NRS 493 Evidence Based Literature Capstone Project

Create a professional presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders. Include the intervention, evidence-based literature, objectives, resources needed, anticipated measurable outcomes, and how the intervention would be evaluated.

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1 Benchmark – Capstone Change Project Objectives Yamil Bernard College of Nursing, Grand Canyon University NRS-493: Professional Capstone and Practicum Dr. Luetke April 18, 2021 2 Objective with Rationale: 1. Understand the project purpose, concepts, its application in nursing practice, as well as how this project will improve patient outcomes. • It is essential for the RN-BSN student to understand the project purpose, concepts, what the application/implementation means for the RN, as well as what the application/implementation means for the patient 2. Implement evidence based practice principles and quality and safety measures. • Evidence based practice principles are essential for providing the best practice available to the patient. Quality and safety measures should always be implemented to provide the best care for the patient. 3. Demonstrate interprofessional collaboration during the implementation of the capstone project change proposal. • Interprofessional collaboration is essential for all aspects of patient care, but especially helpful in care such as this, implementing new guidelines for patient care. Advocation for Autonomy and Social Justice for Individuals and Diverse Populations: This project advocated for autonomy and social justice for individuals and diverse populations by providing support to the patient, as well as a firm understanding of the benefits of the hospital and the skilled nursing facility partnering up. The aim of this project is to create a partnership between the hospital and the skilled nursing facility in order to reduce the readmission rates less than 30 days. Educating patients on their conditions and following up with unresolved issues is the goal of the partnership. 1 PICOT Question Paper Yamil Bernard College of Nursing, Grand Canyon University NRS-493: Professional Capstone and Practicum Dr. Luetke April 18, 2021 2 PICOT Question In patients admitted to a skilled nursing facility how does building a partnership between the skilled nursing facility and the hospital compared to no partnership impact the rates of readmission within 30 days from discharge? The Issue The problem observed at the nursing facility in North Bergen is increased re-admission rates at the facility. The national average percentage of residents who were re-hospitalized after being in a skilled nursing facility (SNF) was 20.8%, in New Jersey it was 21.7%, while in the facility it is 24.8%. At the present time the facility has an average that is above the national and state level causing concern. NRS 493 Evidence Based Literature Capstone Project

This problem affects the health of the patient and economically hurts the facility and the hospital as well. Patients may be discharged from the hospital before they are even ready to be discharged or there is little to no communication between the hospital and the facility making it difficult for a team-based approach on the patient’s case. Extensive planning by members of both the hospital and the SNF are necessary to deliver care (Higbea et al., 2017). There will always be some cases in which a patient must be transferred due to medical conditions or doctor’s recommendation, but in the case of this facility there are a handful that could have been avoided with proper planning and collaboration with the hospital. An Evidenced Based Nursing Intervention In order to improve the facility’s readmission rates the plan is build a partnership between the skilled nursing facility and the hospital along with reviewing each patient that is sent out to the emergency room. Partnerships between the hospital and skilled nursing facilities are showing improvements in hospital readmission rates. In the first example we have the partnership between John Hopkins University and five nearby SNFs. These two entities used a centralized 3 database in order to analyze the most frequent causes of rehospitalizations from the SNFs. Protocols were then developed by medical, nursing, and administrative leaders for the most common reasons. The data from the period prior to the partnership and the period after showed that the number of discharges from the acute care hospital to the SNF declined by 29% (Worcester, 2019). In another similar program at the Cleveland Clinic partnering up with seven nursing homes was associated with a 14% point reduction in readmissions (Worcester, 2019). Moreover, Cedars-Sinai Medical Center created the Enhanced Care Program (ECP) available to patients discharged to SNFs, which includes an interdisciplinary team including a nurse practitioner, physician, and pharmacist to follow up on unresolved patient care issues (Traynor, 2015). The Cedars-Sinai’s ECP nurses coordinate the care between inpatient and SNF settings, they work with the physician in both places, meet with the patients in the hospital, and assess them again within a day after admission to the nursing facility. Before the implementation of this program 30-day readmissions to Cedars-Sinai from participating SNFs had a rate of about 20%, but have since declined by 25% after the ECP began (Traynor, 2015). Overall, it is important to note that the Centers for Medicare and Medicaid Services (CMS) has identified hospital’s partnership with SNFs on post discharge support as a likely factor in reducing 30-day readmission rated for Medicare beneficiaries (Traynor, 2015). Clinical Problem and Patient Outcome This issue mentioned above has a great impact on patients. According to Smith et al. (2019), hospital readmissions have long served as an indicator of patient recovery and the effectiveness of care. With readmission rates increasing in the facility it is our job as nurses and part of the healthcare team to find out where it is that we are failing our patients. Unplanned readmissions are considered disruptive to the patient, causing them stress and increasing their 4 risk of contracting a hospital-acquired infection and complications (Smith et al., 2019). The focus should be shifted to managing the patient rather than managing the acute care episode (Traynor, 2018). This clinical problem not only affects the patient, but it also economically affects the facility. The CMS are combating the issue of hospital readmission, SNFs with higher than average rates of unplanned hospital readmission will face a 2% reimbursement cut (Smith et al., 2019). This issue will affect the health and well-being of patients as well as economically NRS 493 Evidence Based Literature Capstone Project