Data Analysis and Quality Improvement Initiative

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A quality improvement initiative is established and implemented to observe, evaluate, and improve the quality of health care in a given organization. Health organizations do not exist only to make profits but also to ensure patients are well catered for. SAMC’s in-home hospice seeks to provide palliative care to patients with terminal illnesses to provide comfort during their last moments on earth. However, it has recorded cases of patients living with high levels of pain and inadequate symptom relief. The proposed QI initiative aims at controlling pain and managing symptoms through an amalgamation of effective communication, pain assessment tools, and the right medication based on pain levels.

Data Analysis of the In-home Hospice Program

The program that I seek to improve is the SAMC’S in-home hospice program. In 2014, the length of stay in less than seven days was 50; there were 47 inpatient unit admissions, 13 cases of high pain levels of 7-10 in more than 24 hours, and 13 inadequate symptom relief cases in more than 24 hours. In 2015, the length of stay in less than seven days was 46; there were 27 IPU admissions, 17 cases of high pain levels of 7-10 in more than 24 hours, and 22 inadequate symptom relief cases in more than 24 hours.

This data matters a lot because it shows the performance of the hospice between 2014 and 2015. Within the two years, pain levels between 7 and 10 increased from 13 to 17, while inadequate symptom relief cases increased from 13 to 22. The data shows that the hospice is failing in pain control and symptom management. A hospice’s purpose is to improve a patient’s quality of life during their moments and manage pain and symptoms.

Pain and symptoms management is an important part of hospice programs because it improves a patient’s wellness and buys the patient more time on earth. Pain management seems to be weak in this case. Palliative symptom management includes managing the physical, psychological, and spiritual aspects of pain and suffering to manage and realize total relief (Dy et al., 2016). The hospice has recorded high inadequate system relief cases. The data shows that the areas of improvement include pain management and system relief management.

Stability of Processes/Outcomes

The processes in the in-home hospice programs may be somewhat unstable based on the data presented. In this case, the program is not performing well in managing pain and symptoms relief, which might hasten death, which is contrary to the aim of a hospice program. I believe that this data is of high quality and reliable because it came from the hospital’s database and was shared by Sienna Pope, the Director of Medical Support Services. The data teaches us that improvements need to be made to advance the processes of pain management and symptoms relief. Outcome measures and information needed to calculate the quality and performance improvement include coordinated teamwork, pain and symptoms management, patient and staff satisfaction, and effective and time-bound responsiveness (Dy et al., 2015). The metrics that show the opportunity for quality improvement are the increased pain levels and inadequate system relief, which shows that patients are going through tough experiences while in the in-home hospices, which shouldn’t be the case.

Quality Initiative Proposal

Benchmarking involves a comparison of the organization’s performance against another organization’s performance, federal, and other regulatory standards. It is an essential tool that is used to spot areas of improvement. Medicare and Medicaid established quality measure benchmarks, efficient in evaluating healthcare performance in-home care services. These benchmarks are usually used by organizations with Medicare shared savings programs. The programs inspire health practitioners to work together to provide efficient care to Medicare beneficiaries. These benchmarks include patient/staff experience, coordinated care, patient safety, and risk prevention. Accountable Care Organizations provide performance measures, which are providing on-time services, effective communication between the patient and the care providers, how the patient rates the caregiver, access to shared decision-making, patient safety, and pain and symptom management (Centers for Medicare & Medicaid Services, 2017).

Performance measures that have been used in benchmarking various quality initiatives include pain assessment and symptoms management, quantitative pain rating scale, dyspnea assessment, documentation, psychosocial assessment, and patient/family communication. Benchmarking strategies include outcome measures, performance indicators, and process measures. Outcome measures include mortality and morbidity rates, the safety of care, patient experience, effectiveness, and timeliness of care, and data transparency. Performance indicators can be gauged by patient satisfaction, outcomes, and the cost of services. The quality initiatives aim to provide quality care to yield positive outcomes at the best cost (CMS, 2017).

Existing Quality Initiatives

American Academy of Hospice and Palliative Medicine (AAHPM)

The AAHPM’s long term objective is to improve the quality of care to patients with terminal illnesses and whose prediction is limited. The academy established a 20-hour curriculum that trains the skills necessary to provide end-of-life care. The initiative trains on effective techniques to evaluate and manage pain, and relieve symptoms, reduce physical and spiritual suffering, grief management, communicating effectively with patients and families, making moral decisions, and using an interdisciplinary team approach when caring for the terminally ill (Dy et al., 2015).

Alliance for Aging Research, Healthcare costs of the elderly, and Terminally Ill

The initiative was formed to increase scientific evidence to improve the global experience of aging and dying. The agency is based on the notion that further research will improve the elderly’s quality of life. The initiative seeks to increase scientific evidence and enhance lives through improving the quality of care provided. They have researched to show that technology interventions have been focused on other people more than older patients with terminal diseases. Therefore, the agency seeks to direct resources to help the elderly persons have comfortable last days on earth (National Academic Press, n.d).

American Board of Internal Medicine

The quality initiative was developed to improve palliative care. This project’s objective is to improve the proficiency of the nurses who provide care for terminally ill patients. The board provides learning forums where physicians, nurses, and other professionals can learn how to improve the quality of care provided to terminally ill patients. It provides educational and practical activities that improve the professional’s skills (National Academic Press, n.d).

All these quality improvement initiatives have played a significant role in the quality improvement of the care services provided in the palliative and hospice. The problem occurs when they cannot evaluate the extent to which their education is efficient in improving the care provided by the health professionals they train. Information to show that the organizations’ training programs directly improve the care provided to patients is missing, and further research is needed to dig out the outcome and performance measures that the organizations use to gauge the success of their system. I believe the institutions should use evidence-based evaluations to measure the curriculum’s success and push for continuous improvement.

Target Areas for Improvement

According to the data collected, the target areas of improvement include pain management and symptom relief areas. This improvement aims to help patients manage their pain and any disturbing symptoms to improve their stay in the hospice and give them comfortability in the last days of their lives. Research shows that 25% of the patients in palliative care experience daily pain. 67% experience pain even after six months of admission. Another research showed that 40% of cancer patients in hospices and nursing homes suffer daily pain. Caregivers fail to understand the magnitude of pain that patients are in due to a lack of indicators (Kamal et al., 2017).

For physicians to improve the way they manage pain, they have to communicate effectively to patients who will, in return, elaborate on the pain levels. Also, they have to use assessment tools for those patients who can’t explain pain levels. The Federal Nursing, Home Reform Act set national standards for patients receiving end of life care. It insists on rehabilitation and restorative care to increase functionality. Hospices find it hard to provide quality care that aligns with the federal and state expectations of maintaining functionality.

Therefore, to improve pain management and system relief, I suggest that hospices used incorporation of effective communication strategies to understand patients’ pain, pain assessment tools such as multidimensional pain inventory, McGill Pain Questionnaire, pains beliefs, and perception inventories, Leeds assessment of neuropathic symptoms and signs, and a pain assessment checklist. Hospices will then go-ahead to use either nonsteroidal anti-inflammatory drugs, weak opioid medicine, or strong opioids depending on the pain persistence (Kamal et al., 2017).

Other Quality Initiatives on Palliative Care

One quality initiative that has set quality and practice standards for end-of-life care is the Committee of the American Academy of Hospice and Palliative Medicine (AAHPM). The committee established a measuring what matters consensus project, which in return, came up with performance indicators and measurements for hospice and palliative care programs. These indicators revolved around the efficiency of care delivery processes, physical, psychological, spiritual, cultural, ethical, and legal aspects of care. Indicators for structure and processes of care involved a complete valuation and recording of physical, emotional, and psychological valuations within 24 hours of admission (Dy et al., 2015).

Physical aspects of care include examining for physical symptoms. The percentage of terminally ill patients who have been screened for physical symptoms such as pain, dyspnea, nausea, and constipation before seven days of admission in the hospice shows patients are being attended to on time. Delay of care shows that the organization is failing in care delivery. Another indicator of timely care is a pain treatment for patients who have been admitted in the hospices for more than seven days, have been screened for pain, and provided with medication or non-medication treatment before 24 hours after screening (Dy et al., 2015). Hospices should also address the emotional or psychological needs of patients who have been admitted for more than seven.

Challenges that may meet the Prescribed Benchmarks

The proposed quality initiative may be faced with various challenges, such as accessing pain assessment tools. If the nurses lack the right tools to access pain, then it could be hard to make use of the prescribed benchmarks to attain the success of the quality initiative. Secondly, nurses must be trained on how to efficiently use pain assessment tools. Lack of competence may jeopardize the evaluation process. Thirdly, the quality initiative is built on the assumption that the elderly will be able to explain the pain and the symptoms that they are experiencing. Lack of effective communication may also affect the prescribed benchmarks (El-Saed et al., 2013).

Inter-professional Perspectives

During my data collection, I spoke to a few stakeholders: Roger Goldenberg, Jackie Sandoval, David Brooks, and Owen Welch. Roder Goldberg is the Director of the Hospice Services. His role is to oversee the hospice programs, including inpatient and home care, and manage follow-ups. He ensures that quality is maintained, and the care processes meet all regulatory control policies. The Director is also in charge of compiling all reports that involve the company’s operations. He believes that quality depends on the patient-nurse engagement. Thus, he emphasizes that nurses established a rapport with patients to understand them effectively.

Jackie Sandoval, the Chief Nursing Officer, is in charge of upholding clinical standards. She also ensures patient safety. She works hand in hand with stakeholders to source the right resources to improve patient care. I also talked to David Brooks, Quality Assurance organization is Director, whose role is to plan and implement quality assurance initiatives. He also manages the process by ensuring that all medical products used in the care process meet the organization’s standards and government regulations. Owen Welch, the CFO, is responsible for managing its financial activities. The CFO all financial transactions to ensure that organization’s funds are used in the right manner.

All these roles are essential in the quality improvement initiative. The importance of this initiative is to provide quality care at the best cost. Thus, the entire team will have a role to play to ensure that the initiative’s goal is achieved. Roger Goldberg, the Director, will ensure that the quality of processes is maintained in terms of providing the right medicine and the right time, and patients are provided with the right type of medication after their level of pain is assessed. Jackie Sandoval will ensure that the quality of care is also standardized. David Brooks will ensure that the quality of any material used in the care administration meets the company’s and governments’ regulations. Finally, the CFO will ensure that the organization operates within its budget. Patients should be provided with quality care at the best cost. Therefore, CFO could seek loopholes to cut down costs, for instance, through sourcing from the most affordable vendor, using the company’s transport instead of vendor’s transportation, and cutting down on electricity and other overhead costs (Bailie et al., 2017).

The non-nursing concepts that I will incorporate in this initiative include self-actualization, self-esteem, human dignity, honesty, justice, and fairness. I will focus on helping the elderly patients to carry out some activities on their own and take charge of their health. I will also respect my patient’s beliefs and values by considering their preferences during the care process. Moreover, I will ensure to listen to them effectively so that I can understand their needs. I also communicate effectively to them to help them understand the depth of their illness. The elderly have hearing and sight problems; thus, I could engage them by talking slowly, with a language they understand. The outcome measures will affect the inter-professional team. The proposed initiative is meant to improve the nursing staff’s quality of life because they will undergo training concerning pain management and symptom relief. The initiative will measure the nurses’ performance and evaluate the cause of the roots behind any underperformance as well. The initiative seeks to motivate nurses to perform better and challenge them by comparing their performance against the existing performance indicators.

Effective Communication Strategies

Inter-professional communication strategies that will be used to improve the improvement include feedback communication, transparent communication, active listening, and patient education. Professionals must ensure that efficient communication is incorporated into the care system. Communication will involve both patients and staff. Staff must speak to patients in an approach that brings understanding and trust. Communication between inter-professional teams will also be applied to avoid any medical errors when providing care to patients. Nurses will also be mandated to provide feedback and address any issues that could jeopardize the quality of care and patient or coworker safety (Slusser et al., 2018).

Transparency will also be highly upheld in the quality initiative. Nurses will be educated thoroughly to give them an insight into what is expected of them. The model that will be implemented in this quality initiative is the CUS, which stands for concern, discomfort, and safety. Nurses should monitor patients effectively to track any changes. They should be concerned about the patients’ comfort and apply interventions whenever the patient is uncomfortable (Slusser et al., 2018). Nurses must understand that patient’s safety can be compromised if they do not seem concerned about the patient and in case they fail to intervene.

Conclusion

The quality initiative is concerned with managing chronic pain and any distressing pain. Research has shown that patients admitted to the hospice programs experience chronic pain, which often goes unmanaged. SAMC’s in-home hospice program registered 17 cases of pain level 7-10 in more than 24 hours and inadequate symptom relief in more than 24 hours. There is a necessity to manage these conditions to improve life quality during the patient’s last days. Nurses must acknowledge that not managing these conditions may hasten deaths, not the essence of the care we provide. Therefore, effective communication to understand patients, use of pain assessment tools, and effective drug administration based on the level of pain are the proposed strategies to improve the hospice program’s performance.

References

Bailie, R., Larkins, S., & Broughton, E. (2017). Continuous Quality Improvement – Advancing Understanding of Design, Application, Impact, and Evaluation of CQI Approaches. Place of publication not identified: Frontiers Media SA.

Centers for Medicare & Medicaid Services. (, 2017). Current measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Current-Measures

Dy, S. M., Kiley, K. B., Ast, K., Lupu, D., Norton, S. A., McMillan, S. C., Herr, K., Rotella, J. D., & Casarett, D. J. (2015). Measuring what matters: Top-ranked quality indicators for hospice and palliative care from the American Academy of hospice and palliative medicine and hospice and palliative nurses association. Journal of Pain and Symptom Management, 49(4), 773-781. https://doi.org/10.1016/j.jpainsymman.2015.01.012

El-Saed, A., Balkhy, H. H., & Weber, D. J. (2013). Benchmarking local healthcare-associated infections: Available benchmarks and interpretation challenges. Journal of Infection and Public Health, 6(5), 323-330. https://doi.org/10.1016/j.jiph.2013.05.001

Kamal, A. H., Nicolla, J. M., & Power, S. (2017). Quality improvement pearls for the Palliative Care and Hospice professional. Journal of Pain and Symptom Management, 54(5), 758-765. https://doi.org/10.1016/j.jpainsymman.2017.07.040

National Academic Press. (n.d). Approaching death: improving care at the end of life. https://www.ncbi.nlm.nih.gov/books/NBK233591/

Sholjakova, M., Durnev, V., Kartalov, A., & Kuzmanovska, B. (2018). Pain relief as an integral part of palliative care. Open Access Macedonian Journal of Medical Sciences, 6(4), 739-741. https://doi.org/10.3889/oamjms.2018.163

Slusser, M. M., Garcia, L. I., Re, C.-R., & McGinnis, P. Q. (2018). Foundations of Interprofessional Collaborative Practice in Health Care.