Evidence-Based Quality Improvement for Older Adults
For this paper, I will discuss five current evidence-based articles to examine several aspects that impact quality improvement for older adults. I will discuss age-related physical and emotional changes and how they challenge quality improvement in the elderly, barriers and solutions to quality improvement programs, and how these will impact the quality outcomes for the aging adult.
Age-Related Changes
There are many theories that describe the aging process, but current thought is that physical changes begin as early as the 20s and 30s in most adults. Normal aging affects every system in the body because organs become more inefficient. Heart muscle thickens, and oxygen uptake lessens. Arteries become less elastic, and it becomes more difficult to circulate blood. Lung and bladder capacity declines and kidneys cannot excrete waste products as well. Muscle mass declines and mineral loss occurs in bones. Vision close-up and at a distance becomes difficult. Low light environments and glare from headlights can compound this issue and make driving at night challenging. Hearing can diminish but is more prevalent in men than women (Toblaski, 2014-a).
Literature Review
Keeping the elderly patients safe is the most critical and challenging aspect of gerontological nursing due to generalized diminishing function. I reviewed five research articles to look at various improvement programs and how they relate to QAPI (Quality Assurance and Performance Improvement). QAPI is a framework of government guidelines for quality improvement programs in nursing homes (Centers for Medicare & Medicaid Services, 2014).
Training Model Effects on Oral Care in a Long-term Care Facility
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In conclusion, the aging process presents many challenges to providing safe, high-quality care for elderly patients in long-term care facilities. Nursing homes should focus on engaging and involving all departments and staff in quality program initiatives. QI leaders should make staff education an integral piece of improvement efforts and should model their programs using the elements of the QAPI process. While resources are scarce, QI staff need to look at creative ways to encourage staff to adopt EBP. Researchers should increase data collection from real world settings to develop evidence-based practices. As the elderly adult population rapidly increases, the areas of research, nursing care, and quality improvement need work together to find ways to deliver the safest health care available to this vulnerable population.
Leaders recognize improving clinical quality will have many benefits for both, residents and the organization. For example, it will benefit residents by improving satisfaction, reducing complications, and improving their quality of life. It will benefit NCH by reducing turnover, improving occupancy rates, attracting top talent, and enhance employee satisfaction (Advancing Excellence in America’s Nursing Homes, n.d.). Increasing professional development opportunities will be key for improving clinical quality. Professional development enhances the clinical staff’s competencies and will decrease turnover, which will enable NHC to experience a greater financial return on their development
The QSEN initiative is the progression of quality and safety of education for nurses that began in 2005 and has been continued over the past eight years. It is a multi-phase process that shows current and future nurses how to apply knowledge, skills, and attitudes to their everyday nursing activities(QSEN, 2013, 1). Nurses and student nurses can use their knowledge, skills and attitudes to help prevent never events such as hospital acquired conditions. Never events are medical errors that could have been serious and preventable. They could have been caused by poor communication, lack of proper nursing skills, or simply just negligence. QSEN can also be used to improve nursing outcomes for everyone involved in the healthcare field.
The Joint Commission. (2012, January 01). National patient safety goals: Medicare based long term care. Retrieved from http://www.jointcommission.org/assets/1/6/NPSG_Chapter_Jan2012_LT2.pdf
“The overall goal for the Quality and Safety Education for Nurses (QSEN) project is to
Evidently, the healthcare management discipline has interests that overlap (and can be used to study) the Green House nursing home model. The Green House Project offers unique insights regarding changes in nursing home management philosophies that can improve both, the health of residents, as well as the job satisfaction of CNAs. Since nursing home budgets, residents’ healthcare and CNA turnover rates, are important factors in nursing home management, the Green House Project is an excellent case study for the field of healthcare management, as
Moss, A. J. et al. Design and operation of the 2010 National Survey of Residential Care Facilities. Vital Health Stat. 1. 1–131 (2011). at
Without doubt, there are two variables that should be considered when evaluating the benefit of shared governance in long term/nursing home settings. First, obtaining consent from the nursing assistant to volunteer for the leadership role for the duration of one year, and the nursing assistant employment status at the time of consent. Second, the effectiveness of the shared governance project to reduce falls, weight loss, in-house acquired pressure injury, and nosocomial infection rates for the sake of the resident’s comorbidity.
Nursing homes who receive federal funds are required to comply with federal laws that specify that residents receive a high quality of care. In 1987 Congress responded to reports of widespread neglect and abuse in nursing homes during 1980’s, which enacted legislation to reform nursing home regulations and require nursing homes participating in the Medicare and Medicaid programs to comply with certain requirements for quality of care. The legislation, included in the Omnibus Budget Reconciliation Act of 1987, which specifies that a nursing home “must provide services and activities to attain or maintain the highest practicable phys...
Nursing assistants work in many types of settings including nursing homes, hospice, mental health centers, assisted living residences, home care agencies, hospitals, rehabilitation and restorative care facilities (Sorrentuino & Remmert, 2012). There are many types of Long-term care centers. For this paper, I will focus on the long-term care centers often referred to as nursing homes. These LTCs are "licensed facilities that provide extended care for individuals who do not require the acute care provided in a hospital but who need more care than can be given at home" (U.S Department of Health And Human...
Development of The Evidence Based Geriatric Nursing Protocols for Best Practice Guideline originated with the goal of providing strategies that would allow nursing to monitor and support family caregivers (Agency for Healthcare Research and Quality, n.d.). Evidence selection and collection occurred utilizing the PICO question methodology to hand search primary and secondary relevant published literature, in addition to electronic database searches. The data was then analyzed via a meta-analysis of the published materials garnered from the search in addition to a systematic review of the evidence. From the preceding analysis of the evidence, major recommendations arose for
In today’s health care system, “quality” and “safety” are one in the same when it comes to patient care. As Florence Nightingale described our profession long ago, it takes work and vigilance to ensure we are doing the best we can to care for our patients. (Mitchell, 2008)
The overall goal for the Quality and Safety Education for Nurses (QSEN) plan is to meet the challenge of educating and preparing future nurses to have the knowledge, skills and attitudes that are essential to frequently progress the quality and safety of the healthcare systems in the continuous improvement of safe practice (QSEN, 2014).Safety reduces the possibility of injury to patients and nurses. It is achieved through system efficiency and individual work performance. Organizations determine which technologies have an effective protocol with efficient practices to support quality and safety care. Guidelines are followed to reduce potential risks of harm to nurses or others. Appropriate policies
The first nurse to introduce quality improvement was Florence Nightingale, who through gathering data on the positive effects of keeping adequate hygiene, nutrition and proper ventilation on the mortality rate during the Crimean War (Hood, 2014, p. 490-491). The initiatives towards improvement of quality lead to formation the Joint Commission on Accreditation of Hospitals (JCAH), which is now known as The Joint Commission (2007). The Joint Commission is non-profit organization which gives accreditation to hospitals for recognizing their efforts to deliver quality health care with an added advantage of being eligible for the Medicare reimbursement program. Moreover, the Joint Commission also rolled out the Hospital Patient Safety Goals (2013) to prevent patient safety errors. Nursing professionals are essential for health care organizations to achieve and maintain the patient-safety goals as their work directly impacts the quality and safety of the patients. For instance, using two patient identifiers during medication administration to avert errors. Nurses have the distinct skills and responsibility towards patient safety and hence the need for Quality and Safety Education for Nurses (QSEN) is the rational step towards quality improvement. Through the years, the QSEN has developed in Phases to ascertain the areas of competency requirements for nurses to deliver safe, efficient and excellent health care
Nursing excellence is defined in various ways. I believe that nursing excellence is demonstrated when nurses are involved in promoting holistic patient centered care, quality and innovation, education, evidence-based practice, and nursing research. Nursing organizations plays a pivotal role in promoting nursing excellence. For this discussion post, I will be discussing the role of two organizations; the National League of Nursing (NLN) and the Quality and Safety Education for Nurses (QSEN), in promoting nursing excellence and nursing practice.
Understanding quality measurement is essential in improving quality. Teams need to be able to understand whether the changes being made are actually leading to improved care and improved outcomes. For data to have an impact on an improvement initiative, providers and staff must understand it, trust it, and use it. Health care organization must understand the measurement of quality provided by the Institute of Medicine (patient outcomes, patient satisfaction, compliance, efficiency, safe, timely, patient centered, and equitable. An organization cannot improve its performance if it does not know how it is performing. Measuring quality improvements is essential as it reflects the quality of care given by the providers and that by comparing performance