Effective leadership and management in nursing

Nursing

Effective Leadership and Management in Nursing

One of the most important operatives in healthcare reform is value-based purchasing. This is pressuring hospitals to improve and report along with encouraging consumers to purchase healthcare based on outcomes of quality. The current VBP focal point is the CMS Hospital Acquired Condition payment adjustment provision. This denies claims payment upgrades for selected hospital-acquired conditions. For discharges on and after October 1, 2008, the provision requires CMS to adjust Medicare hospital claim payments when specified HACs are not present on admission (Jankowski, Zywiak and Metzger, n.d.).

The increasing rise in health care costs has made it necessary for payers of health care services to examine every opportunity that is available in order to conserve health care dollars. According to the Congressional Budget Office (CBO), if there are not changes made to federal law, the total spending on health care will rise from 16% of the gross domestic product (GDP) in 2007 to 25% in 2025 and 49% in 2082. Federal spending on Medicare and Medicaid is predicted to rise from four percent of the GDP to almost 20% in the same period. Inefficiency in the health care system is seen as the principle variable that contributes to this increased cost (Medicare Nonpayment for Hospital Acquired Conditions, 2010).

The Institute of Medicine has determined that medical errors cost between $17 billion and $29 billion per year and most of the cost is shifted to outside payers such as Medicare. Research conducted by the Harvard School of Public Health

Risk managers are finding themselves working hard on processes like billing and documentation, in order to make sure that payers aren't billed for hospital-acquired conditions. They have to make sure that records document what conditions are present on admission so that there are no questions. One important measure that hospitals must undertake is to integrate the risk management of quality and patient safety. In some facilities, these functions are separate and often report to different leaders. Risk managers must make sure that everyone's aware of the joint needs that are present. When patient safety is potentially compromised, risk managers are making sure they get involved, counseling and working on root-cause analysis (Zieger, 2009).

As a risk manager I would implement a plan that would encompass education along with process control. The first step would be to determine all of the places in which risk for hospital acquired conditions exist and what things can be done to eliminate them. The ultimate goal is to reduce the number of patients that suffer from hospital acquired conditions. An education program aimed at all hospital staff on patient safety and quality control is the best place to start. Knowing where the risk lies and how to eliminate it will help to reduce the overall amount of patients that suffer from hospital acquired conditions.

Several hospitals around the country has implement risk management plans to reduce the amount of hospital acquired conditions that are occurring. Mission Hospital is a 301-bed Level II trauma center located in Mission Viejo, California. The objective of their performance improvement project was to reduce the number of urinary tract infections (UTI) that occurred in their organization by improving the care and management of indwelling catheters. The organization created a front-line staff -- centered infection prevention team to create guidelines for urinary catheter care and management. The hospital also implemented education initiatives to help reduce all infection rates in the hospital. In a period of 18 months, the organization reduced its UTI rate by 20% (Using Data to Reduce Urinary Tract Infections, 2008).

Chester County Hospital in West Chester, Pennsylvania, is a 220-bed, not-for-profit hospital. In January 2006 they began in earnest to reduce surgical site infections with a hospital wide campaign. Their goal was to look at all of the evidence-based care related to surgical patients and incorporate those recommendations into everyday practice. The hospital formed the Hospital of Distinction Campaign in order to improve overall quality performance (Hospitals Discuss Their Efforts to Reduce Surgical Site Infection, 2008).

Chester County Hospital has implemented Medicare's five hospital process-of-care measures related to the prevention of surgical site infections and other complications. Hospitals typically implement measures that prevent other surgical complications such as blood clots in addition to measures that prevent infection. The first measure that they implanted was to determine the percentage of surgery patients who receive prophylactic antibiotics one hour before incision. Research shows that surgery patients who get antibiotics within an hour of their surgery are less likely to develop site infections. Getting an antibiotic either earlier than an hour before surgery begins or after surgery begins is not as effective. Chester County Hospital's rate of patients receiving prophylactic antibiotics one hour before incision for FY 2008 was 97% (Hospitals Discuss Their Efforts to Reduce Surgical Site Infection, 2008).

The second measure they implemented was to determine whether surgery patients receive the appropriate preventive antibiotics for their surgery. Certain antibiotics are recommended for specific surgeries in order to prevent a surgical site infection. Chester County Hospital's rate of patients receiving the appropriate preventive antibiotics for surgery for FY 2008 was 99% (Hospitals Discuss Their Efforts to Reduce Surgical Site Infection, 2008).

The third measure is to determine whether patients receive appropriate treatment to prevent blood clots within 24 hours before or after selected surgeries. Treatments to prevent blood clots must be administered at the right time to prevent blood clots from forming after certain surgeries. Chester County Hospital's rate of patients receiving appropriate treatment to prevent blood clots within 24 hours of surgery for FY 2008 was 92% (Hospitals Discuss Their Efforts to Reduce Surgical Site Infection, 2008).

The fourth measure they implanted was to determine the percentage of surgery patients whose doctors ordered treatments to prevent blood clots for certain types of surgeries. Certain types of surgery can increase the risk of blood clots forming in the veins because patients do not move very much during or, typically, after some surgeries. Prophylaxis can reduce a patient's risk of developing blood clots and can include blood thinning medications, elastic support stockings, or mechanical air stockings, which promote circulation in the legs. Chester County Hospital's rate of patients whose doctors ordered treatments to prevent blood clots for certain surgeries for FY 2008 was 98% (Hospitals Discuss Their Efforts to Reduce Surgical Site Infection, 2008).

The last measure they implemented was to determine the percentage of surgery patients whose prophylactic antibiotics were stopped within 24 hours after surgery. While taking antibiotics for surgery is an important preventive measure, continuing antibiotic treatment for more than 24 hours after surgery is usually unnecessary and may be harmful to the patient. Patients may become resistant to antibiotics taken at a later time if too many antibiotics are given. Chester County Hospital's rate of patients whose prophylactic antibiotics were stopped within 24 hours after surgery for FY 2008 was 95% (Hospitals Discuss Their Efforts to Reduce Surgical Site Infection, 2008).