Reducing Rehospitalizations in Skilled Nursing Facilities Increases the Quality of Care Residents Receive and Decreases Unnecessary Health Care Cost

As a provider of care, professional nurses depend on research, theories, and evidence based practice to guide the care they provide to patients. Nurses deliver care to their patients based on information they have learned through many years of school and training. Training for nurses and other providers of care is founded on theories, research, and evidence based practice in the healthcare field. Theories, research, and evidence based practice are all important for providing care to patients and each can be used in a different manner depending on the situation. Clinicians often use research based evidence to design and implement care that is high-quality and cost effective for patients. Evidence based practice can be used to provide care to patients in a steadily changing clinical environment. (PDF page 8-9). Nursing theories are frequently used as frameworks for establishing nursing care interventions and assessing

Simply, benefits of applying EBP in patient care would be the desired outcome for the patients. According to Haas (2008), in fact, patient care designed based on the latest evidence data have 28% better outcome. Nursing research has been improved in quality, and there is growing awareness that research provides professional nursing

The overall process of discharging a patient from a hospital and the transition back home or to a care facility are critical advancements in the overall course of both acute and long-term care. It is important that the hospitals releasing these patients have ensured the proper overall course of care from beginning to end. The lack of consistency with both the discharge process and the quality of discharge planning has led to many avoidable readmissions. To reduce the amount of hospital readmissions, it is imperative that hospitals recognize the need for focused patient care and that programs are being implemented to assist in the care transition.

Itroduction: Evidence-based practice is an approach to medicine that uses scientific evidence to determine the best practice (Beyea & Slattery, 2006). As nurses perform their daily tasks they must continually ask themselves, “What is the evidence for this intervention?”. Nurses are well positioned to question current nursing practices and use evidence to make care more effective. In order to improve patients’ outcomes it is the responsibility of the nurse to transition evidence-based practice into the norm, through application of daily practice (Flynn Makic, Rauen, Watson & Will Poteet, 2014). Continual evaluation of current practice must be performed to ensure the use of evidence-based practice opposed to practice based upon tradition. The implementation of evidence-based practice standardizes healthcare practices and diminishes groundless variations within care. These variations lead to the production of uncertain health outcomes (Stevens, 2013).

contribute to the costly effect include the fact that nurses have, increased incidence of nurse burnout and patients have poorer outcomes increasing both mortality and readmission rates. Nurses are a large component to keeping readmission rates down through spending time with a patient and educating and empowering patients on self-care through helping patients understand importance of medication regimen adherence, importance of diet adherence, ways to reduce infection and various other skills to care for self at home" (Problem Memorandum Assignment, 2015) The documents exigence is crucial the audience to better the outcome of patients and that of the health

Professionalism in nursing has advanced greatly over the years. A cornerstone for change includes that of evidence based practice (EBP) as the drive of nursing intervention and patient care. According to the Quality and Safety Education for Nurses (QSEN), Evidence-based practice is described as the combination of the most recent evidence with clinical knowledge that includes the patient’s best interests in mind for greater patient outcomes (QSEN, 2017). The QSEN’s goal is to prepare nurses for improvement in quality and safety of patients (2017). Because of this goal, six competencies, including evidence-based practice, are listed for criteria of improvement in nursing practice (2017). I have been fortunate to have experience with implementing this practice and providing education in certain EBP protocols in my career. One EBP protocol in particular that our unit has been involved in since May of this year includes Enhanced Recovery After Surgery (ERAS) now referred to as Improving Surgical Care and Recovery (ISCR).

They are tasked to encourage and facilitate EBP projects. This is one way of actively supporting, promoting and continuing to improve patient outcomes with the use of evidence-based practices. Challenges arise when there are no consistent leadership in this SL group that may be due to personal reasons, schedule challenges and the different challenges that may come during the steps in conducting the EBP project itself. In my personal experience on the EBP project on bedside handoff, the advantages and benefits of changing from nurse-to-nurse handoff at the nurses’ station to bedside handoff were emphasized to all stakeholders, including the increase in patient satisfaction when patients are involved in their care. However, we faced a high push-back form staff when it came to the implementation phase. There were concerns that handoff would be longer than usual, and that breech of patient confidentiality and privacy would ensue if bedside handoff was done. Despite all that, the bedside handoff EBP was successfully implemented mostly due to the timing and adequacy of staff education that included role playing, as well as strong support of the leadership team. According to Adams, Farrington and Cullen (2012), “The final and perhaps most intimidating step in the evidence-based practice (EBP) process is dissemination.” But with proper preparation, this can be

Understaffed nurses can cause longer stay and increase the readmission rates because patients don't get enough education for discharge preparation, and information about how to take care and manage their diseases based on evidence based practice. A study of Marquette University in Milwaukee found that with fully staffed units, patients were unlikely to come back within 30 days. This decreasing of readmission rate happened because when nurse don't have high workload, they can have time to do more effective education for patients about care coordination while they are staying in the hospital or effective discharge planning (Klein, 2011).

In order for Evidenced based practice (EBP) to be successfully adopted and maintained, nurses and other healthcare professionals realize that it has to be adopted by individual providers, microsystems and system leaders, as well as policy makers. Federal, state, local, and other regulatory bodies are necessary for EBP adoption. An example of this is the mark of excellence in nursing used by the Magnet Recognition Program (Stevens, 2013). The development of evidenced based practice is fueled by the increasing public and professional demand for accountability in safety and quality improvement in healthcare (Stevens, 2013). An example of federal program that has emerged because of EBP is Congress funding the Patient –Centered Outcomes Research Institute (PCORI) with the following mission: “The PCORI helps people make informed healthcare decisions, and improves healthcare delivery and outcomes, by producing and promoting high integrity, evidence-based information that comes from research guided by patients, caregivers and the broader healthcare community”(PCORI, 2013).

As nursing leaders, the empowerment of staff to improve the delivery of safe quality care is imperative in today’s healthcare environment. The Management and Leadership track of the American Sentinel MSN program has provided the guidance to cultivate and prepare future nurse leaders to develop a sense of ownership and commitment to their work and organization. The evidenced based practice (EBP) project that is proposed will be implemented at the Veterans Administration Medical Center (VAMC); it will support the staff to improve the quality of care for the veteran population at this facility.

Evidence - Based Nursing, An introduction (2008, p. 285 ) “ The rapidity of change and the reorganization of nursing services within the health care sector presents challenges for the advancement of EBP. Managers and administrators should facilitate the uptake of practice based on current, high-quality research by formalizing the expectation that nurses care be Evidence Based”.

Although nursing homes are here to stay, frequent illness and hospitalization that exist because of a lack of primary prevention in them require unnecessary healthcare costs (Graverholt, Forsetlund, & Jamtvedt, 2014). This problem stems from a downward spiral: As the seven dimensions of health lower from a societal neglect of primary care, susceptibility to illness becomes higher, and the toll illness takes on the patient drives his or her health even further downward. For example, Jim, my uncle, was paralyzed, transferred to a nursing home, and then hospitalized within a week for pneumonia. Immediately after, he was diagnosed with MRSA, transferred to a different nursing home, diagnosed with depression, and hospitalized within three months for a kidney infection. Now he is still in the hospital awaiting another stressful transfer. In the long run, this preventable hassle actually drives up U.S. health care costs by spiking future chronic disease. Patient quality of life also suffers. (U.S. National Diabetes Education Program, n.d.)(Ornish, 2010). Thankfully, etiological risk factors of health deterioration, also defined as causative factors of preventable patient quality of life decline, have been investigated for nursing home residents. Unsurprisingly, the main

Nursing care involves a wide range of interventions which are then draw diverse evidence base of knowledge and research of nurses. When providing evidence in practice it is very important that the records are accurately maintained in order for the evidence to be considered. The main reason for research to be evaluated and critiqued is due to evidence based practice. When carrying out Evidence Based Practice it is important to start off with a clear precisely aimed outcome that needs to be achieved. Evidenced based nursing is also the approach that nurses take to provide their patients with the best care that they can. This doesn’t just begin with the patient but stems to the families. The magnet hospital model upholds this to an exceptional level. They make it their goal to provide absolutely best care for their patients and they are awarded for it. Archiebald Cochran was a pioneer in evidenced based nursing. He published “Effectiveness and Efficiency” in 1971 where he criticized the lack of reliability in EBN. He argued the need for evidence in nursing. Being the founder of evidence based nursing his influence and dedication were said to be the key in making well-formed decisions about healthcare. EBN consists of formulating a question, gathering evidence to answer clinical questions, deciding which would be best, assessment of the patient, and evaluation. EBN paved the way for nursing

My organization uses evidence based practice to improve patient care by setting up "practice council meetings". These meetings have several groups of individuals in the hospitals departments. Comprised of Med-surg Nurses and Clinical assistants, Progressive care RN's and CA's, and pharmacy staff. We meet the last Wednesday of each month to talk about good things that has happened on the Units, practice goals, and problems in practice. Having many disciplines in the meeting allows for different points of views and many solutions. Using PICO we determine what the problem is and talk about what the interventions should be. We explore alternatives and find our outcome. (Masters, 2014).

As a competent registered nurse, my career goal is to become a healthcare quality improvement leader, a position that would enhance my commitment in promoting patient safety. I not only believe in enhancing the capacity of other care providers, but also in improving the quality of the healing environment for the benefit of both patients and their care providers. This means not only promoting collaboration with the multidisciplinary teams, but also building the necessary healing partnerships with our patients. To enhance the quality of the healing environment, I aspire to continue analyzing researches for evidence based practices and advocating for their actualization. I will continue focusing my time and energy in encouraging other nurses to improve their skills through formal education, so they can empower themselves as advocates of quality improvement for the benefit of their patients and coworkers.