NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

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NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

Name

Capella university

NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1

Prof. Name

Date

Abstract

Background: Patients with kidney failure experience significant psychological distress stemming from frequent hospitalizations due to various health issues and numerous medical procedures. This mental and emotional disruption significantly reduces patients’ overall quality of life. 

Aim/Objective: This Quality Improvement (QI) project aims to address mental health issues and medication non-adherence clinical outcomes at Antelope Valley Hospital employing various strategies.

Methods: The Plan-Do-Study-Act (PDSA) model is employed to bring changes strategies such as comprehensive psychological support programs and medication adherence initiatives. 

Conclusion: In conclusion, the project finds that mental support programs are effective in alleviating mental health issues and medication adherence initiatives enhance medication compliance in patients with kidney failure. Nevertheless, the project encountered hindrances such as reluctance to change, limited resources including finances, stigmatization, and communication gaps. Therefore, it is recommended to create collaborative environment among different healthcare professionals to overcoming these obstacles, guaranteeing the success of the project.

Quality Improvement (QI) Method

The Plan-Do-Study-Act (PDSA) model is a systematic framework for iterative testing and implementation of quality improvement initiatives. Due to its simplicity and feasibility, it is a widely employed QI method in healthcare settings. Several QI initiatives have resulted in successful outcomes after using the PDSA model (Chen et al., 2021). In the context of Antelope Valley Hospital, the PDSA model can be applied as: 

Plan – this step involves identifying the problem, thoughtfully designing the project, establishing goals, and allocating resources. For instance, we aim to improve medication adherence rates to 80% and reduce mental health issues to 30% within a year. By outlining our change strategies, allocating resources, and establishing timelines, stakeholders will be ready to move to the next step of the cycle. 

The “Do” step involves implementing the planned changes on a small-scale level. For instance, selecting a group of kidney failure patients for a controlled pilot testing of the project. Further, in this stage, the team must collect data about the number of patients enrolled in the psychological support program and the utilization of medication adherence initiatives. 

This data is then evaluated in the next step, the “study” stage, to understand the impact of change strategies, identify unexpected challenges and barriers, and gather feedback from stakeholders for informed adjustments.

Based on these findings, the organization must make informed decisions about sustainability and modification of the implemented change strategies. If successful, scale the interventions to a larger patient population (Act). In case of undesired results, stakeholders must make necessary adjustments to the action plans. Lastly, the organization should continuously monitor progress through the repetitive PDSA cycle to drive ongoing improvements and sustainability.

Challenges of the PDSA Cycle

The PDSA cycle is beneficial for continuous improvement; however, several difficulties are associated with its implementation. Resistance to change due to the team’s pre-existing beliefs and perspectives is a significant challenge, where individuals are hesitant to adopt new practices, inhibiting motivation among team members (McNicholas et al., 2019). Open communication, involvement of stakeholders in the planning stage, and providing ongoing training and support can help mitigate this resistance. Another challenge is the misconception about using this model as a standalone method.

PDSA model requires a broader approach where other QI methods should be integrated for productive results. To mitigate this misconception, it is imperative to provide training and education on using the model, enhancing teams’ understanding of various QI methods and their application (McNicholas et al., 2019). Finally, the PDSA cycle may encounter time constraints, hindering thorough experimentation and analysis. Prioritizing initiatives and streamlining processes through timelines can help overcome this limitation. 

Evidence to Support PDSA Cycle

The PDSA cycle is widely used in quality improvement initiatives in healthcare sectors. Numerous studies and literature reviews have documented the effectiveness of the PDSA model in driving iterative change and improvement in healthcare settings. Related to our project, a study by Boland (2020) recognizes the PDSA cycle as an effective QI method to bring mental health services within the organization. This cycle improves patient outcomes and safety by smoothly implementing mental health improvement initiatives. Another study on medication adherence initiatives for post-discharge patients reveals that a quality improvement project led by the PDSA cycle enhanced antimicrobial compliance among patients and permitted healthcare providers to resolve discrepancies before discharge to prevent patient safety and avoid medication errors (Gupta et al., 2021). These studies have supported using PDSA as a convenient, highly effective, and iterative cycle to bring sustainable quality improvements within the healthcare sector. 

Knowledge Gaps and Unknowns

However, despite the model’s widespread utilization, there are still knowledge gaps and uncertainties surrounding the effective implementation of the PDSA cycle in healthcare.

  • Lack of standardized guidance on the number of cycles and duration of each cycle. While the model underscores iterative testing, variations in stakeholders’ knowledge about the timing and scope of each cycle remain unclear. 
  • Understanding how to drive changes into organizational workflow for sustainability remains a knowledge gap. 
  • Information about evaluation methods to assess the impact of PDSA cycles on patient outcomes and organizational performance is a persistent knowledge gap.

Addressing these knowledge gaps and uncertainties requires further research and collaboration to enhance the model’s effectiveness for driving continuous improvement and innovation in healthcare delivery. 

 Change Strategy Foundation

Kidney failure patients undergo several medical interventions and receive complex pharmacological and treatment plans. Such medical assistance helps alleviate the disease’s symptoms and prevents aggravation. However, traumatic stress and anxiety due to recurrent hospitalization and complex treatment regimens are common complications for kidney failure patients (Koraishy et al., 2021). This stress may result in several mental health issues and poor clinical outcomes, such as medication non-compliance and poor quality of life. We aim to implement comprehensive psychological support programs and medication adherence initiatives to address these poor outcomes in Antelope Valley Hospital. This project is grounded in effective change strategies to drive quality improvements for patients with chronic diseases, such as kidney failure. 

Comprehensive Psychological Support Programs

The programs have three approaches – patient education, peer support networking, and counseling sessions. Various studies demonstrate the success of these strategies. Shouket (2024) recommends initiatives for psychological well-being as an imperative measure to minimize the emotional influence of chronic diseases on patients’ quality of life. Moreover, the literature supports strategies such as mental health education and peer networking, leading to positive patient outcomes by decreasing mental health symptoms and improving patient satisfaction (Longley et al., 2023). 

Medication Adherence Initiatives

Another successful change strategy advocated by various authors is the medication adherence initiative. This strategy focuses on establishing a team of healthcare professionals (pharmacists, physicians, and nurses) to provide medication education, simplify medication regimens, and address barriers to adherence (Dijkstra et al., 2021). The approaches include medication reconciliation, digital medication reminders and pill organizers, and drug usage and management education. These approaches are supported by the literature where Taibanguay et al. (2019) recommend comprehensive education to underscore the importance of medications in preventing exacerbation and enhancing medication compliance. Similarly, digital reminders and drug organizers simplify complex regimens, allowing patients to remember their medication schedules (Dijkstra et al., 2021). Finally, Stolldorf et al. (2021) highlight the importance of medication reconciliation in simplifying medication lists before discharge, improving medication safety and compliance.  

Challenges of Change Strategy

The organization may encounter several implementation difficulties for psychological support programs and medication adherence initiatives. These include: 

Comprehensive Psychosocial Support Programs

  • Team members may show resistance to change due to additional workload.  
  • Resource constraints because of hiring team members and expanding services. 
  • Stigmatization associated with mental health services and individuals seeking mental health support.

The challenges can be mitigated through training sessions on the benefits of support programs, planned resource allocation and budgeting, and awareness campaigns to destigmatize mental health (Muhorakeye & Biracyaza, 2021). 

Medication Adherence Initiatives 

  • Lack of coordination and communication among patients and provider
  • Financial barriers to access mental health services.

Communication channels such as regular meetings and digital applications can bridge coordination gaps within the team. To improve patient-provider communication, the team can conduct follow-ups and telecommunication meetings. Additionally, to address financial barriers, partnerships with private and public insurers will help patients access mental health services, improving their health outcomes. 

Interprofessional Team Benefits

Interprofessional teams leverage diverse expertise and perspectives, which is essential for successfully implementing psychological programs and medication adherence initiatives. Since comprehensive psychological support programs need mental health professionals, nurses, community leaders, and social workers, diverse expertise and perspectives will ensure holistic patient care during hospital stays and in communities. This teamwork becomes more efficient by employing effective communication mediums, standardized protocols, and understanding each other’s capabilities.

Similarly, medication adherence initiatives require collaboration among nurses, pharmacists, and physicians. Shared decision-making and coordination among interprofessional teams through regular meetings can improve patient outcomes by facilitating unfragmented healthcare (Leykum et al., 2023). Assumptions underlying this analysis include the belief that collaboration among healthcare professionals from different disciplines enhances problem-solving capabilities, fosters innovation, and promotes ownership and accountability for project outcomes. Additionally, interprofessional teamwork enables the pooling of resources and access to specialized knowledge, technology, and tools, which can accelerate progress and overcome barriers to implementation. 

 Overall Project Benefits

In summary, this project is beneficial to reduce mental health issues and improve medication adherence among kidney failure patients in Antelope Valley Hospital. The literature used to develop this poster supports that running comprehensive psychological support programs combats mental health symptoms such as stress and anxiety, leading to improved patient satisfaction and enhanced quality of life. Similarly, implementing medication adherence initiatives can improve treatment outcomes, reduce hospital readmissions, and lower healthcare costs. Thus, the project benefits individual patients and contributes to the overall quality of care, ultimately enhancing the health and well-being of the surrounding communities. 

References

Boland, B. (2020). Quality improvement in mental health services. BJPsych Bulletin44(1), 30–35. https://doi.org/10.1192/bjb.2019.65 

Chen, Y., VanderLaan, P. A., & Heher, Y. K. (2021). Using the model for improvement and plan‐do‐study‐act to effect smart change and advance quality. Cancer Cytopathology129(1), 9–14. https://doi.org/10.1002/cncy.22319

Dijkstra, N. E., Vervloet, M., Sino, C. G. M., Heerdink, E. R., Nelissen-Vrancken, M., Bleijenberg, N., De Bruin, M., & Schoonhoven, L. (2021). Home care patients’ experiences with home care nurses’ support in medication adherence. Patient Preference and Adherence15, 1929–1940. https://doi.org/10.2147/PPA.S302818

Gupta, S., Winckler, B., Lopez, M. A., Costilla, M., McCarthy, J., Wagner, J., Broderick, A., French, K., Le, B., & Lo, H. (2021). A quality improvement initiative to improve post-discharge antimicrobial adherence. Pediatrics147(1), e20192413. https://doi.org/10.1542/peds.2019-2413 

NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

Koraishy, F. M., Coca, S. G., Cohen, B. E., Scherrer, J. F., Mann, F., Kuan, P.-F., Luft, B. J., & Clouston, S. (2021). The association of post-traumatic stress disorder with longitudinal change in glomerular filtration rate in World Trade Center responders. Psychosomatic Medicine83(9), 978–986. https://doi.org/10.1097/PSY.0000000000000968 

Leykum, L. K., Noël, P. H., Penney, L. S., Mader, M., Lanham, H. J., Finley, E. P., & Pugh, J. A. (2023). Interdisciplinary team meetings in practice: An observational study of IDTS, sensemaking around care transitions, and readmission rates. Journal of General Internal Medicine38(2), 324–331. https://doi.org/10.1007/s11606-022-07744-6 

Longley, R. M., Harnedy, L. E., Ghanime, P. M., Arroyo-Ariza, D., Deary, E. C., Daskalakis, E., Sadang, K. G., West, J., Huffman, J. C., Celano, C. M., & Amonoo, H. L. (2023). Peer support interventions in patients with kidney failure: A systematic review. Journal of Psychosomatic Research171, 111379. https://doi.org/10.1016/j.jpsychores.2023.111379 

McNicholas, C., Lennox, L., Woodcock, T., Bell, D., & Reed, J. E. (2019). Evolving quality improvement support strategies to improve Plan–Do–Study–Act cycle fidelity: A retrospective mixed-methods study. BMJ Quality & Safety28(5), 356–365. https://doi.org/10.1136/bmjqs-2017-007605 

Muhorakeye, O., & Biracyaza, E. (2021). Exploring barriers to mental health services utilization at Kabutare district hospital of Rwanda: Perspectives from patients. Frontiers in Psychology12https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.638377 

NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

Shouket, H. (2024). Psychological interventions for end-stage renal disease patients’ receiving hemodialysis. In Updates on Renal Replacement Therapy. IntechOpen. https://doi.org/10.5772/intechopen.112793 

Stolldorf, D. P., Ridner, S. H., Vogus, T. J., Roumie, C. L., Schnipper, J. L., Dietrich, M. S., Schlundt, D. G., & Kripalani, S. (2021). Implementation strategies in the context of medication reconciliation: A qualitative study. Implementation Science Communications2(1), 63. https://doi.org/10.1186/s43058-021-00162-5 

Taibanguay, N., Chaiamnuay, S., Asavatanabodee, P., & Narongroeknawin, P. (2019). Effect of patient education on medication adherence of patients with rheumatoid arthritis: A randomized controlled trial. Patient Preference and Adherence13, 119–129. https://doi.org/10.2147/PPA.S192008 

 

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