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The Readmission Rates of the ElderlyResearch Paper

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Changing the Readmission Rates of Geriatric Patients

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READMISSION RATES

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Changing the Readmission Rates of Geriatric Patients

Geriatric patients are patients, older than 65, that often have multiple co morbidities to contend with as they continue to live their lives. Some of these patients are alone and do not have a family to support them and offer the care they need to thrive. Because of their lack of support, this group of people within the geriatric patient population do not know or have the resources to avoid falling ill again and end up readmitted into the hospital. This can happen as soon as within 30 days of initial hospital admission. The proposed solution is to offer patient education services before the last day of hospitalization. By giving the patient time to absorb the information, and give them the tools with which to feel empowered and motivated to continue their journey to recovery, this may lead to reduced readmission rates. Another possible solution is better handling of medications and possible lifestyle options for geriatric patients to follow.

Change Model Overview

The Johns Hopkins Nursing evidence-based practice model or JHNEBP for short, is a conceptual model consisting of three foundations of nursing: "practice, education, and research. The model directs that both research and non-research evidence form the basis for clinical decision-making. The model also illustrates that internal and external factors must be considered before practice can be changed" (Buchko & Robinson, 2012). This is a conceptual model that allows nurses to make the right decisions concerning a patient's care. This is because in the three phases, it is easy to discern what steps to make, in order for effective change to take place.

The first phase to the JHNEBP model is recognition and identification of an answerable question. If applied to this discussion, the question then becomes "In geriatric patients over 65 years old with several co morbidities and no family support, how does a more targeted and focused quality discharge teaching as opposed to standard discharge instructions affect readmission rates within 30 days?" The second phase tries to answer the question with evidence from a systematic review that includes information derived from research and non-research. The third phase, translation, helps synthesize all the information found to form an adequate conclusion. This conclusion helps see if the information gained can be translated to a feasible implementation of practice changes and a successful dissemination of results.

Practice Question

Step 1: Recruit Interprofessional Team

In order to provide adequate patient education, it is important to recruit medical professionals that will aid in successfully fulfilling this objective. Since the population is comprised of geriatric patients with no family support, the relevant stakeholders will be a doctor, nurse, medical assistants, and hospital volunteers. They must work together in order to give sufficient patient information to the patient before the day when the patient leaves. Without proper prescription dosages given from the doctor, instructions provided by the nurse, and patient education provided by the medical assistants and or hospital volunteers, the change in case cannot take place in an effective and relevant manner.

Step 2: Develop and Refine the EBP Question

In geriatric patients over 65 years old with several co morbidities and no family support, how does a more targeted and focused quality discharge teaching as opposed to standard discharge instructions affect readmission rates within 30 days?

Population: Geriatric patients over the age of 65 with no family support.

Intervention: Multidisciplinary educational approach

Comparison: Educational methods that will provide inpatient and outpatient education

Outcome: To identify various educational approaches that will aid in preventing readmissions of geriatric patients over the age of 65 with no family support.

The research will help identify ways in which medical professionals handling these specific types of patients can successfully educate them in lifestyle choices, medication requirements, and preventative efforts in order to avoid and reduce he readmission rate.

Step 3: Define the Scope of the EBP

Readmission rates can put a strain on any hospital. Patients over the age of 65 frequently experience multiple chronic health problems that put them in a state where they may experience a health-related event that requires hospitalization. If they do not receive adequate medical attention, they may not know what to do to avoid another health-related incident. Proper patient education helps teach patients when and why they should take the medications prescribed to them, prevent unnecessary falls, and adopt healthy lifestyle choices so the likelihood of readmission diminishes.

Readmissions are a problem not just for healthcare systems due to the financial strain, but also because of the lower quality of life the patient experiences that results in a readmission. "Among Medicare patients, almost 20% who are discharged from a hospital are readmitted within 30 days. Unplanned readmissions, at a cost of USD $17.4 billion, accounted for 17% of total hospital payments from Medicare in 2004" (Uptodate, 2016). Ever since 2012, and the passing of the Affordable Care Act's Hospital Readmission and Reduction Program, hospitals receive penalties for having too many readmissions. Therefore, it is of top priority hospitals learn to reduce readmissions to save hospitals from facing financial penalties and delivering higher quality healthcare to their patients.

Steps 4 and 5: Determine Responsibility of Team Members

Doctors provide adequate discharge summaries that when done appropriately, give enough information on what is needed for the patient to have a successful and full recovery along with prescriptions and correct medication dosages. Nurses are the ones that there to explain what the medications are for and why they are used along with what lifestyle choices will keep a patient from having to return back to the hospital as a readmission. Medical assistants and volunteers are there to give patients enough time to learn and digest all the information given to them. They are the ones that have the most time to teach these patients what not to do to avoid readmission.

Evidence

Steps 6 and 7: Conduct Internal / External Search for Evidence and Appraisal of Evidence

What type of evidence did you find? EBP guidelines? Quality improvement data? Position statements? Qualitative research? Quantitative research? Briefly discuss the strength of this research. This is not where you describe the results of your studies. This is done in the following steps.

Steps 8 and 9: Summarize the Evidence

Empowerment and patient education should go hand-in-hand when delivering patient care that helps diminish readmission rates. A 2014 study details the benefits of using such an approach as it relates to patients over 65 with multiple co morbidities. "The activities led by an Advanced Practice Nurse, rather than a general nurse, conducting individualized education with a cognitive behavioral approach, were able to provide positive clinical and patient outcomes" (Chow & Wong, 2014, p. 2257). Another article from 2013, states that perhaps the problems do not solely lie within lack of patient education, but also low-quality transitional care (Mudge, Shakhovskoy, & Karrasch, 2013). Although patient education appeared to be a major reason as discussed in the article, another reason is lack of timely outpatient review and discharge medication reconciliation from pharmacists. These are things that comprise the whole of transitional care.

Certain illnesses affecting the heart and renal system are more likely to cause readmission in geriatric patients (Franchi et al., 2013). These are important to note through patient histories so patients are more aware of potential readmissions and can take the steps necessary to reduce their chances of going back for another health-related episode. Recognition of high-risk patients and medication adherence is crucial. Patients that have a habit of not taking their medications can also lead to a higher likelihood for re-admittance (Olson, Dey, Kumar, Monsen, & Westra, 2016).

Step 10: Develop Recommendations for Change Based on Evidence

Recommendation is to create a patient education program that should be administered before a patient is about to leave the hospital. This will ensure enough time not only for the medical professional to educate the patient, but also for the patient to absorb and learn the information. This involves a collaborative effort from doctors, nurses, medical assistants, and volunteers as the role of the pharmacist is easier to fulfill than the others. Patient education is the most crucial aspect and will need to be implemented thoughtfully and thoroughly.

Translation

Steps 11, 12, and 13, 14: Action Plan

Meetings must be held as this is a collaborative effort. Patients that are older than age 65, have no family support, and have multiple co morbidities will be assessed with regards to medication adherence and knowledge of appropriate lifestyle choices. They will be educated for at least 1 hour on what to do after outpatient treatment ends and why they should adhere to these steps. Patients data will be recorded along with readmission rates to see effectiveness of implementation. This will take place over the course of one month.

Steps 16 and 16: Evaluating Outcomes and Reporting Outcomes

The desired outcomes are reduced readmission rates and enhanced… [END OF PREVIEW]

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