Quality/Performance Improvement Framework

Follow-up is a large aspect in how the HF people follow the recommendations concerning medication intake and self-monitoring of symptoms. Telephone follow-ups by quality care providers to HF patients have been found to reduce hospital readmissions and increase the quality of life of patients with HF (Broadway, 2021). As stated by Lee et al. (2020), it is possible to reduce the risks of the HF patients requiring re-admission by using regular administrative phone calls between the nurses who have discharged such patients and those patients. A gap has been identified in both the hospital’s Heart and Vascular Care and its follow-up treatment for HF patients after being discharged. To ensure compliance with daily habits among the HF patients who are discharged, a weekly Target HF Form Telephone would be adopted where the discharged patient would be followed up on daily practices like weight changes, medication intake and low sodium diet (Broadway, 2021; Riegel et al. , 2019). That is the strategy under quality improvement (QI). The intended result of the review is to get an approach that would enhance the implementation of the planned QI at North Atlanta Heart & Vascular Center.

Current Practice Needing Improvement

NURS FPX 9901 Assessment 2 Moise et al. (2022) reported that there is not much evidence that the targets of the HF Form could be adjusted to fit the HF patients in the US who are called once a week. Thus, the need for the suggested QI effort and its application is particularly pressing due to the high readmissions in HF care settings typical for the US healthcare system. According to Lan et al. (2021), the approximately 14% of patients with HF who terminated their care before the study passed away within 30 days. Additionally, the study established that one out of five patients who were discharged were readmitted within the first one month at a great cost to the economy. The results also indicated that no reunion between Nurses assigned to manage HF patients and planned follow-up, checkup with the patients was the key reason why majority of the patients returned to the hospitals or died (Lan et al. , 2021).

 The care outcomes for HF patients are not very promising and thus, the follow-up or follow-up care must be adjusted to reinforce the patients’ compliance with their medications, to monitor their weight and adhere to a low-sodium diet (Drews et al . , 2021). Largely due to the lack of adequate follow-up care through the North Atlanta Heart and Vascular Center, there is a disconnection between the intervention and the paperwork. By being in touch with the HF patients more frequently either through technology or physical contact the risk of a relapse and overall care outcomes, partly alleviating the financial burden between the patient and the health facility decreases (Lakshmanan et al. , 2022). Drews et al. (2021) went further to indicate that the follow-up call care for HF patients who were not getting paid as recommended by Sawhney et al. (2017) was evidence based practice which was likely to be utilised in actual field. The practice gap which the suggested QI will plug is the lack of use of the evidence-based QI to reduce the rate of return.

QI Framework for Practice Needing Improvement

The primary purpose for the QI initiative was to implement the use of a nurse unit at NAH&VC to offer post-discharge follow-up services for HF patients; this was done using the Target HF Form formulated by the AHA. Resource solicitation as well as evidence collection from the literature for the application of the care organization and how the intervention performs for the purpose of quality improvement constitutes a section of the first phase of the QI evaluation. Other aspects that can be taken from the initial review are the number of HF patients readmitted to the North Atlanta Heart & Vascular Center within the stipulated time, how many die after admission, the number of follow-up calls made to them per week, and their compliance to the medication instructions (Huseb et al. , 2021). Thus, the chosen Framework for the Quality Improvement (Clarke, 2023) project at North Atlanta Heart & Vascular Center is the Plan-Do-Study-Act (PDSA) plan.

 The model shows that during the planning step (Plan) of the frame, the most significant aspects of the QI project will be assessed. Some of the elements highlighted are need for nurses, availability of technology, patient information and the AHA’s Target HF Form (Broadway, 2021). In the second part (Do), the nurses’ knowledge and skills will include the completion of HF form used during the telephone with HF patients in the post-discharge settings (Clarke, 2023). NURS FPX 9901 Assessment 2 policy will also be initiated during the aspect of calling patients discharged from the hospital at least one time per week for ten weeks per patient. The third step is labeled as “Study,” which looks at how effective the program aided by identifying elements such as the readmission rate per patient, the number of calls that each patient receives per month, and paperwork regarding administrative records for each HF patient (Broadway, 2021). Using the QI framework’s last stage (Review), the results from the third stage (Act) will be analyzed to adjust how QI is implemented at North Atlanta Heart & Vascular Center.

NURS FPX 9901 Assessment 2 Collection and Analysis of QI Data

Secondary objectives are also obtained through interviews while analytics are applied to obtain main aims of QI data (Kao et al. , 2020). Thus, future review of the implemented QI system will be possible and effective if these two types of data are collected. The first group employs quantitative data analyzed from the North Atlanta Heart & Vascular Center’s website to establish the number of returns for heart failure patients. The data will help delineate ways in which the main goal of reducing the number of readmissions to the hospital is being achieved (Negarandeh et al. , 2019). Information for QI gleaned through second-hand sources will be obtained from views of the HF patients through weekly phone discussions.

 Accordingly, below are the three key indices, which will be used to data collect: prevalence of drug compliance among patients at North Atlanta Heart & Vascular Center who were discharged; compliance with weight check daily; and, Low-sodium dietary compliance among the patients at North Atlanta Heart & Vascular Center who have been discharged. One of these will be extracted from the Target HF Form, while the other would represent the average number of HF patients released each month to arrive at the percentage of patients willing to follow through with post-discharge nursing care by phone. The secondary aims of the project are to equally ensure that discharged patients attend clinic regularly for weight check, follow to low sodium dietary regime, and adhere with the use of the prescribed medicine as recommended. This will be achieved under the above-said data collection and analysis technique (DeVore et al. , 2021). These types of data will be collected from the first person data source as screens and phone records and then analyzed numerically to know what way the implementation of the suggested QI could be done and why North Atlanta Heart & Vascular Center requires it (Kao et al. , 2020).  

Proposed QI Changes and Expected Outcomes

According to the components indicated on the QI map for North Atlanta Heart & Vascular Center, there are two significant modifications being proposed. The first transformed QI is a rule that the released HF patients should be contacted at least once a week using the Target HF Form. With the new QI, information related to HF patients that are discharged in a month on their medicine, food, and weight tracking plans can be provided by the nurses (Negarandeh et al. , 2019). With regards to the first recommendation, patients with HF should adhere to the medications recommended by the QI change so that they do not end up in the hospital often, monitor their weight, and stick with a low-sodium diet (Riegel et al. , 2019). The results on these should be availed within the next 10 weeks from now. The things that might hamper the outcome that could have been expected from this change too in QI are; Some HF patients have no intention of reporting their compliance and some are even able to lie about it Some of the patients cannot speak English explaining that aspect Some of the nurses at the North Atlanta Heart & Vascular Center may not be doing a good job in analyzing the data (Negarandeh et al. , 2019).

NURS FPX 9901 Assessment 2 Patients Complied 

 The second modification to QI is that nurses will teach others on how to ensure that patients are called at least 10 weeks after discharge and how the areas of communication, essential competencies, and how patients complied the planned actions needed to be discussed (Grainger et al. , 2019). Therefore, through the new development, all the nurses in the hospital will undergo a course to enhance their thinking process so that they will be in a better position to engage their patients in enhanced communication. The change should result into nurses at the North Atlanta Heart & Vascular Center being more competent in noting how HF patients comport themselves whenever they are on self-monitoring, and on the other end patients being satisfied with the kind of care they are receiving . The change in QI will also facilitate the ability to discuss the medications’ necessity, monitor weight, and discover the efficiency of diets in 10 weeks (Drews et al. , 2021). NURS FPX 9901 Assessment 2 projected results may be impacted by low learning behaviour from nurses as well as from too much work intensity, resistance to change, and challenges regarding work-life balance among the nurses, among other factors (Grainger et al. , 2019).  

Evaluation of QI Changes

There are two major ways through which the alterations and effect in QI that has resulted from the application of the method will be evaluated. In the case of the first way, the return measure will be data analytics, and to gather data in this process, the display of the North Atlanta Heart & Vascular Center will be used. Before and after implementing the changes in the policy and practice regarding calling HF patients after discharge, the study’s outcome measures will be first assessed (Negarandeh et al. , 2019). The assessment will also assess the last two and a half month of the execution phase of the case. To have details on how strictly the patients adhere to the low-sodium diet, their medication regimen, or the daily weigh-in, patients will be interviewed by phone once a week (Riegel et al. , 2019). Further, the typical level of cooperation that the opposite party provides before and after the QI implementation will be evaluated. Individuals at North Atlanta Heart & Vascular Center have employed the increase in compliance, and the reduction in the readmission rate for the HF patients as a yardstick of the QI program significance (DeVore et al. , 2021). Hence, the most crucial parameter that will be employed to assess the outcome of the QI changes within HF patients will be the decrease in the readmission frequency. For instance, the cost recovery on patients with HF is 25 % per one month’s treatment. This will reduce to between 10% and 15% once the North Atlanta Heart & Vascular Center accomplishes QI program.

Conclusion

In NURS FPX 9901 Assessment 2 is important because high return rates charge high treatment costs per patient, poor care and bad outcomes to HF patients at NAH&VC. In another QI effort the follow up calls made to people once weekly should incepted to ensuring that people take their medications as required by their physicians, check their weights every single day, and have a healthy diet. When it comes to QI the PDSA model was used This model enables the reporting of changes done and their impacts This is the model that was used when carrying out the QI This model enables change to be made on a small scale for the process to be tested and if the results are positive the change is made until the required results are achieved. It is expected that the migration to QI is going to reduce in the readmission rate of the health care facility. There is a proposal to use data from the analytics dashboard and phone calls to conduct data gathering and determine how the QI project is faring.

References

Broadway, D. (2021). Implementation of telephone-based medication adherence conferences to improve health outcomes of heart failure patients. University of Arkansas Fayetteville, 1, 1-64. https://scholarworks.uark.edu/nursstudent/11/

Clarke, M. (2023). Impact of an automated text and phone call post-discharge follow-up program on patient satisfaction scores and 30-day hospital readmission among adult patients. Doctor of Nursing Practice Projects, 1, 1–64. https://hsrc.himmelfarb.gwu.edu/son_dnp/123/

DeVore, A. D., Granger, B. B., Fonarow, G. C., Al-Khalidi, H. R., Albert, N. M., Lewis, E. F., Butler, J., Piña, I. L., Allen, L. A., Yancy, C. W., Cooper, L. B., Felker, G. M., Kaltenbach, L. A., McRae, A. T., Lanfear, D. E., Harrison, R. W., Disch, M., Ariely, D., Miller, J. M., & Granger, C. B. (2021). Effect of a hospital and postdischarge quality improvement intervention on clinical outcomes and quality of care for patients with heart failure with reduced ejection fraction. Journal of American Medical Association, 326(4), 314–323. https://doi.org/10.1001/jama.2021.8844

Drews, T. E. I., Laukkanen, J., & Nieminen, T. (2021). Non‐invasive home telemonitoring in patients with decompensated heart failure: a systematic review and meta‐analysis. European Society of Cardiology (ESC) Heart Failure, 8(5), 3696–3708. https://doi.org/10.1002/ehf2.13475

Grainger, L., Amin, K., & Watkins, D. (2019). Simulation-based training to teach nurses skills in falls assessment and prevention. Nursing Older People, 31(1), 36–38. https://doi.org/10.7748/nop.2019.e1071

Heidenreich, P. A., Fonarow, G. C., Breathett, K., Jurgens, C. Y., Pisani, B. A., Pozehl, B. J., Spertus, J. A., Taylor, K. G., Thibodeau, J. T., Yancy, C. W., & Ziaeian, B. (2020). 2020 ACC/AHA clinical performance and quality measures for adults with heart failure. Circulation: Cardiovascular Quality and Outcomes, 13(11). https://doi.org/10.1161/hcq.0000000000000099

Husebø, A. M. L., Storm, M., Urstad, K. H., Søreide, J. A., Karlsen, B., & Morken, I. M. (2021). Post-hospitalization follow-up of patients with heart failure using e-health solutions: A restricted, systematic review. Journal of Medical Internet Research, 24(2), 1–13. https://doi.org/10.2196/32946

Kao, D. P., Trinkley, K. E., & Lin, C.-T. (2020). Heart failure management innovation enabled by electronic health records. Journal of the American College of Cardiology (JACC): Heart Failure, 8(3), 223–233. https://doi.org/10.1016/j.jchf.2019.09.008

Lakshmanan, G., Sandeep, S., Deepak, S., & Tembhre, M. K. (2022). A randomized controlled trial to assess the effectiveness of a nurse-led structured telephonic heart failure management program on selected health-related outcome variables among patients of heart failure at 3 months. Drugs and Cell Therapies in Hematology, 10(2), 2281-4876. https://www.researchgate.net/publication/358900554_A_Randomized_Controlled_Trial_t o_Assess_the_Effectiveness_of_Nurse_- Led_Structured_Telephonic_Heart_Failure_Management_Programme_on_Selected_Heal th_Related_Outcome_Variables_Among_Patients_of_Heart_Fa

Lan, T., Liao, Y.-H., Zhang, J., Yang, Z.-P., Xu, G.-S., Zhu, L., & Fan, D.-M. (2021). Mortality and readmission rates after heart failure: A systematic review and meta-analysis. Therapeutics and Clinical Risk Management, 17(1), 1307–1320. https://doi.org/10.2147/tcrm.s340587

Lee, K. K., Thomas, R. C., Tan, T. C., Leong, T. K., Steimle, A., & Go, A. S. (2020). The heart failure readmission intervention by variable early follow-up (THRIVE) study: A pragmatic randomized trial. Circulation: Cardiovascular Quality and Outcomes, 13(10). https://doi.org/10.1161/circoutcomes.120.006553

Moise, N., Cené, C. W., Tabak, R. G., Young, D. R., Mills, K. T., Essien, U. R., Anderson, C. A. M., & Lopez-Jimenez, F. (2022). Leveraging implementation science for cardiovascular health equity: A scientific statement from the American Heart Association. Circulation, 146(19), 260–278. https://doi.org/10.1161/cir.0000000000001096

Negarandeh, R., Zolfaghari, M., Bashi, N., & Kiarsi, M. (2019). Evaluating the effect of monitoring through telephone (tele-monitoring) on self-care behaviors and readmission of patients with heart failure after discharge. Applied Clinical Informatics, 10(02), 261–268. https://doi.org/10.1055/s-0039-1685167

Riegel, B., Lee, S., Hill, J., Daus, M., Baah, F. O., Wald, J. W., & Knafl, G. J. (2019). Patterns of adherence to diuretics, dietary sodium and fluid intake recommendations in adults with heart failure. Heart & Lung, 48(3), 179–185. https://doi.org/10.1016/j.hrtlng.2018.12.008