A Nursing Perspective

Medicaid’s Joint Commission And The Centre For Medicare Core Measures

The core measures of the joint commission is a stepwise process of the development that involves taking input from the multiple stakeholders, validating and aligning the care indicators of the patients among the Medicare and Medicaid centres. Core measures refer to the standards for treatment and care that help decrease complications. In shorts, it instructs the hospital to give recommended treatment for certain medical conditions (Crider & Ulrich, 2016). Three of the core measures are given below.

Three of the core measures for the heart attack-

1. Beta blocker at arrival- as it reduces the risk of death. After hospital arrival it is administered within 24 hours provided the patient is without the contradiction and above 18 years old. It strongest measure is found in patients with systolic dysfunction and EF <40%.
2. Adult smoking cessation- improves the patients with heart failure. It improves the self-reported quality of life. Smoking cessation by the counselling during the hospital stay may reduce the risk of future heart failure.
3. ACE inhibitor or Angiotensin Receptor Blocker (ARB) for Left Ventricular Systolic Dysfunction- Administering the ACE inhibitor reduces the risk of death due to heart failure by 15-25%. For those allergic to it can be given ARB. It is given  at discharge (Cms.gov, 2017)

Other areas where such core measures are available are surgical care, pneumonia management, prevention of falls and many others.

NDNQI stands for the National Database of Nursing Quality Indicators (NDNQI, 2017).  Joint Commission And Core Measures Discussion Paper

NDNQI is important for the nurses as they can deliver the evidence-based support to the patient. By linking the NDNQI with the nurse engagement survey data and the patient experience, the nurse leaders can get the comprehensive source of insights. Thus, NDNQI is important to strengthen the work environment of the nurses, assess the staff levels, increase nurse engagement, measure the nursing quality, and improve the reimbursements under the current policies for performance pay. Since, this system can track progress and meet the data requirements for a magnet recognition program it is possible for the hospitals to attain a high level of nursing performance (NDNQI, 2017).

Yes, there is a need for health care reform. It is needed due to rising health care cost and the consumption of the entire federal budget. It is unaffordable to bear the cost of the preventive care. A lot of innovative procedures have come up which are increasing the life expectancy of the elders and saving the premature babies. Even when prognosis is poor such care is given, and the rate of success is even low. Further, the malpractices lawsuits have led the doctors to prescribe the unwanted tests. Since most people do not pay for the healthcare, there is less price competition. Thus, there is need of health care reform as it will improve the quality of life.  It will help reduce the rate of chronic diseases. The health care reform will help more people to get health insurance to cover their costs. It will help in stemming the economic cost from the health care malpractices (Jacobs & Skocpol, 2015).

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Health care reform will have a good impact on nurses. Both the general nurse and the advanced practice nurse can get money for education from bill. The nurse practice programs such as innovative safety net programs are growing strong. Nurse-managed clinics are well supported with increasing grants and money. There will be no need of jumping for private fundings.  The health care reform will help in expanding the primary care as the grants will allow for sufficient nurse practitioners (Obama, 2016).

NDNQI

National Patient Safety Goals is initiated by the Joint Commission, and it helps in evaluating the care provided to the patients and its safety. The goals are set to have the specific requirements for safeguarding the patients. These goals help in responding to the concerns of the patients specifically. Thus, this critical method enforces and promotes major changes in the patient safety. These goals are designed in a manner such that it can address the medication error, hospital-acquired infections, correct patient identification, promote surgical safety, identify patients at risk for safety (Excellence, 2013).

In the past, I have worked with hip fracture patients. In this area the goals for the patient, post operations are-

• Identify the patient correctly- it is to ensure that the right patient gets right treatment and medication. Identification can be done by resident’s name, date of birth, and use of codes for health care organization.
• Improve the staff communication – it is important to get the patient’s data and important clinical results on time
• Use medication safely- administer the medications for post the hip surgery. This goal will help address the harm associated with the anticoagulant therapy.
• Prevent infections- by using hand hygiene guidelines, evidence-based options for preventing the infections at surgical site
• Prevent the patient from falling-  if in long-term care or home
• Prevent ulcers- regular assessment of the risk of developing ulcer and address the risks (mass.edu, 2017).

Nurses facilitate the patient-centred care by appreciating the perception of the patient and expression of an illness. Nurses provide the self-management support that helps in improving the patient outcomes. Nurse teaches the patient about the chronic disease and problem solving skills to disease management. They provide individualised care to the patients. The nurses ensure the patient safety, respect and dignity and it guides all the decisions (Ignatavicius & Workman, 2015).

Yes, nurses have the power to make the changes. They can participate in the evidence-based research and make changes to the care delivery. The Registered nurses do not directly have the right to formulate policies or set guidelines or modify the nursing standards. Their role is regulated by the nursing board. However, within their scope of practice, they can contribute to improving patient outcomes. For instance, the nurses have the power to innovate in primary care and engage in formal process of quality improvement (Poghosyan et al., 2013).

In my workplace, there was need of decreasing the non-compliance to the hand hygiene protocol. The issues included hospital-acquired infections. In order to deal with the issues, I had recommended the management to conduct open-ended interview to assess the level of awareness on hand hygiene among the nurses.  A survey was also conducted to get objective data. This helped in creating new policies in the workplace as it was evident from the survey that a high number of nurses did not follow the correct technique of hand wash.  It led the management to create a training program and overcome the issues. I was appreciated for my initiate as it promoted health care safety.

The common issue that is mostly encountered in the workplace is the ethical dilemma pertaining to patient freedom and nurses control. A nurse is educated and possess immense clinical knowledge of the illness. He/she is aware of the best clinical course of action. It is commonly seen that a patient rejects the pain medication despite knowing it will increase the patient outcomes. Similar it is difficult to encourage the patient to eat food when they are refusing.  Nurses are bound by their professional obligations and oaths. Welfare of the patient is priority but considering the values of the patient is the key to patient-centered care. The pros of this issue include patient’s satisfaction by respecting the care needs. The cons of such nursing issues creating debate include interpersonal value conflicts. It leads to frustration and anxiety (Oh & Gastmans, 2015).

Personally, as a nurse I believe in moral solution to such issues. I would like to comply with the framework provided by the American Association of Critical-Care Nurses. The action plan as per the framework includes-

• Ask- using verbal and non-verbal skills factors causing tension
• Affirm- resolution to the problem  by coordinating with other nurses
• Assess- determining the merits and demerits of action before implementing
• Act- Implement the action with set a time frame (Gonzalez, 2016)

References

Cms.gov. (2017). Overview of Specifications of Measures Displayed on Hospital Compare as of December 14, 2006. Cms.gov. Retrieved 10 December 2017, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Downloads/HospitalOverviewOfSpecs200512.pdf

Crider, N. M., & Ulrich, E. (2016). EVALUATION OF ORGANIZATIONS AND SYSTEMS. Evaluation of Health Care Quality for DNPs.

Excellence, B. P. (2013). The Joint Commission announces 2014 national patient safety goal. Joint Commission Perspectives.

Gonzalez, J. (2016). Exploring the Presence of Moral Distress in Critical Care Nurses.

Ignatavicius, D. D., & Workman, M. L. (2015). Medical-Surgical Nursing-E-Book: Patient-Centered Collaborative Care. Elsevier Health Sciences.

Jacobs, L., & Skocpol, T. (2015). Health care reform and American politics: What everyone needs to know. Oxford University Press.

NDNQI. (2017). NDNQI – National Database of Nursing Quality Indicators. Pressganey.com. Retrieved 10 December 2017, from https://www.pressganey.com/solutions/clinical-quality/nursing-quality

Obama, B. (2016). United States health care reform: progress to date and next steps. Jama, 316(5), 525-532.

Oh, Y., & Gastmans, C. (2015). Moral distress experienced by nurses: a quantitative literature review. Nursing Ethics, 22(1), 15-31.

Poghosyan, L., Nannini, A., Smaldone, A., Clarke, S., O’Rourke, N. C., Rosato, B. G., & Berkowitz, B. (2013). Revisiting scope of practice facilitators and barriers for primary care nurse practitioners: a qualitative investigation. Policy, Politics, & Nursing Practice, 14(1), 6-15.  Joint Commission And Core Measures Discussion Paper