Quality, Safety, and Cost Considerations Paper

Quality, Safety, and Cost Considerations Paper

Quality, Safety, and Cost Considerations Paper

 How The Patient, Family, Or Population Problem Impacts The Quality Of Care, Patient Safety, And Costs To The System And Individual

Catheter-acquired urinary tract infections (CAUTIs) pose a significant challenge in healthcare settings, impacting the quality of care, patient safety, and healthcare costs. According to a study by Gotha (2023), CAUTIs are associated with increased morbidity and mortality rates, prolonged hospital stays, and a decline in patient’s overall health status. These infections lead to increased healthcare interventions, including additional laboratory tests, imaging studies, and consultations, resulting in a higher burden on healthcare resources and potential delays in delivering optimal care to patients. In nursing practice, CAUTIs demand vigilant monitoring, adherence to infection control protocols, and timely interventions. Nurses play a crucial role in preventing CAUTIs through proper catheter insertion techniques, regular assessment, and prompt catheter removal. However, the prevalence of CAUTIs highlights the need for continuous improvement in infection prevention practices to enhance the quality of care.

In Mrs. Moureen’s case, the presence of CAUTIs leads to recurrent hospitalizations. Each hospitalization represents a disruption in her care and can result in fragmented care delivery. With each hospital admission, there may be variations in the healthcare team, leading to potential inconsistencies in her treatment plan, medication reconciliation, and overall continuity of care (Giles et al., 2020). These interruptions in care can compromise the quality and effectiveness of Mrs. Moureen’s treatment. Additionally, the presence of CAUTIs can lead to a decline in her overall health status. Infections can cause discomfort, pain, and complications such as sepsis, which require additional interventions and resources to manage. This impacts the quality of Mrs. Moureen’s daily life and her ability to engage in activities that promote well-being and independence.

CAUTIs pose a significant risk to patient safety. Patients with CAUTIs are more susceptible to bloodstream infections and sepsis, leading to severe complications and even mortality. Mrs. Maureen has previously been hospitalized after chronic recurrent CAUTIs. A study by Gotha (2023) further established that CAUTIs were associated with a higher risk of sepsis-related deaths. This highlights the critical importance of preventing CAUTIs to ensure patient safety and prevent avoidable harm. CAUTIs pose significant risks to patient safety, as they can progress to bloodstream infections and sepsis. Mrs. Moureen, being an older adult with diabetes, is particularly vulnerable to these complications. In nursing practice, patient safety is a paramount concern. Implementing evidence-based guidelines for CAUTI prevention, such as regular hand hygiene, aseptic catheter insertion, and proper catheter maintenance, is crucial to reducing the risk of infection and subsequent harm. Nurses play a pivotal role in educating patients and their families about the importance of infection prevention practices and monitoring for early signs of infection.

CAUTIs result in substantial healthcare costs, both at the individual and system levels. A report by AHRQ (2019) estimated that the average cost per CAUTI episode ranged from 4,694–$29,743, depending on the setting and patient population. These costs encompass additional healthcare utilization, prolonged hospital stays, increased antimicrobial usage, and potential readmissions. Moreover, CAUTIs contribute to the overall financial burden of healthcare systems, diverting resources that could be allocated to other patient needs. The presence of CAUTIs can significantly impact healthcare costs for both the individual and the healthcare system. For Mrs. Moureen, each episode of CAUTI requiring hospitalization incurs costs related to hospital stays, diagnostic tests, antimicrobial therapy, and additional healthcare resources. The financial burden on Mrs. Moureen and her family can be substantial, including out-of-pocket expenses, potential loss of income due to hospitalizations, and increased healthcare expenditures. In nursing practice, managing CAUTIs requires significant resource allocation, including staff time, supplies, and antimicrobial agents. Healthcare organizations need to invest in infection prevention programs, staff education, and quality improvement initiatives to reduce CAUTI rates and associated costs. Implementing evidence-based prevention strategies, such as catheter-associated urinary tract infection (CAUTI) guidelines, can help optimize resource utilization and minimize the economic impact of CAUTIs.

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How State Board Nursing Practice Standards And Organizational And 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

State board nursing practice standards, like ANA,  provide guidelines for infection prevention and control practices, including specific recommendations for CAUTI prevention and management. These standards ensure that healthcare providers follow evidence-based protocols to deliver high-quality care. Adherence to these standards improves care quality. For example, a study by Jeyashree and Arunagiri (2020) investigated the impact of implementing CAUTI prevention guidelines on national guidelines and found that adherence to these guidelines led to a significant reduction in CAUTI rates, demonstrating the effectiveness of standardized practices in improving care quality.

Organizational policies aligned with state board standards also play a crucial role. Giles et al. (2020) examined the impact of a multifaceted intervention that included protocols, staff education, and audit and feedback strategies and reported a decrease in CAUTI rates and increased adherence to best practices, highlighting the positive influence of organizational policies on care quality.

ANA practice standards and organizational policies emphasize patient safety by promoting infection prevention practices (ANA, 2022). For instance, Giles et al. (2020) evaluated the impact of a comprehensive CAUTI prevention intervention in intensive care units. The implementation of standardized practices, including nurse-driven protocols and catheter removal criteria, resulted in a significant reduction in CAUTIs and related complications, demonstrating the positive impact on patient safety. Governmental policies also contribute to patient safety. For example, the Centers for Medicare and Medicaid Services (CMS) implemented the Hospital-Acquired Conditions Reduction Program, which includes CAUTI as a measure for reimbursement penalties (CMS, 2022), and this program was associated with a reduction in CAUTI rates and improved patient safety outcomes.

State board nursing practice standards and organizational policies also impact healthcare costs by promoting effective prevention strategies and resource optimization (CDC, 2019). According to Jeyashree and Arunagiri (2020), the economic impact of implementing CAUTI prevention guidelines in a large healthcare system demonstrates cost savings through reduced CAUTI rates, shorter hospital stays, and decreased antimicrobial use. Governmental policies and reimbursement models can also influence costs. For example, CMS’s pay-for-performance initiatives, such as value-based purchasing programs, incentivize healthcare organizations to improve quality outcomes while reducing costs. Hospitals with higher adherence to infection prevention practices, including CAUTI prevention, had lower Medicare spending (Jeyashree & Arunagiri, 2020).

How These Standards And/Or Policies Will Guide Your Actions In Addressing Care Quality, Patient Safety, And Costs To The System And Individual

As a healthcare provider, state board nursing practice standards and organizational and governmental policies play a crucial role in guiding my actions in addressing care quality, patient safety, and costs related to catheter-acquired urinary tract infections (CAUTIs). I will closely adhere to ANA  practice standards that provide guidelines for CAUTI prevention and management. These standards outline evidence-based practices, such as proper catheter insertion and maintenance techniques, regular assessment, and early identification of signs of infection (ANA, 2022). I will also follow the organizational policies within my healthcare facility. These policies are designed to align with state board standards and observe protocols for CAUTI prevention and management. This includes such practices as strict adherence to aseptic techniques during catheter insertion, practicing good hand hygiene, and following infection control protocols (Dimas, 2020).

Additionally, I need to stay informed about the latest research that evaluates the effectiveness of standards and policies in addressing care quality, patient safety, and costs related to CAUTIs. By integrating this evidence into my practice, I can ensure that I am utilizing the most up-to-date and effective strategies for preventing and managing CAUTIs. This may involve implementing prevention guidelines, using nurse-driven protocols for catheter removal, and advocating for evidence-based interventions that promote better patient outcomes. By continuously enhancing my knowledge and skills, I can provide the highest quality care, promote patient safety, and contribute to cost-effective care delivery.

Effects Of Local, State, And Federal Policies Or Legislation On Your Nursing Scope Of Practice

Local, state, and federal policies and legislation have substantial effects on the nursing scope of practice within the context of care quality, patient safety, and cost to the system and individual.  Local policies implemented within healthcare facilities directly influence the nursing scope of practice and encompass guidelines and protocols for catheter care, infection prevention, patient safety, and quality improvement initiatives. Adherence to local policies ensures that nurses follow standardized practices, such as proper catheter insertion, maintenance techniques, and timely identification of infection signs (Stevenson, 2023). Patient safety is also significantly impacted by local policies. By establishing protocols for infection control, medication safety, and fall prevention, local policies create a framework that minimizes risks and adverse events.  Additionally, local policies can influence resource utilization and cost-effective practices by implementing guidelines that encourage efficient use of resources, such as reducing waste or implementing evidence-based practices, healthcare facilities can optimize cost without compromising patient care. This, in turn, contributes to cost-effectiveness for both the healthcare system and individual patients like Mrs. Moureen.

State boards of nursing establish regulations and define the scope of practice for registered nurses (RNs) and licensed practical nurses (LPNs). In the case of Mrs. Moureen, state policies ensure that nurses providing care possess the required education, licensure, and competency to manage patients with indwelling catheters and prevent CAUTIs. State policies, which are typically aligned with evidence-based guidelines, promote care quality by ensuring that nurses maintain proficiency through continuing education and professional development (Dang et al., 2021). This guarantees that Mrs. Moureen receives care from knowledgeable and skilled nurses, improving her overall care quality. Furthermore, state policies related to patient safety, such as those that mandate reporting and investigation of adverse events, contribute to Mrs. Moureen’s well-being. Reimbursement rates set by state Medicaid programs and insurance regulations can influence the costs associated with nursing care, including catheter management and infection prevention, put upon by the state. Additionally, state policies may require certain standards or certifications for healthcare facilities, which can influence the costs of maintaining compliance.

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Federal policies and legislation also significantly impact the nursing scope of practice in relation to care quality, patient safety, and costs. Federal agencies such as the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) establish guidelines and policies that shape nursing practice. Federal policies promote care quality by setting standards and requirements for healthcare facilities participating in federal programs. Patient safety is also addressed through federal policies that focus on standardized safety protocols, reporting and analyzing adverse events, and initiatives to reduce medical errors. The establishment of Patient Safety Organizations (PSOs) under the AHRQ provides a platform for healthcare providers to share and learn from patient safety events (Deserno et al., 2022), ultimately improving patient safety outcomes for individuals like Mrs. Moureen. Reimbursement policies, such as those implemented by CMS, incentivize value-based purchasing, which ties reimbursement to quality outcomes (CMS, 2022). This encourages healthcare providers to deliver cost-effective care that aligns with evidence-based practices by optimizing resource utilization and improving overall cost-effectiveness.

Propose Strategies To Improve The Quality Of Care, Enhance Patient Safety, And Reduce Costs To The System And Individual

Mrs. Moureen, a 72-year-old diabetic patient with an indwelling catheter and a history of catheter-acquired urinary tract infections (CAUTIs), is the focus patient case. One strategy to improve care quality and patient safety is the implementation of evidence-based catheter care guidelines. The guidelines include proper catheter insertion and maintenance techniques, regular assessment, and early identification of infection signs (Gupta et al., 2023). Research by Gupta et al. (2023) shows that the consistent implementation of catheter care guidelines can significantly reduce the incidence of CAUTIs and improve patient outcomes.

In terms of reducing costs to the system and individuals, another strategy is to focus on prevention and early intervention. Implementing policies and protocols that emphasize preventive measures, such as appropriate catheter use and regular assessments, can help reduce the occurrence of complications and costly interventions associated with CAUTIs (Gray et al., 2023). Additionally, early identification and prompt management of infection signs can prevent the progression of infections, potentially reducing the need for hospitalization and costly treatments.

National databases, such as the Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ), provide valuable benchmark data on healthcare-associated infections, including CAUTIs. These databases offer insights into infection rates, trends, and best practices for prevention. Additionally, professional organizations and specialty associations often publish guidelines and quality indicators that can serve as benchmarks for measuring care quality and patient safety. By referring to these sources of benchmark data, healthcare providers can monitor their performance, identify areas for improvement, and compare their outcomes to established standards (Jeyashree & Arunagiri, 2020).

References

AHRQ. (2019). Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions. Ahrq.gov. https://www.ahrq.gov/hai/pfp/haccost2019-results.html

ANA. (2022). ANA CAUTI prevention tool. ANA. https://www.nursingworld.org/practice-policy/work-environment/health-safety/infection-prevention/ana-cauti-prevention-tool/

CDC. (2019). Catheter-associated urinary tract infections (CAUTI). Cdc.gov. https://www.cdc.gov/hai/ca_uti/uti.html

CMS. (2022). Hospital-Acquired Condition Reduction Program. Cms.gov. https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/hac-reduction-program

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals: Model and guidelines, fourth edition. Sigma Theta Tau.

Deserno, T. M., Haghi, M., & Al-Shorbaji, N. (2022). Accident and Emergency Informatics. IOS Press. https://books.google.at/books?id=qwN6EAAAQBAJ

Dimas, J. B. (2020). Enduring risk factors for catheter-associated urinary tract infections. https://search.proquest.com/openview/b2987eee102837ac3a8d5d57e1c4793a/1?pq-origsite=gscholar&cbl=18750&diss=y

Giles, M., Graham, L., Ball, J., King, J., Watts, W., Harris, A., Oldmeadow, C., Ling, R., Paul, M., O’Brien, A., Parker, V., Wiggers, J., & Foureur, M. (2020). Implementation of a multifaceted nurse-led intervention to reduce indwelling urinary catheter use in four Australian hospitals: A pre-and postintervention study. Journal of Clinical Nursing, 29(5–6), 872–886. https://doi.org/10.1111/jocn.15142

Gotha, S. (2023). Compliance with external urinary catheter use in the intensive care unit [Mount St. Joseph University ]. https://rave.ohiolink.edu/etdc/view?acc_num=msjdn1683099426815143

Gray, J., Rachakonda, A., & Karnon, J. (2023). Pragmatic review of interventions to prevent catheter-associated urinary tract infections (CAUTIs) in adult inpatients. The Journal of Hospital Infection, 136, 55–74. https://doi.org/10.1016/j.jhin.2023.03.020

Gupta, P., Thomas, M., Mathews, L., Zacharia, N., Fayiz Ibrahim, A., Garcia, M. L., Simbulan, C., Attia Mohamed, F., & El Hassan, M. (2023). Reducing catheter-associated urinary tract infections in the cardiac intensive care unit with a coordinated strategy and nursing staff empowerment. BMJ Open Quality, 12(2), e002214. https://doi.org/10.1136/bmjoq-2022-002214

Jeyashree, K., & Arunagiri, R. (2020). Impact of care bundle implementation on the incidence of catheter-associated urinary tract infection: A comparative study in the intensive care units of a tertiary care teaching hospital in south India. Indian Journal of Critical Care Medicine: Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 24(7), 544–550. https://doi.org/10.5005/jp-journals-10071-23473

Stevenson, P. (2023). The impact of champion training on a two-clinician indwelling urinary catheter insertion technique to prevent catheter-associated urinary tract infection (CAUTI). https://digitalcommons.liberty.edu/doctoral/4364/

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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 subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form. Report on your experiences during your first two practicum hours.

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. Health care 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.

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 of the scholarly and professional literature to inform your assessment and meet scholarly expectations for supporting evidence.

Review the Practicum Focus Sheet: Assessment 2 [PDF]

Download 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.

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 group in the Capella Academic Portal Volunteer Experience Form. Use the Practicum Focus Sheet: Assessment 2 [PDF]

Download 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.

Whom 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?

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 individual.

Discuss research on the effectiveness of these strategies in addressing care quality, patient safety, and costs to the system and individual.

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 group 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.

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.

Update the total number of hours on the NURS-FPX4900 Volunteer Experience Form in Capella Academic Portal.

The BSN Capstone Course (NURS-FPX4900 ) requires the completion and documentation of nine (9) practicum hours. All hours must be recorded in the Capella Academic Portal. Please review the BSN Practicum Campus page for more information and instructions on how to log your hours.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and 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 group 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.

Scoring Guide

Use the scoring guide to understand how your assessment will be evaluated.

**Aiming for a Distinguished**