NUR 550 Identify either a safety or quality improvement initiative related to improving population health
NUR 550 Identify either a safety or quality improvement initiative related to improving population health
The quality improvement initiative related to improving population health is the execution of evidence-based interventions for chronic disease prevention and management. These interventions, which include lifestyle modifications and medication management, have been scientifically proven to reduce the morbidity and mortality associated with chronic clinical conditions like heart disease, diabetes, and obesity. Not only do these tactics benefit individual patients who suffer from these diseases, but they also have system-wide implications as successful interventions lead to savings in healthcare costs for the entire population. Furthermore, improvements in health outcomes due to the utilization of evidence-based interventions have ancillary benefits such as increased resilience to infectious diseases like Covid-19.
Translational research can play a critical role in the development of this initiative by bridging the gap between research and practice (Starokozhko et al., 2021). Translational research has the potential to make a significant difference in the advancement of public health initiatives, specifically surrounding population health. By compiling data from clinical practice and community settings, it is possible to identify effective interventions that can improve both preventative care and chronic disease management. This type of research bridges the gap between scientific discoveries and healthcare practices, allowing clinicians to use evidence-based approaches that have proven successful. As further research is conducted regarding epidemiology and cost-effectiveness analysis in this field, health outcomes are sure to be positively impacted as translational research continues to grow in importance.
As an example, the Diabetes Prevention Program (DPP) is a proven lifestyle intervention that has been shown to reduce the risk of type 2 diabetes (Burd et al., 2020). Citing this success, the CDC launched the National Diabetes Prevention Program (NDPP) in order to bring the benefits of this intervention to more people. This community-based program includes training for lifestyle coaches, materials and resources to assist participants, as well as quality assurance initiatives to make sure that these interventions are delivered safely and effectively. Through this program, community organizations can expand access and provide support for individuals looking to reduce their risk of type 2 diabetes.
In conclusion, by offering evidence-based treatments and methods for implementation and dissemination, translational research may have an impact on the creation of quality improvement programs meant to promote population health. An outstanding illustration of how translational research has been used to bring an evidence-based intervention into practical settings and enhance health outcomes for those at risk for type 2 diabetes is the National Diabetes Prevention Program.
Burd, C., Gruss, S., Albright, A., Zina, A., Schumacher, P., & Alley, D. (2020). Translating knowledge into action to prevent type 2 diabetes: Medicare expansion of the National Diabetes Prevention Program lifestyle intervention. The Milbank Quarterly, 98(1), 172-196. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7077780/
Starokozhko, V., Kallio, M., Howell, Å. K., Salmi, A. M., Andrew-Nielsen, G., Goldammer, M., … & Mol, P. G. (2021). Strengthening regulatory science in academia: STARS, an EU initiative to bridge the translational gap. Drug discovery today, 26(2), 283-288. https://www.sciencedirect.com/science/article/pii/S1359644620304347
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Quality improvement activities are important to achieve the goal of “improving the health of the population, enhancing patient experiences and outcomes, and reducing the per capita cost of care, and to improving provider experience” (Taylor et al., 2020). A quality improvement initiative that aims to improve asthma care in pediatric patients is The Utah Pediatric Partnership to Improve Healthcare Quality (UPIQ) and Utah Department of Health (UDOH) Asthma Program Learning Collaborative. This partnership’s purpose is to “standardize asthma assessment, asthma control documentation, and patient education material in the form of an asthma action plan to improve care management for pediatric asthma patientsa” (Murray, 2022, p. 1). Asthma control in pediatric patients is important in order to decrease hospitalization and ER visits. Pediatric patients, depending on their age, may be unable to manage their own asthma, so parent involvement in managing their asthma is a strategy to improve health outcomes for these children. Providing patient education resources such as asthma action plans are beneficial for the parents and children to familiarize themselves with information on asthma self-management.
Translational research can influence the development of this quality improvement initiative by studying how the outcomes of research can be applied into practice and actually have an impact on health (Centers for Disease Control and Prevention, 2018). T4 research results in improved population health as it involves studying factors and interventions that influence population health.This would be relevant to the quality improvement initiative to improve asthma control in pediatric children.
Centers for Disease Control and Prevention. (2018). Translation Research. https://www.cdc.gov/niosh/topics/translationresearch/default.html
Murray, K. M. (2022). Outcomes of Asthma Quality Improvement in Pediatric Patients. Journal of Nursing & Interprofessional Leadership in Quality & Safety, 5 (1). Retrieved from https://digitalcommons.library.tmc.edu/uthoustonjqualsafe/vol5/iss1/2
Taylor, E., Peikes, D., Geonnotti, K., Mcnellis, R., Genevro, J. & Meyers, D. (2020). Quality Improvement in Primary Care. https://www.ahrq.gov/research/findings/factsheets/quality/qipc/index.html
A safety initiative at my hospital is to eliminate, or at minimum reduce, patient falls. Patient falls can happen for any number of reasons but the one that is of biggest concern for me is falls among post-surgical patients. My PICOT is trying to determine if patients ask for less pain medication when having a total knee arthroplasty (TKA) performed and receive an adductor canal block. While patient falls are not officially included in my PICOT it is important for TKA patients to get out of bed and ambulate as soon as possible. This raises a few concerns regarding whether the patients have good enough motor function post adductor canal block and whether they have enough pain control to ambulate without feeling dizzy. Kim et al. (2014) describes the ideal nerve block for TKA as providing adequate analgesia, reducing the need for opioids, and not effecting motor strength. Translational research can influence the development and implementation of safety and quality improvement projects and lead to better patient outcomes.
Kim, D., Lin, Y., Goytizolo, E., Kahn, R., Maalouf, D., Manohar, A., Patt, M., Goon, A., Lee, Y., Ma, Y., & Yadeau, J. (2014). Adductor canal block versus femoral nerve block for total knee arthroplasty: A prospective, randomized, controlled trial. American Society of Anesthesiologists, 120, 540-550.
Interesting discussion on how to reduce to minimal falls among the post-TKA patient, This raises a few concerns regarding whether the patients have good enough motor function post adductor canal block and whether they have enough pain control to ambulate without feeling dizzy. Kim et al. (2014) describe the ideal nerve block for TKA as providing adequate analgesia, reducing the need for opioids, and not affecting motor strength., This raises a few concerns regarding whether the patients have good enough motor function post adductor canal block and whether they have enough pain control to ambulate without feeling dizzy. Kim et al. (2014) describe the ideal nerve block for TKA as providing adequate analgesia, reducing the need for opioids, and not affecting motor strength. Ideally, pain is one of the risk factors for falls in post-surgical patients, Wet diapers are another risk. In fact, in most facilities, because of the shortage of staff, some of the residents remain in their urine/stool for hours which causes irritation, and some of them get confused in the process of helping themselves. Get on the floor.
Preventing or reducing falls to a minimum, all hands will be on deck. All members of the health team, both, Physical therapists perform exercises to improve ROM, CNAs make sure that residents do not stay for too long in their urine, and MD; prescribes pain medications while nursing administered the medication, in this case, the pain medication should be administered early before the pain become severe to aid comfort. If a resident is comfortable, the risk of falls is reduced. I found this discussion interesting because, in my own facility, we document a number of falls on a daily basis.
Safety culture is an important factor in improving population health. To achieve CAUTI reduction and sustain these improvements, a strategy to address both culture and clinical practice is necessary. Culture consists of the team’s values, attitudes, and beliefs, which all have an impact on the team’s ability to improve clinical practice. The Comprehensive Unit-Based Safety Program (CUSP) is a change model designed to improve resident safety by providing educational videos, tools, and resources to understand the science of safety and integrate evidence-based practices into daily care. The root of improvement lies in the safety culture within the facility. Qualitative measures can provide valuable subjective data that can be used to assess safety culture. Leadership and staff perceptions of resident harms such as CAUTIs or falls, and staff harm such as a punitive response to errors, can influence culture. One way to measure safety culture is improving the use of a safety survey (ahrq.gov, n.d.).
Relationships between facility-level reports of safety culture, as measured by the AHRQ-developed Nursing Home Survey on Patient Safety Culture (NHSOPS) instrument, and CAUTI rates both prior to the delivery of prevention interventions and over time. Findings suggest that reductions in nursing home patient infection rates can be achieved without measurable improvements in safety culture reports. These findings further strengthen calls to prioritize interventions that focus on improvement of the technical aspects of infection control, such as standardizing protocols for catheter insertion, removal and maintenance, through a combination of technical and socio adaptive interventions (Flott, et al;2018).
Flott, K., Nelson, D., Moorcroft, T., Mayer, E. K., Gage, W., Redhead, J., & Darzi, A. W. (2018). Enhancing Safety Culture Through Improved Incident Reporting: A Case Study In Translational Research. Health affairs (Project Hope), 37(11), 1797–1804. https://doi.org/10.1377/hlthaff.2018.0706
Quality and safety improvement initiatives in healthcare aim at enhancing the health and well-being of diverse populations. Nurses and other healthcare providers assess the needs of their populations and implement evidence-based initiatives to address them. Several quality improvement initiatives exist in healthcare. An example of such a program of interest in this project is antimicrobial stewardship. Quality improvement initiatives can be used to advocate for antimicrobial stewardship. The aim is to ensure safe antibiotic prescribing by healthcare providers and their use by patients. Antimicrobial stewardship adopts the strategies of quality improvement such as assessing things that need to be improved in antibiotic prescribing and use, implementing improvement strategies, monitoring, and measuring outcomes. The ultimate aim of antimicrobial stewardship is to ensure patient safety and lower the development of antimicrobial resistance and Clostridiole difficile. The success of antimicrobial stewardship quality-improvement initiatives depends largely on the adequacy of support and infrastructure in an organization (McGregor et al., 2021). Therefore, nurses and other healthcare providers should be actively involved in advocating for change in their organizations.
Translational research can influence the development of quality improvement initiatives on antimicrobial stewardship. One of the ways it can influence is by guiding the processes adopted in the quality improvement project. For example, it may be necessary for the organization to implement the initiative on a small scale as a pilot study to determine its impact. The piloting will provide insights into the strategies needed to deliver the expected outcomes in antibiotics prescribing and use in an organization. Translational research also informs the strategies adopted to ensure the ethical nature of the quality improvement initiative (Ahlin, 2019; Thompson & Schwartz Barcott, 2019). For example, it informs the need for the consideration of ethical principles such as beneficence, justice, and non-maleficence in the implementation of the initiative.
Ahlin, E. (2019). Semi-Structured Interviews With Expert Practitioners: Their Validity and Significant Contribution to Translational Research. https://doi.org/10.4135/9781526466037
McGregor, J. C., Fitzpatrick, M. A., & Suda, K. J. (2021). Expanding Antimicrobial Stewardship Through Quality Improvement. JAMA Network Open, 4(2), e211072. https://doi.org/10.1001/jamanetworkopen.2021.1072
Thompson, M. R., & Schwartz Barcott, D. (2019). The Role of the Nurse Scientist as a Knowledge Broker. Journal of Nursing Scholarship, 51(1), 26–39. https://doi.org/10.1111/jnu.12439