To Prepare:

· Review the case studies (attachment) and answer ALL questions.

· When recommending medications, write out a  complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patient’s current medications.

· Use clinical practice guidelines in developing your answers. Please review all Required Learning Resources. Use the Medscape app or website and JNC 8 to complete assignment.

· Include  at least three references to support  each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.

Current guidelines to use for Cases

1.2023 ESH Hypertension Guideline Update 

https://www.acc.org/Latest-in-Cardiology/Articles/2024/02/05/11/43/2023-ESH-Hypertension-Guideline-Update#:~:text=The%20ESH%20guidelines%20target%20BP,140%20and%20150%20mm%20Hg.Links to an external site.

2. GOLD COPD

3. Asthma -The 2023 Global Initiative for Asthma (GINA) guidelines for asthma treatment include two tracks for adults and adolescents 12 and older:

The Assignment

· Sara is a 45-year-old female presenting for her annual exam. Her blood pressure today is 160/90 HR 84 RR 16. Her height is 64 inches and her weight is 195. Her last visit to the clinic 3 months ago shows a BP of 156/92. She is currently taking ibuprofen 600 mg tid for back pain. She has no known allergies. What is the goal for her blood pressure? What medication would you prescribe to treat her blood pressure? What education would you prescribe?

· Monty is a 52-year-old male following up on his labs that were drawn last week. He smokes 1 pack per day. He is currently on Lisinopril 20 mg po daily. He is allergic to penicillin. Fasting lipid profile shows total cholesterol 266, LDL cholesterol 180, HDL cholesterol 40, and Triglycerides 185. What treatment plan would you implement for Monty’s lipid profile? What is the goal Total Cholesterol (TC), HDL-C, and LDL-C level for Monty? How would you monitor the effectiveness of your treatment plan? How many risk factors for coronary artery disease does this patient have? Identify them specifically.

· Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age 7. During her visit today, she reports having to use her albuterol MDI 3 to 4 days per week over the past 2 months. Over the past week she has been using albuterol at least once per day. She reports being awakened by a cough three nights during the last month. She is becoming more short of breath with exercise. She also has a fluticasone MDI, which she uses “most days of the week.” Her current medications include: Flovent HFA 44 mcg, two puffs BID, Proventil HFA two puffs Q 4–6 H PRN shortness of breath, Yaz one PO daily, Propranolol 80 mg PO BID. What treatment plan would you implement for this patient? What medication changes would you make? How would you monitor the effectiveness of this plan?

· Daute is a 56-year-old man seeking evaluation for increasing shortness of breath. He noticed difficulty catching his breath about 3 years ago. Physical activity increases his symptoms. He avoids activity as much as possible to prevent any SOB. His previous physician had placed him on salmeterol/fluticasone (Advair Diskus) one inhalation twice daily 2 years ago. He thinks his physician initiated the medication for the shortness of breath, but he is not entirely sure. He did not refill the prescription and has not been taking it. Pertinent history – Chronic bronchitis X 8 years with one exacerbation in last 12 months of treatment with oral antibiotics. He has a 40-pack-year smoking history. What treatment plan would you implement for this patient? What medication(s) would you prescribe? How would you monitor the effectiveness of this plan?

Informatics and Nursing-Sensitive Quality Indicators

introduction

The focus of Assessment 4 is on how informatics support monitoring of nursing-sensitive quality indicator data. You will develop an 8–10 minute audio (or video) training module to orient new nurses in a workplace to a single nursing-sensitive quality indicator critical to the organization. Your recording will address how data are collected and disseminated across the organization along with the nurses’ role in supporting accurate reporting and high quality results.

Preparation

As you begin to prepare this assessment you are encouraged to complete the Conabedian Quality Assessment Framework activity. Quality health care delivery requires systematic action. Completion of this will help you succeed with the assessment as you consider how the triad of structure (such as the hospital, clinic, provider qualifications/organizational characteristics) and process (such as the delivery/coordination/education/protocols/practice style or standard of care) may be modified to achieve quality outcomes.

This assessment requires you to prepare an 8–10 minute audio training tutorial (with optional video) for new nurses on the importance of nursing-sensitive quality indicators. To successfully prepare for your assessment, you will need to complete the following preparatory activities:

· Review the nursing-sensitive quality indicators presented in the  Assessment 04 Supplement: Informatics and Nursing Sensitive quality Indicators [PDF]   Download Assessment 04 Supplement: Informatics and Nursing Sensitive quality Indicators [PDF]

Assessment 04 – Informatics and Nursing-Sensitive Quality Indicators For this assessment, you will prepare an 8–10 minute audio training tutorial (video is optional) for new nurses on the importance of nursing-sensitive quality indicators. Before you complete the detailed instructions in the courseroom, first review the Nursing- Sensitive Quality Indicators below and select the one you’re most interested in. Nursing-Sensitive Quality Indicators reflect the structure, process, and patient outcomes of nursing care. Nursing-Sensitive Quality Indicators are developed by identifying potential indicators that reflect nursing care and are not represented by current indicators, performing a literature review, and determining the validity of the potential indicator in nursing practice. After you select one of the Nursing-Sensitive Quality Indicators below, return to the courseroom to review the detailed instructions and complete your assessment. • Incidence of Hospital-Acquired Infections – Outcome. • Patient Falls Without Injury – Process. • Restraint Use Duration – Process and Outcome. • Staffing Levels – Structure. • Nursing Care Hours Per Patient Day by Registered Nurses With a Bachelor of Science in Nursing (BSN) Degree – Structure.

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· resource and select one nursing-sensitive quality indicator to use as the focus for this assessment.

· Conduct independent research on the most current information about the selected nursing-sensitive quality indicator.

· Interview a professional colleague or contact who is familiar with quality monitoring and how technology can help to collect and report quality indicator data.  You do not need to submit the transcript of your conversation, but do integrate what you learned from the interview into the audio tutorial. Consider these questions for your interview:

· What is your experience with collecting data and entering it into a database?

· What challenges have you experienced?

· How does your organization share with the nursing staff and other members of the health care system the quality improvement monitoring results?

· What role do bedside nurses and other frontline staff have in entering the data? For example, do staff members enter the information into an electronic medical record for extraction? Or do

INSTRUCTION

For this assessment, first review the nursing-sensitive quality indicators presented in the  Assessment 04 Supplement: Informatics and Nursing Sensitive quality Indicators [PDF]  Download Assessment 04 Supplement: Informatics and Nursing Sensitive quality Indicators [PDF]resource and select one nursing-sensitive quality indicator to use as the focus for this assessment.

Next, imagine you are a member of a Quality Improvement Council at any type of health care system, whether acute, ambulatory, home health, managed care, et cetera. Your Council has identified that newly hired nurses would benefit from comprehensive training on the importance of nursing-sensitive quality indicators. The Council would like the training to address how this information is collected and disseminated across the organization. It would also like the training to describe the role nurses have in accurate reporting and high-quality results.

The Council indicates a recording is preferable to a written fact sheet due to the popularity of audio blogs. In this way, new hires can listen to the tutorial on their own time using their phone or other device.

As a result of this need, you offer to create an audio tutorial orienting new hires to these topics. You know that you will need a script to guide your audio recording. You also plan to incorporate into your script the insights you learned from conducting an interview with an authority on quality monitoring and the use of technology to collect and report quality indicator data.

You determine that you will cover the following topics in your audio tutorial script:

Introduction: Nursing-Sensitive Quality Indicator

· What is the National Database of Nursing-Sensitive Quality Indicators?

· What are nursing-sensitive quality indicators?

· Which particular quality indicator did you select to address in your tutorial?

· Why is this quality indicator important to monitor?

· Be sure to address the impact of this indicator on the quality of care and patient safety.

· Why do new nurses need to be familiar with this particular quality indicator when providing patient care?

Collection and Distribution of Quality Indicator Data

· According to your interview and other resources, how does your organization collect data on this quality indicator?

· How does the organization disseminate aggregate data?

· What role do nurses play in supporting accurate reporting and high-quality results?

· As an example, consider the importance of accurately entering data regarding nursing interventions.

After completing your script, practice delivering your tutorial several times before recording it.

Professional context

The American Nursing Association (ANA) established the National Database of Nursing Quality Indicators (NDNQI®) in 1998 to track and report on quality indicators heavily influenced by nursing action.

NDNQI® was established as a standardized approach to evaluating nursing performance in relation to patient outcomes. It provides a database and quality measurement program to track clinical performance and to compare nursing quality measures against other hospital data at the national, regional, and state levels. Nursing-sensitive quality indicators help establish evidence-based practice guidelines in the inpatient and outpatient settings to enhance quality care outcomes and initiate quality improvement educational programs, outreach, and protocol development.

The quality indicators the NDNQI® monitors are organized into three categories: structure, process, and outcome. Theorist Avedis Donabedian first identified these categories. Donabedian’s theory of quality health care focused on the links between quality outcomes and the structures and processes of care (Grove et al., 2018).

Nurses must be knowledgeable about the indicators their workplaces monitor. Some nurses deliver direct patient care that leads to a monitored outcome. Other nurses may be involved in data collection and analysis. In addition, monitoring organizations, including managed care entities, exist to gather data from individual organizations to analyze overall industry quality. All of these roles are important to advance quality and safety outcomes.

Reference

Grove, S. K., Gray, J. R., Jay, G. W., Jay, H. M., & Burns, N. (2018).  Understanding nursing research: Building an evidence-based practice (7th ed.). Elsevier.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

· Competency 1: Describe nurses’ and the interdisciplinary team’s role in informatics with a focus on electronic health information and patient care technology to support decision making.

· Describe the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports.

· Competency 3: Evaluate the impact of patient care technologies on desired outcomes.

· Explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports.

· Competency 4: Recommend the use of a technology to enhance quality and safety standards for patients.

· Justify how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes.

· Competency 5: Apply professional, scholarly communication to facilitate use of health information and patient care technologies.

· Deliver a professional, effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.

· Follow APA style and formatting guidelines for citations and references.