NURS 4220: Nursing Home Residents with Alzheimer Disease.

Scenario one in this week’s discussion topic is centered around sending many nursing home residents with Alzheimer’s disease, predominantly with Medicare and Medicaid, to the ED and may not need to be seen. With this scenario, both leadership styles can be incorporated. However, the transformational leadership style will be discussed. All team members will need to be involved, and I would share the concerns and review the issues with the nurse manager. The process would begin with an analysis of nurse to patient ratios, as many ED visits can be prevented with better nurse staffing level at the nursing home. Inadequate staffing can lead to limited time to provide proper medical interventions. Therefore, the ED is used to provide medical coverage that is lacking at the nursing home.

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A staff survey would allow feedback as to why too many patients are being sent to the emergency department, and at the same time, this will encourage staff to present their ideas and give them a sense of empowerment (Yoder-Wise, 2015). Another plan of action would be to petition the ED and encourage an ED utilization review to reduce the unnecessary visits to the ED and learn why the hospital is inquiring about the misuse of the ED visits in question and validate or rescind the problem in question according to data (Spath, 2018).

A more precise understanding of the driving factor associated with inappropriate transferring of nursing home residents to the ED may result in better nursing home practice recommendations and allow for the implementation of quality improvement interventions (Perrin et al., 2017). Once the data from the Ed and staff surveys are validated, a protocol/ map of when a patient would need to be transferred would be implemented. Educating staff on all levels would help to identify the protocol for transferring patients to the ED. Nursing staff would first need to evaluate the patient, having responsibility, and ownership. Guidelines would help the nursing staff complete a conclusive assessment of the medical complaint presented. Determining what an emergent is and what medical complaint can be achieved at the nursing home is vital. The nursing home is part of a more extensive system that includes a major medical network that can be utilized as a part of an integrated network. The nursing staff would need to collaborate with other medical providers and determine the needs of the patient. The collaboration within a provider network would decrease the misuse of the ED visits in the nursing home facility.

References

Perrin, A., Tavassoli, N., Mathieu, C., Hermabessière, S., Houles, M., McCambridge, C., … & Lauque, D. (2017). Factors predisposing nursing home resident to inappropriate transfer to emergency department. The FINE study protocol. Contemporary clinical trials communications, 7, 217-223.

Spath, P. (2018). Introduction of healthcare quality management (3^rd ed.). Chicago, IL: Health Administration Press.

Yoder-Wise, P.S. (2015). Leading and managing in nursing (6^th ed.) St. Louis, MO: Mosby