Assessing the Problem: Quality, Safety, and Cost Considerations
In a 5-7 page written assessment, assess the effect of the patient, family, or population problem you’ve previously defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend exploring these aspects of the problem with the patient, family, or group you’ve chosen to work with and, if desired, consulting with subject matter and industry experts. MAKE UP Patient or group
Introduction
Organizational data, such as readmission rates, hospital-acquired infections, falls, medication errors, staff satisfaction, serious safety events, and patient experience can be used to prioritize time, resources, and finances. Health care organizations and government agencies use benchmark data to compare the quality of organizational services and report the status of patient safety. Professional nurses are key to comprehensive data collection, reporting, and monitoring of metrics to improve quality and patient safety.
Preparation
In this assessment, you’ll assess the effect of the health problem you’ve defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 direct practicum hours working with the same patient, family, or group. During this time, you may also choose to consult with subject matter and industry experts. MAKE UP PATEINT or group ( opioid addicted patient)
To prepare for the assessment:
Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete and how it will be assessed.
Conduct research of the scholarly and professional literature to inform your assessment and meet scholarly expectations for supporting evidence.
Review the Practicum Focus Sheet: Assessment 2 [PDF], which provides guidance for conducting this portion of your practicum.
Note: Remember that you can submit all, or a portion of, your draft assessment to Smarthinking for feedback, before you submit the final version. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.
Instructions
Complete this assessment in two parts.
Part 1
Assess the effect of the patient, family, or population problem you defined in the previous assessment on the quality of care, patient safety, and costs to the system and individual. Plan to spend time exploring these aspects of the problem with the patient, family, or group. MAKE IT UP . During this time, you may also consult with subject matter and industry experts of your choice. Use the Practicum Focus Sheet: Assessment 2 [PDF] provided for this assessment to guide your work and interpersonal interactions.
Part 2
MAKE UP PATIENT OR group- with opioid addiction
Report on your experiences during your first 2 practicum hours, including how you presented your ideas about the health problem to the patient, family, or group.
Whom did you meet with?
What did you learn from them?
Comment on the evidence-based practice (EBP) documents or websites you reviewed.
What did you learn from that review?
Share the process and experience of exploring the influence of leadership, collaboration, communication, change management, and policy on the problem.
What barriers, if any, did you encounter when presenting the problem to the patient, family, or group?
Did the patient, family, or group agree with you about the presence of the problem and its significance and relevance?
What leadership, communication, collaboration, or change management skills did you employ during your interactions to overcome these barriers or change the patient’s, family’s, or group’s thinking about the problem (for example, creating a sense of urgency based on data or policy requirements)?
What changes, if any, did you make to your definition of the problem, based on your discussions?
What might you have done differently?
Sample Paper
Assessing The Opioid Epidemic: Quality, Safety, and Cost Considerations
The opioid use disorder affects millions of Americans whose unprescribed use of opiate-containing substances for medical and recreational purposes negatively affects their health. The opioid epidemic has significantly impacted the healthcare system, particularly regarding care quality, safety, and costs to individuals and the entire system. Hence, the current paper assesses this impact, the role of state nursing boards and organizational/governmental policies, and how new proposals can enhance care quality and safety and lower healthcare costs. Additionally, documenting a two-hour practicum interaction with a patient with opioid use disorder emphasizes the epidemic’s impact on an individual, their family, and the wider society.
Part One
Impact on Care Quality, Safety, and Costs
Care Quality
The opioid epidemic has led to an overall deterioration of healthcare quality. For instance, Painter (2017) stated that an addiction history could make caregivers have a negative attitude towards patients. Thus, the negative outlook hinders their capacity to provide high-quality care by failing to address essential components, such as patient preferences. One can easily observe this trend in today’s practice, especially since most caregivers have inadequate knowledge to cater to the needs of opioid use disorders. Furthermore, the lack of an emotional connection may fail to inspire the highest levels of diligence, resulting in substandard care and suboptimal outcomes. Opioid addiction also increases healthcare needs. Therefore, there are more patients for the same nursing workforce. The deteriorating nurse-patient ratio means that the healthcare providers have a larger workload. Hence, they cannot spend a lot of time on patients, regardless of whether their needs are opioid-abuse-related. Therefore, the unfavorable ratio causes a systematic decline in care quality.
Safety
Opioid use disorder patients are at high risk of physical, mental, and emotional harm. Thus, the epidemic creates significant patient safety, requiring caregivers to always be on high alert. Additionally, opioid addiction poses safety issues to other society members and caregivers. Stone & Rothman (2019) reported that opioid use disorder significantly contributed to the perpetration of intimate partner violence. The patients can also physically and psychologically abuse professional caregivers, complicating the therapeutic relationship. Therefore, it is common to note caregivers take extra personal safety precautions when dealing with opioid use disorder patients.
Healthcare Costs
The opioid epidemic’s annual financial burden in the United States is about 78.5 billion dollars (NIH, 2021). These funds could have funded other health promotion initiatives, such as research, preventive care, and curtailing the spread of infectious diseases. Moreover, this avoidable shared expense increases the per capita costs, resulting in higher insurance premiums and minimum insurance expenditure. The economic burden is even greater for opioid use disorder patients and their families. They spend more money to access healthcare services than the rest, and the payments are out-of-pocket. Such funds could have otherwise gone into personal development endeavors, such as education or investment. This financial impact is observable in practice since many families with opioid use disorders patients tend to have financial struggles that originate from the increased healthcare expenditure.
State Nursing Board Standards and Organizational/Governmental Policies
State nursing board standards relate to regulation, including prescription and administration of opioids. Furthermore, they have educational standards that enhance caregivers’ competence (National Academies of Science, Engineering, and Medicine, 2017). Caregivers engage in continuing education programs to improve various care aspects, such as cultural competence and patient communication. Therefore, the standards enhance the overall care quality. In turn, there is an improvement in outcomes, resulting in improved safety for patients and associated parties. Policies by local authorities, the federal government, and professional institutions are also crucial. For instance, the drug take-back program enhances accountability and transparency in opioid distribution (National Academies of Science, Engineering, and Medicine, 2017). Hence, there is less illegal access to these drugs, helping combat the problem. These policies and standards require more commitment from caregivers, which expands the scope of practice to include pharmaceutical management, care coordination, and extensive patient and family education.
Proposed Strategies
Most of the existing standards and policies fail to address specific impacts of the opioid epidemic. Hence, there is the need to formulate strategies that systematically enhance care quality, safety, and lower costs. One must address the stigmatized perceptions of opioid use disorder patients among caregivers. This intervention would require that government healthcare authorities collaborate with professional bodies to ensure that all caregivers undergo an educational and sensitization program (Madras et al., 2020). In so doing, caregivers will be more competent in dealing with patients, enhancing quality outcomes. The National Academy of Medicine also supports the development of state-based models to address the psychological needs of opioid use disorder patients. Hence, they will pose a lesser risk of harming themselves, their family, and caregivers. Finally, coordinating the care interventions for the patients will enhance the effectiveness of interventions. Hence, a remarkable decline in relapses will result in lower overall and individual costs.
Part Two
Practicum Project Encounter
My practicum encounter was with a thirty-two-year African-American man. I met him after I had attended to a forearm fracture he had. His medical history showed that he had several admissions related to the use of fentanyl, a synthetic opioid. From our therapeutic interaction, he seemed interested in overcoming his addiction. Hence, I requested that he participate in my practicum project, and he agreed. I queried him about various aspects of the disorder, and his responses were very insightful.
He stated that he began using fentanyl fifteen months ago after a friend offered him a small dosage to assist with pain following a double fracture in his forearm. Subsequently, he became addicted to the substance. He would often pick fights, especially when he had not had his daily fix. The violence affected his family and coworkers, causing his wife to divorce him. He also lost his job and served a six-month sentence. After his release, he restarted using the opioid and experienced several overdose events from which he nearly died. He used his savings to pay for the care since he did not have a job. He also enrolled in a community program that helped him overcome the addiction. Presently, he has not used the drug for three months, but he is cautious in considering himself triumphant. He visits a mental health specialist to help him address his anxiety. He has a job now and has enrolled in a private insurance program. Its policies mandate partial coverage for rehabilitation services, per the provisions of Obamacare (affordable care act).
Evidence-Based Documents and Websites
The evidence-based sources in this report cover the clinical and non-clinical aspects of the opioid epidemic. The clinical information shows how the epidemic has affected medical aspects of care, such as care quality and patient safety. They also provide clinical interventions that clinicians can implement to enhance outcomes, e.g., care coordination. Meanwhile, the non-clinical sources offer a more comprehensive outlook of the problem. They explore the financial impact of the disease and policymakers’ role in addressing it. For instance, the National Academies of Science, Engineering, and Medicine (2017) highlights the most current strategies. Hence, it is easy to identify the gaps and propose solutions to address them.
Exploring Leadership, Collaboration, Communication, Change Management, and Policy
So far, the course undertaking to explore the opioid epidemic and the role that leadership, collaboration, communication, change management, and policy have on the outcomes has been an integral learning process. I have encountered various challenges, such as finding the right person to interview. Many patients were unwilling to participate. Hence, it was challenging to find a willing participant, especially from outside the hospital setting. Nevertheless, I overcame the obstacle by repurposing my search for a participant within my care setting, and I was successful.
The process has required me to employ various skills, such as research and evidence-based practice implementation. These competencies have allowed me to gather relevant data and analyze it to determine its clinical significance. I have also extensively used communication skills to connect with various stakeholders. For instance, I had to be very articulate when convincing potential participants.
I did not redefine the problem for the practicum project, as the initial definition allowed me to explore both individual and community-wide factors and implications of the healthcare issue. However, I feel that I would have acquired more information if I had sought out a focus group for the interview. I would have had more diverse stories, allowing me to view the issue from different perspectives. Nevertheless, the process has been successful, and I look forward to implementing the knowledge I have acquired.
References
Madras, B. K., Ahmad, N. J., Wen, J., Sharfstein, J., & Prevention, Treatment, and Recovery Working Group of the Action Collaborative on Countering the U.S. Opioid Epidemic. (2020). Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers Within the Treatment System. NAM Perspectives. https://doi.org/10.31478/202004b
National Academies of Science, Engineering, and Medicine. (2017). Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. National Academies Press.
National Institutes of Health [NIH]. (2021, Mar. 11). Opioid Overdose Crisis. https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis
Painter, S. G. (2017). Opiate Crisis and Healthcare Reform in America: A Review for Nurses. The Online Journal of Issues in Nursing, 22(2), Manuscript 3. https://doi.org/10.3912/OJIN.Vol22No02Man03
Stone, R., & Rothman, E. F. (2019). Opioid Use and Intimate Partner Violence: a Systematic Review. Current Epidemiology Reports, 6, 215-230. https://doi.org/10.1007/s40471-019-00197-2
