Readmission Rates and Infection Control

¶ … HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey offers hospitals and other healthcare centered organizations and facilities the ability to assess how patients perceive the quality of care. While hospitals have implemented this kind of survey in the past, HCAHPS allows the data to be displayed publically and provides national data to allow for valid comparisons across hospitals nationally, regionally, and locally. This data display adds pressure to hospitals to improve their quality of care and increase their accountability. Quality improvement measures are what has resulted from the increase transparency. Such common quality measures hospitals look to highlight are:

Medication Reconciliation/Error

Infection Control

Fall Prevention

Decrease Readmission rate

San Diego, California is where the selected home care agency is located. The California summary of HCAHPS survey results for July 2014 to June 2015 is 75, 78, 62, 69, 61, 70, 51, 85, 49, 68, 69, and 311, with a 26% response rate. Compared with the national average, the scores are lower. The national average is 80, 82, 68, 71, 65, 74, 62, 86, 52, 71, 71, and 30% response rate. Reasons for the lower scores could be higher population, higher population of non-speaking residents, and lower quality patient care. Because these scores are lower, there needs to be a reassessment of what these hospitals can do to improve their results.

One of the most important markers for quality collaboration is medication reconciliation. This is because of the high occurrence of medication error during care transition points. They begin with hospital admission, then transfer, and end in discharge. In between these points any changes in medication regimens or insufficient communication between pharmacists, nurses, or physicians could result in error.

If an error occurs a potential serious result may transpire leading to low quality healthcare. By simply checking for correct medication dosage, correct dosing frequency, and correct medication during and between these transition points, medication reconciliation will be improved. There are five essential steps to medication reconciliation: "determining a current list of medications, developing a listing of medications to be prescribed, comparing the two lists, making clinical decisions based on the two lists, and finalizing and communicating the list of medications to the patient and other clinicians" (Weber & Moffatt-Bruce, 2014, p. 115). Information can be collected in relation to if any mistakes were made with medication and where and when these mistakes were made.

While medication reconciliation is an important quality measure, another is infection control. Infection control allows medical and other facilities like home health agencies prevent unnecessary spread of infectious diseases. While people do not wish to make someone else sick, if there are not protocols in place to prevent cross-contamination, the rate of people acquiring illnesses may increase. One of the basic protocols assessed is if there is a protocol followed for handwashing.

Bathrooms must have soap and running water for employees and guests to wash their hands. There must also be at least one hand sanitizer dispenser available for people to disinfect their hands with as they leave or enter the facility. Hand-hygiene promotion is a key measure in assessing infection control and may be a primary mode of intervention as detailed in a 2013 study. "Hand-hygiene promotion was associated with significant improvement across all specific indications and professional categories" (Allegranzi et al., 2013, p. 70164). Looking for these things along with if employees washed their hands and use hand sanitizer is a good way to collec data for infection control.

Some research points to potential methods that could reduce incidence of certain occurrences. Fall prevention is an important quality improvement measure that is being used by CMS or Centers for Medicare and Medicaid Service in a way that will make hospitals more responsible for the people that walk into their property and fall. "in U.S. hospitals by unit type and to determine the 27-month secular trend in falls prior to the implementation of the Centers for Medicare and Medicaid Service (CMS) rule which does not reimburse hospitals for care related to injury resulting from hospital falls" (Bouldin et al., 2012). By not receiving reimbursement, hospitals feel motivated to avoid falls as much as possible. The results of the 2012 study demonstrated the new rule helped decreased the rate of falls and providing statistical evidence that implantation of certain rules like CMS as well as fall risk assessment can help decrease and prevent falls. How to collect data points to fall risk assessment and number of incidences where patients fell and were injured.

A fourth quality improvement measure that can help any healthcare or medical-based organization improve patient care and overall quality is decreasing readmission rate. Going back to a hospital or medical facility right after a medical visit or emergency visit shows low quality patient care. A 2014 article highlights the effect policy focus has on decreasing readmissions. " ... the policy focus on readmissions has motivated widespread efforts by hospitals and outpatient providers to evaluate and reengineer care processes. Many adult studies demonstrate a link between successful initiatives to improve quality and reductions in readmissions" (Nakamura et al., 2014, p. S39). By promoting the need to decrease readmissions as well as making it a priority, hospitals and other medical facilities can decrease readmissions and provide higher quality patient care. Previous and current readmission rates can be used to notice improvement or lack of improvement after implementation of new strategies.