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Capella 4900 Assessment 2

Capella 4900 Assessment 2 Assessing the Problem: Quality, Safety, and Cost Consideration

Student Name

Capella University

NURS-FPX 4900 Capstone Project for Nursing

Prof. Name

Date

Introduction

In this assessment of our capstone project for Michael’s case of diabetes, we will see how diabetes impacts the quality of care, patient safety, and costs to the patient and hospital organization. The focus of this assessment is to analyze diabetes from quality, safety, and cost perspectives. Moreover, we will find the nursing practice standards and organizational or governmental policies that affect diabetes’ impact on care, safety, and cost. Lastly, we will propose some strategies that can improve the quality of care, enhance patient safety, and reduce costs to Michael and our hospital. 

Impact of Diabetes on Quality of Care, Patient Safety, and Costs

Quality of Care

Diabetes Mellitus is a chronic metabolic disorder where the body is unable to produce or respond to insulin secreted by the pancreas. This chronic ailment requires complex care treatment including continuous blood glucose monitoring, medication management, lifestyle and dietary modifications, and regular physical activity. This complex care treatment is challenging for healthcare professionals to provide effective and adequate quality care as well as for patients to maintain adherence to the care treatment (Longo et al., 2019).

Moreover, diabetes management requires interdisciplinary care such as primary care physicians, nurses, nutritionists or dieticians, and diabetes educators for effective delivery of quality of care to patients. Effective communication among these interdisciplinary team members is required which impacts the quality of care delivered to diabetic patients (Siaw & Lee, 2018). In Michael’s case of diabetes, quality of care was greatly impacted due to unavailability of interdisciplinary team members as a result of poor communication.

Furthermore, Michael’s inability to afford care treatment at our hospital affected the quality of care that his condition required. Therefore, diabetes is a disease that impacts the quality of care delivered by healthcare professionals and to mitigate this impact, effective strategies are required to employ.

 Patient Safety

Diabetes impacts patient safety in numerous ways, but the major safety concern for patients with diabetes is hypoglycemia. Diabetes is a condition in which high blood glucose level requires to be lowered within normal limits with the help of medication and dietary control. Severe hypoglycemia may take place when blood sugar levels drop too low due to various reasons such as medication, significant meal gaps, etc, posing safety risks to individuals particularly when diabetics are involved in some activities like driving or operating some machines.

Hypoglycemia leads to confusion, loss of consciousness, seizure, and coma (Nakhleh & Shehadeh, 2021). Diabetes also leads to foot complications due to peripheral neuropathy or reduced blood flow to extremities if left untreated. The foot complications include foot infections, ulcers, and a prolonged time for healing these wounds. This increases the risk of undergoing lower limb amputation to prevent the spreading of wounds impacting patient safety (Dewi & Hinchliffe, 2020). In case of Michael’s condition, his blood glucose levels were rising to a dangerous level where he was at the risk of acquiring cardiovascular problems or foot complications impacting his safety.

Costs to the System and Individual

Diabetes management requires heavy finances to adhere to the prescribed care treatment of medication, healthy eating, regular monitoring of blood glucose levels, and healthcare visits. These management areas of diabetes require ample amounts of money to procure medication and healthy food. The expenses posed to patients due to diabetes burden patients and impact their disease management.

Furthermore, diabetes-related healthcare services provided by the hospitals implicate heavy costs to the healthcare systems. The total annual cost of diabetes is $327 billion as reported by CDC. The $237 billion costs are on direct medical bills and $90 billion is spent on reduced productivity (CDC, 2020). Michael was greatly impacted by the costly care treatment and was unable to buy expensive anti-diabetic medications which led him to suffer from high glucose levels. 

The impact of diabetes on quality of care, patient safety, and costs found from the supporting evidence is consistent with what I see in my nursing practice where quality of care is affected due to unmanaged diabetes with a risk to patient safety. The heavy costs of diabetes medication, healthy food, and self-management expenses are the prime factors due to which patients are affected financially.

State Board Nursing Practice Standards and/or Organizational or Governmental Policies Affecting Diabetes Impact on Quality, Safety, and Cost

The American Nursing Board provides some nursing practice standards which guide nurses in providing the best quality of care and enhancing patient safety. The ANA nursing practice standards of practice include assessment, diagnosis, outcome identification, planning, implementation, and evaluation (American Nurses Association, 2015). The nurses can follow these standards for nursing practices in improving diabetes’ impact on quality of care and patient safety.

By appropriately assessing diabetes symptoms in patients and diagnosing it early, they can plan and implement particular strategies to manage diabetes such as diabetes self-management education on lifestyle modification, pharmacological therapy, and medication adherence, etc. Through implementing effective interventions, positive outcomes can be expected which will result in improved quality of care and enhance patient safety.

Capella 4900 Assessment 2

The governmental policy i.e. The Affordable Care Act (ACA) can contribute to lowering the costs incurred by patients and the healthcare systems. The policy of expanded health insurance coverage to patients with pre-existing conditions like diabetes has alleviated the burden of the expense from patients’ shoulders. The patients can afford various healthcare services, medications, and related preventive care measures through this policy as a result of increased access to health insurance.

The ACA has also provided provisions to promote delivery system reforms like Accountable Care Organizations (ACOs) that promote effective collaboration and coordination of care among healthcare professionals at hospitals. Through collaborative and coordinated care delivery, hospital costs of diabetes can be reduced as the hospital readmission rates will be lessened when the quality of care provided is improved (Marino et al., 2020).

These standard practices and policies guide  nursing scope of practice by enlightening knowledge on how to assess and identify the symptoms in case of diabetes patients and look for evidence-based strategies and interventions that are tailored to patients condition and needs. The ACA policy can help Michael in affording the expenditures of diabetes-related medication and blood glucose monitoring. As Michael knows little about such policies, I can guide him on that so he can take full benefit of this policy and improve his condition.

Evidence-Based Strategies to Improve Quality of Care, Enhance Patient Safety, and Reduce Costs in Diabetes

Considering Michael’s condition of diabetes and his prime requirements, the evidence-based strategies that can be effective for improving the quality of care, enhancing patient safety, and reducing costs are as follows:

  • Diabetes Self-Management Education and Support (DSMES) program
  • Remote monitoring of medication adherence 

Diabetes Self-Management Education and Support Program

DSMES programs are one of the evidence-based strategies that have the potential to improve the quality of care, enhance patient safety and reduce costs to patients and healthcare systems. In the DSMES program, patients are educated on self-care and self-management tactics and plan to manage their diabetes themselves. Through the DSMES program, patients can be empowered to take their own care with appropriate education and support. Patients who are negligent of their disease acquire knowledge, skills and gain enough confidence to manage their diabetes effectively. These skills can include blood glucose monitoring, medication adherence, healthy eating, physical activity, and managing hypoglycemia.

This leads to improved self-care behaviors and better medication & care treatment adherence as their own participation in improving their condition is enabled. All these factors contribute to improving the quality of care. The DSMES program also facilitates early detection and identification of diabetes-related complications by educating patients about the signs and symptoms of these morbidities related to diabetes. This prevents the incidence of related complications such as cardiovascular problems, renal diseases, and foot ulcerations.

Early detection of diabetes-related complications enhances patient safety, reduces hospital readmission rates, and lowers costs to both the patient and the healthcare systems (Powers et al., 2020). This strategy will be effective in Michael’s case as his primary concern is unhealthy food intake and a sedentary lifestyle.

Remote Monitoring of Medication Adherence

As in Michael’s case, medication non-adherence is a major barrier to diabetes management. For this purpose, remote monitoring is an evidence-based strategy that can promote medication adherence and improve glycemic control. Healthcare professionals can coordinate with patients through either smartphone applications or other electronic devices like smart pill dispensers or electronic health records. Healthcare providers can also send reminders electronically to patients so they can be alarmed to take their medication timely.

These methods improve medication adherence through remote monitoring and improve the quality of care (Munshi et al., 2021). Furthermore, remote monitoring also enhances patient safety as the patient takes medication regularly and on time preventing him from experiencing any diabetes-related complications such as hypertension, vision loss, and foot complications. Additionally, patients can avoid clinical visits as he is acquiring guidance related to medication and their condition through smartphone apps, and the costs can be reduced by traveling to hospitals. 

These strategies can be effective in lowering the high blood glucose levels to normal limits for diabetes in Michael’s case as they promote self-care for diabetes by attaining a healthy lifestyle and medication adherence. Furthermore, the available sources of benchmark data for diabetes can be the glycemic level range provided by the American Diabetes Association which can be the guiding tool in estimating the current status of diabetes in patients. I have documented the practicum hours spent with Michael and his family in CORE ELMS Volunteer Experience Form that can be used to find the details about our meeting session.

Conclusion

Diabetes is a chronic condition that impacts the quality of care as it requires complex care treatment and interdisciplinary team involvement. Under circumstances where the disease is unmanaged, it causes various health complications including cardiovascular problems and foot complications impacting patient safety. Due to expensive care treatment and medication, it burdens patients and healthcare organizations with heavy costs and expenditures.

The American Nursing Association and ACA policy help improve the quality of care, enhance patient safety, and lower costs for individuals and healthcare systems. The DSMES and remote monitoring for medication adherence are the proposed evidence-based strategies that improve the quality of care, enhance patient safety and reduce costs. 

References

American Nurses Association. (2015). Nursing: Scope and standards of practice. https://www.nursingworld.org/~4af71a/globalassets/catalog/book-toc/nssp3e-sample-chapter.pdf 

CDC. (2020, September 29). Cost-effectiveness of diabetes interventions | power of prevention. https://www.cdc.gov/chronicdisease/programs-impact/pop/diabetes.htm 

Dewi, F., & Hinchliffe, R. J. (2020). Foot complications in patients with diabetes. Surgery (Oxford), 38(2), 108–113. https://doi.org/10.1016/j.mpsur.2019.12.002 

Longo, M., Bellastella, G., Maiorino, M. I., Meier, J. J., Esposito, K., & Giugliano, D. (2019). Diabetes and aging: From treatment goals to pharmacologic therapy. Frontiers in Endocrinology, 10. https://doi.org/10.3389/fendo.2019.00045 

Marino, M., Angier, H., Springer, R., Valenzuela, S., Hoopes, M., O’Malley, J., Suchocki, A., Heintzman, J., DeVoe, J., & Huguet, N. (2020). The Affordable Care Act: Effects of insurance on diabetes biomarkers. Diabetes Care, 43(9), 2074–2081. https://doi.org/10.2337/dc19-1571 

Capella 4900 Assessment 2

Munshi, K. D., Amelung, K., Carter, C. S., James, R., Shah, B. R., & Henderson, R. R. (2021). Impact of a diabetes remote monitoring program on medication adherence. Journal of Managed Care & Specialty Pharmacy, 27(6), 724–731. https://doi.org/10.18553/jmcp.2021.27.6.724 

Nakhleh, A., & Shehadeh, N. (2021). Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention. World Journal of Diabetes, 12(12), 2036–2049. https://doi.org/10.4239/wjd.v12.i12.2036 

Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., Hooks, B., Isaacs, D., Mandel, E. D., Maryniuk, M. D., Norton, A., Rinker, J., Siminerio, L. M., & Uelmen, S. (2020).

Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American Diabetes association, the Association of Diabetes Care and Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of Pas, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care, 43(7), 1636–1649. https://doi.org/10.2337/dci20-0023 

Siaw, M. Y. L., & Lee, J. Y.-C. (2018). Multidisciplinary collaborative care in the management of patients with uncontrolled diabetes: A systematic review and meta-analysis. International Journal of Clinical Practice, 73(2), e13288. https://doi.org/10.1111/ijcp.13288

Capella 4900 Assessment 2