Question

Recently you have been approached by several staff members who have expressed concerns about one of the wound center physicians. The medical assistant mentioned that several patients have complained to her that the physican seems in a hurry and does not listen to their concerns. One of your nurses also stated that several of the patients have complained of increased pain after treatment and that their wounds appear worsened. Your clinical nurse leader has expressed that the physician is not documenting his clinic procedures daily; in fact, sometimes several days will pass before he completes his notes in the patient’s medical record. Additionally, the billing associate has complained that the physician has not been filling out the procedures and diagnosis codes on the Superbill for each patient visit for reimbursement. In the last month you have also received several phone calls from the hospital’s outpatient billing department notifying you of payment denials on several wound center patient accounts.

You decide to review the physicians’ healing outcomes in the center’s clinical database and discover that his healing rates and quality indicator scores are far below the standardized expectations. Many of the physician’s entries in the patients charts are incomplete. As you review the physicians’ documentation further you see that his poor outcomes have been an ongoing trend intermittently over the last several years. The physician was counseled twice over a period of two years by the former wound center administrator. After being counseled, the physician showed a slight improvement in outcomes and quality indicators each time. Subsequently, within several months after each counsel a downward trend in quality measures reoccurred. Patient volumes are at an all time high in the clinic and the physician seems stressed. Patient satisfaction scores are declining.

The purpose of developing this portfolio project is for you to demonstrate your leadership skills and knowledge as a health care administrator/manager in the areas of: trends and challenges that exist in health care management; the basic management techniques utilized in health care organizations; the role that communication plays in a health care organization; and the financial responsibility and budgetary process in health care. Your project will discuss issues and solutions in the scenario relating to:

• Delivery of evidence-based health care treatment

• Quality improvement processes

• Financial improvement/costs reduction

• Effective communication

• Formalized written policies and procedures

Answer 1

Answer:Quality improvement program on Reduction of prevalence of chronic wounds and pressure ulcers.

Pressure ulcers,defined as ulceration of the skin and/ or deeper tissues due to unrelieved pressure,represents a serious risk to patient safety and a growing litigation risk for health care workers.

Trends and challenges:

• The increasing complexity of hospitalized patients,coupled with the aging population and the escalating incidence of chronic diseases,result in a continual escalation in health care challenge.
• The human and financial costs of wound care,both to patients and health care organizations as a whole,are exorbitant.financial costs of wound care .
• Assessment,protection and support of skin integrity are lost among the many priorities managed by health care providers.
• Skin care becomes a top priority only when the impact of wound is considered with respect to infections,mortality rate,quality of life,limb amputation,pain and health care costs.
• Hospital acquired pressure ulcers represent a major failure system for patient safety and quality of care.
• A high proportion of pressure ulcers are avoidable with adequate risk assessment and pressure relieving interventions such as regular turning.

Delivery of evidence based health care treatment plays an important role in wound management.By implementing a program in skin and wound care to provide evidence based wound care management is possible,affordable and sustainable by focusing the use of advanced wound care products and proven approaches that can identify,protect and support skin integrity.By implementing proven effective prevention strategies,can decrease achievable overall wound prevalence rate.

Quality improvement process:

• Standardization in the prevention,assessment and treatment of skin and wounds.
• Training for nurses with respect to their knowledge and skills to direct skin and wound care
• Formation of a skin and wound care committee,with a nurse champion from each unit led by a wound care clinical nurse specialist.(CNS)
• The role of the CNS includes the management of wounds and dressing or assisting nurses in dressing changes and education on wound care
• Pressure ulcer prevelance a Quality indicator for outcome measures and identify the areas of improvement. Development of data collection tools and data analysis
• Implementation into practice by applcation of best practices included protocols/ procedures,decision supports,education,enhancing organizational culture,building effective team work and improving communication.
• Securingthe commitment and engagement of staff by a team of dedicated inter- professional clinicians,physicians and those who influence the process collaborated to use their collective knowledge to develop a project plan
• Sustaining the changes by on going training programs,orientation to new employees on skin and wound care program,hospital wide knowledge transfer,bi- annual prevalence study,later- organizational collaboration with community partners.

Financial improvement/costs reduction

Wound prevention and management are among the most direct and cost- effective measures a health care organization can take to improve patient safety and quality of life,and they allow for the reduction of expenditure and re- allocation of funds into other important areas

Cost reduction to wound management

• Daily changing of dressing costs utilization of nursing manpower which can reduce by dressing change three times weekly by using advanced dressing.

Written policies and procedures:

• Staff awareness and education ,product availability,clear accountabilities and expectations for performance.
• Improve the practice of wound care training and education were provided to the point-of- care clinicians
• Complete package of professional wound care training and resource materials.
• Competency- based unit delivery training addressed the application of chronic wound theory and documentation to actual patient care in the patient setting
• Divide the education module that address:- the prevention,identification,management and documentation ( pathways and assessment tools) for each type of wound ( pressure ulcers,diabetic foot ulcers,lower extremities ulcers and surgical wound)
• Integrate the acronym T.I.M.E as a framework into the education to assist nurses with the assessment and management of wounds
• T- Tissue ( type of tissue for both assessment and management)
• I- Infection ( identification and management of infection in a wound)
• M- Moisture ( amount of moisture in a wound,the assessment and management of a wound with great deal or small amount of moisture)
• E- Edge of wound which integrated the peri- wound are,tunnels and or undermining of a wound as well as the evaluation of the edge for healing process.
• For effective communication follow SBAR hand off tool