NURS 5340 Plan Do Check Act Application Exercise

1 PDCA (Plan-Do-Check-Act) Worksheet XXXXXXXXX, BSN, RB-BC College of Nursing, University of Texas Arlington NURS 5340 Management Seminar and Practice Dr. Cynthia Plonien February 29, 2020 2 PDCA (Plan-Do-Check-Act) Worksheet Name of Organization: XXXXXXXXXX Date: 2/10/2020 City: XXXXXXX Selected Improvement Area Organizational Commitment_____ Community ____ Residents and Families ____ Prevention Strategies ____ Treatment ____ Assessment and Monitoring __x__ TOOL: EPIC Schedules STEP: Pend Overdue Orders CYCLE: 1st Attempt • PLAN I plan to: The clinical staff in the primary care clinic will utilize EPIC schedules to help pend overdue diabetic testing orders for providers as part of pre-visit planning process. I hope this produces: This will help reduce the amount of overdue hemoglobin a1c testing and in turn help with follow up treatment of diabetes. Currently 125 patients are overdue in those that are currently scheduled. We would like to capture at least 60 of those in first attempt. Steps to execute: 1. Clinical staff will add overdue hemoglobin a1c to schedule columns. 2. Clinical staff will use the schedules to pend those overdue hemoglobin a1c orders as part of the pre-visit planning. 3. Providers will sign orders and notify patients needed if the provider agrees with need. • DO What did you observe? The clinical team exceeded the goal of 60 patients. They were able to capture 92 of those past due. Many staff and providers were previously unaware that the patient was past due for the testing. • CHECK What did you learn? Clinical staff and providers excelled when they utilized the reminder on the schedules to determine that the patient was overdue for testing. By pending the orders in the previsit planning, the providers had to acknowledge the order by signing or removing prior to closing the visit note. Those that were not completed were deferred due to patient preference or scheduled to be completed later due to patient time constraints. Did you meet your measurement goal? The goal was exceeded. 92 of the 125 were completed. NURS 5340 Plan Do Check Act Application Exercise

The original goal was 60. • ACT What did you conclude from this cycle? We were able to show significant improvement from the schedule reminders and pre-visit planning. We will continue to monitor to see if the method is effective long term. If successful long term we can implement this method for additional overdue testing. 5340 4.2 Managing QI – PDCA 5340 4.2 Managing QI – PDCA Criteria This criterion is linked to a Learning OutcomeProblem Identification This criterion is linked to a Learning OutcomePlan This criterion is linked to a Learning OutcomeDo This criterion is linked to a Learning OutcomeCheck Ratings 10.0 to >6.0 pts Proficient Problem is approved by the Clinical Instructor and is clearly identified and presented articulately in statement format. 6.0 to >4.0 pts Competent Problem is identified and presented in statement format but could be more articulate…. and/or … Problem is appropriate but was not approved by the Clinical Instructor. 20.0 to >13.0 pts Proficient Plan identifies strategy and processes required to to achieve results intended. 13.0 to >7.0 pts Competent Plan identifies strategy and processes required to to achieve results intended but is unclear. 20.0 to >13.0 pts Proficient The plan is not put into place.aThe plan is put the plan into action. The design is tested. Data is gathered to determine whether the outcome meets expectations. 20.0 to >13.0 pts Proficient Analyze, study the results collected in the Do Step and evaluate against expectations. 4.0 to >0 pts Novice Problem identification is unclear or inadequate. 7.0 to >0 pts Novice Plan does not clearly identify strategy and processes. 13.0 to >7.0 pts Competent The plan is put into action but the testing and gather of data is inadequate to evaluate outcomes. 13.0 to >7.0 pts Competent Data is collected and presented but not adequately analyzed against outcomes. . 7.0 to >0 pt Novice The plan is not put into place. 7.0 to >0 pts Novice Data is not presented or is deficient to determine outcomes. 5340 4.2 Managing QI – PDCA Criteria This criterion is linked to a Learning OutcomeAct This criterion is linked to a Learning OutcomeFormatting Total Points: 100.0 PreviousNext Ratings 20.0 to >13.0 pts Proficient A decision is made as to whether expectations are met or if the project requires revision and the cycle is repeated. 10.0 to >6.0 pts Proficient Worksheet is organized and easily understood. 13.0 to >7.0 pts Competent A decision is made, but understanding outcomes is could be presented more clearly 6.0 to >4.0 pts Competent Worksheet present but not clearly and articulately presented. 7.0 to >0 pts Novice A decision is not made or inadequate, inappropriate. 4.0 to >0 pts Novice Appropriate worksheet not utilized. PDCA (Plan-do-/check/study-act) Worksheet Tool: Equipment Levels STEP: Restocking Process Cycle: 1 PROBLEM: There are not enough infusion equipment available at the beginning of dayshift or nightshift. The unit is restocked around 11am each day. Staff must order individual pumps for individual patients when none are available on the unit. Delivery takes around one hour. PLAN: I met with a team which included myself (dayshift manager), the mid-shift manager, a dayshift Clinical Support Technician, and the Unit Operations Coordinator to discuss the problem and possible solutions. I plan to implement a process whereby the unit’s Clinical Support Technicians call the central supply department before the end of each shift to restock infusion pumps to par level. Par level for equipment = 10 Alaris pump brains, 15 infusion channels, and 10 syringe pumps. Two clean supply areas have the same par levels. Baseline Data: Baseline: Percent to Par 2/26 /2020 @7P 2/27/2020 @7A Pump Brains Infusion Channels Syringe Pumps 60% 50% 50% 40% 50% 30% Plan: The Clinical Support Technicians (CSTs) will call the Central Supply Department to restock our infusion equipment to par level at 5am and 5pm. Before calling they will complete an infusion supply inventory check sheet will be developed to determine the necessity of the restock call. A call to restock will be made if any component of the infusion equipment falls below 80%. The forms will be turned in to the dayshift manager for analysis. Goal: Ensure that each infusion pump component is stocked minimally at 60% to par level at the beginning of each shift every day. Do: An email was sent to all CSTs on 2/27 explaining the problem and the plan for restocking the infusion equipment. The Infusion Supply Inventory Check Sheet was attached to the email and they were instructed on its use and to place the completed form in the manager’s box after each shift. I met with two dayshift CSTs and the mid-shift manager met with both nightshift CSTs to explain the new process. NURS 5340 Plan Do Check Act Application Exercise

Check/Study: Percentage to Par Level @ 5am and at the beginning of each shift 2/27 /2020 @7P 2/28/2020 @7A 2/28/2020 @7P 2/29/2020 @7A Pump Brains Infusion Channels Syringe Pumps 0500 7a/7p 60% ——————95% 90% ——————80% 75% —————–100% 70% ——————-55% 0500 7a/7p 65% ————100% 85% ————–70% 85% ————100% 60% ————–50% 0500 7a/7p 40% ———–100% 80% ———— 70% 90% ———–100% 80% ————75% Equipment <80% @ 0500CS called before the shift Yes No Yes Yes After reviewing the above results, the CSTs reported that prior to the beginning of 3 shifts, the infusion equipment level dropped to below 80% of par level which triggered a call to the Central Supply Department. Each of those shifts, supplies were back above 80% of par at the beginning of the next shift. A Central Supply call was not required on 2/28 dayshift, and levels were below 80% at the beginning of the shift, however routine restocking occurred at 11am. On Saturday 2/29/2020, despite the call to the central supply department, the infusion equipment was not above 80% of par at the beginning of the shift. The CST reported calling Central Supply at 0500 and they reported not having the staff available to restock at that time. This was an indication that Central Supply should have been included in the process from the beginning. Success: Providing guidelines regarding when it would be necessary to call helped to eliminate unnecessary calls. The data collection gave us an opportunity to analyze shifts and days of the week. It also allowed us to see how low the equipment levels dropped if not restocked. This information could help determine the extent of the problem. The levels were maintained greater than 60% of part at the beginning of each shift 3 out of 4 shifts. Sustainability: Based on the fact that Central Supply reported not having enough staff to restock on one occasion, a discussion with Central Supply will help determine sustainability. Next Steps: I will add a Central Supply Department Manager in the follow-up meeting to review the data, discuss the plan and its sustainability. I will also see if Central Supply has any suggestions for improvement of this process. ACT: The expectations were met for this project. However, based on the data collected, infusion equipment does not appear to drop to critical levels. The weekend may be the more critical times due to staffing concerns, but more information is needed. I will continue with this process until we collect more data to determine whether the 80% threshold is appropriate. I will continue to collect the worksheets from the CST to support sustainability. I will also collaborate with Central Supply to discuss sustainability of the process. If changes are required after meeting with Central Supply, we will begin Cycle 2 of this process change. Shortage of Nursing Staff Background  The Long term Care Regulatory Services Division experiences a nursing shortage problem  This causes untimely completion of assignments.  There is under-staffing in duties requiring nursing skill judgement, and experience.  Nurses in the private healthcare industry are paid more compared to state government nurses. Patient Care Financial Problem  Patient outcomes and the level of experience and qualification are linked to the quality of nursing care given to patients.  Changes in staff nursing greatly affect the quality of care to patients.  Nursing care has an immense effect on health.  Nursing staff shortages therefore cause problems in healthcare since they affect the quality of healthcare given.  Nursing care counts as a matter of life and death to patients. Patient Care Financial Problem  The shortage in nursing staff has been acknowledged by the American nurses Association (ANA, 2018).  There are about 29 million nurses worldwide with 3.9 million in the U.S. (WHO, 2013)  This is attributed to lack of enough educator, high turn-over, and inequitable distribution of nurses (Sawaenqdee et al, 2016).  The continuously aging population has high healthcare needs thus an increase in the need for nursing health services. Causes of Nurse Shortages  The aging population that has high healthcare needs.  Nurse burnout that leads to high turn-over rates that stand at 8.8% – 37% depending on field of practice (Haddad & Toney-Butler, 2019).  Violence in healthcare forces affected nurses leave stressful environments.  NURS 5340 Plan Do Check Act Application Exercise

The clinical significance of shortages is that they affect staffing ratios.  Hospitals with high patient-nurse ratios have high nurse burnout levels, dissatisfaction, and poor patient experiences leading to high patient mortality rates (Haddad & Toney-Butler, 2019). Potential Budget Impact  Factors affecting budgetary allocations include economic downturns and     recessions. Nurses, being the largest group, are affected most by cost reductions and layoffs. Shortage reduce the healthcare system’s ability to handle crises to do with outbreaks and diseases. In the long run, the government ends up redirecting funding from other dockets and ministries to healthcare which causes budget instability. Patients pay more to receive basic healthcare services from the private sector which would have been cheaper in the public healthcare setting. Potential Solutions  Implementation of proper educational designs and models that fit global     healthcare needs. Design and implementation of communication strategies such as databases across the healthcare fraternity. Collaboration between the business and education fraternities for better training (Nardi and Gyurko, 2013). Creation of new nursing education systems that provide competency-based curriculum will equip nurses skills and expertise to handle pressure in their work environment Investing in national initiatives will develop and evaluate approaches that leverage the skills and expertise through clinical education (Fisher, 2014). References  Alameddine, M., Baumann, A., Laporte, A., & Deber, r. (2012) a narrative review on the effect of economic downturns on the nursing labor market: implications for policy and planning, Human Resources for Health, 10 (23) doi: 10.1186/1478-4491-10-23  Haddad, L, M., & Toney-Bitler, J. (2019) Nursing Shortage. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK493175/  Fisher, M. (2014). A Comparison of professional value development among pre-licensure nursing students in associate degree, diploma, and Bachelor of Science in nursing programs. Nursing Education Perspectives, 35(1),37–42. doi:10.5480/11-729.1  Kieft, R, A, Brouwer, B, B., Francke, A, L & Delnoij (2014) How nurses and their work environment affect patient experiences of the quality of care: a qualitative study, BMC Health Services Research, 14(249) doi: 10.1186/1472-6963-14-249 References  Lindrooth, R, C., Bazzoli, G, J., Needleman,J & Hasnain-Wynia. (2006) The Effect of Changes in Hospital Reimbursement on Nurse Staffing Decisions at Safety Net and Nonsafety Net Hospitals, Health Services Research, 41(3 Pt 1): 701-720 doi: 10.1111/j.1475-6773.2006.00514.x  Nardi, D. A., & Gyurko, C. C. (2013). The global nursing faculty shortage: Status and solutions for change. Journal of Nursing Scholarship, 45, 317-326. doi: 10.1111/jnu.12030. Running head: NURSING STAFF SHORTAGE Nursing Financial Issue: Shortage of Licensed Nursing Staff Ugonma Darling Anyanwu, RN. BSN. The University of Texas at Arlington College of Nursing. In partial fulfilment of the requirements of NURS 5341: financial Management in Nursing Tina Theriaque DNP, MSN, RN September 7th, 2019. NURSING STAFF SHORTAGE 2 Background I work with the Health and Human Services Commission under Long term Care Regulatory Services division. This agency is currently experiencing licensed nursing staff shortage which leads to untimely completion of assignment due to under-staffing in duties that require nursing skills, experience, and judgment. Notably, nurses are paid more in the private healthcare industry in comparison to state government sector which increases turnout rates as they shift to the private sector. In this paper, I use scholarly and academic literature to define the problem, analyze the potential budget impact and provide possible solutions as suggested by various scholars. Patient Care Financial Problem According to Haddad and Toney-Butler (2019), developing evidence shows that there is a link between the patient outcomes, the level of qualification and experience that is also linked with the quality of nursing care provided to patients. According to Haddad and Toney-Butler, a 1996 IOM report indicated that the quality of hospital care to patients is highly affected by restructuring and the change in nurse staffing. Since the development of this report, various studies have come up to try and address the leads problems that nurse staff shortage brings into healthcare. In fact, the research indicates that the healthcare fraternity (healthcare providers, patients, and physicians as well as nurses) understand that the care given by nurses immensely affects health and it is a matter of life and death to the patient. The shortage of nursing staff has been a major problem in healthcare facilities, a situation which highly affects the quality of healthcare that the patients receive. The American Nurses Association (ANA) 2018) acknowledges that there has been a nurse shortage problem in the NURSING STAFF SHORTAGE 3 healthcare industry. According to Haddad and Toney-Butler (2019), the World Health Statistics Report (WHO, 2013) points out that there are about 29 million nurses in the world with 3.9 million being in the United States. Sawaenqdee et al (2016) attributed this to the lack of enough educators, the high turn-over problem as well as inequitable distribution of nurses and other professionals in the different healthcare sectors. Haddad and Toney-Butler (2019) provided several reasons for this and argues that; first, the aging population is the cause of this shortage. He argues that with the continuously aging population, the healthcare needs increase for this patient group. For example, in the United States, there is a growing number of the aging population in the baby boomer generation which increased by 73% from 41 million in 2011 to 71 million in 2019. This means that the need for nursing health services increases. Barr (2014) noted that older persons do not have only one morbidity at a time, this also means that more nurses are needed to meet these needs. Haddad and Toney-Butler (2019) identified nurse burn out as another cause of nurse shortages in the healthcare industry. He notes that some of the nurses graduate and start working in highly intensive environment from what they had expected. Some of these nurses experience burn out and opt to leave the profession to venture into other career fields. According to Haddad and Toney-Butler, (2019), this causes turn-over rates which according to the Nursing Solutions (2016) stand at 8.8% to 37% depending on the area and field of nurse practice. Haddad and Toney-Butler (2019) also point out that other reasons that cause nurse shortages include violence in healthcare (continuous, emotional, or physical abuse in the healthcare that forces affected nurses to leave the stressful environment, the continuous growth of national population and region-wise shortages depending on the specialty of nurses. They argued that the clinical significance of such shortages is that they affect staffing rations. The NURSING STAFF SHORTAGE 4 implementation of proper and acceptable nurse-patient ratios leads to better job satisfaction, higher retention rates as well as less turnovers. It also leads to decrease in errors during healthcare operations and service rendering, increased patient satisfaction and improving the nurse retention rates. In hospitals with high patient-to-nurse ratios, nurses become a target of burnout, dissatisfaction and also lead to poor patient experiences which lead to high patient mortality rates (Haddad and Toney-Butler, 2019). Interviews with Region 6 Regulatory services executives During an interview with the regional Director of my organization, he acknowledged shortage of licensed nursing is one of our financial issues. According to him, this has been going on for some time even though some changes were made by the legislatives some years ago. He indicated that the state employees’ salaries were not competitive with those of private sectors. He also agreed the poor salaries were the major reasons most qualified applicants decline the salaries we offer and those who manage to be employed do not last. The unfortunate fact remains that no one person can make the decision to change the salaries or pay out or even increase budgets to accommodate this without it first being tabled before the state legislators who as an obligation will hear this …