FOR THE DISCUSSION IT ASKED:
Make sure to address all parts of this discussion:
1. Describe a local or domestic healthcare problem associated with your organization that creates a quality improvement opportunity. If you are not currently working for a healthcare organization, use one that you have worked for in the past or one that you hope to work for in the future.
2. Suggest an evidence-based intervention that can be implemented to affect change for the problem.
FOR THIS DISCUSSION I SAID:
Quality Improvement Opportunities and Interventions
Local Or Government Healthcare Problem Associated With Wellstar
I am working for Wellstar, and one key opportunity for improving healthcare quality that I identified lies in management of chronic diseases. This challenge has become increasingly significant given the context of population health and our organization’s patient demographics – an increasing number suffer from chronic conditions such as heart disease, respiratory disorders, diabetes and cancer. Addressing these issues requires ongoing coordination to effectively manage symptoms and prevent complications, promoting patients’ overall well-being. Most of which there is an increased rate of readmissions on patients with chronic illness, therefore leading to an increase in healthcare cost. Studies indicate that a proactive and integrated approach to managing chronic diseases can lead to improved health outcomes and reduced healthcare costs. The Centers for Disease Control and Prevention (CDC) have reported chronic conditions to be responsible for 90% of the country’s medical expenses, with efficient management substantially easing its economic impact (CDC, 2019). Additionally, Hu, Wang, & Li, (2020) found that coordinated care for patients with multiple chronic conditions led to improved clinical outcomes, including reduced hospitalizations (Hu, Wang, & Li, 2020).
Evidence-Based Intervention
An evidence-based intervention that Wellstar could implement to address the management of chronic diseases is the adoption of a Patient-Centered Medical Home (PCMH) model. The PCMH model is a comprehensive and team-based approach to primary care that emphasizes patient-centred, coordinated, and accessible care. This intervention aligns with Wellstar’s commitment to providing high-quality, patient-centered healthcare services. Research has demonstrated the effectiveness of the PCMH model in improving outcomes for patients with chronic diseases. A study by Goldberg, Gimm, Burla, and Nichols (2020) found that practices using the PCMH model were associated with better patient experiences, improved chronic disease management, and reduced hospitalizations. Additionally, a systematic review and meta-analysis concluded that the PCMH model was associated with improved self-management outcomes and hospital admissions and improvements in health-related quality of life (John, Jani, Peters, Agho, & Tannous, 2020).
In the PCMH model, a dedicated care team, including primary care providers, nurses, care coordinators, pharmacists, and other healthcare professionals, collaboratively manage patients with chronic conditions. This team approach allows for more comprehensive and proactive care, ensuring that patients receive the necessary interventions, education, and support to manage their needs effectively. Additionally, the PCMH model often incorporates advanced health information technology, including electronic health records and secure patient portals, which facilitate better communication and information sharing among members of the care team. This technology also gives patients more accessible access to their health information, empowering them to take a more active role in managing their chronic conditions (John, Jani, Peters, Agho, & Tannous, 2020).
At Wellstar, introducing this model will enable us to adopt a patient-focused strategy for managing chronic illnesses that can result in better outcomes, increased levels of satisfaction among patients and more effective healthcare resource utilization.
 
References
CDC. (2019). Health and Economic Costs of Chronic Disease. Retrieved from cdc.gov website: https://www.cdc.gov/chronicdisease/about/costs/index.htm
Goldberg, D. G., Gimm, G., Burla, S. R., & Nichols, L. M. (2020). Care Experiences of Patients with Multiple Chronic Conditions in a Payer-Based Patient-Centered Medical Home. Population Health Management, 23(4), 305–312. https://doi.org/10.1089/pop.2019.0189
Hu, J., Wang, Y., & Li, X. (2020). Continuity of Care in Chronic Diseases: A Concept Analysis by Literature Review. Journal of Korean Academy of Nursing, 50(4), 513. https://doi.org/10.4040/jkan.20079
John, J. R., Jani, H., Peters, K., Agho, K., & Tannous, W. K. (2020). The Effectiveness of Patient-Centred Medical Home-Based Models of Care versus Standard Primary Care in Chronic Disease Management: A Systematic Review and Meta-Analysis of Randomised and Non-Randomised Controlled Trials. International Journal of Environmental Research and Public Health, 17(18), 6886. https://doi.org/10.3390/ijerph17186886
BUT NOW I HAVE TO:
In response to your peers, suggest an evidence-based intervention that has not already been suggested within the thread and explain the reasoning behind your recommendation.
THE PEER SAID:
Describe a local or domestic healthcare problem associated with your organization that creates a quality improvement opportunity.
For many women, having a baby is one of the most joyous times of her life. During the nine-month pregnancy, she envisions the magical moment of meeting her little one, finally seeing their face, kissing them, snuggling with them. What she doesn’t imagine is suffering from a postpartum hemorrhage.
A postpartum hemorrhage (PPH) is an obstetrical emergency that happens after a vaginal or cesarean delivery. Clinicians expect some bleeding with childbirth, however, vaginal deliveries resulting in more than 500ml blood loss or c-sections with more than 1,000ml blood loss is considered a postpartum hemorrhage (Durmaz & Komurcu, 2018). There are five liters of blood in the human body, I’ve had PPHs where women lost all five liters. Miraculously, they survived – and in part, due to fast acting providers, nurses, and life saving measures. One of my most significant, and quite possibly a life-or-death responsibility as a labor and delivery nurse is to proactively assess maternal postpartum hemorrhage risk factors. I also conduct interventions before and after delivery to lessen the risk of a postpartum hemorrhage or complications arising from one.
Sadly, the United States has seen in an increase of postpartum hemorrhages over the last twenty years compared to other industrialized nations. The worldwide maternal mortality rate was on a decline in 2017, but the World Health Organization (WHO) reported that the United States was one of only two countries (the other the Dominican Republic) to report a critical increase in maternal mortality rate (Jayakumaran et al., 2020). From 2000 to 2019, the U.S. rate of postpartum hemorrhage increased from 2.7% to 4.3% (Corbetta-Rastille et al., 2023). The Centers for Disease Control, the American College of Obstetricians and Gynecologists, and the Mayo Clinic Obstetrics and Gynecology have devoted clinical research, technology, and resources to improving postpartum hemorrhage analysis, prevention, and interventions (Mayo Clinic, 2022). Due to the rise of PPHs in the U.S., there is a pressing need for quality improvement.
Suggest an evidence-based intervention that can be implemented to affect change for the problem.
The foundation of healthcare is quality care and patient safety. Evidence-based practice is utilized to implement the most up to date, scientifically based clinical care to ensure equality and safety (John Hopkins Nursing, 2023).
The research by Brenner et al. (2019) concluded that the WHO proposes that women with a postpartum hemorrhage receive 1 gram of tranexamic acid (TXA) intravenously as soon as possible after giving birth. TXA is an antifibrinolytic medication, meaning it inhibits the breakdown of blood clots, thus reducing the bleeding (Farenholtz et al., 2019). The WHO recommends that TXA is included in the standard comprehensive obstetrical care after delivery. A second dose may be administered if bleeding continues after 30 minutes or bleeding restarts within 24 hours (Brenner et al., 2019). In the WOMAN trial, TXA reduced deaths relate to blood loss. This medication should be given quickly and urgently. This medication is most effective when given early (Brenner et al., 2019). Another evidence-based study by Farenholtz et al. (2019) determined that the use of TXA decreased the occurrence of PPH and the amount of blood loss during a delivery when given at the time of delivery. This medication should be routinely given with all deliveries to promote quality care and safety. The administration of TXA is vital evidence-based practice that reduces maternal deaths related to postpartum hemorrhages.
References:
Brenner, A., Ker, K., Shakur-Still, H., Roberts, I. (2019). Tranexamic acid for post-partum haemorrhage: What, who and when. Best Practice & Research Clinical Obstetrics & Gynaecology, 61, 66-74. https://doi.org/10.1016/j.bpobgyn.2019.04.005.
Corbetta-Rastelli, C.M., Friedman, A.M., Sobhani, N.C., Arditi, B., Goffman, D., Wen, T. (2023). Postpartum hemorrhage trends and outcomes in the United States 2000-2019. The American College of Obstetricians and Gynecologists, 141(1), 152-161. https://doi.org/10.1097/AOG.0000000000004972
Durmaz, A. & Komurcu, N. (2018). Relationship between maternal characteristics and postpartum hemorrhage: A meta-analysis study. The Journal of Nursing Research, 26(5), 362-372. https://doi.org/10.1097/jnr.0000000000000245
Fahrenholtz, C. G., Bonanno, L. S., Martin, J. B. (2019). Tranexamic acid as adjuvant treatment for postpartum hemorrhage: a systematic review protocol. The Journal of Biomedical Informatics, 17(8), 1565-1572. https://dx.doi.org/10.11124/JBISRIR-2017-003978
Jayakumaran, J., Schuster, M., & Ananth, C.V. (2020). Postpartum hemorrhage and its risk of maternal deaths in the US. The American Journal of Obstetricians & Gynecologists, 222(1), 178-179. https://doi.org/10.1016/j.ajog.2019.11.276
Mayo Clinic. (2022, June 01). Postpartum hemorrhage, risks and current management. https://www.mayoclinic.org/medical-professionals/obstetrics-gynecology/news/postpartum-hemorrhage-risks-and-current-management/mac-20533920#:~:text=Atony.-,The%20No.,Overdistension%20of%20uterine%20muscle.
John Hopkins Nursing-Center for Nursing Inquiry. (2023). Evidence-based practice. John Hopkins Medicine. https://www.hopkinsmedicine.org/nursing/center-nursing-inquiry/nursing-inquiry/evidence-based-practice
Posts and responses must be evidence-based and include sources in the most recent APA form.
Use scholarly writing to support your initial post, as well as all of your responses.
Cite references using proper APA.
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