Prepare an 8–10-page data analysis and quality improvement initiative proposal based on a health issue of professional interest to you. The audience for your analysis and proposal is the nursing staff and the interprofessional team who will implement the initiative.    Initiative Proposal for Saint Anthony Medical Center by Villa Health Essay Paper

“A basic principle of quality measurement is: If you can’t measure it, you can’t improve it” (Agency for Healthcare Research and Quality, 2013).

Health care providers are on an endless quest to improve both care quality and patient safety. This unwavering commitment requires hospitals and care givers to increase their attention and adherence to treatment protocols to improve patient outcomes. Health informatics, along with new and improved technologies and procedures, are at the core of virtually all quality improvement initiatives. The data gathered by providers, along with process improvement models and recognized quality benchmarks, are all part of a collaborative, continuing effort. As such, it is essential that professional nurses are able to correctly interpret, and effectively communicate information revealed on dashboards that display critical care metrics.
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By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 2: Plan quality improvement initiatives in response to routine data surveillance.
Outline a QI initiative proposal based on a selected health issue and supporting data analysis.
Competency 3: Evaluate quality improvement initiatives using sensitive and sound outcome measures.
Analyze data to identify a health care issue or area of concern.
Competency 4: Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work-life quality.
Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work-life quality.
Competency 5: Apply effective communication strategies to promote quality improvement of interprofessional care.
Apply effective communication strategies to promote quality improvement of interprofessional care.
Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.

Reference

Agency for Healthcare Research and Quality. (2013). Preventing falls in hospitals. Retrieved from https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtk5.html#tiptop Initiative Proposal for Saint Anthony Medical Center by Villa Health Essay Paper

Data Analysis and Quality Improvement Initiative Proposal for Saint Anthony Medical Center (SAMC) by Villa Health
The concept of quality improvement in healthcare is a central issue with regard to patient safety and patient outcomes. As a matter of fact, regulatory agencies such as the Agency for Healthcare Research and Quality or AHRQ as well as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) exist for the sole purpose of guaranteeing that quality is maintained. These regulatory agencies monitor providers and provide quality guidelines that providers are expected to implement. Compliant healthcare organizations then get certifications that show that they provide quality healthcare conforming to set quality standards. Within individual healthcare organizations, there are quality improvement committees that regularly check for areas that need improvement and initiate quality improvement (QI) initiatives to correct them. However, both at the organizational level and the regulatory level, success at quality improvement relies on sound data and data analysis. It is this healthcare data that effectively drives every QI initiative in a sound and scientific way (Wang et al., 2018; Raghupathi & Raghupathi, 2014). To collect data effectively and accurately, both providers and regulatory agencies like AHRQ and JCAHO rely on technology and technological solutions. The notion that technology could be the solution to mitigating human error in healthcare had been fronted first by the 1999 report by the Institute of Medicine (IOM) christened To Err Is Human (Palatnik, 2016). This paved the way for the introduction of the electronic health record or EHR system whose use was made obligatory by the Health Information and Technology for Economic Clinical Health Act or HITECH’s Meaningful Use program (Sweeney, 2017). At the moment, it is the EHR system dashboards in healthcare organizations that facilitate the monitoring of performance and quality metrics that drive quality improvement initiatives. In this, nurse informaticists play a very important role (McGonigle & Mastrian, 2017; Darvish et al., 2014). This is because they are the custodians and resource persons of the EHR systems and the data stored in them. They help secure the systems, train fellow healthcare employees like nurses and physicians in its use, and generally troubleshoot when there is a system issue (McGonigle & Mastrian, 2017). The purpose of this paper is to make use of the available hospice data for Saint Anthony Medical Center and propose a quality improvement initiative through the analysis of that data.
Analysis of Data to Identify an Area of Concern

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The Type of Data Being Analyzed
The type of data that is being analyzed in this particular case concerns the performance in a hospice unit of the SAMC. It is data related to the monthly reporting of events and figures in the hospice unit for the year 2014 and 2015. In particular, the data captures the monthly figures for the length of stay (LOS) at the hospice, in-patient unit (IPU) admissions, pain level of a severity of 7-10 for more than 24 hours, and inadequate symptom relief for more than 24 hours. The data for the two consecutive years is juxtaposed so that comparison can be made and the trend analyzed with ease.
Why this Data Matters, What It Is Telling Us, and What Is Missing
This data from the hospice of SAMC matters for several reasons. First, the length of stay of a hospice patient at the facility is indicative of how long they will have lived in their terminal state before passing on. With this in mind, therefore, a LOS of less than 7 days would mean that the terminally ill patient was in the hospice for just less than one week before passing away. In these circumstances, it becomes difficult to ascertain whether the loss of life is due to poor quality of care at the hospice or late referral when the patient has already deteriorated to a point of no return. Secondly, admission to the IPU of the hospice would indicate that the patient’s condition has deteriorated so much so that they need closer 24-hour supervision and treatment. A deterioration in condition could be a result of the natural progression of the disease; but it could also be the result of poor hospice care that lacks in quality. Of course, for a hospice patient who is terminally ill to have pain rated 7-10 (severe pain) for more than 24 hours it would mean that the quality of pain relief measures at the hospice is wanting. One of the main objectives of hospice care is to improve the quality of life of the patient as opposed to treating the underlying condition. Inability to provide appropriate pain relief is therefore poor quality care. Lastly but not least, this data is important because it also provides monthly data for inadequate symptom relief occurring for more than 24 hours. This would mean that the quality of care at the hospice is low allowing patients to have symptoms for more than 24 hours.
The data from SAMC hospice is telling us a lot of things. It is telling us that in 2014 from January to December, the number of patients who stayed at the hospice for less than 7 days before passing on was 50 patients. It is also telling us that:
• Total in-patient unit admissions for 2014 was 47 patients
• The total number of patients in 2014 with severe pain rated 7-10 for more than 24 hours was 13, and
• The total number of patients with inadequate symptom relief for more than 24 hours at the SAMC hospice in 2014 was also 13 patients.
The grand total of all the patients in these four categories who passed through the SAMC hospice in 2014 is 123 patients.
In contrast and for the same measures, the data from this hospice tells us that in 2015:
• Total of 46 terminally ill patients had a LOS of less than 7 days at the facility
• 27 patients had IPU admission
• 17 patients reported having pain levels of 7-10 severity rating for more than 24 hours, and
• 22 patients reported having inadequate symptom relief for a duration of more than 24 hours.
Assessing this data, what appears to be missing is the mortality rate. This data on deaths is significant because it would then place the rest of the data into context and enable better comparison and the drawing of inferences. For instance, if there are fewer deaths in a year compared to the number of patients who had IPU admissions. This would mean that most referrals occurred when it was too late and the patients were already close to death (maybe dying within a day or two of being brought).
Analysis of Dashboard Metrics and Provision of the Data Set in the Proposal
Analysis of the dashboard metrics reveals that an average of 4.2 patients had a length of stay of less than 7 days from January to December in 2014. Another average of 3.9 patients were admitted in the IPU in that year. On pain, an average of 1.08 patients reported severe pain rated 7-10 on a scale of 1-10 and lasting for more than 24 hours. Lastly, another average of 1.08 patients also reported inadequate symptom relief lasting for more than 24 hours in 2014. A side-by-side comparison of these metrics between 2014 and 2015 is presented in the table below.
Table 1: A data set of comparison of EHR dashboard metrics between 2014 and 2015 for the Saint Antony Medical Center (SAMC) hospice

Dashboard Metric Average Number of Patients
2014 2015
Length of stay (LOS) of less than 7 days 4.2 3.8
IPU admission 3.9 2.25
Pain level of 7-10 for more than 24 hours 1.08 1.40
Inadequate symptom relief for more than 24 hours 1.08 1.80

Presentation of the Dashboard Metrics Related to the Selected Issue
A close examination of the above dashboard metrics shows that between 2014 and 2015, the number of patients at the hospice who had a LOS shorter than 7 days has reduced from an average of 4.2 to 3.8 patients. This is good news because it shows that effective care is making the terminally ill patients stay longer at the facility while receiving care. Also, the average number of patients admitted to the IPU of the SAMC hospice between 2014 and 2015 reduced from 3.9 patients to 2.25 patients. This means care is efficient and effective that the patients are not deteriorating so much to an extent of requiring admission to the IPU.
However, the above (reductions in metrics with an optimistic outlook) is not the same with the dashboard metrics concerning pain management and symptom relief. These are the ones related to the selected QI issue of poor pain management and ineffective symptom relief. The dashboard metrics related to this issue of interest are:
• A rise in the average number of patients with a pain level of 7-10 for more than 24 hours from 1.08 in 2014 to 1.40 in 2015.
• A rise in the average number patents with inadequate symptom relief lasting for more than 24 hours from 1.08 in 2014 to 1.80 in 2015.
Clearly, the dashboard of the hospice is showing that the quality improvement issue at hand that needs to be addressed through a QI initiative is inadequate ain relief and ineffective symptom relief.
Performance Failures and Stability of Processes
For pain management and symptom relief in a hospice setup to be poor, there must be performance failure and lack of stability of the internal processes. This performance failure may have occurred at the structural or process level. Structurally, it may be that the hospice nurses are not given the authority to administer stronger pain relieving medications unless a particular person authorizes the same. On the other hand, if it is a process failure then the standard operating procedures (SOPs) are the ones that are at fault. For instance, it may be that the procedure at the hospice is that once medication is given, no other dose or type of medication will be administered even if the patient reports an increase in their pain. The structural and process failures must therefore be addressed with QI according to the Donabedian principle (Moore et al., 2015). There is therefore a sense that there is no stability of processes and outcomes in this hospice and that needs to be corrected.
Quality of the Data and Lessons Learnt, Trends and Outcome Measures, and Opportunities for QI
A look at the data above shows that it is of good quality. This is because it is detailed enough to show which particular months had what statistics. This is important because the QI initiative can set out to investigate and find out why those particular months had those concerning statistics. What can be learnt from this is that healthcare data appearing on the EHR dashboard should be detailed and unambiguous for ease of analysis. The outcome measures and information needed to calculate specific rates include admission rates and mortality rates. In this, the trend shows an increase in the occurrence of undesirable outcomes with regard to pain and symptom management. Lastly, the metrics that indicate opportunities for quality improvement are those for the (i) pain level of 7-10 for more than 24 hours, and (ii) inadequate symptom relief for more than 24 hours.
The Quality Improvement Initiative Proposal Based on the Selected Health Issue and the Above Data Analysis
Benchmarks aligned to existing QI initiatives set by local, state, and federal laws and other policies exist. They allow for aggressive management of intractable pain in palliative care by physicians and nurses in a very controlled manner. This is because the laws allow for the use of the strongest opioid medications (controlled drugs) in these circumstances. However, some of these QI initiatives are insufficient probably due to structural and/ or process inefficiencies as has been discussed above from a Donabedian perspective. Cea et al. (2016) in their study found that use of valid pain rating scales in hospices in the United States was relatively low (just 69% and 54% for the initial and last assessments). They found that up to 95% of the patients were given pain medications but only 42% received nonpharmacologic pain therapy. It can therefore be concluded that the non-utilization of nonpharmacologic therapies for pain management in the hospices could partly explain the insufficiency of pain relief. The target areas for improvement include proper and timely use of pain assessment tools, empowerment of the registered nurses in decision making, and entrenchment of the bioethical principle of autonomy with regard to the terminally ill patient (Haswell, 2019). Thus the terminally ill patient should be granted their wish whenever they request for pain relief medication or therapy. The processes that can therefore be modified to improve outcomes are pain assessment, pain monitoring, and medication/ therapy administration.
The proposed evidence-based strategies to improve quality in this case therefore include:
i. Effective pain assessment using one of the several pain assessment tools (Cea et al., 2016)
ii. Use of alternative and other nonpharmacologic therapies such as music and also to alleviate pain and provide symptom relief. A study by Pommeret et al. (2019) found that music produced significant benefit to hospice patients in terms of pain relief and symptom management (Pommeret et al., 2019).
iii. Streamlining the structure of pain intervention at the hospice in terms of the chain of command for interventions.
iv. Empowerment of the hospice nurses to make decisions independently after critical evaluation of situations.
A comparison of QI initiatives for this healthcare issue with existing quality indicators from other facilities, governmental and non-governmental agencies and bodies shows that the situation is no different with those other bodies. The same quality drawbacks prevail in those institutions and require to be addressed.
The challenges posed by compliance to prescribed benchmarks for a healthcare organization and the interprofessional team could be summarized a strain on fiscal resources, the need to obtain buy-in of employees, and the risk to organizational reputation. Meeting prescribed benchmarks means setting up a budget for training and equipment purchase. It also poses the challenge of devising ways of enticing the employees to give their buy-in so that the project can succeed. Last but not least is that by deciding to meet the prescribed benchmarks, the organization is opening itself up for scrutiny and may suffer reputation damage in the process when other stakeholders hear of the quality problems they were having. The interprofessional team is mainly challenged by the need to obtain buy-in from the employees as they must first come up with strategies to achieve this.
Integration of Interprofessional Perspectives to Lead Quality Improvements in Patient Safety, Cost Effectiveness, and Work-Life Quality
Offering palliative care requires great interprofessional collaboration among the healthcare team members and others. The roles and responsibilities of the interprofessional team members are geared towards the same goal. They are to keep the terminally ill patient symptom-free and to improve the quality of their remaining lives. To do this, the physician will prescribe with understanding, the nurse will counsel an administer therapy/ medication with compassion, and the others including music artists will play their craft with emotional attachment and empathy to uplift the spirits of the patients and make them smile. To ensure that all roles are engaged in fully, care coordination and transformational leadership will be required. This will mean having effective communication at all times and ensuring psychological safety at the workplace where everybody works towards the wellbeing of the patient without fear of victimization or blame (Choi et al., 2016). In other words, I will have to act as the patient advocate and the care coordinator who prevents fragmentation by keeping the objective and roles of the interprofessional team members aligned.
The non-nursing concepts that I would incorporate into the initiative are systems theory and six sigma’s zero defects (Williams, n.d.). The former helps to understand the importance of everyone’s contribution in the larger scheme of things. The latter is a QI model used in product manufacturing (especially vehicles) that has zero tolerance to defects or errors. In this case, no patient should be allowed at any given time to have pain or experience symptoms (defects). Outcomes to measure the effects of the intervention affect the interprofessional team in that favorable outcomes will motivate them while failure will discourage effort. If the proposed intervention succeeds and the patients are effectively kept pain and symptom free, job satisfaction will increase and work stress will decrease. This will elevate work-life quality as the nurses and interprofessional team in general will be uplifted in spirits and feel that they are doing something for society. This psychological wellbeing will translate to a healthier life even outside the hospital.
Effective Communication Strategies Promoting Quality Improvement of Interprofessional Care
The kind of interprofessional communication strategies needed for effectiveness and successful performance are two-way communication and bottom-up communication approaches. These will ensure everybody is heard and contributes to the patient’s management without fear. Apart from writing and entering data in the electronic system, the SBAR (Situation-Background-Assessment-Recommendation) tool will also be included in the quality initiative proposal. It will be useful in passing information about a patient among the interprofessional team members.  Initiative Proposal for Saint Anthony Medical Center by Villa Health Essay Paper

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References
Cea, M.E., Reid, M.C., Inturrisi, C., Witkin, L.R., Prigerson, H.G., & Bao, Y. (2016). Pain assessment, management, and control among patients 65 years or older receiving hospice care in the U.S. Journal of Pain and Symptom Management, 52(5), 663-672. https://doi.org/10.1016/j.jpainsymman.2016.05.020
Choi, S.L., Goh, C.F., Adam, M.B.H., & Tan, O.K. (2016). Transformational leadership, empowerment, and job satisfaction: The mediating role of employee empowerment. Human Resources for Health, 14(1), 73. https://doi.org/10.1186/s12960-016-0171-2
Darvish, A., Bahramnezhad, F., Keyhanian, S. & Navidhamidi, M. (2014). The role of nursing informatics on promoting quality of health care and the need for appropriate education. Global Journal of Health Science, 6(6), 11–18. https://doi.org/10.5539/gjhs.v6n6p11
Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177
McGonigle, D., & Mastrian, K.G. (2017). Nursing informatics and the foundation of knowledge, 4th ed. Jones & Bartlett Learning.
Moore, L., Lavoie, A., Bourgeois, G., & Lapointe, J. (2015). Donabedian’s structure-process-outcome quality of care model. Journal of Trauma and Acute Care Surgery, 78(6), 1168–1175. Doi: https://doi.org/10.1097/TA.0000000000000663
Palatnik, A. (2016). To err is human. Nursing Critical Care, 11(5), 4. Doi: https://doi.org/10.1097/01.CCN.0000490961.44977.8d
Pommeret, S., Chrusciel, J., Verlaine, C., Filbet, M., Tricou, C., Sanchez, S., & Hannetel, L. (2019). Music in palliative care : A qualitative study with patients suffering from cancer. BMC Palliative Care, 18(78), 1-6. https://doi.org/10.1186/s12904-019-0461-2
Raghupathi, W. & Raghupathi, V. (2014). Big data analytics in healthcare: Promise and potential. Health Information Science and Systems, 2(3). https://doi.org/10.1186/2047-2501-2-3
Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics (OJNI), 21(1). https://www.himss.org/library/healthcare-informatics
Wang, Y., Kung, L., & Byrd, T.A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3–13. https://doi.org/10.1016/j.techfore.2015.12.019
Williams, P.H. (n.d.). Zero defects: What does it achieve? What does it mean? Isixsigma. https://www.isixsigma.com/new-to-six-sigma/sigma-level/zero-defects-what-does-it-achieve-what-does-it-mean/

Further Instructions
Analyze dashboard metrics related to the selected issue.
• Provide the selected data set in the proposal.
o Assess the stability of processes or outcomes.
o Delineate any problematic variations or performance failures.
• Evaluate QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and non-governmental bodies on quality improvement.
o Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization and the interprofessional team.
• Outline a QI initiative proposal based on the selected health issue and data analysis.
o Identify target areas for improvement.
o Define what processes can be modified to improve outcomes.
o Propose strategies to improve quality.
o Define interprofessional roles and responsibilities as they relate to the QI initiative.
o Provide recommendations for effective communication strategies for the interprofessional team to ensure the success of the QI initiative. Briefly reflect on the impact of the proposed initiative on work-life quality of the nursing staff and interprofessional team.
• Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.
Note: Remember, you can submit all, or a portion of, your draft to Smarthinking for feedback, before you submit the final version of your analysis for this assessment. However, be mindful of the turnaround time for receiving feedback, if you plan on using this free service.
The numbered points below correspond to grading criteria in the scoring guide. The bullets below each grading criterion further delineate tasks to fulfill the assessment requirements. Be sure that your Quality Improvement Initiative Evaluation addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels that relate to each grading criterion.
1. Analyze data to identify a health care issue or area of concern.
o Identify the type of data you are analyzing (from your institution or from the media piece).
o Discuss why the data matters, what it is telling you, and what is missing.
o Analyze dashboard metrics and provide the data set in the proposal.
o Present dashboard metrics related to the selected issue.
o Delineate any problematic variations or performance failures.
o Assess the stability of processes or outcomes.
o Evaluate the quality of the data and what can be learned from it.
o Identify trends, outcome measures and information needed to calculate specific rates.
o Analyze what metrics indicate opportunities for quality improvement.
2. Outline a QI initiative proposal based on a selected health issue and supporting data analysis.
o Identify benchmarks aligned to existing QI initiatives set by local, state, or federal health care policies or laws.
o Identify existing QI initiatives related to the selected issue, and explain why they are insufficient.
o Identify target areas for improvement, and define what processes can be modified to improve outcomes.
o Propose evidence-based strategies to improve quality.
o Evaluate QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and non-governmental bodies on quality improvement.
o Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization and the interprofessional team.
3. Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work-life quality.
o Define interprofessional roles and responsibilities as they relate to the data and the QI initiative.
o Explain how you would you make sure that all relevant roles are fully engaged in this effort.
o Explain what non-nursing concepts would you incorporate into the initiative?
o Identify how outcomes to measure the effect of the intervention affect the interprofessional team.
o Briefly reflect on the impact of the proposed initiative on work-life quality of the nursing staff and interprofessional team. Describe how work-life quality is improved or enriched by the initiative.
4. Apply effective communication strategies to promote quality improvement of interprofessional care.
o Identify the kind of interprofessional communication strategies that will be effective to promote and ensure the success of this performance improvement plan or quality improvement initiative.
o In addition to writing, identify communication models (like CUS, SBAR) that you would include in your initiative proposal.
5. Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
6. Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.
Submission Requirements
• Length of submission: 8–10 double-spaced, typed pages, not including title and reference page.
• Number of references: Cite a minimum of five sources (no older than seven years, unless seminal work) of scholarly, peer-reviewed, or professional evidence that support your evaluation, recommendations, and plans.

This piece must be utilized in the paper
Capella Multimedia
Use this media piece if you do not have access to dashboard metrics to complete the final assessment.
Vila Health™
Data Analysis
• Introduction
• Email from Sienna Pope
• Hospice Adverse Event Data 2014-2015
• Interviews with Stakeholders
• Email Response to Sienna Pope
• Conclusion
• Credits
Introduction
Quality improvement initiatives are a critical tool in the ongoing effort to improve patient care at health care organizations. But without data, many QI initiatives would fail — or the problem behind them might never be detected. That’s why data, and the dashboards that present data in a comprehensible fashion, are essential for QI efforts to succeed.
In this activity, you will assume the role of a quality assurance analyst at St. Anthony Medical Center. You will be offered both a dataset that you can use to outline a quality improvement initiative, and input from stakeholders who can help you contextualize the data.
Educational Goals
After completing the activity, you will be prepared to:
• Analyze data to identify a health care issue or area of concern.
• Outline a QI initiative proposal based on a selected health issue and supporting data analysis.
• Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work–life quality.

Email from Sienna Pope
QI Data For You
From: Sienna Pope, Director of Medical Support Services
To: Patricia Ollom
Patricia,
Hi! I heard through word of mouth that you were looking for some possible areas of improvement in the hospital. I’ve got some data from SAMC’s in-home hospice program that might be useful.
I realize that you may not be familiar with the hospice program, so I also set up some meetings with a few people with a stake in the program. I’m hoping they can give you some context for the data you’re looking at.
Let me know if you need anything!
Sienna Pope,
Director of Medical Support Services

Hospice Adverse Event Data 2014-2015
Per Vila Health policy, these figures include near misses as well as events that resulted in some level of harm or potential harm to the patient. This is a summary of the data; a downloadable spreadsheet that provides all the data you will need for your presentation is also available below.
Unit – Year LOS Less than 7 Days IPU Admission Pain Level 7-10 More than 24 Hours Inadequate Symptom Relief More than 24 Hours
Hospice 2014 50 47 13 13
Hospice 2015 46 27 17 22
Download XLS  Initiative Proposal for Saint Anthony Medical Center by Villa Health Essay Paper

Interviews with Stakeholders
Here is a list of stakeholders that you had the opportunity to interview.
Roger Goldenberg
Director of Hospice Services
Jackie Sandoval
Chief Nursing Officer
David Brooks
Quality Assurance Director
Owen Welch
CFO
Owen Welch
CFO
• What is the current state of the hospice program’s physical plant?
Well, the current technology — secure laptops with remote access to the EHR — is working, although I think there’s always something better out there. We’re thinking about experimenting with video conferencing to improve care on site; for example, when a physician isn’t available but another is available by video link, that’s an opportunity to improve care. I’ve heard of technology that pushes electronic alerts to hospice nurses so that they can coach caregivers to deliver better care. But of course, we can’t have everything.
• Do you feel that the hospice program is resourced adequately?
Well, of course, as with any offsite program like this, you start to have staff issues when staff are stretched too thin. So are they having to spend too much time traveling to patient’s homes, or feeling that their patient census is too high to give each patient the care they really need? I like to think that we’ve balanced care loads among our hospice nurses pretty well. But we can’t know if we’re wrong — absent adverse events, which we really don’t want — unless our nurses tell us.
Roger Goldenberg

Director of Hospice Services
• What are the overall goals of the hospice program?
Well, given the unique mission of hospice, we take a different tack from other practices. Since we’re providing end-of-life care, our goal is comfort care, not urgent or life-saving care. That means we treat the symptoms, not the disease. Unlike other units, the patient is a recipient of care, but so is the family.
• What is your approach to meeting those goals?
We use a holistic approach, in that we try to address not just physical, but also emotional, psychological, and spiritual needs. With each patient, there’s an interdisciplinary team that delivers care at home. When symptoms arise that need more aggressive management than home care can provide, we do temporary inpatient admissions.
Jackie Sandoval
Chief Nursing Officer
• Roger Goldenberg mentioned that an interdisciplinary team is an important part of the hospice approach. Who do you consider to be part of that team?
Many different roles, actually. Of course the nurse, a hospice physician, and a social worker are going to be involved. Often home health aides are part of the team, as well as the volunteer coordinator and the chaplain. Depending on the patient and their circumstances, sometimes music, art, or physical therapists are also engaged in the patient’s care.
• What would you consider to be quality-related “red flags” as far as the data categories?
One big problem we see in hospice is that patients are referred too late — that is, too close to their end of life. So they aren’t able to receive all of the benefits of being in the hospice program. So length of stay is something you’ll want to look at. Then, of course, the effectiveness of pain and symptom management.
• How do hospice nurses document and communicate data between their on-site location and the rest of the team?
All of our hospice nurses carry laptops so they can live-chart patient-related data, just like inpatient nurses on site use connected devices to update the EHR. In some homes, where wi-fi isn’t available, those nurses just take notes on their laptops on site and then chart later.
David Brooks

Quality Assurance Director
• What are the processes that the hospice program uses to ensure safety?
We’ve got processes and procedures in place for managing movement for patients who are at risk of falls, for maintaining sanitary conditions, for managing medical waste (for example, if a patient has a catheter in place), and for safe storage of pain and other medications. And we have processes for pain assessment, which are also part of our protocol for assessing the need for an IPU admission.
• What about quality?
That’s somewhat reflected in our adverse event reporting. Obviously, we’re not delivering quality care if all we do is prevent adverse events. But our processes are geared to prevent those events and make sure we’re helping the patient to face the end of life as comfortably as possible. So our nurses monitor pain levels, symptom levels, and the patient’s overall level of comfort, as well as that of the family and caregivers. They ask a lot of specific and general questions to get at the patient’s quality of life, from their own perspective and from that of their loved ones.
Email Response to Sienna Pope

QI Data For You
From: Sienna Pope, Director of Medical Support Services
To: Patricia Ollom
I hope you got what you needed from Jackie, David, Roger, and Owen. Can you send me an email and let me know what your initial thoughts are? It doesn’t have to be anything formal, just your ideas about what the data suggest, and whether there are any QI initiatives that you would recommend based on what you’re seeing. If there are, make sure you explain how the initiatives you recommend might affect the different roles on the hospice team.
Thanks!
— Sienna
Your reply to Sienna’s email should summarize what you’ve learned during this activity. It might also be helpful to articulate any questions or research you plan to do. The reply will be available in your activity log and can be used as a pre-writing activity for the unit assignment.
Email you sent
What is the nurse to patient ratio?
Has anyone directly talked to the nurses to inquire how they feel their workload and quality of care correlates?
Is it possible to offer a hot spot so nurses are real-time charting? This would allow the team to see the assessment immediately versus when the nurse has an opportunity.
Is there any concrete data on the following: pain assessment, when the patient was placed on hospice, medications utilized to control pain and dosages, nurse to patient ratio?
I am sure I will have more questions once I reevaluate the interviews.

Conclusion
Having met with some stakeholders, you should now have a solid understanding of what the data you gathered is telling you. You should be able to use this information to complete your assignment in the course.
Benchmarks for Quality Indicators
These databases provide recognized benchmarks for quality indicators.
• Montalvo, I. (2007). The national database of nursing quality indicators. Online Journal of Issues in Nursing, 12(3), 1–11.
• The Joint Commission. (2017). National patient safety goals. Retrieved from https://www.jointcommission.org/standards_information/npsgs.aspx . Initiative Proposal for Saint Anthony Medical Center by Villa Health Essay Paper