The main issue that the organization is facing is a lack of resources for the community
1)Dounfo Thelusma
Re: Topic 2 DQ 1
The main issue that the organization is facing is a lack of resources for the community. The organization is grant-funded, which means they have a budget to stick to. They provide certain services free of charge and others at a discounted rate. Medication regimen compliance is a major issue that the community is facing. The individuals cannot afford to pay for their medications. If the organization could provide prescribed medications for free, they would. This is underserved/low income/no income/homeless population. According to Scarlett and Young (2016), “medical noncompliance is occurring at epidemic proportions for countless reasons. Patients may need to purchase food instead of hypertensive medication, or they may disregard a follow-up test because they are unable to take the time off from work or cannot find transportation to and from the hospital”. This is exactly what happens in this community. Being able to afford health insurance would solve so many problems. According to Ransom and Olsson (2017), “health insurance became available through employer-sponsored insurance plans and, in the 1960s, entitlement programs—including Medicare and Medicaid. In spite of the presence of these forms of payment, demands for all aspects of health care continue to exceed its available resources. Millions of people in the United States, including children, continue to lack health insurance or avenues to access health care resources”.
Ransom, H., Olsson, J. M. (2017). Allocation of Health Care Resources: Principles for Decision-Making. In Pediatrics in Review, July 2017, 38 (7) 320-329. Retrieved from https://pedsinreview.aappublications.org/content/38/7/320
Scarlett, W., Young, S. (2016). Medical Noncompliance: The Most Ignored National Epidemic. In The Journal of the American Osteopathic Association, August 2016, Vol. 116, 554-555. Retrieved from https://jaoa.org/article.aspx?articleid=2538817
2) Donna Reamer
Re: Topic 2 DQ 1
An issue facing this hospital organization is the high 30-day hospital readmission rate of heart failure (HF) patients. I will work, along with my preceptor and a Quality & Safety group, to implement a HF pathway while the patient is still in the acute care setting and a stronger alliance with the ambulatory coordination team in the post-acute setting.
This plan could have implications/barriers. This organization does not have a dedicated unit for HF patients so HF admissions could be scattered on many units. Educating a large number of nurses on the HF pathway rather than just a small pool of nurses could be difficult.
Another issue that might inhibit this plan is that the patient could be difficult to contact post-discharge for many reasons: incorrect contact information, failure to answer the phone, etc.
3) Kelly Botello
Re: Topic 2 DQ 1
An issue facing the organization is high use of indwelling foley catheters and catheter-associated urinary tract infections (CAUTI’s). Prevention of hospital-acquired infections is a significant focus of the health care system. It is estimated that the additional cost to treat a patient who developed catheter-associated urinary tract infection (CAUTI) amounts to three hundred and forty billion (Ferguson, 2018). The centers for Medicare and Medi-caid services do not reimburse the cost of treatment, and the facilities absorb the damage (Ferguson, 2018). About seventy-five percent of urinary tract infections are caused by indwelling urinary catheters (Center for Disease Control and Prevention, 2015). The number one contributing factor for the development of a CAUTI is prolonged use (Center for Disease Control and Prevention, 2015). Thus, the urinary catheter should be used for appropriate indications and should be removed as soon as possible (Center for Disease Control and Prevention, 2015). Nursing implications include prevention of inappropriate use, nurse-driven timely removal, and proper catheter care during placement.
References
Center for Disease Control and Prevention. (2015, October 16). Catheter-associated urinary tract infections (CAUTI) | HAI | CDC. Retrieved February 27, 2020, from https://www.cdc.gov/hai/ca_uti/uti.html
Ferguson, A. (2018). Implementing a CAUTI prevention program in an acute care hospital setting. Urologic Nursing, 38(6), 273-281, 302. doi:10.7257/1053-816X.2018.38.6.273
4 )
Alyssa Camacho
Re: Topic 2 DQ 2
One main issue the organization has in addressing a solution to evidence-based nursing practice is a lack of nursing staff. In the clinic, there are two nurse practitioners that operate out of multiple clinics and see hospital patients as well. There are four RN’s that provide care for patients in the clinic including education and laboratory draws. With few nurses in the clinic, there is rarely downtime for nurses to pursue research for evidence-based nursing practice. A first step could be to select a nurse that is in charge of researching evidence-based practice and implementation for the cardiology clinic. For example, a nurse manager would be a good place to start. The nurse manager would be in charge of developing an evidence-based project with the help of staff nurses. Nurse managers can play a crucial role in facilitating evidence-based nursing practice (Kueny, Shever, Lehan, Titler, 2015). Outpatient cardiology clinics have an important job in developing evidence-based care for patients so that the patients are getting the most up to date, effective treatment for their cardiac care. Evidence-based practice is essential in nursing and can result in desired patient outcomes (Yougblot, Brooden, 2001).
Kueny, A., Shever, L. L., Lehan Mackin, M., & Titler, M. G. (2015). Facilitating the implementation of evidence- based practice through contextual support and nursing leadership. Journal of healthcare leadership, 7, 29–39. https://doi.org/10.2147/JHL.S45077
Youngblut, J. M., & Brooten, D. (2001). Evidence-based nursing practice: why is it important?. AACN clinical issues, 12(4), 468–476. https://doi.org/10.1097/00044067-200111000-00003
5)
Donna Reamer
Re: Topic 2 DQ 2
HF practice guidelines, toolkits, and established resources distributed by professional organizations should be reviewed as the first step for HF management, care, and readmission reduction initiatives. Resources like HF patient & family educational guides should be reviewed and modified to ensure best practices for medical management and to ensure that staff is consistently delivering the same information across the continuum of care.
Wood, R., Migliore, L., Nasshan, S., Mirghani, S., Contasti, A. (2018). Confronting challenges in reducing heart failure 30-day readmissions: Lessons learned with implications for evidence-based practice. Worldviews on Evidence-Based Nursing. doi: 10.1111/wvn.12336
6) Dounfo Thelusma
Re: Topic 2 DQ 2
A main issue for my organization in successfully carrying out evidence-based nursing practice is lack of resources, including lack of funds. The organization is staffed with a family nurse practitioner, a psychiatric nurse practitioner, a social worker, and a medical assistant. They’re not able to hire more staff, and they also can’t afford to have medications on hand to give out. The organization is grant-funded with a limited budget but there are other venues to look into for resources assistance. The first step is identifying what options are available in Georgia and how to apply for them. These resources will help with medication complicance. Accoding to the U.S Food & Drug Administration (2016), taking medicine as prescribed, or medication adherence, is important for controlling chronic conditions, treating temporary conditions, and overall long-term health and well-being. Rx Outreach is an easy and affordable way for people of all ages to get medicines they need. Through this program, people who qualify financially can get medications that treat a wide range of conditions including diabetes, asthma, heart disease, and depression. Georgia Drug Card is the statewide free prescription assistance program available to all Georgia residents. The program was launched July 2010 to help uninsured and underinsured Georgians afford prescription medication. Residents with insurance can use the program to discount non-covered medications. Pharmaceutical manufacturers may sponsor patient assistance programs (PAPs) that provide financial assistance or drug free product (through in-kind product donations) to low income individuals to augment any existing prescription drug coverage.
https://dch.georgia.gov/pharmacy-assistance-programs
https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PAPData
U.S. Food & Drug Administration. (2016). Why You Need to Take Your Medications as Prescribed or Instructed.
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