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Capella 4900 Assessment 2

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

Name

Capella university

NURS-FPX 4900: Capstone Project for Nursing

Prof. Name

Date

Introduction

This assessment is based on the selected patient’s health problem as mentioned in assessment one. Brian, a 52-year old went through hypertensive crises but was prevented from facing major health consequences including heart attack, stroke, etc. This assessment is a continuation of Brian’s case of hypertension with a view to its impact on quality of care, patient’s safety, and associated costs. These main concerns are brought into consideration in this paper. Furthermore, the strategies which can improve the quality of care, enhance patient safety, and reduce costs are detailed. 

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

Hypertension or high blood pressure is when the patient’s blood pressure level elevates from the normal range of 120/80 mmHg. It is often called a “silent killer” as the patients are mostly asymptomatic. Therefore, it requires regular blood pressure monitoring in routine medical checkups.  Moreover, hypertension treatment requires long-term management in terms of less salt intake in the diet, regular physical activity, weight management, and stress reduction. These lifestyle modifications are often challenging for patients to implement and sustain them. Limited resources such as healthy food, exercise facilities, and professional support are obstacles to acquiring adequate care and hence result in poor outcomes in terms of quality of care (Kebede et al., 2022).

As hypertension requires chronic care treatment, any events of uncontrolled hypertension increase the risks of cardiovascular complications such as heart attacks, strokes, aneurysms, and heart failures. These life-threatening conditions impact negatively patient’s safety if the timely management of hypertension in not ensured. Moreover, hypertension requires ongoing treatment and management adherence. If medication adherence is compromised, the patient may confront hypertension crises as happened in the case of Brian, which may lead to death in case timely medical attention is not provided. This results in reduced patient safety as a result of hypertension (American Heart Association, 2022). 

Capella 4900 Assessment 2

 The ongoing treatment and self-management of hypertension require a large amount of money. According to CDC, the costs incurred by hypertension on a national level are about $131 to $198 every year (CDC, 2021). Furthermore, regular monitoring of hypertension requires a blood pressure monitoring device such as a sphygmomanometer which adds additional cost to the patient. Hypertension not only impacts patient in terms of cost but also impacts healthcare systems as preventive measures for hypertension like preventive screenings, public health campaigns, patient educational programs, and patient-centered care requires financial resources.

Moreover, the increased number of hospital readmissions and emergencies due to uncontrolled hypertension requires immediate and extensive care services which pose further financial crises to healthcare systems (Wierzejska et al., 2020). As in the case of Brian, his emergency admission to the hospital due to hypertension crises impacted both the patient and the healthcare systems in terms of cost due to heavy bills, immediate supply of care services, and further related interventions.

State Board Nursing Practice Standard and Policies’ Impact on Quality, Safety, and Cost

The Preventive Cardiovascular Nursing Association (PCNA) has provided various standard tools for nursing practices to assist and improve the quality of care to hypertensive patients. These valuable practice standards and resources include patient education brochures and handouts on hypertension to promote education on hypertension Moreover, PCNA provider tools are helpful for nurses in better implementation of proper guidelines to treat hypertensive patients and associated heart diseases (PCNA, n.d.).

Nurses can utilize resources and practice guidelines that will improve the quality of care delivered to hypertensive patients like Brian. These standard practices and guidelines will enhance patient safety as hypertension is managed by adequate and timely interventions like screening and assessment, patient education, medication management and manage hypertensive crises. Improved quality of care delivered to patients by nurses will ensure patient safety and improve quality of life by managing and controlling blood pressure within limits. 

Capella 4900 Assessment 2

The Affordable Care Act impacts the patients and system costs incurred as a result of hypertension. This ACA policy by the government has reduced the costs by enhancing health insurance coverage for people with chronic diseases like hypertension in the case of Brian. Brian can make use of these provisions by ACA and manage his condition as the health insurers will not be able to deny health insurance due to his chronic condition of hypertension. Moreover, preventive care services like screening or monitoring blood pressure levels and counseling can be acquired without charging copayments as a result of insurance coverage by ACA. This extended health coverage aims to reduce costs to both the systems and individuals (Angier et al., 2020). 

These policies help nurses enhance their scope of practice as these practices and policies will facilitate them in treating hypertensive patients with credible guidelines and improved outcomes will be obtained. As the nursing scope of practice involves the responsibilities pertaining to patients regarding diagnosis, assessment, care planning, medication administration, and education; therefore, these policies guide the nurses in obtaining an intervention best suited to the patient’s condition which in the present case is Brian’s hypertension crisis. 

Strategies to Improve Quality of Care, Enhance Patient Safety and Reduce Costs

Health information technologies or Digital Health Technologies are effective strategies to improve quality of care which have the potential to enhance patient safety and reduce costs. One of these digital health technologies includes the use of Electronic Medical Records (EMR). EMR is the digital way of recording patient data and clinical information in the form of data elements. The benefit of using EMR is that it organizes, stores, and shows related clinical information by deriving key data elements from current and previous EMR documentation. Furthermore, it has the features of notifying healthcare professionals with timely reminders and online alerts when patients are not following established guidelines (Martin et al., 2023).

Physicians and nurses can use EMR technology to improve the quality of care and patient safety in hypertensive patients. The comprehensive patient information entered into EMR provides health professionals with easier access to patient’s medical history such as blood pressure readings, medications, laboratory readings, and treatment plans. This comprehensive and concise view of all hypertension-related data of patients will enable health providers to make informed and wise decisions. This will improve the quality of care and enhance patient safety as there will be fewer chances of treatment and medication errors (Lopez et al., 2019). For example, in Brian’s case, nurses can monitor his blood pressure regularly and record them in EMR data. 

Capella 4900 Assessment 2

Furthermore, seamless communication through EMR across the healthcare department will improve care coordination in hypertension management. EMR can potentially reduce costs to the health system and patient as the patient information is stored in digital form, less paper-based resources will be required for recording health data. Patients will be less likely to face errors and further health interventions can be avoided which will reduce the costs for patients. Additionally, this EMR can be connected to home-based self-monitoring of blood pressure data so that health professionals also get notified about Brian’s hypertension readings (Rodriguez et al., 2019).

Another strategy to improve the quality of care, patient safety, and reduced costs is teaching Brian and other patients like him about self-management of hypertension. With educational sessions on lifestyle modifications, self-monitoring, and medication adherence, the quality of care delivered is improved as patients will be engaged in healthy and educational activities with health providers. These strategies are effective in managing and treating hypertension as their main aim is to control blood pressure and reduce the onset of any cardiovascular complication.

Capella 4900 Assessment 2

The available sources of relevant benchmark data include the target blood pressure levels recommended by American Heart Association is less than 120/80 mmHg for most patients. Furthermore, population health metrics associated with hypertension and EMR also act as benchmark data for the assessment of the overall health status and outcomes of populations. These metrics include the prevalence of hypertension, rates of cardiovascular events (e.g. heart attack, heart failure, strokes), and the impact of EMR implementation on these outcomes (Casey et al., 2019).

Conclusion

Hypertension is a chronic illness that is untreatable and requires management strategies. If medical attention is not provided to hypertensive patients, it is probable that hypertension will negatively impact the quality of care due to enhanced complications associated with hypertension. This will further affect patient safety and increases costs. As hypertension management requires multiple medications, a nutritious diet, and self-management facilities which enhance the economic burden on the patient and the system as well. The PCNA provides resources for nurses to practice in the management of hypertension which guide nurses in developing an intervention. The governmental policy of ACA has provisions related to patients with chronic ailments like hypertension which permits them to have enhanced health insurance coverage and decreases their financial burden. EMR and Self-manage education programs on hypertension are effective strategies to manage hypertension and can improve the quality of care, enhance patient safety and reduce costs.

References

American Heart Association. (2022, March 4). Health threats from high blood pressure. https://www.heart.org/en/health-topics/high-blood-pressure/health-threats-from-high-blood-pressure#:~:text=Left%20undetected%20or%20uncontrolled%2C%20high 

Angier, H., Huguet, N., Ezekiel-Herrera, D., Marino, M., Schmidt, T., Green, B. B., & DeVoe, J. E. (2020). New hypertension and diabetes diagnoses following the Affordable Care Act Medicaid expansion. Family Medicine and Community Health, 8(4). https://doi.org/10.1136/fmch-2020-000607 

CDC. (2021, November 18). Health topics – high blood pressure – POLARIS. Centers for Disease Control and Prevention. https://www.cdc.gov/policy/polaris/healthtopics/highbloodpressure/index.html#:~:text=Economic%20Burden 

Casey, D. E., Thomas, R. J., Bhalla, V., Commodore-Mensah, Y., Heidenreich, P. A., Kolte, D., Muntner, P., Smith, S. C., Spertus, J. A., Windle, J. R., Wozniak, G. D., & Ziaeian, B. (2019). 2019 AHA/ACC clinical performance and quality measures for adults with high blood pressure: A report of the American College of Cardiology/American Heart Association task force on performance measures. Circulation: Cardiovascular Quality and Outcomes, 12(11). https://doi.org/10.1161/hcq.0000000000000057 

Capella 4900 Assessment 2

Kebede, T., Taddese, Z., & Girma, A. (2022). Knowledge, attitude and practices of lifestyle modification and associated factors among hypertensive patients on-treatment follow up at yekatit 12 general hospital in the largest city of east africa: A prospective cross-sectional study. PLOS ONE, 17(1). https://doi.org/10.1371/journal.pone.0262780 

Lopez, P. M., Divney, A., Goldfeld, K., Zanowiak, J., Gore, R., Kumar, R., Laughlin, P., Sanchez, R., Beane, S., Trinh-Shevrin, C., Thorpe, L., & Islam, N. (2019). Feasibility and outcomes of an electronic health record intervention to improve hypertension management in immigrant-serving primary care practices. Medical Care, 57, S164–S171. https://doi.org/10.1097/mlr.0000000000000994 

Martin, E. A., D’Souza, A. G., Lee, S., Doktorchik, C., Eastwood, C. A., & Quan, H. (2023). Hypertension identification using inpatient clinical notes from electronic medical records: An explainable, data-driven algorithm study. CMAJ Open, 11(1). https://doi.org/10.9778/cmajo.20210170 

PCNA. (n.d.). Clinical resources. https://pcna.net/clinical-resources/ 

Rodriguez, S., Hwang, K., & Wang, J. (2019). Connecting home-based self-monitoring of blood pressure data into electronic health records for hypertension care: A qualitative inquiry with primary care providers. JMIR Formative Research, 3(2), e10388. https://doi.org/10.2196/10388 

Wierzejska, E., Giernaś, B., Lipiak, A., Karasiewicz, M., Cofta, M., & Staszewski, R. (2020). A global perspective on the costs of hypertension: A systematic review. Archives of Medical Science : AMS, 16(5), 1078–1091. https://doi.org/10.5114/aoms.2020.92689  

Capella 4900 Assessment 2

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