Assessing the Problem: Quality, Safety, and Cost Considerations
The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.
Explain how the patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
Cite evidence that supports the stated impact.
Note whether the supporting evidence is consistent with what you see in your nursing practice.
Explain how state board nursing practice standards and/or organizational or governmental policies can affect the problem’s impact on the quality of care, patient safety, and costs to the system and individual.
Describe research that has tested the effectiveness of these standards and/or policies in addressing care quality, patient safety, and costs to the system and individual.
Explain how these standards and/or policies will guide your actions in addressing care quality, patient safety, and costs to the system and individual.
Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of care quality, patient safety, and cost to the system and individual.
Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual.
Discuss research on the effectiveness of these strategies in addressing care quality, patient safety, and costs to the system and individual.
Identify relevant and available sources of benchmark data on care quality, patient safety, and costs to the system and individual.
Use paraphrasing and summarization to represent ideas from external sources.
Apply APA style and formatting to scholarly writing.
Cite at least 5 sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old.
Topic Type 2 Diabetes: Personal patient my father, his disease is caused by his comorbidities being over weight, lack of access to healthcare due to finances and undereducated
Type 2 Diabetes: Quality, Safety, and Cost Considerations
Type 2 Diabetes Mellitus is one of the most prevalent lifestyle diseases in the United States. Over thirty million Americans have a positive diagnosis, and while it appears in all ages, the disease is common among adults over forty-five. Therefore, it presents a significant burden to the American healthcare system, warranting an investigation into how it impacts care quality, patient safety standards, and healthcare costs. Additionally, it is necessary to explore the current practice standards and policies, identify areas requiring improvements and suggest solutions to address them.
Impact on Care Quality, Patient Safety, and Healthcare Costs
The disease increases the complexity of patients’ needs. Hence, they require advanced resources and caregiver skills to address them. For instance, the patients require retinopathy tests to assess eye damage (Scheiders et al., 2019). Failure to conduct such tests, either due to resource scarcity or lack of caregiver competency, lowers the overall care quality. Additionally, the care quality challenges are evident in prevention techniques. According to Golden et al. (2017), 5.2% of Americans have undiagnosed diabetes, and 38% have prediabetes. The data shows a huge gap in the quality of preventive care relating to the disease. The niche mainly exists due to medical practitioners’ shortage since the available ones focus on treatment and disease management.
Type 2 diabetes also has patient safety implications. For instance, hypoglycemia affects over eighteen percent of all patients (Dhatariya et al., 2020). The condition is usually life-threatening, especially if the diabetic individual is not at the hospital and lacks sufficient knowledge to prevent them. Conventional safety issues such as medication errors are still common in treating diabetes, especially due to the administration of different drugs in varying doses. Taking multiple drugs also compounds the side effects, though most are mild and treatable. Finally, inpatients with diabetes are also at a higher risk of ulceration. The increased blood sugar levels impede wound healing, and if one acquires a skin injury, e.g., bedsore or a foot ulcer, it will take longer to heal. Therefore, the patient is at a higher risk of developing sepsis, resulting in longer hospital stays, adverse episodes, limb amputation, and even death. Hence, diabetes elevates an individual’s risk factor.
The increase in patient needs complexity means that type 2 diabetes increases overall healthcare costs. For instance, in 2017, Americans spent 327 billion dollars on diabetes-related actions. Moreover, people with diabetes spend over 3.2 times more on healthcare than people without it (Khan et al., 2020). Therefore, the financial burden is both communal and individual. Patients with adequate healthcare covers receive financing for medical consultations, tests, procedures, and medication. However, those who cannot afford such insurance products are likely not to receive adequate medical attention for their needs.
These literature findings are consistent with my observations. My father, the project’s focus patient, has experienced some safety issues due to diabetes. For instance, his vision has deteriorated, impairing his ability to self-inject insulin. Poor administration could cause further damage to the eyes and other major organs such as the heart and kidneys. Luckily, he has not experienced any adverse events that require emergency care or hospitalization. He takes three drugs, two taken orally, and the third, long-acting insulin, administered subcutaneously. One of the oral medicines, Metformin, causes him to experience diarrhea, which he manages using Loperamide. He has a sound medical cover that pays for the medication and an annual doctor’s visit. Therefore, he is among the diabetes patients without major health or non-health complications, but, unfortunately, that is not the case for a sizeable population in the country.
State Nursing Boards’ Standards and Organizational/Governmental Policies
State-based healthcare and nursing fraternities have established some standards that enhance patient outcomes. For instance, forty-six states (including Illinois) and the District of Columbia have a diabetes coverage mandate. Thus, all state-regulated health plans in the ACA (affordable care act) marketplaces cover diabetes-related needs (National Conference of State Legislatures, 2021). Additionally, insulin copayments policies have assisted residents of eighteen states in affording insulin, whose price tripled between 2002 and 2013. Thus, while not many type 2 diabetes patients use insulin, those that do can afford it and enhance their care quality and safety. This change has been recent, but healthcare stakeholders believe that it would improve medical products access and regulate future costs (Endocrine Society, 2021).
Meanwhile, various professional organizations offer competence-enhancing programs to healthcare practitioners. The American Diabetes Association has continuing education programs for physicians, specialists, nurses, among other professionals. Such skill and knowledge improvement interventions have been effective in other places. For instance, in China, the educational efforts improved a multidisciplinary team’s knowledge, attitude, and high patient self-management success (Zhou et al., 2020). In the United States, continuing education programs have enhanced patient safety due to enhanced competence in drug and insulin administration (Haque et al., 2021). Thus, these policies have helped improve patient safety, care quality, and cost outcomes.
Impact on Nursing Practice
These standards influence nursing action in various ways. First, they demand that nurses be highly competent in managing diabetes. Thus, nurses must continually seek new information to ensure that their practice facilitates the achievement of the ideal outcomes. Therefore, one must engage in educational programs or regularly attend diabetes workshops and conferences. Additionally, nurses can subscribe to peer-reviewed journals to access the latest literature regarding clinical diabetes interventions. Therefore, the provision for nurse competence improvement will result in nurses adopting an evidence-based approach in their practice.
The policies and standards also enhance the nurses’ advocacy roles. Nurses must actively identify individual and community-wide diabetes-related challenges and directly address them or present them to policymakers. Therefore, they will advocate for better access and affordability of healthcare resources in marginalized communities (such as immigrants), enhancing their outcomes. Also, nurses will guide patients in subscribing to insurance programs that offer financial benefits, such as insulin copayments. They will continually update their information sources to provide patients with up-to-date information.
Finally, the standards and policies impact the nurses’ patient education roles. Nurses will avail their educational services to diabetes patients and their families. Here, they will educate the patients on self-management techniques, including drug administration and lifestyle changes. They will also encourage the relatives to undergo tests to determine whether they have diabetes or prediabetes. In so doing, the nurses will lower the disease burden that arises from late or missed diagnosis and disease mismanagement.
Impact on Nursing Practice Scope
The policies and standards will impact the nursing scope. For instance, the educational improvement mandates will expand nurses’ autonomy. Particularly, community health nurses will have more authority to advise, order tests, and interpret results. They will also develop customized treatment plans for their management, including medication, diet, and activity. Meanwhile, the insurance copayments will expand the nurses’ scope to encompass case management. For example, if a nurse meets a patient recently diagnosed with diabetes, they will guide them through the healthcare system. They will identify and recommend the best insurance covers and tertiary resources. Therefore, expanding the nursing scope to include the case manager’s role will result in better disease management outcomes.
Improving care quality, patient safety, and financial outcomes for type 2 diabetes patients requires the use of multidisciplinary care teams. These are healthcare groups consisting of various experts, each addressing a unique aspect of the disease. Thus, the multidisciplinary team approach will avail all the necessary competencies to the patient under one roof. For example, one can see a dietician or a physiotherapist to assist them in developing healthier lifestyle habits, as recommended by the physician or nurse. Multidisciplinary care teams will also cut down on transport costs and time that patients accrue when traveling between facilities to meet various specialists (Haque et al., 2021). Finally, the team members can consolidate their interventions to ensure that none of the individual actions are counteractive or counter-indicative, enhancing patient safety and care quality.
Next, caregivers must address the stigma and anxiety surrounding diabetes. For example, they should show the community about the disease, dispelling fears and misconceptions. Consequently, more people will be willing to undergo diagnostic tests, resulting in better management for prediabetes and those with genetic or lifestyle risk factors (Liu et al., 2017). Addressing anxiety will also enhance patient adherence, causing a reduction in adverse events and organ damage. Therefore, patients will be less likely to develop complications that lower their quality of life.
Healthcare facilities should also offer patients vital organ monitoring services. They will allow caregivers to develop accurate interventions at different stages of the disease. Thus, the patients will have comparable quality of life in their old age as their non-diabetic counterparts. Hence, if well-implemented, this proposal will cause a cumulative reduction in healthcare costs arising from diabetes complications and comorbidities.
Lastly, the use of telehealth in diabetes management will be crucial. Telehealth platforms will allow patients to access healthcare services remotely, lowering individual costs. They will also improve clinical outcomes since patients can consult a professional immediately they notice an adverse symptom. Particularly, the quick access to healthcare services will be crucial to recently-diagnosed patients and those living in rural areas (Lee et al., 2019). Thus, integrating telehealth in managing diabetes will improve clinical and financial outcomes.
Benchmark Data Sources
The American Diabetes Association website offers patients and caregivers a vast wealth of information on diabetes. The data may be contemporary, e.g., the location of the nearest diabetes facilities and medication outlets or research-based. Thus, users browsing the website can learn more about the most affordable, effective, and realistic approaches to managing the disease. On the other hand, the American Association of Diabetes Educators provides healthcare practitioners with training resources to enhance their competency. The organization has developed these practices or amassed them from other entities and made them available on its website. Finally, the organization holds an annual national conference where stakeholders exchange research data, enhancing the diseases’ knowledge base.
Type 2 diabetes significantly impacts care quality, patient safety, and healthcare costs. The current policies and standards mitigate these challenges partially, necessitating the need to implement more solutions. Thus, the proposals seek to address the existing gaps, resulting in reduced healthcare expenditure and better clinical outcomes.
Dhatariya, K., Mustafa, O. G., & Rayman, G. (2020). Safe care for people with diabetes in hospital. Clinical medicine, 20(1), 21–27. https://doi.org/10.7861/clinmed.2019-0255
Endocrine Society. (2021, Jan. 12). Increasing Insulin Affordability. https://www.endocrine.org/advocacy/position-statements/increasing-insulin-affordability
Golden, S. H., Maruthur, N., Mathioudakis, N., Spanakis, E., Rubin, D., Zilbermint, M., & Hill-Briggs, F. (2017). The Case for Diabetes Population Health Improvement: Evidence-Based Programming for Population Outcomes in Diabetes. Current diabetes reports, 17(7), 51. https://doi.org/10.1007/s11892-017-0875-2
Haque, W. Z., Demidowich, A. P., Sidhaye, A., Golden, S. H., & Zilbermint, M. (2021). The Financial Impact of an Inpatient Diabetes Management Service. Current Diabetes Reports, 21(5). https://doi.org/10.1007/s11892-020-01374-0
Khan, M., Hashim, M. J., King, J. K., Govender, R. D., Mustafa, H., & Al Kaabi, J. (2020). Epidemiology of Type 2 Diabetes – Global Burden of Disease and Forecasted Trends. Journal of epidemiology and global health, 10(1), 107–111. https://doi.org/10.2991/jegh.k.191028.001
Lee, P. A., Greenfield, G., & Pappas, Y. (2018). Patients’ perception of using telehealth for type 2 diabetes management: a phenomenological study. BMC Health Services Research, 18(549). https://doi.org/10.1186/s12913-018-3353-x