Colleton Medical Center
Consultative Change Recommendations
Interviewed Elaine Kiser, Director of Quality and Dialysis at Colleton Medical Center, Walterboro, SC
Using Colleton Medical Center Hospital located in Walterboro, SC 29488
*Recommended change is improving Medication Reconciliation by using dedicated Pharmacists to reconcil all patient medications upon admission and discharge with proper education on medications to take once discharged in turn increasing HCAHPS score for patient satisfaction in giving proper education on medications upon d/c*
184 beds in rural area,
Consultative Change Recommendations
The nursing role has long been easier to defined as well as limited over the past decades. Nevertheless, within the dynamical change in the contemporary world, the role of a nurse has become complex since it is implemented within diverse settings that encompass a significant populace. As such, the nursing role entails numerous professional roles geared towards the achievement of a full range of responsibilities within these settings. According to Singer et al. (2012), the role of a nurse has become limited about the domains of authority encompassed with and extensive influence necessitating leadership unceremoniously and officially. Arguably, the standards of care are now changing, and evidence-based practice is now utilized as a parameter to authenticate as well as implement changes within a health care organization (DeNisco & Barker, 2016). Nurse consultants are sought out by healthcare organizations to aid in meeting patient needs as well as improving safety, effectiveness, and efficiency of care services. To accomplish this, nurse consultants participate in the external and internal assessment of a healthcare facility and how it provides services to its clients. Additionally, nurse consultants undertake community needs assessment of which the organization serves.
Aim of Consultation and Overview
This paper transcends an analysis and identification of change and/or improvement required at Colleton Medical Center (CMC) as well as how health care practitioners are taking part in fostering change at CMC. As such, the methods utilized in developing recommendations will be aided by data from an assortment of sources. CMC’s assessment will be conducted by obtaining Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, survey results for agencies that offer accreditation such as the Joint Commission, and analysis of feedback from staff at CMC through interviews and surveys. Also, community assessment will entail an evaluation of neighborhood health profiles, county rankings regarding health, demographics at CMC and how the public views CMC.
Specifically, recent HCAHPS scores of CMC will be used to determine the areas of weakness and compared with one of the Magnet Status Hospital in the same county. Additionally, health profiles and community assessment utilize county/state health rankings to establish the health necessities of the CMC’s community. Nursing Leadership at CMC will be assessed by interviewing one of the hospital staff through a discussion of CMC’s contemporary state as well as the efforts in place that CMC undertakes to improve quality. Additionally, feedback from stakeholders will be obtained through online staff review and post-discharge phone calls to its clientele.
Description of the Organization
Colleton Medical Center, located at Robertson Boulevard Walterboro, SC, 29488, is an 184-bed propriety healthcare facility. CMC is a general and surgical unit that offers emergency services as well as rehabilitation units (8 beds) (Hospital Data, 2017). According to a CMC’s Community Benefits Report of 2012, the hospital has 562 employees and approximately 191 medical staff (Colleton Medical Center, 2017a). Annually, the facility has experienced 4,933 admissions, 27,000 ER visits, 32,000 outpatient visits, and 400 births. Colleton Medical Center offers the following services to its clients; behavioral services, diagnostic imaging, emergency care, laboratory services, orthopedics, pediatric services, physical therapy, rehabilitation, surgery, and wound management (Colleton Medical Center, 2017b). The facility is affiliated with Lowcountry Imaging Associates located at 211 Meadow Street Walterboro, SC 29488. The administration structure is designed in a hierarchal manner with the Board of Trustees comprising of a Chairperson, president, vice president, CEO, Chief of Staff, and 8 Physicians. The hospital is ranked at to 15% of America’s hospital for quality care, and it has received the Top Performer on Key Quality Measures Award from The Joint Commission for five years consecutively.
Primary Needs of Organization Population
Colleton Medical Center is situated in Colleton County in South Carolina State has an overall county ranking of 41/46 of the state. The community at CMC, based on county demographics indicate that Colleton County has a population of 37,731 individuals with 22.7% of the population being of age 18 years and below and 19.2% being if age 19.2%. Furthermore, 75.6% of the area is rural, and the general population is comprising of 52.1% females (County Health Rankings, 2017). Additionally, Colleton County rated at the 34 out of 46 counties regarding health outcomes. As such, has experienced 11, 300 cases of premature deaths triggered by malignant neoplasms, heart diseases, accidents, respiratory failure and cerebrovascular diseases. In terms of length of life, Colleton County is ranked 37/46. More so, CMC serves Non-Hispanic African Americans (37.7%), Non-Hispanic Whites (56%), and Hispanics (3.2).
Analysis of health behavior at Colleton County suggests a ranking of 39/41 indicating 21% of its population have a smoking addiction, 39% depict adult obesity, 30% do not take part in physical activities, most of its populace have sexually transmitted infections. Alternatively, excessive drinking at Colleton County is at minimum levels, 14%. Clinical factors that need to be addressed at Colleton County include uninsured populace, increased number of preventable hospital stays, failure to undertake mammography screening. Socioeconomic factors that need to be addressed at Colleton County indicate that the unemployment rate is at 7.0% and 37% of children and poverty-stricken. Also, there is an increased number of violent crime and injury deaths.
As such, these risks have an impact on the health status of Colleton County. First, the decreased tendency to undertake physical activity might have been a risk factor to escalated increase of premature death by CVD [reference] (Day, Fulton, Dai, Mihalopoulos, & Barradas, 2009; Huang, Webb, Zourdos, & Acevedo, 2013; Oguma & Shinoda-Tagawa, 2004; Sallis, Floyd, Rodriguez, & Saelens, 2012; Stensel, 2010 Also, the increased rate of injury-related deaths would have been caused by the escalating cases of violent crimes (Granja, Zacarias, & Bergström, 2002). Additionally, cases of chronic diseases are associated with the increased number of hospital stays (Russo, Ho, & Elixhauser, 2006).
Nurse Leader Interview Summary
Role of The Nurse Leader
To gain a clear understanding regarding the current and proposed quality improvement activities, the nurse leader interviewed in this scenario was Elaine Kiser, the Director of Quality and Dialysis at CMC. Elaine Kiser is a Registered Nurse with both NEA-BC and CWCN certifications. She holds a BSN from Medical University of South Carolina-College of Nursing and an MSN from Western Governors. As a Director of Quality and Dialysis, her major roles entail evaluating the contemporary nursing practices at CMC, warranting the delegated standards of practice are upheld and making sure that evidence-based practice is integrated into care delivery at CMC. As per the requirements of CMC, Kiser takes part in the development and assistance of plans to implement nursing practice changes and policies.
Additionally, the director of quality and dialysis frequents EMR auditing, analysis of data, facilitation, and identification of potential as well as actual problems areas within CMC, conducts surveys, and reviews policies and research. Furthermore, the Director of Quality and Dialysis (DOQD) assesses the implications of newly implemented policies and practices at CMC. Also, the DOQD recurrently collaborates with an interdisciplinary team of professionals emanating from different fields of study during operations meetings and when addressing QI efforts. As such, Kiser works with departmental nurse educators as she provides them with information regarding the need for improvement and implementation of a particular policy or plan. Also, as dialysis medical director, the DOQD leads in group decision-making, analyses essential processes and patient outcomes as well as stimulating a team strategy to continuous QI. The role of medical director of dialysis has led to a close relationship between companies that offer dialysis services and the medical expert who provides medical insight (Maddux, Maddux, & Hakim, 2007).
The DOQD will evaluate the results from the Joint Commission for CMC. These results/outcomes will aid in the decision-making process to implement any change or improve the current practices at CMC. The DOQD reports directly Chief Nurse Educator, appreciated and buoyed by the CEO. The DOQD at CMC allows for reformations and recommendations from the nurse educators about their evaluation of standards of quality and the need to integrate evidence-based practice into care delivery at CMC. More so, Kiser takes part in risk management as well as acts an injection preventionist. Also, she creates an engagement with employees to set a new culture of caring for patients by focusing on care plans
As a master prepared nurse, it is evident that her role in leadership demonstrates the vital components stipulated in Essential II: Organizational and Systems Leadership in that she plays a role of translating evidence-based research into nursing practice by acting as a leader to foster change in policies and practice (American Association of Colleges of Nursing, 2011). As an enthusiastic learner and her understanding of the dynamics of nursing and healthcare, her office library consists of recent publications and books focused on healthcare quality and research. Furthermore, she understands her role is influential to all the stakeholders at CMC, and she ensures that delivery of care at CMC is at its best, based on the contemporary standards and evidence-based research.
Characters of the Organization
Regarding quality improvement, CMC, as mentioned earlier, has been a recipient of the Top Performer on Key Quality Measures Awards for the last five years. Additionally, CMC recognizes the need to collaborate with the community on some projects. Notably, CMC advocate for quality patient care to the community of Colleton County. As such, its mission indicates through partnering with other institutions CMC creates a caring environment that allows for healing and where the quality of life is enhanced. Additionally, they have initiatives that give back to the Colleton community as the consumer benefits reports suggest that a number of organizations have benefited from CMC. Some of these organizations include American Cancer Society Relay for Life, USC- Salkehatchie, South Carolina Artisan Center, and Colleton County Arts Council. Reports from the Department of Health and Environmental Control (DHEC) suggest that Colleton Medical Center scoped the first-time award for “First Sound Quality Improvement Project” as it was the top performing hospital in the South Carolina within the project (Walters, 2016). As per these awards, Kiser concluded that the facility has standardized clinical care.
One of the salient weak point for CMC is evident after an evaluation of online survey. As such, it was indicated that patient dissatisfaction regarding admission and discharge events. Arguably, HCAHPS scores indicate that 16% of patients reported that CMC sometimes or never explain about the medication before being administered to patients, which equate to the state/national level of 20% (Hospital Data, 2017). Also, Health Grades suggests that only 66% of patient agreed that physicians give information about medication to patients before administering the medication. Furthermore, from the interview results, it is evident that the facility has a low-income family and patient engagement which needed to be addressed
Evidence Based Practices and Quality Improvement Plans
The use of SBAR handoff system has been researched thoroughly in the field of nursing as it is associated with better patient outcome (Leonard, Lyndon, Morgan, & Stone, 2014). As an evidenced based approach to care, CMC utilizes this toolkit to provide the best of healthcare delivery to its clientele. Additionally, Kiser suggested that the facility utilizes Electronic Medical Records for handover practices. According to Baca, Rajan, and Horn (2015), it is evident that use of EMRs has been associated with minimization of medical errors as well effective handoff procedures in hospitals across the country. As such, these method is utilized at the CMC’s emergency departments to eradicate the issues of missed handoffs.
Recommendation for Organization Change
Recommendations and Rationale for Change
As mentioned earlier, it is evident that patients at the facility are dissatisfied with the admissions and discharge events regarding medication reconciliation. As such, I would recommend that to improve Medication Reconciliation, CMC need to use dedicated pharmacists to reconcile all patient medications upon admission and discharge with proper education on medications to take once discharged. Notably, this will increase the HCAHPS score for patient satisfaction in giving proper education on medications upon discharge and admissions at the facility.
To enhance patient education at discharge, RNs at CMC need to furnish patients with their guidelines of discharging and review it with the family of the. Caregivers need to use the educate back technique with each experience. At the point when the patient is released from the facility, a disposition document will report in the medicinal records that the patient had been familiarized with care guidelines, medicine instruction and the patient’s show of cognizance. This documentation is consistently evaluated by the DOQD at CMC. Additionally, CMC must create a culture of medical reconciliation by making it a requirement for any pharmacist at CMC.
Measures to Evaluate Effectiveness
The HCAHPS score is one of the national benchmarks that evaluates patient satisfaction through survey and interviews. By improving medicine reconciliation at CMC by having dedicated pharmacists will reflect the feedbacks on patient satisfaction surveys stipulated by the HCAHPS. Additionally, this measure can also be reflected on a local level regarding patient discharge survey stipulated by the director of quality and dialysis at CMC.
Change is a
major factor for healthcare institutions to
implement as they are focused on improving both the patient and the
healthcare professionals. Through comprehensive assessments and survey at
national and county level, it is evident that Colleton County has some health risks that hospitals such as CMC must
consider as it formulates its plans and policies. As per this paper, CMC need
to satisfy its patients through an improvement of the medication reconciliation
processes during admissions and discharge. As such, if these changes are implemented with the help of the director
of quality, patient satisfaction scores will be reflected on the HCAHPS
national benchmark of America, hospitals.
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