Description
In a 5–7 page written assessment, assess the effect of the patient, family, or population problem you’ve previously defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend approximately 2 direct practicum hours exploring these aspects of the problem with the patient, family, or group you’ve chosen to work with and, if desired, consulting with subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form. Report on your experiences during your first two practicum hours.
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Introduction
Organizational data, such as readmission rates, hospital-acquired infections, falls, medication errors, staff satisfaction, serious safety events, and patient experience can be used to prioritize time, resources, and finances. Health care organizations and government agencies use benchmark data to compare the quality of organizational services and report the status of patient safety. Professional nurses are key to comprehensive data collection, reporting, and monitoring of metrics to improve quality and patient safety.
Preparation
In this assessment, you’ll assess the effect of the health problem you’ve defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 direct practicum hours working with the same patient, family, or group. During this time, you may also choose to consult with subject matter and industry experts.
To prepare for the assessment:
Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete and how it will be assessed.
Conduct research of the scholarly and professional literature to inform your assessment and meet scholarly expectations for supporting evidence.
Review the Practicum Focus Sheet: Assessment 2 [PDF] Download Practicum Focus Sheet: Assessment 2 [PDF], which provides guidance for conducting this portion of your practicum.
Note: As you revise your writing, check out the resources listed on the Writing Center’s Writing Support page.
Instructions
Complete this assessment in two parts.
Part 1
Assess the effect of the patient, family, or population problem you defined in the previous assessment on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 practicum hours exploring these aspects of the problem with the patient, family, or group. During this time, you may also consult with subject matter and industry experts of your choice. Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form. Use the Practicum Focus Sheet: Assessment 2 [PDF] Download Practicum Focus Sheet: Assessment 2 [PDF]provided for this assessment to guide your work and interpersonal interactions.
Part 2
Report on your experiences during your first 2 practicum hours, including how you presented your ideas about the health problem to the patient, family, or group.
Whom did you meet with?
What did you learn from them?
Comment on the evidence-based practice (EBP) documents or websites you reviewed.
What did you learn from that review?
Share the process and experience of exploring the influence of leadership, collaboration, communication, change management, and policy on the problem.
What barriers, if any, did you encounter when presenting the problem to the patient, family, or group?
Did the patient, family, or group agree with you about the presence of the problem and its significance and relevance?
What leadership, communication, collaboration, or change management skills did you employ during your interactions to overcome these barriers or change the patient’s, family’s, or group’s thinking about the problem (for example, creating a sense of urgency based on data or policy requirements)?
What changes, if any, did you make to your definition of the problem, based on your discussions?
What might you have done differently?
Requirements
The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.
Explain how the patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
Cite evidence that supports the stated impact.
Note whether the supporting evidence is consistent with what you see in your nursing practice.
Explain how state board nursing practice standards and/or organizational or governmental policies can affect the problem’s impact on the quality of care, patient safety, and costs to the system and individual.
Describe research that has tested the effectiveness of these standards and/or policies in addressing care quality, patient safety, and costs to the system and individual.
Explain how these standards and/or policies will guide your actions in addressing care quality, patient safety, and costs to the system and individual.
Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of care quality, patient safety, and cost to the system and individual.
Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual.
Discuss research on the effectiveness of these strategies in addressing care quality, patient safety, and costs to the system and individual.
Identify relevant and available sources of benchmark data on care quality, patient safety, and costs to the system and individual.
Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
Use paraphrasing and summarization to represent ideas from external sources.
Apply APA style and formatting to scholarly writing.
Additional Requirements
Format: Format your paper using APA style. APA Style Paper Tutorial [DOCX] is provided to help you in writing and formatting your paper. Be sure to include:
A title page and reference page. An abstract is not required.
Appropriate section headings.
Length: Your paper should be approximately 5–7 pages in length, not including the reference page.
Supporting evidence: Cite at least 5 sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old. Provide in-text citations and references in APA format.
Proofreading: Proofread your paper, before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on its substance.
Capella Academic Portal
Update the total number of hours on the NURS-FPX4900 Volunteer Experience Form in Capella Academic Portal.
The BSN Capstone Course (NURS-FPX4900 ) requires the completion and documentation of nine (9) practicum hours. All hours must be recorded in the Capella Academic Portal. Please review the BSN Practicum Campus page for more information and instructions on how to log your hours.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
Competency 3: Transform processes to improve quality, enhance patient safety, and reduce the cost of care.
Explain how a patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual and document the practicum hours spent with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
Competency 5: Analyze the impact of health policy on quality and cost of care.
Explain how state board nursing practice standards and/or organizational or governmental policies can affect a patient, family, or population problem’s impact on the quality of care, patient safety, and costs to the system and individual.
Competency 8: Integrate professional standards and values into practice.
Use paraphrasing and summarization to represent ideas from external sources.
Apply APA style and formatting to scholarly writing.
Assessing the Problem: Quality, Safety, and Cost Considerations Scoring Guide
CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Explain how a patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual. Does not describe the impact of a patient, family, or population problem on the quality of care, patient safety, and costs to the system and individual. Attempts to describe the impact of a patient, family, or population problem on the quality of care, patient safety, and costs to the system and individual. Explains how a patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual. Provides a convincing explanation of how a patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual by providing specific individual, family, or population examples of such impacts.
Explain how state board nursing practice standards and/or organizational or governmental policies can affect a patient, family, or population problem’s impact on the quality of care, patient safety, and costs to the system and individual. Does not identify state board nursing practice standards and/or organizational or governmental policies that could affect a patient, family, or population problem’s impact on the quality of care, patient safety, and costs to the system and individual. Attempts to explain state board nursing practice standards and/or organizational or governmental policies that could affect a patient, family, or population problem’s impact on the quality of care, patient safety, and costs to the system and individual. Explains how state board nursing practice standards and/or organizational or governmental policies can affect a patient, family, or population problem’s impact on the quality of care, patient safety, and costs to the system and individual. Provides an explanation—based on a perceptive and coherent synthesis of current literature—of how state board nursing practice standards and/or organizational or governmental policies can affect a patient, family, or population problem’s impact on the quality of care, patient safety, and costs to the system and individual. Provides clear insight into how policy affects nursing scope of practice and will inform and guide an intervention.
Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual and document the practicum hours spent with these individuals or group in the Capella Academic Portal Volunteer Experience Form. Does not propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual, and does not document practicum hours in the Capella Academic Portal Volunteer Experience Form. Proposes leadership strategies that are not clearly related to care quality, patient safety, or cost reduction, or which are unlikely to significantly improve outcomes, and/or does not document practicum hours in the Capella Academic Portal Volunteer Experience Form. Proposes strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual and documents the practicum hours spent with these individuals or group in the Capella Academic Portal Volunteer Experience Form. Proposes strategies, supported by examples, to improve the quality of care, enhance patient safety, and reduce costs to the system and individual. Exhibits clear insight into the effectiveness of the strategies and available sources of relevant benchmark data. Documents the practicum hours spent with these individuals or group in the Capella Academic Portal Volunteer Experience Form
Use paraphrasing and summarization to represent ideas from external sources. Incorporates plagiarized information. Paraphrasing or summarization is awkward, inaccurate, or borders on plagiarism. Uses paraphrasing and summarization to represent ideas from external sources. Uses concise paraphrasing or summarization to accurately represent ideas from external sources. Exhibits an insightful interpretation and synthesis of credible sources.
Apply APA style and formatting to scholarly writing. Does not apply APA style and formatting to scholarly writing. Applies APA style and formatting to scholarly writing incorrectly and/or inconsistently, detracting noticeably from good scholarship. Applies APA style and formatting to scholarly writing. Applies APA style and formatting to scholarly writing. Exhibits strict and nearly flawless adherence to stylistic conventions, document structure, and source attributions.
Youssef, Thank you for assessment #2 submission. However, there should be more discussion with prevent complications from CKD for your patients and promote health and wellness. My recommendation is to review the assessment’s instructions and requirements in each rubric’s section more carefully. Please be sure to highlight all the revision sections. TIPS for Assessment 2: There should be the actual research data with the cost to the system and individual. Please see the “distinguished” requirements from the rubric. You will also need to provide a clear insight into how different policies affects nursing scope of practice, will inform and guide an intervention that is more specific to your patient’s health problem (DM). You will need to discuss on how the health polic(ies) or BON impact the quality of care as well as cost of care for your health concern conditions. You will need to gather your statistical data for analysis to measure the effectiveness of the EBP strategies in your discussion. Dr Swanson-Tracey SwansonScoring GuideTransform processes to improve quality, enhance patient safety, and reduce the cost of care.Explain how a patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.Does not describe the impact of a patient, family, or population problem on the quality of care, patient safety, and costs to the system and individual.Faculty Comments:You did not describe the impact of a patient, family, or population problem on the quality of care, patient safety, and costs to the system and individual. (For higher scores, I would have wanted to read more about the actual research data with the cost to the system and individual. Please see the “distinguished” requirements from the rubric.) There should be discussing on how this health concern impact patients. You are discussing something that is not relating to your patient’s CKD.Show all Performance RatingsPropose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual and document the practicum hours spent with these individuals or group in the Capella Academic Portal Volunteer Experience Form.Does not propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual, and does not document practicum hours in the Capella Academic Portal Volunteer Experience Form.Faculty Comments:You did not propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual, and does not document practicum hours in the Capella Academic Portal Volunteer Experience Form. need to exhibit a clear insight into effectiveness of strategies and available sources of relevant benchmark data. You will need to gather your statistical data for analysis to measure the effectiveness of the EBP strategies to improve your patient’s CKD conditions.Show all Performance RatingsCompetency 5Analyze the impact of health policy on quality and cost of care.Explain how state board nursing practice standards and/or organizational or governmental policies can affect a patient, family, or population problem’s impact on the quality of care, patient safety, and costs to the system and individual.Does not identify state board nursing practice standards and/or organizational or governmental policies that could affect a patient, family, or population problem’s impact on the quality of care, patient safety, and costs to the system and individual.Faculty Comments:You did not identify state board nursing practice standards and/or organizational or governmental policies that could affect a patient, family, or population problem’s impact on the quality of care, patient safety, and costs to the system and individual. For higher scores, you will also need to provide a clear insight into how policy affects nursing scope of practice, will inform and guide an intervention that is more specific to your patient’s health problem (DM). You will need discuss on how the health policy or BON impact the quality of care as well as cost of care for your health concern conditions.Show all Performance RatingsCompetency 8Integrate professional standards and values into practice.Use paraphrasing and summarization to represent ideas from external sources.Uses concise paraphrasing or summarization to accurately represent ideas from external sources. Exhibits an insightful interpretation and synthesis of credible sources.Faculty Comments:You use concise paraphrasing or summarization to accurately represent ideas from external sources. You exhibited an insightful interpretation and synthesis of credible sources.Show all Performance RatingsApply APA style and formatting to scholarly writing.Applies APA style and formatting to scholarly writing. Exhibits strict and nearly flawless adherence to stylistic conventions, document structure, and source attributions.Faculty Comments:You applied APA style and formatting to scholarly writing. You exhibited strict and nearly flawless adherence to stylistic conventions, document structure and source attributions.
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Effect of Chronic Kidney Disease on Quality of Care, Patient Safety, and Care Costs
Youssef Tawfik
Capella University
Professor Tracey Swanson
NURS-FPX4900 Capstone Project for Nursing
Sep 25th, 2023
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Effect of Chronic Kidney Disease on Quality of Care, Patient Safety, and Care Costs
How chronic kidney disease (CKD) impacts the quality of care, patient safety, and costs to
the system and individual
CKD is associated with a considerable risk of medication errors, which hinders patient
safety. New et al. (2021) note that since CKD patients have a higher hospitalization rate than the
healthy population, they face a higher risk of medical errors. The American Heart Association
(AHA) reports that older adults with CKD should be considered to be at high risk for medication
errors (Milani et al., 2011). In collaboration with the Institute for Healthcare Improvement (IHI)
and the Institute for Safe Medication Practices, AHA concurs that antithrombotic drugs in CKD
are high-risk pharmacological agents (Milani et al., 2011). Should a CKD patient misuse these
high-risk agents, they face a profound risk of injury. CKD management demands a coordinated
intervention because of the risk to patient safety caused by pharmacological agents that are
otherwise well tolerated in healthy persons. Medications such as enoxaparin and eptifibatide,
well-tolerated and appropriately cleared in healthy persons, expose CKD patients to considerable
risks of bleeding complications (Milani et al., 2011). Collaboration among healthcare
practitioners is paramount in diminishing the risk to patient safety when managing a CKD
patient.
The prevalence of adverse drug events (ADRs) is higher in CKD patients than in their
healthy counterparts. Roux-Marson et al. (2020) report that CKD increases the risk of ADRs by
3-10 times compared to a healthy cohort. The incidence and severity of ADRs are compounded
in elderly CKD patients than in a younger population. CKD also increases the number of
potentially inappropriate-for-the-elderly medications (PIMs). A French study reported a PIM rate
of 66% among elderly patients, while a US-based study observed a rate of 13% in 100 patients
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above 70 years (Roux-Marson et al., 2020). The longer the list of PIMs, the higher the risk of
ADRs, which compromises patient safety.
CKD often requires dose adjustment for most pharmacological agents. Dose adjustment
is a complicated process plagued with considerable risk of dosing errors. Roux-Marson et al.
(2020) report that at least one medication requiring dose adjustment or is contraindicated is
prescribed to over 77% of patients with advanced CKD. According to Hassan et al. (2021), dose
adjustment in CKD patients is often performed incorrectly. The prevalence of incorrect dose
adjustment varies from 25% to 77% (Hassan et al., 2021). The risk of incorrect dose adjustment
in CKD is prevalent in developed and developing countries (Hassan et al., 2021). Some
practitioners overlook dose adjustment, often at considerable risk to patient safety. Hassan et al.
(2021) established that 30.99% of medication administered to CKD patients require dose
adjustment. Of those requiring adjustment, 40.42% are adjusted accurately, while 59.58% are not
adjusted (Hassan et al., 2021). Incorrect dose adjustment and failure to adjust the dose for CKD
patients pose a risk to their safety and the cost of care to the individual and the system. In my
nursing practice, I have witnessed the full range of possibilities, from correct dose adjustment to
incorrect adjustment. By my estimation, correct dose adjustment accounts for 50% of
prescriptions in CKD, while the remaining 50% is split between incorrect adjustment and failure
to adjust.
How state board nursing practice standards and/or organizational or governmental policies
can affect the CKD’s impact on the quality of care, patient safety, and costs to the system
and individual
CKD patients require frequent hospitalization. During hospitalization, these patients
require health practitioners to leverage their safe patient handling and mobility (SPHM)
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knowledge and techniques to limit their risk of injury. In 2020, there were over 806,200 private
industry injuries in the healthcare and social assistance sector (HCSA), at least half of which
precipitated one lost day due to injury (CDC, 2020). SPHM entails using assistive devices in
patient handling and mobility to avoid exposing healthcare practitioners to manual, high-risk
patient-handling exercises (VA, n.d.). The American Nursing Association (ANA) reports that a
single bad lift during patient handling and mobility tasks is enough to end a nurse’s career and
adversely affect their quality of life (ANA, 2021). The New York State Nursing Association
(NYSNA) encourages healthcare facilities to adopt the stipulated SPHM protocols in developing
their programs (NYSNA, n.d.). SPHM reduces injuries to healthcare practitioners by 60-95%,
indemnity costs by 92%, workers’ compensation costs by 95%, and lost work days due to injury
by 100% (NYSNA, n.d.). SPHM policies safeguard the welfare of healthcare practitioners,
NYSA limits the scope of nursing practice to activities within the nurse’s scope of
competence. The board prohibits nurses within the state from offering services for which they
are incompetent, even if they are legal under New York law (NYSA, n.d.). CKD management is
an intensive process requiring competent practitioners across the board. Collaboration among
practitioners ensures that each person only provides the services they are licensed and competent
to offer. NYSA promotes patient safety and quality of care by limiting nurses’ scope of practice
to their competence. Limiting nursing activities to areas within one’s competence minimizes the
risk of errors and promotes EBP, thereby ensuring safe, high-quality care. High-quality care is
instrumental in managing care costs to the individual and the system.
Strategies to improve the quality of care, enhance patient safety, and reduce costs to the
system and individual
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Drug dose adjustment has far-reaching ramifications on patient safety, quality of care,
and costs to the individual and the system. CKD patients require dose adjustment at various
stages of disease progression, exposing them to incremental risk of incorrect dose adjustment or
failure to adjust (Stefani et al., 2019). Adopting an EBP-based dose adjustment protocol would
provide a standard operating procedure, significantly diminishing the risk of incorrect dose
adjustments. Some practitioners presumably overlook dose adjustment because it risks patient
safety. A tried and proven dose adjustment formula with precisely defined parameters would
minimize this risk, resulting in a comparatively high success rate and diminishing the risk of
toxicity. Several dose adjustment protocols, including the Cockcroft-Gault and Serum Cystatin
C-based formulas, have been developed to adjust the dose in CKD patients correctly. The
Cockcroft-Gault formula is less effective than the Serum Cystatin C-based formula in estimating
the GFR and adjusting the dose (Delanaye et al., 2021). A more effective formula for estimating
GFR is necessary to improve the accuracy of drug dose adjustment for CKD patients.
CKD is a progressive condition. Despite the quality of care and strict compliance with the
prescribed regimen, disease progression can only be retarded but not averted. CKD patients are
also at increased risk of hospitalization, exposing practitioners to situations requiring safe patient
handling and safety. Adopting SPHM protocols is essential to protect practitioners from injuries
related to patient handling and mobility. According to the CDC (2020), Dr. Thomas Waters
adapted the revised NIOSH Lifting Equation (RNLE) for determining the maximum weight that
health practitioners can lift without injuries by increasing the minimum distance between them
and the patient to 14.5 inches. Subsequent to the modification, the maximum weight limit that a
healthcare practitioner can handle safely is 35 lbs. (CDC, 2020). Estimating the effectiveness of
lifting-related solutions is not straightforward because the risk of injury when different
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individuals are exposed to the same weight varies from person to person (Fox et al., 2019).
However, implementing an effective SPHM protocol reduces the risk of injury by at least one
lifting index (LI) (Fox et al., 2019). An effective SPHM program for healthcare practitioners in
CKD management would be instrumental in promoting patient safety and quality of care while
minimizing costs to the individual and the system.
Sources of benchmark data on care quality, patient safety, and costs to the system and
individual
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is the
go-to reference for the recommended best practices for CKD management. NIDDK provides
reliable, EBP-based guidelines on CKD management from the definition, diagnostic criteria,
management, and prevention. The platform also contains information on available clinical trials
and other resources that may benefit CKD patients, families, and healthcare practitioners.
NIDDK also provides data sources from the US Renal Data System (USRDS), a surveillance
program that tracks the prevalence of CKD, quality of care, and patient safety parameters. The
Center for Disease Prevention and Control (CDC) is also an invaluable resource for benchmark
data on care quality, patient safety, and the associated costs to the individual and the system. The
CDC also has a CKD surveillance program that provides accurate data on quality of care, patient
safety, and care costs to individuals and the system. The National Kidney Foundation may also
provide valuable insight into CDK management that could inform management practices.
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References
ANA. (2021). Safe Patient Handling and Mobility: Interprofessional National Standards Across
the Care Continuum (2nd ed.). American Nurses Association (ANA).
Delanaye, P., Björk, J., Courbebaisse, M., Couzi, L., Ebert, N., Eriksen, B. O., Dalton, R. N.,
Dubourg, L., Gaillard, F., Garrouste, C., Grubb, A., Jacquemont, L., Hansson, M.,
Kamar, N., Lamb, E. J., Legendre, C., Littmann, K., Mariat, C., Melsom, T., …
Nyman, U. (2021). Performance of creatinine‐based equations to estimate glomerular
filtration rate with a methodology adapted to the context of drug dosage
adjustment. British Journal of Clinical Pharmacology, 88(5), 21182127. https://doi.org/10.1111/bcp.15132
Fox, R. R., Lu, M., Occhipinti, E., & Jaeger, M. (2019). Understanding outcome metrics of the
revised NIOSH lifting equation. Applied Ergonomics, 81,
102897. https://doi.org/10.1016/j.apergo.2019.102897
Hassan, Z., Ali, I., Ullah, A. R., Ahmed, R., Rehman, S., & Khan, A. (2021). Assessment of
medication dosage adjustment in hospitalized patients with chronic kidney
disease. Cureus, 13(2). https://doi.org/10.1101/2020.05.04.20090787
Milani, R. V., Oleck, S. A., & Lavie, C. J. (2011). Medication errors in patients with severe
chronic kidney disease and acute coronary syndrome: The impact of computer-assisted
decision support. Mayo Clinic Proceedings, 86(12), 11611164. https://doi.org/10.4065/mcp.2011.0290
New, L., Goodridge, D., Kappel, J., Lawson, J., Dobson, R., Penz, E., Groot, G., & Gjevre, J.
(2021). Improving hospital safety for patients with chronic kidney disease: A mixed
methods study. BMC Nephrology, 22(1). https://doi.org/10.1186/s12882-021-02499-4
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Roux-Marson, C., Baranski, J., Fafin, C., Extermann, G., Vigneau, C., Couchoud, C., &
Moranne, O. (2020). Medication burden and inappropriate prescription risk among
elderly with advanced chronic kidney disease. https://doi.org/10.21203/rs.2.10876/v4
Safe patient handling and mobility (SPHM). (2020, June 24). Centers for Disease Control and
Prevention (CDC). https://www.cdc.gov/niosh/topics/safepatient/default.html
Safe patient handling and mobility. (n.d.). New York State Nurses Association
(NYSNA). https://www.nysna.org/safe-patient-handling-and-mobility
Scope of practice. (n.d.). New York State Nurses Association
(NYSNA). https://www.nysna.org/nursing-practice/practice-resources/scope-practice
Stefani, M., Singer, R. F., & Roberts, D. M. (2019). How to adjust drug doses in chronic kidney
disease. Australian Prescriber, 42(5), 163. https://doi.org/10.18773/austprescr.2019.054
VA.gov | Veterans affairs. (n.d.). Public Health
Home. https://www.publichealth.va.gov/employeehealth/patient-handling/
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