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Organizational QI Plan, Part 111


        Every health sector aims at delivering quality services to patients. Quality services are safe, timely, effective and are recipient-centered. Nurses have to be giventhe responsibility of taking care of a particular patient at the comfort of his/ her home with loved ones. This makes them become more familiar with the specific needs of a particular patient both medically and emotionally. Most of the patients who benefit from these services are the elderly with chronic ailments like heart diseases, diabetes, blood pressure andstroke. The nurses can monitor the sugar level of the blood, dress wounds, change urine and feeding tubes at the patient’s residential place.


        This paper will look into some of the methods thatcan be used to improve the quality of such home-base care services.  Information technology methods ascomponents of the management of quality improvement will also be looked at. Last, the paper will present the milestones and benchmarks that hinder the management of quality improvement.


 Methodology

       The quality of nursing homes is generally multi dimensional as compared to institutional quality. The characteristics of the two are not the same in terms of the needs, the setting which the services are being provided,the circumstances andthe home. This therefore means that the methodologies that have been considered in improving the quality of home nursing services will depend on several quality dimensions. The residents at nursing homes vary from the type of care and the duration needed for medical care.   Some of the patients require little amount of care. These are the independent ones who can do various activities on their own. Whereas others may require daily assistance because theyare physically disabled or mental impaired.


        Four methods can be used in improving the different needs and quality of service to the patients. First, there should be a proper and adequate record keeping system for each patient’s information thatcan be understood and used by every staff in the home nursing. This data should have to be collected and reviewed consistently. The data should aim at improving the quality of life in general and the quality of services offered by the homes nursing, which are market -based incentives. The data collected should also include the kinds of inadequacies available that can help the nursing home to set goals that will see improvements, for exampleimproving the quality of services for the aged or the dinning services of the residents. Such goals assist the home nursing officials to address and prioritize on the required facilities, which have are resident-focused and that help them meet their needs. Electronic means of storing such records have proven to be the source of accurate and improved level of health care. The major disadvantage however is that the patient’s records will lack privacy as compared to pen and paper recording becauseall the records will be made accessible at a central computer system. Another challenge with this is that it requires a high cost to start up.


        Second, there should be cooperation and participation of all caregivers of the home nursing becauseno single form of service is totally exclusive; for example through the nurses, the physicians canaccess information concerning a drug used on a patient so that if no desired results are achieved, the dosage can be adjusted. The multidisciplinary teamswill also be responsible for the consistent review of information given by the residents and see all the improvement areas. A possible challenge that will be expected in this method will be lack of adequate corporation becauseactivities will be done in form of teamwork. Some may not corporate because they know if they don’t accomplish a duty; someone will step in to save the team (Shorr, Fought &Ray 1994, p 217).


        Employees’ incentive is another aspect that has been tackled by nursing homes. Such incentives are not exclusive to financial benefits but mainly deal with staff support such as educative programs to enhance their skills. The management should be aware of employees’ problems and possibly come up with solutions to assist and address the challenges.  The management should also record the performance rate of each staff member in which the best performing are rewarded financially.


        Finally, quality improvement mechanisms must be repetitious. The desired changes and improvement could be achieved but from time to time frequent analysis and changes must go on. This process will be a measuring tool to address any challenges that require improvement. Therefore, nursing homes should be part of this cycle that deals with problem identification and response. These frequent reviews maybe a costly process for the home nursing health service provider (Institute of medicine, 1996).


 Information Technology

       Computerized technologies have been used in rating the quality and setting of nursing home services. The National Health Corporation established this patient assessment system that shows the profile data of each patient. Issues pertaining to eating, mobility, hygiene, dressing and position have been recorded in this system. This system has worked in Hill haven Corporation nursing homes; they have been installed in more than three hundredbranches.


             This system has helped with information required by Medicaid for the determination of payment to all its beneficiaries.  The IT system has beensuccessful in Montana home nursing in which various case-mix information has been obtained


             The IT instrument has been beneficial for quality assurance for it makes it easy to classify patients with common needs, health problems, and possible day of discharge and recovery chances. From the data, an analysis of motility risk can be found and represented on a longitudinal form.


Information technologies have also assisted in the improvement of pharmaceutical services in nursing homes. The medication given to patients is recorded clearly showing how it is supposed to be dispensed,prescribed, administered andmonitored. This is a type of informatics system that has promoted safety in medicine handling among all home nursing officials. Thus there will be reduction and elimination of incidences of errors with medication such as prescribing wrong doses to patients. This system also allows providers to know patients’ recent results from the lab like allergy reactions (Dhall, Larrat & Lapane 2002 pp 8896).


             Information technology has been successful in home nursing when it comes to documenting all the clinical records and notes such as clinical visits, frequency attendants, authenticates, corrects and addends. They have been used for assessing the performance of the nursing home as well as for effective communication and innovations within it.  The records stored electronically have assisted home nursing officials to manage the census of all patients in various demographics. This software can solely be used to know when to transfer residents, discharge them andadmit a patient. The management has also benefited from the software for it can easily schedule its staff and make payroll changes.


 Potential benchmarks and milestones

            The attainment of quality improvement in nursing homes is essential. However, fundamental challenges of most nursing homes root from the nature of services it provides. These changes have to consider opinions of residents and the voices from the family members whichis not usually the case. These are the people to determine and judge the qualities of services they have been given,yet in the real world not all their grievances have been fulfilled.The nursing home management mostly relies on the percentages of a certain problem whereby the highly rated have been handled first. The low percentage problems have been ignored.This therefore means that not all the needs of patients have been satisfied.  A remedy for this is almost next to impossible and will require a totally new scope of knowledge and new approaches (Kane, et al.2003, pp 58).


             As each of the proposed methods of strategy has its own limitation, it becomes hard to say that such a method will be the only way forward. The improvements of home nursing quality will require several methodological approaches and considerations so as to minimize the disadvantages of one approach.


 

            Measuring the performance of a strategy becomes a challenge. Many other mechanisms will have to be implemented and will go hand-in-handwith the strategy. It therefore calls for health policy makers as well as consumers to make nursing homes have a system of reporting all its activities either on a state basis or national basis. Such a transformation will therefore have to happen across most nursing homes.  Available information has shown that as the nursing homes adopt new models of care, most have not been fruitful becausesuch changes require iterative examinations so as to achieve long term and sustainable high quality care (U.S. Government Accountability Office 2005, pp 117).


 Reference

Institute of medicine (1996) improving the quality of care in nursing homes. Retrieved   

          from

          http://www.nap.edu/openbook.php?record_id=646&page=61

          On 24th February 2010

Kaiser Commission (2007) Medicaid and the uninsured. Medicaid and long-term care

          services and supports. Retrieved from

          http://www.kff.org/medicaid/upload/2186_05.pdf

           On 24th February 2010

U.S. Government Accountability Office (2005) Nursing homes: despite increased

          oversight, challenges remain in ensuring high-quality care and resident safety.

         Washington (DC), Report no.6 pp117.

Shorr R, Fought L, & Ray W (1994) changes in antipsychotic drug use in nursing homes

           during implementation of the OBRA-87 regulations. JAMA. Issue no 5, pp 271

Kane R, Kling C, Barshefsky B, Kane L, Giles K, Degenholtz B, et al (2003)Quality of

           life measures for nursing home residents, third edition pp 58

Rahman N and Schnelle F (2008) the nursing home culture-change movement: recent

            Past, present, and future directions for research. Pp 48

Dhall J, Larrat P, Lapane L. (2002) potentially inappropriate medication use in nursing

              homes. First edition. Issue no22, pp 88–96


 

 
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