In this assignment, you will select a program, quality improvement initiative, or other project from your place of employment. Assume you are presenting this program to the board for approval of funding. Write an executive summary (850-1,000 words) to present to the board, from which they will make their decision to fund your program or project. The summary should include: The purpose of the program or project. The target population or audience. The benefits of the program or project The cost or budget justification. The basis upon which the program or project will be evaluated. Share your written proposal with your manager, supervisor or other colleague in a formal leadership position within a health care organization. Request their feedback using the following questions as prompts: Do you believe the proposal would be approved if formally proposed? What are some strengths and weaknesses of the proposal? Submit the written proposal along with the “Executive Summary Feedback Form.” Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment. You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin. Quality health care is defined as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (Lohr and Schroeder, 1990) and a quality improvement strategy is defined as “any intervention aimed at reducing the quality gap for a group of patients representative of those encountered in routine practice” (Shojania, 2004). The purpose of this paper is to design a project regarding the quality improvement initiative that includes the purpose, target population, benefits and cost of the project; also the basis for project evaluation. Night Time Noise Reduction Project The author of this paper wants to present the proposal of a Night Time Noise Reduction Project in the hospital for the funding to the board. Sleep is the essential part of human life and it is related to the normal functioning of the body. According to Ulrich and Joseph, “Hospitals are extremely noisy, and noise levels in most hospitals far exceed recommended guidelines” (Joseph and Ulrich, 2007). The noise of the hospitals includes the noise from machine and equipments, staffs conversation, roommates, alarms, intercoms and pagers. This author is a registered nurse who wants to propose the night time noise reduction project for the improvement of the quality and patient outcome. She is well aware of the various issues worsened by the noise-induced stress affecting not only the patients but also the family members. Therefore, I hope this kind of project will help to reduce noise during night time promoting the quality care to patients and great hospital environment. Purpose There is plenty of evidence that sleep is a biological necessity, and disturbed sleep is associated with a number of health problems. Noise heightens the anxiety and stress and lead to physiological responses such as facial grimacing, muscular flexion, increased blood pressure, increased heart rate and vasoconstriction; also slows the healing process. Moreover, nurses’ performance is highly affected by the hospital environment; nurse working in noisy environment complaints of exhaustion, burnout, irritability and depression (Mazer S.E., 2012). Night noise has various effects such as increase in heart rate, arousals, increase in medicine use and insomnia (WHO, 2009). The main purpose of this project is to access the noise level of the hospital units and contribute to the maintenance of sound environment using Yacker Tracker device. This project also aims to generate awareness about the consequences of noise in the health of patients and staffs. Target Population A large number of groups are at risk due to hospital noise especially at night. Elderly people and pregnant women at higher risk, besides them children and patients with ill health are also considered as risk groups. To add up, registered nurses and shift workers are also at risk as their sleep structure is under stress (WHO, 2009). Benefits A number of aspects of health and quality of life are associated with the sleep and these aspects are impaired with disturbance in sleep. Therefore, sound sleep is essential for the patients and various measures should be applied to maintain the peaceful and quiet environment in the hospital especially at night time as a component of patient care. Many studies has shown that various pilot projects were initiated for the reduction of noise in the hospital and they all have positive outcome leading to the sound hospital environment and sound sleep of patients at night. This project aims to promote the patients health and create great environment for the workers by reducing the noise at night. Sleep deprivation results in unsatisfied patients and that ultimately causes the declination of the overall rating of hospitals. This may also affect the hospital revenue in the long term. Therefore, the Night Time Noise Reduction project helps to cope with such consequences in the long run. Cost Justification The most common cause of disruptive noise in the hospital is staff conversations (Wallis, 2012). Educating staff and planning can help for the reduction of noise; however this cost the minimal amount. Furthermore, this projects aims in reduction of the noise by using Yacker Tracker; a noise alerting device. A Yacker Tracker costs approximately $100 (based on amazon.com) and each unit requires two devices each for nurse station and for hallways. Project Evaluation Project evaluation is necessary to determine the effectiveness of the project and for the continuation of the project in the future. Prior to the implementation of the project, sound environment assessment is carried out for the determination of noise-level in each unit of the hospital. Same method is applied to determine the noise-level after the implementation of the project, and differences between them are measured statistically (Kol et al, 2015). An evaluation for the project can be developed by using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data before and after the implementation of the project (Murphy et al, 2013). In conclusion, the Night Time Noise Reduction project will be very effective to reduce the noise in a cost friendly way. This project will not only improve the environment of the hospitals but will also have beneficial effect on the health of patients and staffs. This project will be helpful in answering one of the reasons behind the declining quality of hospital environment and will help in improving the overall rating of the hospital. prevention of pressure ulcer ;Pressure ulcer prevention is a prevalent topic in health care setting today. It can have a devastating effect on a person`s health and quality of life. During the time of admission, it is important to identify the high-risk patient prone for getting pressure ulcer and implement the preventive measures immediately. “Each year, more than 2.5 million people in the United States develop pressure ulcers. These skin lesions bring pain, associated risk for serious infection, and quality of life. These measures allow for the reduction of expenditures and re-allocation of funds into other important increased health care utilization (ARHO, 2013)”. Most pressure ulcers can be prevented by the health care team. Purpose There are several wound care products in health market that have dramatically improved, protected and supported skin from pressure ulcer. The main purpose of this project is to practice foam dressing called Mepilex border Flex proven to prevent pressure ulcer, alone with performing the Braden scale skin assessment. The use of Mepilex bordered dressing reduces friction and redistribute pressure as well as provided an optimal microclimate. Mepilex foam bordered dressing have antimicrobial actions of ionic silver with soft silicone adhesive reduced pain and provide healing. The frequency of occurrence and increased cost for treating pressure ulcer has promoted health care industry to implement new interventions in order to prevent hospital acquired pressure ulcers. In the past nurses were responsible for pressure ulcer care prevention but the current research has proven that a multidisciplinary approach is needed for management of pressure prevention. Effective pressure ulcer prevention needs educating health care providers and patients in prevention technique. Pressure ulcer prevention and management are the most direct and very cost effective measures hospital can utilize to improve patient safety areas in the facility. Hospitals need to become more rapacious in creating wound care protocols that will assist in the treatment and prevention of pressure ulcers (Ackerman, 2011). The target population According to Agency for Healthcare Research and Quality “90% of all pressure ulcer related hospitalizations are due to secondary pressure ulcer diagnosis, 72% of patients are 65years or older and about 60,000 patients die each year as a result of a pressure ulcer” (ARHO, 2013). Poor nutrition, dementia, age, mobility, medical condition is the primary reason for hospital admitted patient to get pressure ulcers. Here the targeted patient population is over age 18 and older who are admitted with debility, and who should be assessed closely for pressure ulcer. The benefits of the program or project This report is presented through coordination of multidisciplinary approaches. The team includes unit supervisors, managers, material management, quality improvement team and physicians. The main purpose of this project is to implement the use of Mepilex dressing into the hospital in order to prevent pressure ulcers. This project target to prevent complication and cost associated with hospital acquired pressure ulcer. If the patient has an existing pressure ulcer or occurrence of new users, Mepilex foam dressing will be initiated for skin prevention. According to the research conducted by International Journal of Tissue Repair and Regeneration, Mepilex bland dressing aids in ulcer healing by 67% compared to other brands and reduces pain. Mepilex dressing, is a “multiple layered foam dressing which is designed to absorb wound discharge and protect the wound from infiltration of microorganisms and has its own absorbent properties”(Just Home Medical). It is also very easy to remove without affecting the skin around the wound. This program is proposed to provide a safe environment by developing new practice using evidence based practices. Out of “371 critically ill patients who received customary care with the bordered sacral foam dressing in situ had PU rates of 0–3.1%, compared with 3.8–13.1% for the control groups. A variety of less well-controlled studies involving more than 1000 patients provides supporting data (Berlowitz, D. , 2014, October 02)”. The Cost or Budget Justification Hospital acquired pressure ulcer increases the health cost, length of hospital stay and can delay the recovery time.“Pressure ulcers cost $9.1 billion to $11.6 billion per year in the United States. Cost of individual patient care ranges from $20,900 to $151,700 per pressure ulcer. Medicare estimated in 2007 that each pressure ulcer added $43,180 in costs to a hospital stay” (Berlowitz, D. , 2014, October 02). Another cost related to pressure ulcers involves daily dressing change. Mepilex dressing does not have to be changed daily. According to the study conducted at North York General Hospital (NYGH), “at least 48 patients had dressings changed daily. This amounted to 56 hours of nursing time per week or 1.4 full-time nurses per week. Reducing this to three times weekly saves 33 hours of nursing time per week, equal to 0.9 full-time nurses. Only 100 patient wounds treated with non-advanced dressings (gauze) can be treated in the same time as 230 patient wounds with advanced dressings” (Popovich, K., &Tohm, P. (2010, September). Evaluation of the project: The principle of quality focuses on improvement of quality and performance. The interdisciplinary team will be responsible for initiating and preventing pressure ulcer project into each unit, making decisions about the design and monitoring progress. A comprehensive skin assessment, standardized pressure ulcer risk assessment, care planning and implementation to address areas of risk should be done every shift and documented per protocol. A data collection survey will be conducted for the effectiveness after the intervention. The survey will include number of pressure ulcer in hospital, clinical indication, clear accountabilities, product availability, staff awareness, education and expectations for performance documentation of actual patient care. The recommendation and patient care impact as well as cost effective of the Mepilex foam dressing will be reevaluated within a year. Summary Pressure ulcer has been one of the topics of concern today in the health care industry because it brings serious risk to patients and the quality of their life. The evidence has found that the use of Mepilex dressing along with standard skin assessment, to decrease the cost of health and hospital stay of an individual. After the investigation, discussion and some research done at this hospital about hospital acquired pressure ulcer, the team has concluded to implement new practice of Mepilex use for further prevention of pressure ulcer.
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