Make a follow-up of a student's weekly discussion and respond with your opinion regarding to her post

——You don't have to post this in APA format necessarily, it's just giving feedback to the student .

Jacqueline Kenney

Good Evening Professor,

 

              I work in one of the largest hospital systems in Atlanta. The facility I work for has the bed capacity for 686 patients. The hospital specializes in cardiovascular procedures (the implantation of the LVAD) and transplantation of liver, and kidneys. The hospital attracts people from across the country. People coming from literally every state, and sometimes from out of the country.

            The area where I see the EHR impeding patient care, and again this might be in part, due to end-user negligence, are providers not utilizing the information and data contained within the patient's EHR frequently enough.  We run off a system called EPIC (EHR). I have come to realize most hospitals in the state of Georgia, and other states use EPIC as well.  Embedded within the EPIC system is a hyperlink called Care Everywhere. The Care Everywhere tab allows all providers on the EPIC system to see notes, documentation, tests results, frequency of visits, and more. This data covers every hospital, clinical, urgent care, and office visit the patient has encountered so as long as the facility is on the EPIC system. I believe the shear amount of medical information becomes overwhelming and time consuming to comb through, especially for medical providers who are already seeing numerous patients at the bedside and in specialty offices. 

          Despite medical documentation being readily available to providers across the healthcare spectrum, there seems to be little time for a busy Cardiologist to review necessary documentation from the patient's Pulmonary doctor, or the notes placed from Endocrinology. Often a patient comes for a visit due to CAD, but the patient is also a diabetic with uncontrolled elevated blood glucose. We know one disease process feeds the other, but in spite of the EHR containing valuable patient data, providers are still missing imperative clinical information required to treat the patients holistically. 

          The one department which I see consistently using chart review to coordinate care with patients, providers, and families are RN Case Managers within the hospital setting.  RN Case Managers, and Care Coordinators are responsible for knowing what is missing in the patient continuum of care. The RNCM interfaces with the providers, and assists in providing education to both medical MDs and patients regarding critical clinical information which will advance the clinical process and bring better patient outcomes. McBride & Tietze (2018) discussed unintended harm, or consequences suffered by patients with the implementation of the EHR. One such consequence has to do with physicians required to research, and review copious amounts of previous documentation, as well as being required to spend greater amounts of time entering documentation.  Such time consuming tasks often create information, and important patient data not being read, or documented in an effort to save time, and so providers can physically see more patients. 

 

Resources

                FAAN, S.M.P.R. C., & FAAN, M.T.P.R. F. (2018). 
Nursing Informatics for the Advanced Practice Nurse (2nd ed.). Springer Publishing LLC. 

https://ambassadored.vitalsource.com/books/9780826140555Links to an external site.

           Williams, M. D., Asiedu, G. B., Finnie, D., Neely, C., Egginton, J., Finney Rutten, L. J., & Jacobson, R. M. (2019). Sustainable care coordination: a qualitative study of primary care provider, administrator, and insurer perspectives. 
BMC health services research, 
19(1), 92. https://doi.org/10.1186/s12913-019-3916

 Reply

• Refer to the “Population-Focused Nurse Practitioner Competencies” found in the Week 1 Learning Resources, and consider the quality measures or indicators advanced nursing practice nurses must possess in your specialty of interest.
• Refer to your Clinical Skills Self-Assessment Form you submitted in Week 1, and consider your strengths and opportunities for improvement.

Learning From Experiences

• Revisit the goals and objectives from your Practicum Experience Plan. Explain the degree to which you achieved each during the practicum experience.
• Reflect on the three (3) most challenging patients you encountered during the practicum experience. What was most challenging about each?
• What did you learn from this experience?
• What resources were available?
• What evidence-based practice did you use for the patients?
• What would you do differently?
• How are you managing patient flow and volume?
• How can you apply your growing skillset to be a social change agent within your community?

The table below gives some operational statistics for two hospitals located in the same community. Use the table to answer the following questions.

1. Calculate the following measures for each hospital (wherever appropriate, calculate the measure for each pay type). Discuss the meaning and significance of each measure and point out the differences between the two hospitals.
   1. Hospital capacity
   2. ALOS
   3. Occupancy rate
2. Operationally, which hospital is performing better? Why?
3. Do you think the nonprofit hospital is meeting its community benefit obligations in exchange for its tax-exempt status? Explain.
4. Do you think the hospitals have a problem with excess capacity? If so, what would you recommend? In your answer to this question, please consider how hospital governance may impact the ability of an administrator to make changes.

Assignment: National Patient Safety Goal

This assignment will be done in the classroom with discussion to follow.

1.  Read the following chapter from the book, “Patient Safety and Quality: An Evidence-Based Handbook for Nurses” and provide a brief overview.

https://www.ncbi.nlm.nih.gov/books/NBK2681/

2.  List the National Patient Safety Goals from the Joint Commission’s website appropriate to the long-term care environment and what precautions should the nurse take relative to EACH safety goal? 

https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2022/npsg_chapter_alc_jan2022.pdf

3.  From the book, “Patient Safety and Quality: An Evidence-Based Handbook for Nurses,” select one other chapter to read and provide a brief overview.  Apply the main concepts to the long-term care facility environment.  This could be a situation from work or from school or a personal experience. 

http://www.ahrq.gov/qual/nurseshdbk/

4.  Select a Speak Up brochure developed by The Joint Commission. Follow this link to the proper website: https://www.jointcommission.org/topics/speak_up_campaigns.aspx and answer the following questions.

a.  Identify the brochure you chose and the demographic it applies to. Who else can utilize this information?

b.  Why is the brochure you chose important?

c.  What was done well? What could be improved?

d.  How will patient safety be improved from the chosen brochure?

e.  Discuss how current nursing or healthcare-related research supports the information presented in the brochure.

Title

Assignment:  National Patient Safety Goal

Put X in box to correspond with the SLO (s)

Put X in box to correspond with the Competency (s)

Knowledge/Practice/Ethical Comportment

K

P

E

Student Learning Outcome(s)

Patient-Centered Care

Communication Skills

 

Nursing Process

Learning Needs

Technology

Documentation

Informatics

Nursing Judgment

Prioritization

Nursing Judgment

Professionalism

Professionalism

Ethical/Legal

Quality Improvement

Patient Care Concerns

Systems

Safety

x

Patient Complications

Safe Nursing

x

x

x

Teamwork/Collaboration

Communication

Conflict Recognition 

Managing Care 

Managing Care of the Individual Patient

Assign/Monitor 

Where should this assignment be used:

Classroom

X

Clinical Setting

X

Independent Study

X

Online/Web Based

X

Skills Lab

Simulation

 

Revised from Linda Caputi © (What type of assignment is this?)

Patient Care Assignment

Non-Patient Care Assignments

Patient Care

The assignments are related to the student while providing patient care in the clinical setting.
Example:  Concept mapping care for one or multiple patients. 

Thinking Focused
Assignments encourages critical thinking and clinical reasoning and teaches students to think like a nurse.

Patient Focused

The student focuses on specific aspects of patient care such as safety, falls, diabetes, other diseases, etc.

Systems Focused

Assignments help the student understand the clinical world, the nurse’s work therein, and the effect of the system on the nurse and the patient.
Example:  How the system completes medication administration from order to delivery to patient.  

x

x

x