The Intervention Mapping Model

 

Intervention mapping mode was developed as an iterative path for problem solving and mitigation. The model describes different steps that can be taken to mitigate a situation, including health related complication. The steps integrate both theory and evidence and make subsequent actions which lead to the elimination of health problems (Bartholomew (2016). Thus, to understand the condition, an assessment or problem analysis must first be undertaken. Subsequently, matrices must be created based on the determinants of the condition and the targeted intervention. Theory-based intervention methods and integrative approaches are considered. Finally, adoption, implementation and sustainability is put in place through an evaluation plan to improve intervention (Bartholomew (2016).

In the program design, some components of the model must, however, be considered to effectively eliminate the infection. Cancer, the health associated infection is a chronic condition being considered here can be evaluated based on the four components of the model. Social assessment is the first which considers the quality of life of the individual. Epidemiological assessment, the second phase include health, genetics, behavior and environmental players in the condition. In the third phase, education and ecological assessments are considered including predisposition, reinforcement, and the creation of an internal enabling environment. The final phase involves administrative and policy assessment which ultimately lead to better educational programs and policy regulations (Bartholomew (2016).

However, the intervention model requires an explicit description of the different stages of improving intervention which can prolong the overall process and ultimately affect patient improvement. Nonetheless, this is the most useful model in addressing this chronic condition as it provides the exact actions to take including the directions to follow and the procedure for developing the intervention.

 

 

Reference

Bartholomew Eldrigde, L. K., Markham, C. M., Ruiter, R. A. C., Fernàndez, M. E., Kok, G., & Parcel, G. S. (2016). Planning health promotion programs: An Intervention Mapping approach (4th ed.). Hoboken, NJ: Wiley.

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Healthcare Associated Infections

 

Health Associated Infections (HAI) is a major health challenge in diverse locations across the United States. Ventilator-associated pneumonia, gastrointestinal ailments, and urinary tract infections are the common types of HAIs in the U.S. Data from the American Centre for Disease Control (CDC) postulate that over 157,000 individuals contract ventilator associated pneumonia, gastrointestinal illnesses at 123,000, and UTIs at 93,000. The data further postulates that health institutions in diverse locations across the U.S admit over 2 million patients suffering from a diverse array of HAIs each year. Besides, over 100,000 patients succumb to the HAIs annually (Youngquist et al., 2007). The government further disburses over 4 billion dollars to cater for individuals suffering from various HAIs. Medical specialists argue that a large portion of the HAI is preventable. However, lack of appropriate intervention plans has led to the high proliferation of the HAIs. A critical analysis of the ventilation-associated pneumonia equips individuals with suitable knowledge on techniques that can help in addressing its prevalence.

An Overview of Ventilator-Associated Pneumonia

Heath specialists postulate that VAP frequently occurs among patients admitted in health institutions. Patients using ventilators and in the ICU are at a higher risk of contracting the ailment unlike their counterparts in other admission rooms. A diverse array of bacteria causes the infection that leads to the death of over 4,000 individuals each year. Based on the available literature, the VAP strain is resistant to antibiotics thus endangering a patient’s life. The ailment causes severe symptoms such as chest pain, confusion, cough, fatigue, and shortness of breath (Youngquist et al., 2007). Lack of an appropriate diagnosis and medication plan may further lead to the emergence of medication errors thus endangering the patient’s life.

The article further explores the preventive and biomedical perspective that helps in addressing the high proliferation of the ailment. Based on the study, pneumonia is among the recurring ailments. Therefore, an individual should take efficient rest to enhance the comprehensive recuperation from the ailment. An individual should further take sufficient fluids to hydrate the lungs thus preventing the occurrence of dry coughs. Adherence to the medication plan is also an efficient strategy that hinders the reoccurrence of the ailment (Youngquist et al., 2007). Appropriate hygiene habits further reduce the transmission of bacteria that cause the ailment.

The article further explores suitable biomedical strategy that can help in reducing the contraction of VAP among patients under breathing machines in the ICU. A longitudinal study in an ICU ward at the Mayo clinic facilitates the collection of credible insights on the strategy. The researcher argues that the adoption of a ventilation bundle is a proficient technique that helps in addressing the high proliferation of VAP among patients. As a result, nursing personnel should constantly adjust a patient’s head to facilitate efficient breathing and functioning of the body activities (Youngquist et al., 2007). The specialist should further sanitize the surroundings to prevent the existence of bacteria that may lead to the contraction of VAP. Continuous interruption of sedation and assessing the patient’s weaning habits are essential measures that help in addressing the health challenge. Medical specialists should further apply a suitable prophylaxis to reduce the patient’s risk of contracting the ailment. The study further affirms that health care experts should further focus on the formulation of an efficient medication plan to reduce the occurrence of medication errors. Patient education on how to prevent and cope with VAP is also essential in addressing the pertinent health challenge. The incorporation of the level four perspectives on the involvement of the community is also essential in reducing the prevalence of the ailment.

 

References

Youngquist, P., Carroll, M., Farber, M., Macy, D., Madrid, P., Ronning, J., & Susag, A. (2007). Implementing a ventilator bundle in a community hospital. The joint commission Journal on quality and patient safety, 33(4), 219-225.

 

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Medication Reconciliation Flowchart

 

Name:

School Affiliation:

Medication Reconciliation Flowchart

Description of the Patient Safety Problem

Medication reconciliation is the process in which nurses, physicians, and other healthcare professionals work with the patients to ensure that medical information is accurate and complete at the various interfaces of care. Medical reconciliation is necessary in mitigating adverse drug effects, which are a leading cause of morbidity and mortality within health care systems around the globe(Andel, Davidow, Hollander, & Moreno, 2012). Many adverse drugs events occur due to poor communication between medical professionals and between medical professionals and patients especially in cases where care is transferred. Care transfer refers to instances when patients are admitted to a care facility, moved between wards within a hospital or are discharged home or to a residential facility.

Over fifty percent of medical errors that occur in the clinical environment is estimated to occur on admission or discharge. Further, thirty percent of these errors can harm patients. Errors occurring on admission entail obtaining the patient’s medical history, when prescribing medicines, and when recording the medications in the medical records. According to the World Health Organization (2015), 67 percent of patient’s prescription histories recorded on admission are inaccurate. Additionally, up to 80 percent of patients have discrepancies between the prescribed medications and the medications they are taking at home(Elias, Damle, Casale, Branson, Churi, Komatireddy & Feramisco, 2015). The repercussions of inadequate transition from a hospital to home are far-fetching for patients (World Health Organization, 2014). They include adverse drug effects, hospital readmission, and mortality.

Medication Reconciliation at Admission


Flow Chart

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Description of the Process

Medication reconciliation starts with obtaining the patient’s best possible medication history (BPMH). This means that the health care worker admitting the patient should compile a comprehensive list of medications that the patient has previously taken or is currently taking. They achieve this by interviewing the patients or their guardians, deriving information from referral letters as well accessing previous medical information from electronic health records. The Best Possible Medical History (BPMH) should include all drugs that the patient is taking, both prescribed and non-prescribed. Prescribed medications are those taken under the advice of a prescriber while the latter are not based on a prescribed advice. Complementary (herbal), recreational drugs, and prn medication should be included in the Best Possible Medical History (Elias, Damle, Casale, Branson, Churi, Komatireddy & Feramisco, 2015). Only if a patient or their guardian are not in a positionto describe their medical history before admission should the other sources be utilized to obtain their medication history or to clarify a conflicting piece of information about them (World Health Organization, 2014). It is not professional for a heath care professional to use other sources of information in the place of a thorough interview with a patient or their guardians.

Next, the patient’s Best Possible Medical History is verified and documented. The information should be verified with more than one source including their medication lists, the federal medication database, inspecting their medication containers, or verifying with their home care providers and community pharmacists. The Best Possible Medical History is a record of a patient’s medication information including their generic and brand names, dosage, a patient’s route and frequency of administration (McGonigle & Mastrian, 2012). A BPMH is different from and more comprehensive than the conventional primary medication history. As such, it should be documented in a computer template that prompts for the required information(Elias, Damle, Casale, Branson, Churi, Komatireddy & Feramisco, 2015).

The third step of the medical reconciliation process entails reconciling the Best Possible Medical History with the prescribed medicines. Medication reconciliation on admission is in figure 1 above. It is a retroactive modelwhereby medication admission orders are written before the Best Possible Medical History has been obtained. The BPMH and the admission orders are reconciled, whereby discrepancies are identified and resolved (World Health Organization, 2014).

To begin the reconciliation, patient’s conventional primary medication history is taken and admission medication orders documented before the Best Possible Medical History is created. When created, the Best Possible Medical History is compared retroactively against the admission medication orders. Discrepancies are then identified and resolved as appropriate. The discrepancies are categorized into intentional discrepancies and undocumented intentional discrepancies. Undocumented intentional discrepancies are those which the prescriber makes an intentional decision add, adjust, or stop a medication, but do not document the decision (Giles, Harris, & Parker, 2010).Unintentional discrepancies are those which a prescriber changes, omits, adjusts, or stops a medication that the patient was taking before they are admitted. The reconciliation should occur within 24 hours of admitting the patient.

The final step entails communicating to the patient the Best Possible Medication Discharge Plan at the end of the patient’s episode of care. The plan should also be communicated to their personal care physicians, community pharmacy and the facility that will provide them care next (Andel, Davidow, Hollander, & Moreno, 2012). On receiving the plan, all the recipients should make sure that they update their records so that they reflect an accurate record of the patient’s current medications.

In any clinical process, patients are the only constants. Medication reconciliation, therefore, will only work with the active involvement of patients and their families in the process. Patients are best placed to provide accurate information about their medications(Huser, Rasmussen, Oberg & Starren, 2011). As such, they should be educated about the essence of participating in the medication reconciliation process. They should be encouraged always to speak up if the think that there is a discrepancy or an error with their medication. They should also be advised to keep an updated list of all the medications that they are currently taking. Additionally, they should be advised to always bring their medications and medication records with them when they come to the hospital. Achieving this would require the use of educational tools and materials to support patients in self-maintaining their medication records.

Areas of Improvement

Patient and Family Involvement

After the Best Possible Medical History has been obtained, patients should continue to be engaged in the subsequent steps leading to a successful medication reconciliation process. It is important to notify them of any changes made to their medication records and regimen so that they can have an understanding of how to continue taking their medicines. When they are discharged to home and in ambulatory visits where the patient’s medication has been modified, it is important that they receive counseling on the updated regimen (Howlett & Atkinson, 2012).

Conclusion

The process of medication reconciliation is complex because it encompasses a multitude of professional disciplines across a broad spectrum of care (Huser, Rasmussen, Oberg & Starren, 2011). While the fundamental guiding principle of communication alongside its value to the safety of patients is widely accepted, the medication reconciliation process is sometimes considered as exasperating. As such, the process may be resisted within a care setting if not implemented in a systematic manner. It is recommended that a quality improvement approach is applied in applying medical reconciliation.Medication reconciliation is a matter dealing with information management and the implementation of medical reconciliation systems depends largely on the existing staff in a health care organization as well as the systems and processes established to collect, use, and communicate medication information. It is imperative that information management activities that facilitate medication reconciliation are integrated into a health care organization’s existing systems and processes as much as possible. To provide patients with the safest form of care, it is important that licensed practical nurses and registered nurses follow the steps outlined in the workflow for proper medication reconciliation. This will reduce the rate of infections as well as the possibility of adverse effects occurring in a healthcare facility. Chances to improve the efficiency of the medication reconciliation process need to be identified, prioritized and implemented.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Andel, C., Davidow, S. L., Hollander, M., and Moreno, D. A. (2012). The economics ofhealth care quality and medical errors. Journal of Health Care Finance, 39(1), 39-50.

Baron, J. M., and Dighe, A. S. (2011). Computerized provider order entry in the clinicallaboratory. Journal of Pathology Informatics, 2(35)

Charles, K., Willis, W., & Coustasse, A. (2014, March). Does computerized physician order

entry reduce medical errors? In proceedings of the Business and Health Administration Association Annual Conference. Chicago, IL.

Du, D. T., Goldsmith, J., Aikin, K. J., Encinosa, W. E., and Nardinelli C. (2012) Despite 2007

law requiring FDA hotline to be included in print drug ads, reporting on adverse drug events by consumers still low. Health Affairs, 31(5), 1022-1029.

Elias, P., Damle, A., Casale, M., Branson, K., Churi, C., Komatireddy, R., & Feramisco, J. (2015). A Web-Based Tool for Patient Triage in Emergency Department Settings: Validation Using the Emergency Severity Index. JMIR Medical Informatics, 3(2), e23. doi:10.2196/medinform.3508

Giles, K., Harris, J., & Parker, L. (2010). Improving margins through a patient access initiative.

Healthcare Financial Management, 64(6), 92-96. Retrieved from Walden Library Database.

Hammel-Jones, D, McGonigle, D, & Mastrian K. (2015). Nursing informatics: Improving workflow and meaningful use. In D. McGonigle & K.G. Mastrian (Eds.), Nursing informatics and the foundation of knowledge (Laureate Education, Inc., custom ed., pp. 229-244). Burlington, MA: Jones and Bartlett Learning.

Howlett, M. K., & Atkinson, P. T. (2012). A method for reviewing the accuracy and reliability of a five-level triage process (canadian triage and acuity scale) in a community emergency department setting: building the crowding measurement infrastructure. Emergency Medicine International, 2012636045. doi:10.1155/2012/636045

Huser, V., Rasmussen, L. V., Oberg, R., & Starren, J. B. (2011). Implementation of workflow engine technology to deliver basic clinical decision support functionality. BMC Medical Research Methodology, 11(1), 43-61. doi:10.1186/1471-2288-11-43

Koppel, R., & Kreda, D. A. (2010). Healthcare IT usability and suitability for clinical needs: challenges of design, workflow, and contractual relations. Studies in Health Technology and Informatics, 1577-14.

McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge.

(2 ed., pp. 97-99). Burlington, MA: Jones & Bartlett Learning.

World Health Organization (2015). Assuring Medication Accuracy at transitions in Care: Medication Reconciliation. The High5s Project- Standard Operating Protocol for Medication Reconciliation.

 

 

 

 

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My Major Register Nurse

Write a description of a current topic or development (IN THE PAST 12 MONTHS) in your field and an explanation of its significance. Audience: Students new to your major who have a curiosity or research interest in this particular topic but no prior specialized knowledge of the topic; Instructor Length: at least 2 to 3 pages, not counting references page. There are two basic tasks to fulfill in this paper: -to describe this topic or development as clearly and concisely; in other words, to educate your audience about this topic as thoroughly as possible given the space constraints. – to make a compelling, specific, and explicit case explaining obvious and not-so-obvious reasons this development is important to the world outside your major. You will receive a provisional grade on this paper. If you choose to revise the paper, that provisional grade will be entirely replaced by the final grade. Please see your syllabus for more information about this paper. Use MLA format.

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Transportation (Design of a roundabout)

Our group split the work to be done on the report per individual. For my part of the report, i will be working on
Introduction
A. Important information about the roundabout being studied (1 page)
– Location
– Connecting highways
– Purpose of constructing the project
– Budget
– Start of operation (partial and full)
B. Problem/Reason why this has become an important topic (1 page)
C. Introduction of MAYA engineering (check LOI) (1 page)
– Objectives

The total pages under the introduction should be no more than 3 pages

For part A of the introduction please refer to the document i\’ll attach titled \”MAYA-Engineering-Inc-Report-updated.pdf\” under section II part 2.3 Project overview. Feel free to also use the references listed at the bottom of the report for any further guidance.
A side note for the budget, you do not have to come up with a new one. Refer to budget that was used to design the existing roundabout.

For part B, use the reference below, it was a major part of the reason we decided to go with a redesign of the round about. Please free to look at other references in relation to this news article. http://blackburnnews.com/chatham/chathamnews/2015/04/14/tractor-trailer-hauling-steel-flips/

For part C, refer to the letter of interest document (LOI) which will also be attached below and also the PDF report titled \”MAYA-Engineering-Inc-Report-updated.pdf\”

The last section of the report i will working is the Conclusion which requires stating the
– Importance of roundabout (1/2 page max)
– And justifying why this roundabout is an integral part of the city of Windsor’s transportation system (1 page max)

To assist you with this section please refer to the letter of interest (LOI) and the report

The roundabout being discussed in this project is located in the city of Windsor, ON Canada. It connects highway 3, highway 401, highway 9 and Huronchurch

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Communication Plan

Using your completed strategic action plan, create a 500-750 word communication plan for disseminating your action plan to all of the stakeholders. Which strategies do you plan to utilize and why? Your plan should demonstrate how you plan to use formal and informal communication channels to implement the plan.

In addition, explain how the communication plan addresses what you are hoping to achieve with your strategic goal. What leadership or managerial skills will you draw upon in implementing this plan?

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Discussion 8 finc

Read the article: “Reality Retirement Planning: A New Paradigm for an Old Science.” by Ty Bernicke. Follow instructions for posting answers to discussion questions regarding the article.

Critically assess one or more of the key statements or main theses of the author. Research a \”Scholarly (peer reviewed) Journal\” article that supports your position or argument. Cite your sources using MLA style. At the bottom of your first posting, include a list of works cited in MLA format.

For the scholary journal article please use an article I can access online.

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1984

Read this article, please:
http://msxnet.org/orwell/print/1984.pdf

Please post three-hundred words. analyze the first chapter of 1984 to explain how the story relates to current concerns about privacy and civil rights, what do we learn? How is your nation either submitting to similar public and private restrictions or working to prevent their circumvention? Please present specific examples to support your opinions.

please, watch this movie:
https://www.youtube.com/watch?v=rGgon2YeISw

please, do not copy from anywhere; just write your opinion and what you understand.

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Applied Analytic Methods

Here is the description: Tables with Reservations – Because there is such a wide variety of things to be learned in statistics and research methods, these exercises give you an opportunity to put into practice some of the concepts that you are learning in these courses. Following class discussion of these tables, you will be asked to write up our observations of how useful (or not) these tables are.
1 paragraph per study

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Week 8 Discussion 18

Define affirmative action and describe the two views: reverse discrimination/racism and undoing discrimination/racism. How effective have affirmative action policies been for African Americans? For women? (Use evidence from your text to answer this question). Based upon the information presented in the text See attachment from Farley, John. E.2012. Majority-Minority Relations, 6th edition) should affirmative action policies be abolished or continued? Why? Are there other alternatives to equal opportunity? Support your answer. I don\’t want biases, personal anecdotes, or simplistic thinking here. In order to earn full credit in this post, you will need to show thorough knowledge of the arguments made in the Farley text.

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