I have a capstone due in 10days Need in APA dauble space 8-10 pages. I have uploaded rubric, reading material. I will also find a sample paper
Capstone Project
13 stroke patients admitted in 14 weeks
13 flyers passed out to nurses of stroke patients
· Pt education is centered around comorbidities (underlying health issues) and risk factors to reduce the risk of another stroke and reduction in readmission due to another stroke and complications from the stroke
· Staff surveyed during unit council and to discuss outcomes
· Out of 7 nurses, all 7 felt education was beneficial.
· There were no readmissions thus far.
· Community resources were provided
· Pt was referred for dietary consult with a nutritionist
· Stroke support group flyer was provided, and encouragement to attend support group was given offered by SWRMC
· Smoking cessation consults were provided as well.
***Staff made copies of surveys, and voiced interest in continuing to provide education o patients beyond capstone research
***Nurses were also provided BE FAST information along with survey to assist patients in recognizing signs and symptoms of stroke
Reducing Stroke Readmissions in Acute Care Setting
Contents
Introduction:
2
Objective of the study: 3
Readmission Factors: 3
Statins:
3
Long term care: 4
Demographics: 4
Personal Reflections:
4
Events: 4
Empirical Evidence: 6
Interventions for discharged patients: 6
TRACS: 7
COMPASS: 7
MISTT: 8
Clinical requirement:
8
Timeline:
8
Collaboration with the preceptor:
8
Proposed evaluative criteria:
9
Evaluative criteria discussed:
9
Conclusion:
9
Bibliography 10
Introduction:
Stroke refers to a cardiovascular disease which has been one of the leading reasons for deaths and long term disability. A stroke is an abrupt onset of a neurological deficit led by a vascular rupture or blockage that reduces the blood flow to brain. Subsequently, causing death to the tissue in the brain region if interruption of the blood flow persists. The indications of stroke vary, but may include the loss of function to one side of the body, the inability to speak or talk, and reduced vision or severe headache (Poston, 2018).
Issue: Discovery Research
Over time, the financial penalties on readmissions to the hospital have been taking place, which is promoting hospitals to take measures to reduce the instance of readmissions. A variety of interventions are taking place on different levels to ensure that pre and post discharge care is in place to avoid readmissions. The efficacy of interventions is dependent on the variety of components. Single component interventions are least effective and tend to have no effect on readmissions to the hospitals. Patients that are discharged to post-acute care accommodations are subjected to multi-component interventions and readmissions have dropped drastically. These interventions work through communication, advanced planning of care, and training to tackle simple medical issues that might cause readmissions. The availability of risk stratification methods have made it easier for the hospitals to give more care and attention to the patients that are more likely to get readmitted. Home based services are provided to ensure proper medical care for the patients.
This capstone project attempts to discuss the factors causing the readmissions of stroke patients to the hospitals. The past 20 years have proven to be important in acute and inpatient stroke care however, quality of post-acute care varies specially for the patients that are discharged to home. (Condon, Lycan, & Duncan, 2016). Different reasons for stroke readmissions are to be examined in this capstone project.
Expected Outcomes: Discovery Research
This project aims to take into account the reasons of stroke and readmissions after being treated for stroke. Stroke is the second primary reason of readmissions in the hospital. Major readmissions comprise of elderly people. 20-70% people who survive stroke are readmitted in the first year of their treatment (Bravata, Ho, Meehan, & Brass, 2006). Poor health conditions and high treatment costs both account for the largest reasons for recurrent strokes. Cardiac arrest is also common after strokes.
Literature: Evidence Summary-Knowledge Generating Stage
Prevention of ischemic strokes can be achieved if the reasons for readmissions are studied and considered. In 2013, Nationwide Readmission Database provided statistics regarding strokes. It showed that 12.1% patients having stroke were readmitted in a time period of 30 days of discharge of which 89.6% were not planned and rest were foreseen. Annual cost of Stroke care in United States of America is $34 billion.
Statins:
Statins are the drugs prescribed by health care professional to reduce or control cholesterol levels. Studies show that patients using statins are less likely to be readmitted to the hospitals as compared to those not taking statins. Another important factor is age. People less than 80 years of age are less likely to be admitted to the hospital and those above the age of 80 are more likely to be readmitted.
Methodology for implementation of the Project
Studies reveal that one third of the patients of stroke require long term care after they are discharged. Certain patient characteristics such as lower comorbidity scores or higher level of participation in nursing homes after discharge from hospital lower the odds of readmissions.
Findings from what you’ve implemented
Patients from urban areas are more health conscious and have more awareness and information regarding post discharge care. Therefore, urban area patients are less likely to get admitted to the hospital after being discharged.
Evaluation- Process and Outcome Evaluation. Impact of EBP
Summary: Practice Integration
Personal Reflections:
Different health conditions are prevailing that result in readmission to the hospital. However, it has been observed that stroke accounts for 20.5% of readmissions in hospital. Therefore, this has been selected for capstone project. Western countries are most vulnerable to this situation because of lifestyle conditions. Smoking, drinking, diabetes and hypertension are contributing factors. Lack of healthy lifestyle and exercise also play their part in deteriorating health conditions (Kripalani & Theobald, 2014). The need of the hour is to educate nurses so as to create awareness for adoption of a better life style. Also, nurses have to have awareness to take better steps to ensure proper health conditions before discharging stroke patients.
Analysis: Translation into Guidelines
Various activities and steps are formulated to educate nurses to reduce readmissions to the hospitals. Community awareness programs are also on the agenda to adopt healthy lifestyle and incorporate exercise in daily routine. First of all, I plan to chalk out a proposal so as to identify the areas where improvements are needed. The cardiac head of the facility should be included in the program. Stroke alerts are important step that needs to be taken. The researcher plans to take rounds to the inpatient rehab physician and outdoor units. This will help collect data to feed the awareness program. After the collection of data, information regarding health care will be provided to the nurses. Family information of the patient is also required to have a better look at the events. Taking all information into account, nurses will have a better understanding of the reasons leading to readmissions. They can then use this information to make sure those readmissions decreases as much as possible. PowerPoint presentations are on the agenda as creating awareness visually is better and efficient. Also, families and peers of the patients are also to be included in the program because they are the ones who will be taking care of the patients. Extra fats and cholesterol are to be discouraged and dietary intake, fruits and vegetables is to be promoted.
60% of the stroke patients require care in a proper setting that includes nursing centers, rehab centers and home health. This shows that healthcare transitions to a better facility can be achieved by identifying and documenting issues and implementing strategies to address them. The transition plan also needs to be effectively delivered to the nurses to have a beneficial outcome.
The research plans to get an outcome in the form of less readmissions and awareness among the nurses. Reoccurrences of strokes would decrease as people move towards a better and healthy lifestyle. Evidence from the research shows that acceptance of a healthy lifestyle and giving up smoking makes people less prone to another stroke. This has led to a decrease in readmission rates. Pre discharge and post discharge care and use of proper medications would decrease the chances of stroke (Kristen, 2018).
Research encompassing readmissions due to stroke is not very extensive. Most of the studies do not even include stroke patients. Transitional care model formulated for other diseases when applied to stroke showed promising results. It was surprising as they were not even formulated for the stroke patients. However, the researchers are still looking and formulating other models as multi models helps in cost cutting, provision of patient-centered care and lesser readmissions. Various programs have been initiated in other states, such as TRACS (Transition Coaching for Stroke), COMPASS (Comprehensive Post-Acute Stroke Services) and MISTT (Michigan Stroke Transitions Trial) etc. (Kristen, 2018).
It is quite evident from the research that patient care after discharge is imperative to control readmissions. Journals have also focused studies on the importance of ambulatory care practice in promoting efficient evolutions post-acute care.
A study conducted by Hansen and associates shows that readmission to the hospital can be reduced using various interventions. The authors suggested that intervention constituents should be classified. Pre discharge interventions include understanding of medication, scheduled appointments before discharge, educating the patients and planned discharge. Post discharge intervention comprises of home visits, hotline for patients information, PCP communication, well-timed follow ups and telephone follow ups by the hospital. Bridging interventions are to be promoted too, which encompasses discharge instructions focused on patients and transition coaches. However, the study revealed that adopting only one form of intervention does not ensure less readmission.
Coleman developed a CTI (Care Transitions Intervention) that encompasses a training nurse that helps patients to take better care of them. It comprises of four key points; self-managing medicines, recording health essentials, follow-ups and awareness of red flags. This helped in reduction of 30 day and 90 day readmissions and was applicable globally (Coleman, 2009).
TRACS provides one of the most encouraging frameworks to provide additional clinical trial at the time of discharge of stroke patients. It provides immediate coaching sessions through a nurse to the stroke patients that are discharged recently. The participants of the program receive follow up phone calls that reviews medications and assess problems that might arise. Each participant patients gets a call regarding their appointments with the doctor. This was quite successful as the medication persistence reached 80.3%. Also, patients getting follow up calls regarding checkups are more likely to go for checkup and this resulted in 48% decrease in readmission rate.
This model comprises of an extensive trial encompassing 41 hospital sites and 6000 participants. The foundation of this model lies in TRACS. But, it has more extensions so as to discuss the problem comprehensively. The main points of this model include follow up calls after 2, 30 and 60 days after being discharged. Provision of transport facilities to appointments is also an important part of this program. A web based application named as COMPASS-CP is formulated to provide all the basic and necessary information. This application also provides referrals and generates a customized plan form individuals.
MISTT addresses health related and psychosocial challenges that are faced by survivors of stroke and their caretakers. This emphasizes on patient activities and quality of life and take measures to improve it. This program ensures that health workers plan a visit to the patient’s house within a week of discharge and another visit after 30 days of discharge and follow up phone calls every week. The eventual aim is to promote the engagement of patients and caregivers in decision making and achieving good health via incorporating proper and healthy lifestyle.
Clinical requirement:
Proper follow up of patients is required. Also, they are required to take their medications timely and adopt a healthy life style. The nurses need to provide all the required information regarding health care and patients are to give up bad eating and lifestyle habits.
Timeline:
It is expected that the results would be seen after a time period of 14 weeks. One month of rigorous training would be provided and then one month would be required to create awareness.
Collaboration with the preceptor:
The preceptor which is the head of nurses would keep on providing relevant data to give necessary insight. Also, they would be a channel through which proper communication would take place. Also, they would make sure that the nurses are sticking to the given protocol.
Proposed evaluative criteria:
Evaluation criteria refer to the outcomes of the project. The researcher would study and evaluate the effectiveness of the project by observing the number of readmissions. Lesser the readmissions due to stroke, greater would be the efficiency of the project.
Evaluative criteria discussed:
The nurses would keep an eye on the patients and provide information to them regarding post-acute health care. Also, they would make sure that the families and relatives of the patient conform to the prescribed medications and lifestyle.
Conclusion:
Medication issues are the most common ones that lead to seeking emergency prematurely. Need for education and support is also required to cater this issue. According to a research the cost of for uninsured patients is $52,000 annually and the cost for readmission is $11,200. Readmissions after ischemic strokes is of crucial importance and is quite complex (Leonhardt, Burgen, & Wolfe, 2016). Identification of key issues needs to be done which is why this study is being conducted. The scientific literature reveals that individual efforts are less likely to cater this problem, however, some steps can be taken such as promoting multiple components that deals with both inpatient and outpatient care. Evidence of relationship between number of components and effectiveness of a program is also observed which calls for more robust interventions. There is a window of opportunity among the acute care of stroke and readmissions which can be helpful to reduce the post stroke morbidity burden.
Bibliography
Bravata, D., Ho, S., Meehan, T., & Brass, L. &. (2006). Readmission and Death After Hospitalization for Acute Ischemic Stroke.
Coleman, E. A. (2009). Rehospitalizations among patients in the Medicare fee for service program. 18-28.
Condon, C., Lycan, S., & Duncan, P. &. (2016). Reducing Readmissions After Stroke With a Structured.
Kripalani, S., & Theobald, C. &. (2014). Reducing Hospital Readmission: Current Strategies and Future Directions. Annual Review of Medicine .
Kristen, M. (2018, Decemeber 10). Reducing readmissions in stroke patients. Retrieved March 18, 2020, from American Nurse: https://www.myamericannurse.com/reducing-readmissions-in-stroke-patients/
Leonhardt, A., Burgen, D., & Wolfe, J. &. (2016). Development of a Collaborative Transition Coaching Program for Reduction of Post-stroke Hospitalizations. AHA.
Poston, M. K. (2018). Reducing readmissions in stroke patients . American Nurse Today.