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MSN-FPX6021 Assessment 2 Change Strategy and Implementation Paper

MSN-FPX6021 Assessment 2 Change Strategy and Implementation Paper

Change Strategy and Implementation

Healthcare environments vary, and various strategies have varying degrees of success in promoting safety and enhancing quality and equitable care. Healthcare professionals review current data and utilize their skills and knowledge to remedy problems in the selected settings. Infection rates in diabetes are relatively higher in diabetic patients, and so are infection-related deaths secondary to diabetes. This essay reviews the burden of diabetes and proposes strategies to manage diabetes in primary care settings.

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Data Table

Current Outcomes Desired outcomes Strategies
The current poor outcomes in healthcare settings, according to AHRQ, are:·       Individuals have inadequate glycemic control, leading to a high risk for infection (Verstraeten et al., 2020).

·       Individuals with diabetes have high rates of infections (About six percent of all infections) (Carey et al., 2018).

·       There are high rates of diabetes infection-related deaths (about 12% of the total infection-related deaths) (Carey et al., 2018)

 The desired outcomes, according to the AHRQ, are:·       Individuals’ FBS and RBS measures remain within acceptable limits (RBS below 180md/dl, and FBS 80-130mg/dl according to ADA) (ADA, n.d.)

·       Individuals do not get infections secondary to diabetes

·       Decreased mortalities from infections in diabetic individuals

 Effective strategies that could lead to the desired outcomes include:a). The first strategy is patient education that focuses on;

·       Advocating for vigorous glycemic controls through diet and exercise besides medications (ADA, n.d.)

·       Increase individuals’ awareness of diabetics and the high risk for infection

b). Advocate for Influenza and Pneumococcal vaccines in diabetic patients (Verstraeten et al., 2020).

c). Advocate for increased patient follow-up and adherence to the recommended routine tests and exams by the AHRQ (eye and foot exams and HbA1c tests) (Ernawati et al., 2021).

Infection in Diabetes

The burden of diabetes and diabetes complications is deeper than often perceived. Diabetes and infections have interrelations, and each condition worsens the other. Studies also show that diabetes complicates the management of virtually all chronic conditions through poor infection management (Carey et al., 2018). Significant complications are diabetic foot and peripheral and eye neuropathies, hypertension, and cerebrovascular accidents. A major silent killer is infections in diabetic patients. High blood sugar is common in diabetes mellitus, and low immunity increases the risk of developing notorious infections even with less virulent microorganisms (Kim et al., 2019).

Infections further complicate diabetes management, including gangrenous cholecystitis, foot infections, malignant external otitis, and rhinocerebral mucormycosis (Carey et al., 2018). Some studies claim that infections are the major cause of death in diabetes and diabetes complications. Existing evidence from a large, well-structured retrospective study in primary care revealed that diabetes accounts for about 6% of infection-related hospitalizations and about 12% of all infection-related mortalities (Zoppini et al., 2018).

The major causes of infection-related mortalities in diabetes are septic arthritis, osteomyelitis, septicemia, and cellulitis (Zoppini et al., 2018). High levels of blood sugar are the primary cause of poor prognosis. Most of these infections are found in areas with poor blood circulation, such as the bone and joints. Blood supply to the skin and the most affected organs is low, and they also have poor penetration of antibiotics, hence the severity of illnesses (Akash et al., 2020).

Infections and diabetes have complex relationships that require keen considerations to minimize the high prevalence and mortalities of diabetes. Glycemic control carries a huge weight in managing these infections, and healthcare providers should ensure they develop effective change strategies in their respective healthcare institutions (Carey et al., 2018).

Change Strategies, Justification, and Quality Improvement

To achieve the desired quality outcomes, several strategies should be implemented. Comprehensive diabetes infections awareness through diabetes education, empirical antibiotic choices, influenza and pneumococcal vaccines, and routine monitoring and referral of complicated cases are vital strategies for managing diabetes-related infections (Akash et al., 2020; Carey et al., 2018). The empirical antibiotic choice is a complex strategy that requires the input of pharmacists, nutritionists, nurses, and doctors and requires higher-order functions in organizations. Thus, it will not be included in our change strategies.

Comprehensive patient education is a vital strategy in this situation. Most individuals are unaware of the complications, and the information provokes perceived severity and susceptibility and promotes health self-care behavior (Luk et al., 2019). Existing evidence on patient education shows that education increases patient knowledge, promotes self-care practices (such as increased hospital visits), and changes therapeutic outcomes (such as HbA1c, RBS, and FBS) (Ernawati et al., 2021; Ghisi et al., 2021).

Education promotes equitable care through knowledge and self-care skills and the availability of resources to manage their health. Education helps individuals perform self-assessments, determine their problems, and seek healthcare for them. Illiteracy is the leading cause of the under-utilization of healthcare services (Carey et al., 2018). For example, knowledge of the severity of diabetic foot may provide individuals to seek healthcare services when they get any leg injuries. Thus, education will improve the quality of care they receive and

Vaccinations offer protection from common diseases that have severe morbidity and mortality. Influenza and pneumococcal infections are notorious infections that could lead to potentially fatal health effects. These vaccines reduce the susceptibility of diabetic individuals, reducing the rates and mortalities from infections in diabetes (Verstraeten et al., 2020).

Pneumococcal infections account for more than half of the fatal infections in diabetes. These vaccines are recommended, but the governing bodies hardly emphasize them, thus their low implementation rates. Developing an institutional policy for the uptake of these vaccines is therefore vital for the health of diabetic individuals. The adherence rates are relatively low due to the lack of a clear structure and follow-up on these vaccines (Verstraeten et al., 2020).

Individual differences in care delivery are vital, and providing these vaccines is critical in protecting individuals. Immunization protects individuals from preventable severe diseases and thus improves their quality of life and ability to manage their illnesses. Promoting their utilization will reduce the infection rates and associated mortalities and morbidity, hence better-quality care.

Routine visits are vital for diabetes management. The Agency for Health Research and Quality healthcare quality and disparities report recommends at least one diabetic foot exam, eye exam, and HbA1c test yearly (AHRQ, 2019). HbA1C tests are an important measure in determining an individual’s glycemic control activities effectiveness over time, unlike random blood sugar (RBS) and fasting blood sugar (FBS) tests, which show the immediate blood sugar state (ADA, n.d.).

The HbA1c tests reflect the effectiveness of diet, exercise, and medications and thus inform the clinical decision-making process to produce quality healthcare decisions. These visits help determine the effects of diabetes and the effectiveness of glycemic controls to inform management. The routine visits also help monitor the progress of existing complications and thus aid in the referral of complex cases to decrease associated mortalities and morbidities. Eye and foot complications are the most diabetes complications and indicators of underlying conditions.

Diabetes affects the microvascular structures of vital organs, and it is a leading cause of blindness in diabetic patients, especially the elderly (Mendez et al., 2021). Diabetic foot indicates underlying peripheral vascular neuropathies and is often associated with loss of sensations in plantar and dorsal foot surfaces. The results are the painless progress of the disease. Infections complicate diabetic foot, and due to poor circulation and wound healing in diabetes, they lead to necrosis, gangrene, and subsequent amputations due to complete loss of function.

All infections in diabetes follow a similar sequela; hence, the high rates of septicemia, septic arthritis, osteomyelitis, and diabetic complications can be avoided early through early diagnosis and referral for complex care (Zoppini et al., 2018). In addition, they can be avoided through vigorous education, leading to effective glycemic controls, and thus, the strategies are interdependent.

Change Strategies and Interprofessional Considerations

The change strategies mentioned will require interprofessional collaboration for holistic patient management and the achievement of quality patient outcomes. The interprofessional team inputs will be vital in the planning, implementing, and evaluating these interventions. Planning education to improve awareness and promote adherence to follow-up visits will require information from other healthcare professionals to aid in its success (Ernawati et al., 2021). The healthcare informatics team, nurses, and doctors will collaborate to plan comprehensive education.

They will assist manage change and enhance buy-in from all stakeholders. Involving interprofessional will improve holistic interventions that do not affect the patients anyway. During the education sessions, patients and care providers work together to achieve the desired outcomes. The timing of the vaccination will require deliberations from healthcare providers to determine the best time to implement them (Verstraeten et al., 2020). The American Diabetes Association (ADA) recommends these vaccines but does not give clear instructions on when the vaccine should be given to diabetes patients.

Conclusion

Diabetes is a complex chronic condition with high healthcare costs, as seen above. Diabetes and infections have a complicated relationship, with each worsening the other. Infections in diabetes are a leading cause of death. Diabetes complications such as diabetic foot are exacerbated, and infections make their management difficult. Comprehensive patient education increased patient follow-up/ routine visits, and influenza and pneumococcal vaccines are strategies to minimize these infection rates. Healthcare providers should be collaborative to enhance the success of these initiatives.

References

Agency for Healthcare Research and Quality (AHRQ, 2019). 2019 National Healthcare Quality and Disparities Report. https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2019qdr.df

Akash, M. S. H., Rehman, K., Fiayyaz, F., Sabir, S., & Khurshid, M. (2020). Diabetes-associated infections: development of antimicrobial resistance and possible treatment strategies. Archives of Microbiology, 202(5), 953–965. https://doi.org/10.1007/s00203-020-01818-x

American Diabetes Association (ADA) (n.d.) Understanding A1C Diagnosis. https://www.diabetes.org/diabetes/a1c/diagnosis.

Carey, I. M., Critchley, J. A., DeWilde, S., Harris, T., Hosking, F. J., & Cook, D. G. (2018). Risk of infection in type 1 and type 2 diabetes compared with the general population: a matched cohort study. Diabetes Care, 41(3), 513–521. https://doi.org/10.2337/dc17-2131

Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021). Effectiveness of diabetes self-management education (DSME) in type 2 diabetes mellitus (T2DM) patients: Systematic literature review. Journal of Public Health Research, 10(2). https://dx.doi.org/10.4081/jphr.2021.2240 

Ghisi, G. L. D. M., Seixas, M. B., Pereira, D. S., Cisneros, L. L., Ezequiel, D. G. A., Aultman, C., Sandison, N., Oh, P., & da Silva, L. P. (2021). Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study. BMC Public Health, 21(1), 1-16. https://doi.org/10.1186/s12889-021-11300-y

Kim, E. J., Ha, K. H., Kim, D. J., & Choi, Y. H. (2019). Diabetes and the risk of infection: a national cohort study. Diabetes & Metabolism Journal, 43(6), 804-814. https://doi.org/10.4093/dmj.2019.0071

Mendez, I., Lundeen, E. A., Saunders, M., Williams, A., Saaddine, J., & Albright, A. (2022). Diabetes Self-Management Education and Association with Diabetes Self-Care and Clinical Preventive Care Practices. The Science of Diabetes Self-Management and Care, 26350106211065378. https://doi.org/10.1177/26350106211065378

Verstraeten, T., Fletcher, M. A., Suaya, J. A., Jackson, S., Hall-Murray, C. K., Scott, D. A., Thoma, B. S., Isturiz, R. E., & Gessner, B. D. (2020). Diabetes mellitus as a vaccine-effect modifier: a review. Expert Review of Vaccines, 19(5), 445–453. https://doi.org/10.1080/14760584.2020.1760098

Zoppini, G., Fedeli, U., Schievano, E., Dauriz, M., Targher, G., Bonora, E., & Corti, M. C. (2018). Mortality from infectious diseases in diabetes. Nutrition, Metabolism and Cardiovascular Diseases, 28(5), 444-450. https://doi.org/10.1016/j.numecd.2017.12.007

MSN-FPX6021 Assessment 3 Biopsychosocial Concepts for Advanced Nursing Practice 1 The Quality Improvement Presentation Poster

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MSN-FPX6021 Assessment 2 Change Strategy and Implementation Paper

Assessment 2 Instructions: Change Strategy and Implementation

Develop a data table that illustrates one or more underperforming clinical outcomes in a care environment of your choice. Write an assessment (3-5 pages) in which you set one or more quantitative goals for the outcomes and propose a change plan that is designed to help you achieve the goals.

Introduction

Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, it is recommended that you complete the assessments in this course in the order in which they are presented.

Knowing what is the best practice for our patients is very important in providing safe and effective care. Understanding best practices can help nurses identify areas of care that need to be improved. To identify areas of need, nurses must use evidence from various sources, such as the literature, clinical practice guidelines (CPG), professional organization practice alerts or position papers, and protocols. These sources of evidence can also be used to set goals for improvement and best practices with an eye toward improving the care experience or outcomes for patients.

The challenge facing many care environments and health care practitioners is how to plan for change and implement changes. For, if we cannot effectively implement changes in practice or procedure, then our goals of improving care will likely amount to nothing. This assessment focuses on allowing you to practice locating, assessing, analyzing, and implementing change strategies in order to improve patient outcomes related to one or more clinical goals.

This assessment will take the form of a data table to identify areas for improvement and to set one or more outcome goals, as well as a narrative describing a change plan that would help you to achieve the goals you have set.

Preparation

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.

The assessment will be based on one or more outcomes that you would like to see improve. Think about experiences you have had working on setting goals for outcomes or using data to identify areas of need. Part of achieving your goal will be your ability to implement change in pursuit of improving outcomes. The Vila Health: Using Evidence to Drive Improvement simulation may be helpful in this regard.

  • Where do you look for resources and evidence to help you get started when treating a specific condition?
  • Where do you look for resources and evidence to help you get started when setting clinical goals?
    • When there are no guidelines or policies for setting clinical goals, where do you look for resources and evidence to help you get started?
  • How do you use these resources and evidence to begin constructing evidence-based treatment, or developing evidence-based goals?
  • What data do you plan to use as a basis for setting improved outcome goals?
    • What care environment do you envision using as the context of your assessment?
      • How would change models, strategies, or theories need to be applied to help ensure achievement of your outcome goals?
      • Which change models, strategies, or theories seem to be the best fit for your goals and environments. Why?

Scenario

Consider the current environment. This could be your current care setting, the care settings presented in the Vila Health: Using Evidence to Drive Improvement or Vila Health: Concept Maps as Diagnostic Tools media, or a care setting in which you are interested in working.

For the setting that you choose you will need to have a data set that depicts sub-optimal outcomes related to a clinical issue. This data could be from existing sources in the course (Vila Health: Using Evidence to Drive Improvement), a relevant data set that already exists (a data set from the case study you used as a basis for your Concept Map assessment, or from your current place of practice), or an appropriate data set that you have created yourself. (Note: if you choose to create your own data set, check with your instructor first for approval and guidance.)

After you have selected an appropriate data set, use your understanding of the data to create at least one realistic goal (though you may create more) that will be driven by a change strategy appropriate for the environment and goal.

Potential topics for this assessment could be:

  • Consider ways to help minimize the rate of secondary infections related to the condition, disease, or disorder that you focused on for your Concept Map assessment. As a starting point you could ask yourself, “What could be changed to facilitate safety and minimize risks of infection?”
  • Consider how to help a patient experiencing traumatic stress or anxiety over hospitalization. As a starting point you could ask yourself, “How could the care environment be changed to enhance coping?”

Once you determine the change you would like to make, consider the following:

  • What data will you use to justify the change?
  • How can the team achieve this change with a reasonable cost?
  • What are the effects on the workplace?
  • What other implementation considerations do you need to consider to ensure that the change strategy is successful?
  • How does your change strategy address all aspects of the Quadruple Aim, especially the well-being of health care professionals?
  • Once the change strategy is implemented, how would you evaluate the efficiency and effectiveness of the care system if the desired outcomes are met?

Instructions

Your assessment submission should include a data table that illustrates the current and desired states of the clinical issue you are attempting to improve through your application of change strategies. Additionally, you will need to explain the rationale for your decisions around your chosen change strategies, as well as how the change strategies will be successfully implemented.

The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your change strategy addresses all of them. You may also want to read the Change Strategy and Implementation scoring guide and Guiding Questions: Change Strategy and Implementation [DOCX] to better understand how each grading criterion will be assessed.

  • Develop a data table that accurately reflects the current and desired states of one or more clinical outcomes.
  • Propose change strategies that will help to achieve the desired state of one or more clinical outcomes.
  • Justify the specific change strategies used to achieve desired outcomes.
  • Explain how change strategies will lead to quality improvement with regard to safety and equitable care.
  • Explain how change strategies will utilize interprofessional considerations to ensure successful implementation.
  • Communicate the change plan in a way that makes the data and rationale easily understood and compelling.
  • Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.

Example Assessment

You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Additional Requirements

  • Length of submission: 3-5 double-spaced, typed pages, not including the title and reference pages. Your plan should be succinct yet substantive.
  • Number of references: Cite a minimum of 3-5 sources of scholarly or professional evidence that supports your goal setting, proposed change strategies, quality improvement, and interprofessional considerations. Resources should be no more than five years old.
  • APA formatting: Use the APA Style Paper Tutorial [DOCX] to help you in writing and formatting your analysis. No abstract is required.

Competencies Measured

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

  • Competency 1: Design patient-centered, evidence-based, advanced nursing care for achieving high-quality patient outcomes.
    • Develop a data table that accurately reflects the current and desired states of one or more clinical outcomes.
  • Competency 2: Develop change strategies for improving the care environment.
    • Propose change strategies that will help to achieve the desired state of one or more clinical outcomes.
    • Justify the specific change strategies used to achieve desired outcomes.
  • Competency 3: Apply quality improvement methods to practice that promote safe, equitable quality of care.
    • Explain how change strategies will lead to quality improvement with regard to safety and equitable care.
  • Competency 4: Evaluate the efficiency and effectiveness of interprofessional care systems in achieving desired health care improvement outcomes.
    • Explain how change strategies will utilize interprofessional considerations to ensure successful implementation.
  • Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards.
    • Communicate change plan in a way that makes the data and rationale easily understood and compelling.
    • Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.