making similar mistakes or near misses.Assignment: QI Project Impact of Residents Presentation Medical personnel fail to report some mistakes, fearing blame and punishment (Fukami, Uemura, & Nagao, 2020). Eliminating such problems in healthcare requires developing an incident reporting system. Healthcare personnel is responsible for ensuring patient safety. Developing a reporting and safety culture encourages doctors and nurses to report problems because of a lack of criticism or blame for the reported incidents. Research Evidence Supporting the Proposed Quality Improvement Initiative One of the project outcomes of implementing the initiative to develop incident reporting in hospitals is reduced medical errors and near misses. The healthcare setting will QUALITY IMPROVEMENT PROPOSAL guarantee confidentiality for all the reported cases. The study by Fukami, Uemura, & Nagao (2020) in a hospital in Japan showed that incident reporting benefited the healthcare professionals by coordinating the treatment of patients with chronic illnesses and helped develop transparency within the hospital. Healthcare personnel within the hospital are more willing to report incidents to prevent them from happening in the future. Even though some doctors might have reported more incidents than other doctors, the rate of incident reporting has helped the hospital advance. The high rate of incident reporting is healthy or healthcare institutions to improve and provide quality healthcare. According to Wahlin, Kvarnstrom, Ohrn, & Nilsing Strid (2020) reporting is essential in hospitals since it improves learning at the individual and organizational levels. The study showed a high prevalence of incidents in Swedish hospitals. However, the hospitals have reduced the errors by implementing an incident reporting system to improve their healthcare delivery. Medical practitioners admit that despite the impossibility of preventing errors, healthcare institutions can install procedures to form barriers to making mistakes (Carlfjord, Ohrn, & Gunnarson, 2018). Assignment: QI Project Impact of Residents Presentation The challenge of failing to develop an incident reporting system is that the hospital can fail to know the hospital’s problems, thus making it hard to develop a plan or system to improve healthcare delivery. An example is that failing to report drug errors means no one will know the prescription sheets’ confusingly. Developing an open reporting system helps alleviate the near misses and adverse incidents. Steps for Implementing the Quality Improvement Initiative Developing the steps to follow in a healthcare setting is central to accomplishing the plan. The proposed initiative steps start by developing a clinical governance group in the healthcare setting that comprises a senior doctor, hospital manager, senior nurse, and pharmacist. The group needs to be experienced enough in the industry because of the complexity of the information to analyze and have the necessary authority within the 4 QUALITY IMPROVEMENT PROPOSAL 5 healthcare setting to make changes. A representative from the relevant department is vital to ensure that all the areas are covered during the practice. The second stem is designing an incident reporting form with few questions to encourage medical personnel to fill the forms. Developing a form with long and complicated questions will make people reluctant to fill the form. The information to develop in the form is the patient’s name, incident’s location, date and time of the incident, witnesses’ name, any harm caused, action taken, and the reporter’s contacts. The next step is ensuring the availability of the forms in the clinical area. Healthcare management should ensure that the clinical governance group receives the completed forms of confidentiality. Assignment: QI Project Impact of Residents Presentation The final is stepping is making sure everyone within the healthcare setting knows about the reporting system and encouraging them to report any incident. Evaluating the Quality Improvement Initiative After implementing the incident reporting system in the healthcare setting, the hospital can evaluate the improvements by checking the rate of reported errors. The reports should focus on patient injuries and reduced healthcare costs. An incident reporting system can help hospitals develop a positive safety culture (Engeda, 2016). Improved safety culture due to minimal patient injuries and other near misses highlights the reported incidents’ significant progress. A descriptive analysis of the errors’ parameters shows the changes the hospitals have achieved in their setting. Hospitals need to ensure that they have the necessary materials to check the changes. A systematic review of medical personnel’s compliance with the stipulated policies helps understand the developed system’s importance. Real-time observations are central to improving healthcare delivery. A coherent design of better interventions helps healthcare institutions enjoy quality care. The Variables and Statistical Test to Prove the Initiative’s Success The healthcare setting’s important knowledge when developing any initiative is improving patient safety by preventing harm and delivering quality care. One of the central QUALITY IMPROVEMENT PROPOSAL variables to measure in the proposed initiative to implement an incident-reporting system is the harms prevented and the saved patients. Focusing on improving the quality of healthcare settings is a commitment to improve patient safety and develop a positive relationship with patients. The tests to prove the initiative’s success is calculating the rate of error occurrence. Calculating and recording the errors and comparing them with previous results help shed light on the progress made in quality improvement. The frequencies and the severity of the injuries and near misses from the reported incidents help minimize errors and develop a healthy competitive safety culture in the healthcare setting. Patient outcomes are central to having the best possible quality care. An incident reporting system would help the hospital advance their medical practices and improve the quality of care. 6 QUALITY IMPROVEMENT PROPOSAL References Carlfjord, S., Ohrn, A., & Gunnarson, A. (2018). Assignment: QI Project Impact of Residents Presentation Experiences from ten years of incident reporting in health care: a qualitative study among department managers and coordinators. BMC health services research, 18(1), 113. Engeda, E. H. (2016). Incident reporting behaviours and associated factors among nurses working in Gondar University Comprehensive Specialized Hospital, Northwest Ethiopia. Scientifica, 2016. Fukami, T., Uemura, M., & Nagao, Y. (2020). Significance of incident reports by medical doctors for organizational transparency and driving forces for patient safety. Patient Safety in Surgery, 14, 1-7. Wahlin, C., Kvarnstrom, S., Ohrn, A., & Nilsing Strid, E. (2020). Patient and healthcare worker safety risks and injuries. Learning from incident reporting. European Journal of Physiotherapy, 22(1), 44-50. 7 QI Project Antipsychotics, Cardiometabolic Monitoring Introduction Cardiovascular disease is a major contributor of the increased mortality in subjects with schizophrenia and other severe mental illnesses. Compared with the general population, patients with severe mental illness have nearly twice the risk of dying from cardiovascular disease, especially at an early age Metabolic syndrome also known as syndrome X, syndrome of chronic cardiovascular disease, or Reaven’s syndrome is a constellation of conditions including: • Abdominal obesity • Insulin resistance • Dyslipidemia (elevated triglycerides levels and low high-density lipoprotein cholesterol) • Hypertension. Patients with metabolic syndrome meeting formal criteria are at increased risk for premature cardiovascular disease, type 2 diabetes mellitus, and early death. Metabolic syndrome represents a global epidemic. Severe mental illness, unhealthy lifestyles, and the use of antipsychotic medications all play an important role in increasing the risk of metabolic syndrome. Diagnosis Diagnostic Criteria Major clinical and research organizations proposed harmonized criteria defining the syndrome. Diagnosis is based on the presence of any three of the following abnormal findings: ?Fasting glucose – ?100 mg/dL (or receiving drug therapy for hyperglycemia). ?Blood pressure – ?130/85 mmHg (or receiving drug therapy for hypertension). ?Triglycerides – ?150 mg/dL (or receiving drug therapy for hypertriglyceridemia). ?High-density lipoprotein cholesterol – <40 mg/dL in men or <50 mg/dL in women (or receiving drug therapy for reduced high-density lipoprotein cholesterol). ?Assignment: QI Project Impact of Residents Presentation Waist circumference – ?102 cm (40 in) in men or ?88 cm (35 in) in women; if Asian American, ?90 cm (35 in) in men or ?80 cm (32 in) in women. (The International Diabetes Federation criteria allow the use of a body mass index >30 kg/m in lieu of the waist circumference criterion.) 2 Epidemiology Prevalence in general population — Using criteria proposed by the American Heart Association , studies have estimated prevalence by ethnicity: ?Europeans – 14.4 percent in women; 18.4 percent of men . ?South Asian – 31.8 percent in women; 28.8 percent in men. ?African Caribbean – 23.4 percent in women; 15.5 percent in men . ?Taiwan – 15.7 percent. ?United States – 23.4 percent* in women; 24.0 percent* in men. •African Americans – Women approximately 57 percent > men. •Mexican Americans – Women approximately 26 percent > men . ?East Asia – 2 to 18 percent in women; 8 to 13 percent in men. ?South America – Mean prevalence of 14 to 30 percent. ?Australia – 20 to 30 percent. CONTRIBUTING FACTORS Mental disorders — Antipsychotic medication-naive patients with schizophrenia or schizoaffective disorders have been shown to present with hepatic insulin resistance suggesting a direct link between schizophrenia and insulin resistance independent from the use of antipsychotic medications. Lifestyle factors -: patients with schizophrenia and severe mental illness: • unhealthy diet • smoking • lack of physical activity. Antipsychotic drug side effects Although second-generation antipsychotics are better tolerated, they are well known to be associated with: • increased risk of obesity • impaired glucose tolerance • new-onset diabetes • hyperlipidemia • cardiovascular disease and metabolic syndrome. The prevalence of antipsychotic-related metabolic syndrome has been reported in samples ranging from 23 to 50 percent. Almost all antipsychotics with prolonged use are associated with causing weight gain to varying degrees: ?High – Clozapine and olanzapine ?Intermediate – Quetiapine, risperidone, paliperidone iloperidone ?Low – Aripiprazole, amisulpride, ziprasidone, asenapine, lurasidone, and most high- to mid-potency first-generation antipsychotics Copyrights apply PATHOPHYSIOLOGY Obesity, insulin resistance, hyperglycemia, and diabetes The turnover of free fatty acids, which are released into the portal circulation and shuttled to the liver, where they are stored as triglyceride (the portal theory of metabolic syndrome). Assignment: QI Project Impact of Residents Presentation Hepatic insulin resistance and the abundance of free fatty acids lead to an increase in gluconeogenesis that leads to hyperglycemia. Pancreatic beta cell continues to decompensate for the increased need for insulin to overcome resistance, and the result is type 2 diabetes mellitus. Insulin resistance and hypertension — The relationship between insulin resistance and hypertension is likely to be multifactorial: Mediated by endothelial dysfunction caused by free fatty acidmediated generation of reactive oxygen species Hyperinsulinemia-induced sympathetic nervous system activation and inhibition of nitric oxide synthase, and the effects of adipose tissue-derived cytokines. Hyperactivity of the renin-angiotensin-aldosterone system in seen with obesity. Metabolic syndrome and adipokines dysregulation Increased adiposity is associated with overproduction of adipokines with pro-inflammatory properties. Deleterious adipokines overproduced in obesity include tumor necrosis factor-alpha, interleukin 6, monocyte chemoattractant protein 1, plasminogen activating factor 1, angiotensinogen, retinol binding protein 4, and adipocyte fatty acid binding protein. Beneficial adipokines dysregulated in obesity include leptin, adiponectin, apelin, resistin, and visfatin. Metabolic syndrome and inflammation — Metabolic syndrome is associated with an elevated inflammatory state. Elevated: • C-reactive protein • tumor necrosis factor-alpha • plasma resistin • interleukin 6, and interleukin 18 Associated conditions • Nonalcoholic fatty liver disease • Polycystic ovarian syndrome • Obstructive sleep apnea • Hypogonadism • Microvascular disease • Cancer Copyrights apply QI Steps I. Idea II. Planning & criteria requirements III. Data collection & Monitoring IV. Data analysis V. Countermeasures VI. Implementation plan VII. Follow-up planning and measurement Idea Throughout the first few years we realized the amount of patients who are on antipsychotics. We also witnessed an increased on possible indications for antipsychotics , FDA approved and off-label use. Most of patients seen during those years were at the inpatient unit , not allowing you observe if outpatient psychiatrist/PCP was following cardiometabolic monitoring recommendations. Idea During outpatient rotation we start questioning ourselves how much of the recommended cardiometabolic monitoring was followed. Our objective was to increase the quality of care, improved quality of life and prevent medical complications. Not following recommendation can result in a huge liability. Planning & criteria requirements All started presenting a rough idea that what we were trying to analyze. Assignment: QI Project Impact of Residents Presentation He guided and refined the idea to what look for , potential settings to conduct the study , probable hypothesis and predictable results. Planning & criteria requirements Title: Deficiencies in Cardiometabolic monitoring on patients taking antipsychotics Planning & criteria requirements Problem statement: Deficiencies in implementing the recommended cardiometabolic monitoring on patients diagnosed with schizophrenia currently taking antipsychotics. Criteria for a QI project When conducting research it is important to ask your self, if your study meets the FINER criteria. F= Feasible I=Interesting N=Novel E=Ethical R=Relevant Criteria for a QI project Feasibility: Multiple treatment setting at LCH Cooperation from other departments Large amount of patient on antipsychotic medications Availability of EMR. Criteria for a QI project Interesting & Novel The interest in this quality improvement project was anticipated to be high given the repercussion on quality of care and patient’s safety. Criteria for a QI project Ethical This topic was ethical in relation to the field of Psychiatry. Information was obtained from records without disclosing any identifiable information. Our project would display how to improve quality of care. Criteria for a QI project Relevant This project was relevant to our patient population at Hospital. The project will allow improved patient’s quality of care. Relevance is further supported by the amount of patients on antipsychotic medication in our population. The possibility to implement changes on all Hospital settings. Data collection Data was collected from hospital. Data transmission occurred via paper copies or via encrypted email. Data collections were kept private and in accordance with HIPPA. Data collections were not shared with third parties. Data collection Inclusion criteria Only patient with diagnosis of Schizophrenia and currently or started on antipsychotics. Other diagnosed were excluded despite on being on antipsychotics. No age, sex or other exclusion criteria was used. Data collection Charts of 40 patients seeing during March 2019 were reviewed. Last results and date of HGBA1c, CMP, waist circumference and Lipids were obtained and determined if was up to date with current recommendations. Possible cause for not compliance was analyzed( Root causes) Other data like specific an … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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