D156 Updated HIP Paper Template for Nursing Weekly Assessment
Student Name
Western Governors University
D156 Business Case Analysis for Healthcare Improvement
Prof. Name
Date
Healthcare Improvement Project: Introduction and Project Initiation
Organizational Problem
The healthcare improvement project aims to create a standardized weekly nursing assessment form specifically designed for acute psychiatric patients. This tool will enable nursing staff to consolidate interdisciplinary information into a single document, offering a comprehensive update on each patient’s progress regarding treatment goals and discharge readiness.
Currently, documentation is fragmented. Licensed nurses and mental health technicians chart separately based on patient status: licensed nurses document direct 1:1 care and 15-minute observation statuses, while non-licensed staff complete 60-minute observation notes. Although registered nurses perform weekly head-to-toe assessments and document findings, the information relayed to social workers—who handle community placement referrals—is often reliant on non-licensed staff notes, which do not adequately reflect patients’ clinical progress. This fragmentation hinders effective discharge planning and interdisciplinary communication.
The proposed unified assessment form is designed to comply with Centers for Medicare & Medicaid Services (CMS) standards and enhance interdisciplinary communication by providing weekly summaries of patient engagement, medication adherence, behaviors, and medical issues. This will support timely modifications to treatment plans and improve discharge coordination by accurately capturing clinical progress.
Stakeholders
The following table outlines the key stakeholders involved in the project, their roles, and their influence within the organization:
| Stakeholder Name | Role and Expertise | Influence and Power |
|---|---|---|
| Amanda Rivers, CNP | Clinical Nurse Practitioner | Influences clinical guidelines and treatment protocols |
| Maggie Donohue, RN, BSN | Registered Nurse | Provides frontline nursing insights and documentation expertise |
| Bobbie Steinle | Director of Social Services | Oversees discharge planning and community liaison |
| Susan Lynch | Director of Nursing Education | Responsible for staff training and policy updates |
| Rachel Smith | NGMH Administrator | Holds leadership authority over hospital policy and resource allocation |
These individuals hold significant organizational authority and clinical knowledge, ensuring that the documentation improvement aligns with hospital standards and operational goals.
Project Team Roles and Responsibilities
The project manager has several critical duties, including:
- Process Management: Identifying existing issues, coordinating stakeholders, and steering implementation efforts to ensure project success.
- Coaching: Facilitating team development to foster a culture centered on continuous improvement and patient-focused care.
- Communication: Maintaining transparent, ongoing dialogue within the team, actively listening, and collaboratively directing the project.
- Accountability: Tracking task completion and holding team members responsible to prevent delays and sustain momentum.
Two vital skills the project manager brings to this initiative are active listening and analytical thinking. These skills allow the project manager to accurately assess departmental needs and ensure documentation is meaningful, supporting clinical and discharge decisions effectively.
Susan Lynch, as Director of Nursing Education, contributes significantly by designing the nursing assessment template based on clinical experience, leading training efforts for staff, and revising policies to integrate the new documentation process.
Needs Assessment
The team used the “5 Whys” technique to identify root causes of poor nursing documentation. They discovered that inconsistent reporting of patient behaviors related to treatment plans was due largely to non-licensed staff documenting daily progress notes. This inconsistency complicated discharge planning, resulting in referral packets that were incomplete or inaccurate.
The assessment concluded that a comprehensive weekly document—including head-to-toe physical exams, medication compliance, PRN (as-needed) medication use, behavioral observations, and activities of daily living (ADL) support—would effectively meet both clinical and administrative requirements.
SWOT Analysis
The SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis highlighted the following insights and strategies:
| Category | Key Findings | Mitigation Strategies |
|---|---|---|
| Weaknesses | High proportion of agency staff; slow administrative processes | Recruit recent graduates via partnerships with local colleges; pilot the project on one unit to speed approval |
| Threats | Excessive departmental input during initial stages; staff resistance to new documentation practices | Delegate input gathering to workgroup representatives; Nurse Supervisors to provide education and audit compliance |
| Strengths | Experienced nurse supervisors; strong education department | Utilize supervisors to support staff and audit assessments; leverage education department for training development |
| Opportunities | Ability to apply CMS and Joint Commission guidelines to standardize documentation | Integrate regulatory standards into assessment tools and audits to maintain ongoing quality improvement |
This analysis informed the implementation approach, addressing organizational challenges proactively.
Impact Analysis
The impact analysis scored the project’s benefits and risks as follows:
| Area | Benefits | Risks |
|---|---|---|
| Medication Monitoring | Enables timely medication adjustments; enhances provider oversight | Potential increase in medication error reports; possible staff morale decline due to education or disciplinary actions |
| Nursing Documentation | Improves interdisciplinary communication; ensures CMS compliance | Reduced nurse-patient interaction during documentation; risk of falsified records due to workload stress |
With a benefit-to-risk ratio of 1.57 (total benefit score of 11 vs. risk score of 7), the analysis concluded that the advantages of improved documentation and medication monitoring outweigh the potential downsides.
Justification and Project Purpose
This project’s objective is to implement a consolidated weekly nursing assessment to improve treatment tracking and documentation quality for acute psychiatric patients. The assessment form will:
- Track patient engagement, medication usage, and medical concerns comprehensively.
- Provide accurate, multidisciplinary data to support treatment and discharge planning.
- Ensure compliance with CMS and The Joint Commission documentation standards, elevating regulatory adherence and quality of care.
Available resources, such as experienced nurse supervisors and an active nursing education department, combined with adherence to healthcare standards, make this project both feasible and essential for improving clinical outcomes.
Review of Relevant Scholarly Sources
Several peer-reviewed studies underscore the need for this project:
- Wong and Muller (2023) emphasize the importance of documenting PRN medication use and patient behaviors to reduce overreliance on pharmacological interventions.
- Moldskred, Snibsøer, and Espehaug (2021) link high-quality nursing documentation to improved patient outcomes and discharge preparedness.
- Ameel, Kontio, and Valimake (2019) identify nursing interventions, including coping skills support, highlighting the importance of regular therapeutic engagement and documentation.
- Schoretsanitis et al. (2020) stress the necessity of lab monitoring and antipsychotic drug level tracking to optimize psychiatric treatment.
- Barr et al. (2019) demonstrate how nurse-patient rapport and consistent documentation affect treatment effectiveness and patient safety.
Collectively, these sources advocate for a comprehensive weekly nursing assessment to optimize care and discharge planning.
Project Environment
CMS guidelines mandate weekly documentation of patient progress in acute psychiatric care (Centers for Medicare & Medicaid Services [CMS], 2024). The project merges clinical evaluation—including head-to-toe exams—with summaries of medication adherence, behavioral observations, lab results, and discharge planning to ensure holistic, regulatory-compliant patient care documentation.
SMART Goal
The project goal is articulated as follows:
| SMART Element | Description |
|---|---|
| Specific | Develop and implement a weekly nursing assessment form covering physical assessment, engagement, and medication compliance. |
| Measurable | Achieve 95% completion rate of the assessment form by nursing staff for all patients by May 29, 2024. |
| Achievable | Leverage organizational support from nursing leadership, education, and supervisors for staff training and compliance monitoring. |
| Relevant | Improve documentation to enhance patient care, regulatory compliance, and discharge planning. |
| Time-bound | Start date: February 14, 2024; full implementation by May 29, 2024. |
Project Management Lifecycle
The project follows these phases:
- Initiation: Identify stakeholders and define the problem clearly.
- Planning: Develop a detailed timeline, assign roles, and prepare resources.
- Implementation: Educate staff, deploy the assessment form, and initiate usage.
- Evaluation and Closure: Review outcomes against objectives and determine next steps or adjustments.
Each phase ensures continuous progress toward lasting improvement in nursing documentation and patient care.
References
Ameel, M., Kontio, R., & Valimake, M. (2019). Interventions delivered by nurses in adult outpatient psychiatric care: An integrative review. Journal of Psychiatric and Mental Health Nursing, 26(9-10), 301–322. https://doi.org/10.1111/jpm.12543
American Nurses Association. (2010). ANA’s Principles for Nursing Documentation: Guidance for Registered Nurses. https://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/principles-of-nursing-documentation.pdf
Barr, L., Wynaden, D., & Heslop, K. (2019). Promoting positive and safe care in forensic mental health inpatient settings: Evaluating critical factors that assist nurses to reduce the use of restrictive practices. International Journal of Mental Health Nursing, 28(4), 793–1014. https://doi.org/10.1111/inm.12588
D156 Updated HIP Paper Template for Nursing Weekly Assessment
Centers for Medicare & Medicaid Services (CMS). (2024, July 21). State operations manual Appendix A: Survey protocol, regulations and interpretive guidelines for hospitals. https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/som107ap_a_hospitals.pdf
Hansmann, M. L. (2018, March 30). The top 8 skills every healthcare process improvement leader must have. HealthCatalyst. https://www.healthcatalyst.com/8-skills-needed-healthcare-process-improvement
Moldskred, P. S., Snibsøer, A. K., & Espehaug, B. (2021). Improving the quality of nursing documentation. BMC Nursing. https://doi.org/10.1186/s12912-021-00629-9
Schoretsanitis, G., Kane, J. M., Correll, C. U., Marder, S. R., Citrome, L., Newcomer, J. W., … Gründer, G. (2020). Blood levels to optimize antipsychotic treatment in clinical practice: A joint consensus statement. The Journal of Clinical Psychiatry, 81(3), e1–e12. https://legacy.psychiatrist.com/jcp/delivery/consensus-on-monitoringblood-antipsychotic-levels/
The Joint Commission. (2018). Behavioral Health Care Standards Sampler.
Wong, S., & Muller, A. (2023). Nurses’ use of pro re nata medication in adult acute mental healthcare settings: An integrative review. International Journal of Mental Health Nursing. https://doi.org/10.1111/inm.13148