Concepts of Autonomy Confidentiality and Anonymity

Instructions
Read and review the resources listed above.
Review the IRB Process with assessment guides for your agency, or you may review those provided by IWU.
Present the Topics below (as assigned by your facilitator until all are taken): Concepts of autonomy, confidentiality and anonymity
Defining/describing the topic.
Explaining the scope of the topic i.e. its boundaries or overlap with another topic.
Giving the key points a researcher should know, do, avoid, etc.
Addressing only the informed consent section of a proposed IRB application, in layman’s words, thoroughly explain what their participation will look like, how their data will be collected and used, the potential benefits and risks to them, and who to contact should the risks become real.
Also, explain to the IRB committee members, the proposed mitigation and reparation should the risks come to fruition. Last, explain why or why not an expert in your topic should be added to the IRB committee membership to help guide the evaluation of risk and reparation inherent to your study

Evidence Based Practice EBP Considerations

Instructions
Explore these sites and review these guidelines
The CDC’s, Vaccines and Immunization Guidelines of the ACIP
The Canadian Pediatric Society’s, Clinical Tools & Resources for monitoring infant and pediatric growth & development
The American Psychiatric Association’s, Recently Released Guidelines covering multiple topics, including the prescribing of psychotropic drugs
American Association of Nurse Practitioners’, Clinical Practice Tools
Look up the Scope & Standards of Practice for each major/role:
Nurse Administrators
Nurse Educators
Nurses Practitioners
Meet with a member of your EBP / Clinical Practice Guidelines Council and discuss the process used for translating research into practice to discuss the following questions:
What process is used in your agency for ensuring that practice guidelines are applicable to your patient population?
What process is used to updated practice guidelines?
Of these guidelines and scope and standards of practice, which one(s) do you believe need the greatest attention for updating and why?
How do these guidelines impact each of the major roles in nursing: administrator, educator, provider?

Compare Retail and Nurse-managed Clinics with  Traditional Primary Care Providers

How are retail and nurse-managed clinics different from traditional primary care providers and are they in competition with traditional primary care providers? Use at least two references to support your response. Your text can serve as one of your references, but you must also use one additional recent, professional reference in your response. Both references must be clearly integrated in your response.
Has the ACA created more opportunities for professional nurses? What does the literature say?
Create a brief (3-5 slide) voicethread presentation with your response with current (no older than 5 years old) references (may use professional organizations as well as journals) with narration of your presentation.
Think of the 3 goals of the ACA: increase access to care, improve quality of care, and decrease costs of care–How do you see these three goals playing out in your workplace?
What do you see are the specific provisions within the ACA that have directly impacted the quality and delivery and type, or method, of care you give to your patients? What does the literature say about how quality, and type, or method, of care, since the passage of the ACA? Be specific.
What does current literature (no older than 5 years old) say about how the ACA has affected quality and costs of healthcare?
Create a brief voicethread presentation (3-5 slides) with your response and narration of your presentation.

Risk Evaluation and Mitigation Strategy

• Pick a pharmaceutical or biologic that is approved in the EU or US that does not presently have a REMS Risk Evaluation and Mitigation Strategy.
• Try to choose one that has had previous safety issues as evidenced by either communications from Regulatory Authorities or SAE’s (Serious Adverse Event) reported by healthcare facilities or patients.
• Prepare a REMS for the product that you choose following the FDA guidance document, “Format and Content of a REMS Document, dated October 2017. https://www.fda.gov/media/77846/download
• Each REMS should contain a either a mocked-up patient enrollment form or a prescriber enrollment form.
• Make sure that you include at least one REMS element (i.e., Medication Guide, patient package inserts or communication plan).
• The REMS element will be separate from the REMS. Either do it as a separate document that is appended to the REMS or start it separated by a page or section break of your REMS

Note: if the drug or biologic you choose has a medication guide then you cannot provide the medication guide as your one REMS element.

You will have to choose another REMS element to provide. The REMS elements should be created by you.

Format:

Times New Roman, 12 font

Cite your references.

Due:

REMS document that includes:

1. Include either a mocked up patient or prescriber enrollment form
2. Include one REMS element (i.e., Medication Guide, patient package inset or communication plan)

Prepare an 8 page data analysis and quality improvement initiative proposal based on a health issue of professional interest to you. The audience for your analysis and proposal is the nursing staff and the interprofessional team who will implement the initiative.

“A basic principle of quality measurement is: If you can’t measure it, you can’t improve it” (Agency for Healthcare Research and Quality, 2013).

Health care providers are on an endless quest to improve both care quality and patient safety. This unwavering commitment requires hospitals and care givers to increase their attention and adherence to treatment protocols to improve patient outcomes. Health informatics, along with new and improved technologies and procedures, are at the core of virtually all quality improvement initiatives. The data gathered by providers, along with process improvement models and recognized quality benchmarks, are all part of a collaborative, continuing effort. As such, it is essential that professional nurses are able to correctly interpret, and effectively communicate information revealed on dashboards that display critical care metrics.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 2: Plan quality improvement initiatives in response to routine data surveillance.
  • Outline a QI initiative proposal based on a selected health issue and supporting data analysis.
• Competency 3: Evaluate quality improvement initiatives using sensitive and sound outcome measures.
  • Analyze data to identify a health care issue or area of concern.
• Competency 4: Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work-life quality.
  • Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work-life quality.
• Competency 5: Apply effective communication strategies to promote quality improvement of interprofessional care.
  • Apply effective communication strategies to promote quality improvement of interprofessional care.
  • Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.

Reference

Agency for Healthcare Research and Quality. (2013). Preventing falls in hospitals. Retrieved from https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtk5.html#tiptop

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

Reflect on QI initiatives focused on measuring and improving patient outcomes with which you are familiar.

• How important is the role of nurses in QI initiatives?
• What quality improvement initiatives have made the biggest difference? Why?
• When a QI initiative does not succeed as planned, what steps are taken to improve or revise the effort?

Quality Improvement Examples and Results

These resources explore the effectiveness and lessons learned from various quality improvement initiatives.

• Ohde, S., Terai, M., Oizumi, A., Takahashi, O., Deshpande, G. A., Takekata, M., . . . Fukui, T. (2012). The effectiveness of a multidisciplinary QI activity for accidental fall prevention: Staff compliance is critical. BMC Health Services Research, 12, 197.
• Berman, J., Nkabane, E. L., Malope, S., Machai, S., Jack, B., & Bicknell, W. (2014). Developing a hospital quality improvement initiative in Lesotho. International Journal of Health Care Quality Assurance, 27(1), 15–24.

These articles showcase examples of strategic QI projects.

• Nazir, A., Dennis, M. E., & Unroe, K. T. (2015). Implementation of a heart failure quality initiative in a skilled nursing facility: Lessons learned. Journal of Gerontological Nursing, 41(5), 26–33.
• Schoenfelder, S. L., Wych, S., Willows, C. A., Harrington, J., Christoffel, K. K., & Becker, A. B. (2013). Engaging Chicago hospitals in the baby-friendly hospital initiative. Maternal and Child Health Journal, 17(9), 1712–1717.

This resource evaluates a QI initiative based on a communication strategy.

• Wysham, N. G., Mularski, R. A., Schmidt, D. M., Nord, S. C., Louis, D. L., Shuster, E., . . . Mosen, D. M. (2014). Long-term persistence of quality improvements for an intensive care unit communication initiative using the VALUE strategy. Journal of Critical Care, 29(3), 450–454.

Benchmarks for Quality Indicators

These databases provide recognized benchmarks for quality indicators.

• Montalvo, I. (2007). The national database of nursing quality indicators. Online Journal of Issues in Nursing, 12(3), 1–11.
• The Joint Commission. (2017). National patient safety goals. Retrieved from https://www.jointcommission.org/standards_information/npsgs.aspx

In this assessment, you will propose a quality improvement (QI) initiative proposal based on a health issue of professional interest to you. The QI initiative proposal will be based on an analysis of dashboard metrics from a health care facility.

• Analyze data from the health care facility to identify a health care issue or area of concern. You will need access to reports and data related to care quality and patient safety. If you work in hospital setting, contact the quality management department to obtain the data you need.
• You will need to identify basic information about the health care setting, size, and specific type of care delivery related to the topic that you identify. You are expected to abide by HIPAA compliance standards.

Option 2

If you do not have access to a dashboard or metrics related to a QI initiative proposal:

• You may use the hospital data set provided in the media piece titled Vila Health: Data Analysis. You will analyze the data to identify a health care issue or area of concern.
• You will follow the same instructions and provide the same deliverables as your peers who select Option 1.

Instructions

Analyze dashboard metrics related to the selected issue.

• Provide the selected data set in the proposal.
  • Assess the stability of processes or outcomes.
  • Delineate any problematic variations or performance failures.
• Evaluate QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and non-governmental bodies on quality improvement.
  • Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization and the interprofessional team.
• Outline a QI initiative proposal based on the selected health issue and data analysis.
  • Identify target areas for improvement.
  • Define what processes can be modified to improve outcomes.
  • Propose strategies to improve quality.
  • Define interprofessional roles and responsibilities as they relate to the QI initiative.
  • Provide recommendations for effective communication strategies for the interprofessional team to ensure the success of the QI initiative. Briefly reflect on the impact of the proposed initiative on work-life quality of the nursing staff and interprofessional team.
• Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

The numbered points below correspond to grading criteria in the scoring guide. The bullets below each grading criterion further delineate tasks to fulfill the assessment requirements. Be sure that your Quality Improvement Initiative Evaluation addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels that relate to each grading criterion.

• Analyze data to identify a health care issue or area of concern.
  • Identify the type of data you are analyzing (from your institution or from the media piece).
  • Discuss why the data matters, what it is telling you, and what is missing.
  • Analyze dashboard metrics and provide the data set in the proposal.
  • Present dashboard metrics related to the selected issue.
  • Delineate any problematic variations or performance failures.
  • Assess the stability of processes or outcomes.
  • Evaluate the quality of the data and what can be learned from it.
  • Identify trends, outcome measures and information needed to calculate specific rates.
  • Analyze what metrics indicate opportunities for quality improvement.
• Outline a QI initiative proposal based on a selected health issue and supporting data analysis.
  • Identify benchmarks aligned to existing QI initiatives set by local, state, or federal health care policies or laws.
  • Identify existing QI initiatives related to the selected issue, and explain why they are insufficient.
  • Identify target areas for improvement, and define what processes can be modified to improve outcomes.
  • Propose evidence-based strategies to improve quality.
  • Evaluate QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and non-governmental bodies on quality improvement.
  • Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization and the interprofessional team.
• Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work-life quality.
  • Define interprofessional roles and responsibilities as they relate to the data and the QI initiative.
  • Explain how you would you make sure that all relevant roles are fully engaged in this effort.
  • Explain what non-nursing concepts would you incorporate into the initiative?
  • Identify how outcomes to measure the effect of the intervention affect the interprofessional team.
  • Briefly reflect on the impact of the proposed initiative on work-life quality of the nursing staff and interprofessional team. Describe how work-life quality is improved or enriched by the initiative.
• Apply effective communication strategies to promote quality improvement of interprofessional care.
  • Identify the kind of interprofessional communication strategies that will be effective to promote and ensure the success of this performance improvement plan or quality improvement initiative.
  • In addition to writing, identify communication models (like CUS, SBAR) that you would include in your initiative proposal.
• Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
• Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

QI data

Hi! I heard through word of mouth that you were looking for some possible areas of improvement in the hospital. I’ve got some data from SAMC’s in-home hospice program that might be useful.

I realize that you may not be familiar with the hospice program, so I also set up some meetings with a few people with a stake in the program. I’m hoping they can give you some context for the data you’re looking at.

Let me know if you need anything!

Sienna Pope,

Director of Medical Support Services

Hospice and Home Health Adverse Event Data 2014-2015

Per Vila Health policy, these figures include near misses as well as events that resulted in some level of harm or potential harm to the patient, for both home health care and hospice care patients. This is a summary of the data; a downloadable spreadsheet that provides all the data you will need for your presentation is also available below.

Unit – Year	LOS Less than 7 Days	IPU Admission	Pain Level 7-10 More than 24 Hours	Inadequate Symptom Relief More than 24 Hours
Hospice 2014	50	47	13	13
Hospice 2015	46	27	17	22

Quality improvement initiatives are a critical tool in the ongoing effort to improve patient care at health care organizations. But without data, many QI initiatives would fail — or the problem behind them might never be detected. That’s why data, and the dashboards that present data in a comprehensible fashion, are essential for QI efforts to succeed.

In this activity, you will assume the role of a quality assurance analyst at St. Anthony Medical Center. You will be offered both a dataset that you can use to outline a quality improvement initiative, and input from stakeholders who can help you contextualize the data.

 Educational Goals

After completing the activity, you will be prepared to:

• Analyze data to identify a health care issue or area of concern.
• Outline a QI initiative proposal based on a selected health issue and supporting data analysis.
• Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work–life quality.