NURS 3065 Community And Population Health Nursing

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Discussion Point 1: How are quality and safety measured at your current work/clinical site (or a past work/clinical site)? Have these particular assessments been affected by the ACA, and consistent with ACA elements regarding quality?

Within the hospital I work, there are many quality and safety measures which go through rigorous data collection and reporting to the appropriate agencies. In searching our employee database, I found the easiest to interpret to be the HAIs, or hospital associated infections. Our organization produces monthly reports titled the Infection Prevention and Control Monthly Report, compiled by our Infection Prevention and Control Department. That being said, within the report it is clearly stated that specific data is not to be shared beyond the facility, thus I will not be sharing specific data. This is not to say the organization does not make these reports public, but rather these are preliminary reports prior to releasing the public reports.

The data collected within the reports are obtained through surveillance methods such as daily lab results, previous emergency department visits, monthly post-discharge surgical procedure reporting from providers, verbal reports from nursing or other providers, chart review, and multidisciplinary rounding. Specific HAIs being tracked include CLABSIs, CAUTIs, VAEs (ventilator associated events) and VAP (ventilator associated pneumonia), hospital onset C. diff. infections, hospital onset MRSA events, and number of surgical site infections (SSIs).

The reports clearly state that both the Colorado Department of Public Health and Environment (CDPHE) and the U.S. Centers for Medicaid and Medicare Services (CMS) legally require hospitals to publicly report selected HAIs. All measures are entered into the NHSN, or National Healthcare Safety Network, where they can be viewed publicly. Additionally, the Colorado Hospital Association or CHA has created the Colorado Hospital Report Card. This is an online tool which allows the public in Colorado to view quality and safety data specific to Colorado hospitals, this can be found at https://cha.com/colorado-hospitals/reportcard/ (Links to an external site.)Links to an external site.. However, it should be noted that not all hospitals in CO participate and the reporting is not as in depth and diverse as the data entered into the NHSN.

Student 2

Discussion Point 1: How are quality and safety measured at your current work/clinical site (or a past work/clinical site)? Have these particular assessments been affected by the ACA, and consistent with ACA elements regarding quality?

The clinic that I am currently completing my clinical hours was awarded the Level 3 National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home award earlier this year. To be awarded this Level 3 award, they must participate in HEDIS measures that are focused on quality and safety measures within the primary care realm. Some examples of HEDIS measures include proper treatment of upper respiratory illnesses in pediatric populations, screening for postpartum depression, assessing for statin use, completing diabetic screenings, and assessing for immunization needs (NCQA, 2018). I have attached a pdf that shares some of the most recent quality measures that are being monitored and reported.

The Patient-Centered Medical Home was supported by the Affordable Care Act (ACA) and provides incentives for providers that provide a team-based approach to care that enhances the care of their patient panels (Nash, 2016). Because Patient-Centered Medical Homes were developed from the ACA, it provides consistency in what the ACA finds important regarding quality.

Discussion Point 2: What are critical success factors (at least two) for EHR implementation and unintended consequences (at least two) of inserting information technology into healthcare work flows?

Critical success factors include a supportive administration that is willing to provide the infrastructure required to deploy the EHR appropriately. Having been a part of the EHR implementation of 3 different EHR systems, I know how much work goes into preparing the EHR implementation before the end-users (providers, nurses, ancillary staff) ever get to touch the system. Even once the implementation of an EHR has occurred, there is still a high level of need for administrative support to have ongoing support when upgrades are required. Another critical success factor is a well thought out EHR that has been integrated in a way that is user friendly and will provide not only a record of the patient’s care, but also allows for quality and safety measures to be pulled out and reported. Having this ability allows for implementation of new evidence-based care with a way to measure those improvements in the care of patients.

One of the unintended consequences from information technology, is that meeting quality measures can benefit the majority of patients, but sometimes results in not allowing for the decision of the individual patient. One example that my preceptor discussed is the starting of a statin in an older adult patient and providing the risks and benefits to the patient. While they always have the right to refuse, there are measures that are where electronic reports are looking at diagnosis codes and also medications prescribed. While there may be a note explaining the discussion, that is not in a discrete data field to be captured within the report. Another unintended consequence is that providers can become more reliant on the computer and it can interfere in developing meaningful relationships. While it can help clue providers into issues that need to be addressed, it also can result in the provider missing the subtle non-verbal cues that could make a difference in diagnosis and ways in which we should approach a topic. Nash et al. (2016) also discusses the change in workflows when entering orders or medications. I have experienced this on multiple occasions when ordering imagining or placement of medication orders. It is easy to choose the wrong order which can result in delayed studies being completed, or medications that are not ordered for the correct route or dosage.

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