Main Discussion Post

For this week’s discussion post I used the Medicare Hospital Compare to look at the facility that I work for per diem. Hospital Compare is a website that provides potential patients with access to over 4,000 Medicare-certified hospitals across the country. The information within the website allows patients to make informed decisions regarding the care provided at a specific facility and also provides feedback to these hospitals regarding the quality of care and areas of improvement. According to the website, the creation of hospital care was a collaboration that included hospitals, practitioners, employers, consumers, accrediting organizations and federal agencies. The information available to those using this website include the hospitals overall rating, general information (name, address, phone number, etc.), survey of patient experiences, timely and effective care, complications and deaths, unplanned hospital visits, use of medical imaging and payment and value of care. There is a potential of 57 quality measures shown. When I reviewed my facility, unfortunately, they only received two out of five stars, so there is obviously a need for improvement.

The three variables that I chose to discuss in order to better understand a patient safety problem were:

1. Timely and effective care, specifically heart attack care
2. Complications and death, specifically CLABSI/CAUTI
3. Unplanned hospital visits, specifically MI

“Timely and effective care measures the hospital’s ability to provide the most appropriate treatments that are shown to give the best results” (Medicare.gov, 2018). The subcategory associated with timely and effective care I chose was heart attack. There are many policies and procedures in place to immediately implement when a STEMI has arrived. There is a STEMI bundle that we use that guides that practitioner in the most appropriate direction regarding lab work, EKG, medications and definitive care. The results show that there is an average of 8 minutes before the patient receives an EKG and that 90% of outpatients received Aspirin within 24 hours of arrival to the ED. There were no results for outpatients regarding the average number of minutes who needed specialized care that needed to be transferred or for patients that received medications to break up blood clots within 30 minutes of arrival. The website states that for those measures that are unavailable, “there are not enough patients or cases to report and that the results are based on a shorter time period than required” (Medicare.gov, 2018). The available results are very comparable to the Missouri and national average.

The second variable I identified was CLABSI/CAUTI which is a subcategory of complications and death. With my previous ICU experience, this is a topic that I am very passionate about. There is always the potential for hospital-acquired infections. Although they are preventable, the incidence is still concerning. There were zero reported CLABSI, and two reported CAUTI’s. The central line days were 1195 and the catheter days were 2204. The resulted number of infections is very low considering the number of indwelling days. The evaluations show that these are no different than the national benchmark.

The third variable was unplanned hospital visits, specifically MI. My hospital was ranked “no different than the national rate (Medicare.gov, 2018). The unplanned hospital visit measures included rates of readmission, hospital visits and hospital return days.

The collection periods for the above-mentioned variable spanned over one year, 7/1/2016-6/30/2017. These results provide everyone involved with facts directly related to patient care and overall satisfaction. This can lead to improvements not only to patient care but to the facility as a whole. Being aware of these results is essential in maintaining clarity and knowledge related to available resources.

Data is used in my facility to improve patient safety and quality care through several avenues. Our ED has a unit practice team (UPT) which uses core measures as it relates to these variables. The information and results are disseminated throughout our facility through newsletters, forums, and emails from upper management. By ensuring that this information is kept updated and shared among the facility, areas for improvement are identified as well as what has been accomplished through hard work and diligence.

References

Medicare.gov. (n.d.-a). Hospital compare. Retrieved June 21^st, 2018, from

https://www.medicare.gov/hospitalcompare/About/Wha…

Megan D.

RE: Discussion – Week 5

COLLAPSE

For this week’s discussion, I used the website Medicare Hospital Compare (www.medicare.gov) to examine data that is used to monitor and improve quality and safety of patient care within healthcare facilities. “The information on Hospital Compare helps you make decisions about where you get your health care and encourages hospitals to improve the quality of care they provide” (Medicare.gov, 2018). The three variables I chose to compare are: patients who reported that they “always” received help as soon as they wanted, Clostridium difficile (C.diff.) intestinal infections, and patients assessed and given influenza vaccination. I chose to compare data for the hospital I currently work at with another local hospital that is located about 5 miles away.

For the first variable, (patients who reported that they “always” received help as soon as they wanted) I found that the hospital I work for is 61%, which is above the nearby hospital, and the same as the state average. The national average for all reporting hospitals is 69%, so there is room for improvement in this area of the HCAHPS survey. The second variable, (C.Diff infections) a confidence interval is used to display data. Above the graph states “lower numbers are better”. My facility is 0.830, the nearby facility 1.188 the state average was 0.940, and the national average 1.0. This data shows that my facility and the state average is greater than the national average and the compared facility is below the national average. The third variable I chose, (patients assessed and given the influenza vaccine) the data shows my facility is 99%, the local facility 88%, state average 90%, and national average 93%.

The variables I chose to compare are few of many essential topics that are vital to nurses providing safe, effective, and quality care. The purpose of the data provided on this website is to evaluate areas that we are doing well in and areas that need improvement. With this data, we can implement new changes to improve nursing care and patient outcomes. In my facility, nurses are kept up to date with new data. The data is printed and posted in the break room for viewing, with recognition in areas we are exceeding in and feedback in areas that require more work. We also take turns monitoring data for the unit on CAUTI’s, CLABSI’s, and daily weight monitoring for heart failure patients.

Resources

What is Hospital Compare? (n.d.). Retrieved June 25, 2018, from https://www.medicare.gov/hospitalcompare/About/What-Is-HOS.html

 

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Assignment 3: Test Development Exercises

Part 1: Design a Test Blueprint

The Test Development Exercises will help you to gain insight into the systematic development of effective evaluation plans. The exercises will acquaint you with the process of designing tests to assess student achievement in academic and clinical settings.

For this week’s assignment, you will develop a test blueprint. Revisit the lesson plan that you developed in NSG6003. If you have not taken that course, search the Internet and locate a lesson plan in the nursing setting of your choice. Based on this lesson plan, you are required to develop a test blueprint for the learning outcomes that you expect your learners to achieve. You should clearly mention the goals, learning objectives, and the test elements for each of the learning outcomes defined in your lesson plan. Please see the example below to help you in constructing the Test Blueprint, using the stated formulas to determine how many questions will be needed in each Bloom’s Taxonomy cognitive domain for each objective.

Directions and Example

You need to include an introduction from your lesson plan from NSG6003, including the learning goal(s) and learning objectives or from a lesson plan located on the Internet. You need to state the number of test items for the entire test (minimum of 50 questions) then add the different test formats (multiple choice, T/F, essay, etc.) you will use for your test, then give an example of each of the test questions (not the entire test) that will be used to evaluate the different levels of Bloom’s Taxonomy in the body of your paper.

You will also state and give an example of an alternative test method. For the test blueprint, you need to state the goal of the class, list the learning objectives (4), and use the formula at the top of the blueprint to determine how many questions will be needed in each Bloom’s Taxonomy cognitive domain for each objective.

You will need formulas, numbers, and calculations on your Test Blueprint (please show your work), no words, except for the learning objectives (4). You need to write example test questions with answers (correct answer identified with an asterisk) linking them to your objectives and the six domains of learning in the body of your paper. You need a title and reference page according to APA format.The assignment is to be uploaded to the drop box as only one paper not two.

 

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Please progress through this module as follows:

Due Tues Nov 16. Allow four hours to complete this module.

1. View both short YouTube videos on Rogerian argument.

Link

Link

2. Drafting and Writing a Rogerian Argument. Print and read the Rogerian argument GO. Notice how the sentence starters relate to the videos you saw.

3. Building Background. Read the articles. These articles are intended to build your background information about the issues involved in the controversy.. None of them counts as one of the 2 pro or 2 con articles that you must find from Opposing Viewpoints database or other Troy University database.

Drafting and Writing a Rogerian Argument. Print and read the Rogerian argument GO. Notice how the sentence starters relate to the videos you saw.

3. Building Background. Read the articles. These articles are intended to build your background information about the issues involved in the controversy.

“Do You Spend Too Much Time on Smart Phones Playing ‘Stupid Games’?” Link

“Just One More Game”–the rest of the article that we read in class: Link

Link This is a video article “Are Video Games a Sport?” Link This link is to its companion article

Link This link is to a Ted Talk with Jane McGonigle, an alternate reality game inventor

4. Sources.

You must have 2 scholarly / peer reviewed sources retrieved through the Troy University databases. I suggest the Opposing Viewpoints database (video games in search box) or the New York Times database.You will also be including ‘just One More Game’ and the McGonigal Ted Talk as sources, for a total of 4.

For each article, do an annotated bibliography entry. There is an example in your grammar book (spiral) around p. 399-401 or p.432- 434. Look annotated bibliography up in the green index for the exact page number.

Sources not retrieved from the TU databases will not be accepted. Essays with incorrect or insufficient sources, or sources without annotated bibliographies will receive a grade of 60 or below.

additionally, do ann bib entries for ‘Just One More Game’ (you already took notes on it in class 11/8) and the Ted talk with Jane McGonigal–due 11/3.

5. Documentation. Use the posted document MLA 8 models to do the citation part of your annotated bibliography entries. When you do your Works Cited page, your entries must be exact. Correct MLA citation there and in-text will count as a major part of the paper grade.

6. Pre-Writing.Before coming to class to discuss, make a list of the issues involved in this question. I

Prewriting activity–Please give thoughtful answers. Only your teacher will see, and she will maintain your confidentiality and promise to forget what you said.

1. Are you interested in sport(s) or game(s)? Which one(s)? Why, or why not?

2. Do you play a sport or game? Which one(s)? Why? None? Why not?

3. What competitions do you engage in?

physical against another person

physical against oneself

physical against the natural world (e.g. gardening, agriculture?)

mental against another person

mental against oneself

mental against the natural world

4. Do you regularly view a sport or game in person or on media? (watching a contact sport; watching gaming, such as world class poker or e-sports; watching movies in which people try to outwit each other)? Which ones? Why, or why not?

This list should be carefully and thoughtfully made. It is the key to discussing in class appropriately, and to writing an effective Rogerian argument.

7. Prompt:

Write a Rogerian argument of at least five paragraphs (intro, 3 body paragraphs, conclusion) arguing whether e-gaming, or video games, are a waste of time or not.

Use your sources to help you present the opposing point of view fairly, and to support your own point of view.

Correct integration of sources into the body of the paper and a correct Works Cited page are an important part of the grade. Remember that, if you use a source in the body, the source must be listed on the Works Cited page, and if you have a source listed on the WC page, it must be cited in the body of the paper.

 

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Refer to “Sallie Mae Fisher’s Health History and Discharge Orders” for specifics related to the case study used to inform the assignment.

Using “Home Visit With Sallie Mae Fisher findings” and “Sallie Mae Fisher’s Health History and Discharge Orders,” complete the following components of this assignment:

After viewing the home visit findings, write an essay of 500-750-words in which you do the following:

1. Identify, prioritize, and describe at least four problems.
2. Provide substantiating evidence (assessment data) for each problem identified.
3. Identify and describe at least four medical and/or nursing interventions.
4. Discuss your rationale for the interventions identified.

Prepare this step of the assignment according to the APA guidelines.

Sallie Mae Fisher’s Health History 
and Discharge Orders

Sallie Mae Fisher Health History

Ms. Fisher is an 82-year-old female with a history of chronic congestive heart failure (CHF), atrial fibrillation, and hypertension. During the last 6 months, she has been hospitalized four times for exacerbation of her CHF. She was discharged home last Saturday from the hospital after a 3-day stay to treat increased dyspnea, an 8-pound weight gain, and chest pain.

Ms. Fisher is recently widowed and lives alone. She has a daughter, Thelma Jean, who lives in town but works full time and has family issues of her own. Therefore, family support is limited.

Hospital Discharge Instructions

• Mountain Top Home Health to evaluate cardio-pulmonary status, medication management, and home safety.
• Medical Equipment Company to deliver oxygen concentrator and instruct patient in use. O2 at 2 liters per nasal prongs PRN.
• Prescriptions given at discharge:
  • Digoxin 0.25 mg once a day
  • Lasix 80 mg twice a day
  • Calan 240 mg once a day
• Order written to continue other home meds.
• Zocar 50 mg once a day
• Minipres 1 mg once a day
• Vasotec 10 mg twice a day
• Prilosec 20 mg once a day
• Furosemide 40 mg once a day
• Effexor 37.5 mg at bedtime
• Lanoxin 0.125 mg every other day
• Multivitamin once a day
• Potassium 40 mEq once a day
• Ibuprofen 400 mg q 4 hours as needed for pain
• Darvocet N 100 mg q 4 hours as needed for pain
• Nitroglycerin ointment, apply 1 inch every day

home visit findings

• area rug on the floor- fall hazard
• Door unlocked, she doesn’t answer it, just tells person to “come in” without looking to see who is there- safety hazard
• Dehydrated- tenting present, dry mucous membranes, BP 90/56
• No appetite- eating canned soup- lost 14 pounds in 1 week
• Not using prescribed O2- resp rate 24,
• No BM for 3 days, likely due to dehydration
• Lonely, widowed and her daughter is “busy

 

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