Healthcare

After reading the case study below answer the following question in approximately 100-150 words: 1. give your recommendations on how the organization could improve their operations and quality. Case Study CCHS-5  Standardization of Heparin Nomograms  Shannon Phillips, MD, MPH, and Robert Patrick, MD, MBA  Background  Cleveland Clinic identifies priorities in safety and quality through both public reporting expectations and internal monitoring and reporting systems. The internal monitoring and reporting structure for patient safety is an interdisciplinary patient safety committee led by a physician patient safety officer. This committee oversees the operation of an anonymous, voluntary intranet-based safety event reporting system (SERS), which can be easily accessed by anyone in the institution to report actual safety events or potential risks to safety. SERS entries are collated and reviewed by the committee monthly, and consistent patterns warranting further attention are identified.  Methods, Resources, and Performance Targets  Anticoagulation—thinning the blood to prevent or treat clotting—is a critical part of safe care for many hospitalized patients. The most common medication errors reported by our frontline caregivers were related to anticoagulants, specifically the intravenous anticoagulant heparin. Successful anticoagulation with heparin is measured by a blood test (PTT), which is collected 6 hours after every change in infusion rate and then daily once therapeutic levels are achieved. Heparin infusions are sometimes started with a one-time large dose of medication (bolus) in an attempt to get the patient inside the therapeutic range quickly. A PTT below the therapeutic range places the patient at risk for clotting, and above the range the risk is for spontaneous bleeding with potentially catastrophic consequences. Heparin-related SERS events were believed to be above a tolerable threshold, and consequently the patient safety committee chartered a project to improve the safety and efficacy of intravenous heparin. Although SERS events are a good trigger for further investigation, they are anecdotal by nature and cannot accurately quantify the magnitude of any given risk. The first task of the team was to develop clinically relevant outcome measures and an information infrastructure to monitor them. Time to initial therapeutic PTT is the traditional outcome used to measure the quality of heparin therapy. This was believed to be inadequate as it measured only how fast the therapeutic range was attained and ignored what happened afterward. A new outcome was defined by the team as a percentage of time on therapy spent below/inside/above range, and initial data showed a 40%/40%/20% distribution. Detailed process mapping with key stakeholders was undertaken and showed prescribing, dosing, administration, and monitoring as the critical steps requiring intervention. Process mapping also allowed us to identify the key leads for our improvement initiative: physician staff, nursing, pharmacy, and laboratory. The team was expanded and the plan step of the first PDSA cycle was undertaken using a combination of Microsystems and Lean techniques. The bundle of interventions developed in this stage is detailed below: •    Ordering: physicians  •   Standardizing electronic ordering into three nomograms and limiting heparin ordering to one of the nomograms.  •   Defaulting choices within the nomogram such that once a nomogram is chosen, the only remaining choice is bolus or no bolus.  •   Clear visual distinction in order between bolus/no bolus.  •   Order cannot be exited without choosing bolus/no bolus.  •   Dosing: nurses  •   User-friendly dosing calculator similar to a smart-phone application programmed into the EMR.  •   Maximum dose limits programmed into the calculator.  •   Clear, documented nursing acknowledgment of bolus/no bolus choice from the physician order. •   Administration: nurses  •   Smart pumps synchronize with maximum dose limits in the EMR, and overdose cannot be accidentally programmed into the pump.  •   Monitoring: lab and nurses  •   Decreased variation in turnaround time for PTT.  •   Visual display of an icon on a large television screen notifies the nurse that PTT is available and it is time for recalculation of dose and infusion change.  Results  Pilot sites for the intervention were chosen based on both volume of heparin use and an assessment of willingness to change. The pilot was run for 2 months with improvement from 40%/40%/20% below/inside/above range to 21%/57%/22%. Additionally, there were improvements in process measures such as the percentage of PTT lab draws completed within 15 minutes of designated time and reduction in total cycle time. The target percentage inside range defined in the plan stage was a doubling from 40% to 80%, and so the study portion of this PDSA cycle included a detailed review of “failures” from the pilot. It revealed poor nursing documentation and continued mistakes in dosing as contributors, and consequently two additional interventions were added to the bundle:  •   Dosing: nurses  •   Two nurses calculate the dose independently and check figures with each other.  •   Administration: nurses  •   The same two nurses who calculated the dose together also program the pump together and record an entry in the EMR.  Conclusion  The main financial driver in previous clinical trials of anticoagulation was a decrease in cases of catastrophic bleeding associated with anticoagulation. This outcome turned out to be extraordinarily difficult to measure in a real-world setting and even more difficult to attribute directly to improved control of heparin, so there was no attempt made to calculate financial return on investment, and the project was justified solely on the merits of improvement in patient safety. This bundle of process changes has recently been rolled out to all units in our 1,200-bed academic hospital. We continue to monitor percentage time in range and look closely for complications of treatment. Anecdotally, members of the nursing staff have increased confidence in the care they give and call out the important teamwork that has developed as a result of this improvement program.

Many providers have expressed that patients need to be more accountable for their own health care since many conditions are created or furthered by a patient’s failure to comply with doctor’s instructions. This also means that conditions that have many complications could be prevented by better patient self-care. What are your thoughts about this issue? Do you believe that patients should be more accountable for their own health care? Why, or why not? Your journal entry must be at least 200 words. No references or citations are necessary.

Think about how religion and ethics can affect health care as presented in this unit. What would you do if you were receiving care from a physician and some part of the care went against your ethical or religious beliefs? Would you continue to receive the care or reject it, against the doctor’s advice? Your journal entry must be at least 200 words. No references or citations are necessary.

Please read the following: https://www.childwelfare.gov/topics/systemwide/youth/resourcesforyouth/rights-of-youth-in-foster-care/ https://www.thenationalcouncil.org/BH365/2019/07/08/stigma-regarding-mental-illness-among-people-of-color/ e20161118.full.pdf   Then answer the following letter: Many parents do not understand the mental health needs of their children. Do you think that children should be removed because their parents refuse mental health treatment for them?  Do you think, there is a mistrust of the mental health system by families of color? Why?

written summary outlining current health care issues in Taiwan to illustrate your understanding of the political, economic, and cultural factors of the health care system in these countries based on current facts; the history and current health care statistics.

Select a disease problem (heart disease) and apply the Precede-Proceed model described in the chapter.   How should HSO (Health Service Organization)/HS (Health Systems) governing bodies and managers use this model?

Coyne and Messina Articles: Part 1 – Analysis   In a paper (1,000-1,250 words), compare and contrast the major elements of the assigned articles by Coyne et al. and Messina et al. Complete the “Coyne and Messina Articles Analysis” resource. Study the information in the right-side column related to the Coyne et al. study, which identifies the required elements as found in the reading. Complete the information for the Messina et al. article by identifying the required elements from the article. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. Attachments

Write a 2-page essay in which you explain the role of health service managers in participating in the evaluation processes of health institutions. Be sure to write according to APA, include citations and references, and submit to NetTutor for feedback. The facilitator will send the written works to SafeAssignTM to detect cases of plagiarism. Place the document in the assignments area on Blackboard, created by the facilitator. Come prepared to class so that it abounds.

   Address factors influencing people’s behavior regarding this health issue.   This section must include accurate citations and references for at least 3 academic articles. Use APA format for citations (within the text) and references (list at end of paper). Use library databases (Academic Search Premier, CINAHL, Medline), to find articles on your topic that address the four points listed above.     Step 2: Analyzing and selecting a Target Audience You are selecting and describing whom your campaign will target and why, and thoughts and behaviors of this targeted group of people that could be addressed by your campaign: 1.       Based on articles addressing your health issue, think carefully about the people affected by the issue (target population).  Describe the people/groups affected by your health issue. 2.       Choose a target audience that your campaign could significantly impact (i.e. your family/friends).  Describe this group and why it is particularly important that they be the focus of a campaign on your health issue (i.e., why is it important to change their behavior?)   Your writing needs to explain why you chose this target population.   Why should a campaign be focused on their behavior?  3.       Find out everything you can about your “target audience.”  Why are they particularly vulnerable on your health issues?  What thoughts/behaviors offer information about how to persuade this group?      Step 3: Establishing Campaign Goals and Objectives In this section, you are setting objectives for your campaign (e.g convince family to have a virtual Thanksgiving) and you are planning the communication efforts that will enable you to reach them (e.g., facetime, zoom, email, letters, powerpoint etc). 1.       State the overall goal of your campaign.   What do you want to achieve?  What kinds of changes do you want your campaign to make?  Identify specific objectives, and think in terms of short-term outcomes (awareness of the campaign), mid-term outcomes (changes in beliefs, attitudes, perceptions), and long-term outcomes (behavioral changes, health improvements). 2.       Apply the SMART (specific, measurable, attainable, relevant, and timeframe) criteria to the objectives you identified.   Work with your objectives until you have the set you want that meets these criteria. Write tis this section of your paper laying out your objectives and how they meet the SMART criteria.   Step 4: Selecting Channels of Communication In this section you’re going to plan the communication that will enable you to reach your objective(s).   What is your campaign going to DO to get you to those SMART objectives?    1.       Channel Characteristics  Choose a communication method that will best meet your goals for successfully implementing your message e.g.(facetime, zoom, email, letters, powerpoint etc). 2.       Explain why and how this channel is the best choice for persuading your target audience 3.       How does this channel affect the impact of the message in terms of involvement and aroussal   Step 5: Designing Campaign Messages This section is the heart of the campaign.  You will choose a theory to guide you in developing the message Choosing a Voice and/or Spokesperson: for this project you are the spokesperson for the campaign addressing your family/friends persuading them to have a virtual Thanksgiving celebration. Write about what makes you a good spokesperson for this particular audience.   Theoretical Foundation for message framing. Choose one of the theories covered in chapters 13 and 14 of the duPre textbook to guide you in framing your message. The text book gives a limited explanation of the theories.  In order to demonstrate a deeper understanding of the theory you choose, do a search for more information on the theory.  This section must include accurate citations and references for at least 2 academic articles or book chapters. Use APA format for citations (within the text) and references (list at end of paper). Use library databases (Academic Search Premier, CINAHL, Medline), to find articles on your theory.   1.       Explain the major theory that undergirds  your campaign.                           2.       Define all major terms used in the theory. 3.       Explain the major predictions of the theory. 4.       Explain how the theory is useful in you campaign.   Designing the Message  Appeals:  Which appeals will best fit you target your audience and why (e.g. Community Expectations, Narrative Messages, Logical Appeals, Emotional Appeals, Novel and Shocking Messages).  How will you use these appeals in the design of your message? Define the appeals you use.   Transcript:  For this section you will write a transcript of the actual message you will deliver in your campaign address to your audience. Let the reader know the communication channel you are using to deliver this message. Because the reader will not have access to the visuals you may use in your message, describe the visuals and their purpose as they are used throughout the message.  Write your  visual descriptions in a manner that would make senses to a visually challenged person using a screen reader.   PSA Checklist  answer each of the following questions evaluating the transcript you wrote above. 1.      Does the PSA clearly state what people should or should not do? If so, what behavior is encourage/discouraged? 2.      Does the PSA explain that people will be adversely affected if they do not adopt the desired behavior If so, how? 3.      Does the PSA establish that adverse effects will be considerable if people do not heed advice? If so, how? 4.      Does the PSA establish that adopting the recommended behavior will be effective in preventing the adverse outcome? If so, how? 5.      Does the PSA establish that the effort and cost of adopting the advocated behavior is worthwhile? If so, how? 6.      Is there a specific to call to action? If so, what is it? 7.      Does the PSA refer to the social implications of adopting/failing to adopt the recommended behavior? If so, how? 8.      Does the PSA establish that positive outcomes are possible? If so, how? 9.      Does the PSA address self-efficacy? If so, how? 10.   Do you believe the PSA is effective? Why? Why not? 11.   How could you rewrite the message to make it more effective? Step 6: Piloting and Implementing the Campaign In this section give the specifics of how and when you will deliver the message for your campaign. Refer back to your SMART goals you wrote about in Step 3.   Step 7: Evaluating and Maintaining the Campaign What steps will you take to measure the efficacy of your campaign.  Refer back to your SMART goals you wrote about in Step 3.  Describe how you will assess, measure, survey, etc. to evaluate the effectiveness of your campaign.   Write this out in paragraphs.

read following discussion post and respond what you think about it The B’More Active program, modeled after the Billion Step Challenge, is an initiative designed to place a spotlight on health and wellness, and encourage physical activity amongst Baltimore City residents.  The Billion Step challenge is a short-term fitness goal, held in cities across the country, during National Public Health Week, which encourages citizens to walk and conduct other physical activities with other citizens as part of a team (American Public Health Association, 2020).  The program is designed to promote good health and physical activity within communities.  Baltimore City embraced the challenge in the summer of 2017 and engaged city residents toward a goal of 1 billion steps.  The initiative organized walks, runs, and wellness events throughout the city, and worked with community-based organizations, churches, businesses, and other stakeholders to promote health (Baltimore City Health Department, 2018).  The goals and objectives of the B’More Active program are similar to that of the Billion Step Challenge, however, planning will be focused on long-term outcomes.  The planning model that will be utilized is the MAP-IT model in order to mobilize partners, assess community needs, and track the program’s progress.  The Community-level behavior change model would be most appropriate as it provides frameworks for multi-dimensional approaches to health promotion and incorporates strategies to change the social and physical environment to encourage behavior change.    ~Lillian     References American Public Health Association. (2020). APHA’s Billion Steps Challenge – Get Started. http://www.nphw.org/get-involved/steps-challenge/get-started Baltimore City Health Department. (2018). Baltimore City Successfully Completes the Billion Step Challenge.  https://health.baltimorecity.gov/news/press-releases/2018-10-10-baltimore-city-successfully-completes-billion-step-challenge