Gerontology Quality Improvement

Evidence Based Practice for Quality Improvement
In today’s society, the number of aging people are steadily increasing, leading to longer lives with advances in medicine and technology. Gerontology is the study of the physical, social, psychological, and cognitive characteristics of aging (Tabloski, 2014). These studies bring forth valuable information of the geriatric population to enhance quality of life. The purpose of this paper is to discuss challenges related to age, provide literature on the elements of Quality Assurance and Performance Improvement (QAPI), reveal physical and emotional changes in elderly that make the execution of the project more arduous, present barriers and solutions to quality improvement (QI) programs, and offer
future insight on the quality of care for the elderly. Nurses must unite to bestow continued excellence in nursing for the growing geriatric population.
Age-Related Challenges
There are many hurdles that the elderly must overcome as aging takes a toll on the body. As the body ages, there is a gradual decline physically, socially, psychologically, and cognitively. From a physical standpoint, the years of a person’s lifestyle will gradually reveal itself exposing major organs, vasculature, skin, body fat, muscles, bones, and sensory systems to be more vulnerable to disease. Therefore, maintenance of multiple chronic diseases can become complicated in providing care. Socially, numerous theories speculate either engagement or withdrawal from social participation. As people grow older, the loss of loved ones may disengage a person from social life. Psychologists have postulated various hypotheses surrounding adaptations near the end of life, such as development or acceptance of successes and disappointments or achieving different stages of life. If personal accomplishments have not been fulfilled, the older person can feel a sense of loss and despair. Cognitively, there is loss of neurons which leads to deterioration of the ability to process information, retain memory, and dull awareness. The aging population may sense cognitive decline and withdraw into depression. Nurses must be cognizant of providing age appropriate care as numerous adaptations to the aging body must be made in lifestyles.
Literature Review
Nursing facilities across the nation adhere to the five elements of QAPI.
These elements include a blueprint and scope, governance and management, response, data structure and observing, performance improvement projects (PIPs), and system evaluation and action plans (Centers for Medicare & Medicaid Services [CMS], 2014). In reviewing the five elements of QAPI, there are several evidence-based literature reviews that support these components. In an evidence-based study for fall prevention in a nursing facility, the practice of fall prevention was inadequate, therefore a QI process was implemented (Gama, Medina-Mirapeix, & Saturno, 2011). In a systematic analysis of the problem in element five of the QAPI, it was found that there were unsafe practices. As part of the PIP in element four, the use of multidisciplinary teams was effective in preventing falls. A QI model was integrated from an internal development stemming from evidence-based practice (EBP), along with feedback, design and application of interventions to augment quality (Gama et al., 2011). These components touched on element three in receiving feedback and benchmarking baseline data. Interventions for the QI process included modifications in registration systems, education and awareness for health care staff, and work configuration (Gama et al.,
2011).
The primary intention in a study of hourly rounding was to reduce the risk of falls. The design in element one was carefully constructed after countless observations in other hospitals to employ the best evidence and obtain measurable goals. In element two, leadership interactions that were encouraging to staff strengthened positive reinforcement for quality rounds and advanced staff with constructive feedback and coaching (Hutchings, Ward, & Bloodworth, 2013). In element three, feedback and coaching provided staff with a voice to safeguard the process for long-term use. In element four, integrating leadership into hourly rounds alongside driving cultural change shaped the basis for change. Finally, in element five, a systematic analysis revealed that investing in staff education instilled a desire for adopting change.
In an article about evidence-based care enhancing quality improvement; the art of practice, the patients’ partialities, and the accessibility of proven research go hand in hand (Gillam & Siriwardena, 2014).
In element one of designing a QI project, the intervention that will be initiated will need to demonstrate a progression of value and centered on useful evidence to fulfill these advances. A systematic approach is used by health care professionals to include asking a concentrated question, discovering the most useful evidence, assessing evidence judiciously, modifying practice in uncovering evidence, and gauging performance (Gillam & Siriwardena, 2014). In receiving feedback from health care professionals, limitations of professional autonomy, deficiencies in training, and constraints of resources were identified as obstacles in fulfilling EBP (Gillam & Siriwardena, 2014). To entice health care professionals in promoting EBP, incentives are bestowed for
reinforcement.
This article proposes the assessment of fall risk as a sixth vital sign. In element one, identification for the prevention of falls was identified to improve safety. The measurable goal was to reduce and sustain the number of falls within a set time period. In element two, nursing leaders and staff collaborated to develop fall signs. In element three, feedback was received from nursing staff, families, patients, and leadership. In element four, a committee for falls assessed and amended policies and procedures. In element five, a systematic root cause determined that predicted physiological falls was also accounted for in the statistics, along with accidental falls. Research was conducted in EBP interventions for falls to show that a variety of assessments and interventions for falls had the most successful outcomes (Younce, Hinton, Haynes, & Berg, 2011).
A QI initiative was founded after the discovery of the necessity for multiple staff members to be able to effectively network and communicate to reduce risk factors for falls. In reducing falls, case studies revealed a positive link between effective communication when management interacted with staff. Hence, a trial for engaging staff to enhance communication skills and solving problems with one another began. In element one, the design for the program were cluster randomized, controlled trials to pursue three measurable goals. In element two, leadership was involved to incorporate staff and to facilitate training. In element three, input from staff was obtained to gauge outcomes. In element four, this article obtained trials to examine meaningful outcomes. In element five, evaluation of the trials revealed that augmenting interaction behaviors of staff improved the learning environment and assisted staff to embrace the falls QI program for EBP (Anderson et al., 2012).