NHS FPX 6004 Assessment 2 Policy Proposal

Name

Capella university

NHS-FPX 6004 Health Care Law and Policy

Prof. Name

Date

Policy Proposal

Based on our evaluation of the performance dashboard from Mercy Medical Center (MMC) on diabetes tests against the state-level benchmarks set forth by the Agency for Healthcare Research and Quality (AHRQ), it was concluded that MMC is short falling all the critical diabetes tests, including eye examination, feet examination, and HBA1c tests. However, the significant underperformed metric is the feet examination. This paper proposes policy and practice guidelines for MMC to address this underperforming benchmark to enhance patient safety, quality of care, and organizational performance. 

Importance of Policy and Practice Guidelines

Policy and practice guidelines are crucial in MMC in addressing underperformance in foot examinations. These policies and practice guidelines set standards for quality of care, establishing accountability among healthcare providers. According to AHRQ, the current state-level benchmark is 78.8% for feet examination among diabetic adults; however, MMC’s performance falls significantly lower at 41% in 2019 and 42% in 2020, indicating a substantial underperformance (AHRQ, n.d.). 

This benchmark underperformance substantially impacts the quality of care and organizational operations. Inadequate foot examinations are directly related to an increased risk of diabetic foot complications, which include foot ulcers, infections, and amputation (Stancu et al., 2022). These poor consequences compromise the quality of care and negatively impact patient outcomes. Failure to meet benchmark targets may also decrease patient satisfaction and trust in the organization’s ability to deliver comprehensive diabetes care. This can lead to patient attrition and reputational damage, resulting in poor organizational performance (Greene & Samuel-Jakubos, 2021). Finally, the shortfall results in strained resources and inefficient workflows, as healthcare providers, especially nurses, may need to allocate additional time and resources to address patients’ needs related to foot complications, potentially compromising organizational efficiency and quality of services. 

Failure to make practice amendments may lead to suboptimal patient outcomes and increased healthcare costs due to preventable complications and hospitalizations (Kansra & Oberoi, 2023). Moreover, continued underperformance will erode patient trust and satisfaction, resulting in MMC’s inability to retain patients, attract new referrals, and maintain competitiveness in the healthcare market (Greene & Samuel-Jakubos, 2021). Additionally, MMC may encounter several regulatory penalties and loss of accreditation, damaging the organization’s reputation, financial unsustainability, and compromised quality of care. Thus, implementing policy and practice guidelines is imperative for organizational stakeholders. 

Policies and Practice Guidelines for Mercy Medical Center

As part of the organization’s commitment to deliver high-quality care to diabetic patients, MMC should introduce a comprehensive policy and practice guidelines to improve foot examination rates. This proposal aligns with the benchmarks set by AHRQ and practice recommendations by the American Diabetes Association (ADA) and the Centers for Disease Control and Prevention (CDC). The proposed policy and practice standards aim to address the current shortfall observed in MMC’s performance.

Proposed Policy

The proposed policy mandates that all diabetic patients receive foot examinations and a yearly comprehensive exam during each hospital visit. Patients with poorly managed diabetes and high blood pressure should get their feet checked every 3-6 months (AHRQ, n.d.; CDC, 2022). 

Practice Guidelines

Several practice guidelines for foot examination are developed for nurses and nurse practitioners. According to evidence by the ADA, nurses should include five standards in their practices to ensure diabetic patients receive adequate foot assessments and care. These guidelines include comprehensive assessment, regular screening, patient education, collaborative care, and accurate documentation (Leonard, 2024). 

• Nurses should conduct thorough foot examinations for diabetic patients at every healthcare visit. This assessment should include an evaluation of skin integrity, sensation, vascular status, and identification of deformities or abnormalities.
• They should provide regular screening using standardized protocols to ensure timely detection of foot complications, particularly for high-risk patients.
• Nurses should educate patients on foot care, emphasizing the importance of daily foot inspections, appropriate footwear, and early identification and reporting of abnormal signs. 
• They should collaborate with multidisciplinary teams, including physicians, podiatrists, and other healthcare professionals, to facilitate holistic management of diabetic foot care.
• Lastly, it is essential for nurses to accurately document findings from foot examinations in patients’ medical records, including assessments, interventions, and patient education. 

Environmental Factors

Nevertheless, environmental factors, such as regulatory considerations and resource allocation, may impact these policy and practice guidelines. Accreditation standards set forth by accrediting bodies such as The Joint Commission (TJC) require healthcare organizations to implement evidence-based practices for patient care (Ibrahim et al., 2022). Failure to meet these standards may result in loss of accreditation, which could have significant implications for reimbursement and organizational reputation. This underscores the importance of aligning practice guidelines with regulatory requirements. Similarly, staffing levels, financial resources, and logistical considerations influence practice guidelines. Insufficiencies of these factors may lead to reduced frequency of foot tests and suboptimal care, impeding timely care for foot complications. Therefore, addressing resource constraints is essential to effectively implement practice guidelines and optimize patient care outcomes (Kansra & Oberoi, 2023). 

Ethical and Evidence-Based Practice Strategies

The evidence-based strategies to mitigate the challenge of underperforming foot examination benchmarks are patient education and empowerment, streamlined appointment scheduling, and interdisciplinary training for providers. According to Shukla et al. (2020), educating patients about the importance of regular foot examinations, appropriate self-management techniques, and early detection of complications empowers patients to participate actively in their health management. This strategy aligns with the ethical principles of autonomy and informed decision-making and can be made culturally inclusive by tailoring educational materials according to patients’ literacy levels, language preferences, and cultural backgrounds (Spinner et al., 2021). 

Another evidence-based strategy is streamlined appointment scheduling to improve performance in foot examinations among diabetic patients. Nurses can optimize appointment scheduling processes to ensure timely access to foot examinations, reducing wait times and minimizing barriers to care (Stancu et al., 2022). To ensure ethical and culturally inclusive application, appointment scheduling systems should accommodate patients’ diverse needs, preferences, and constraints. Moreover, it should promote justice by providing equitable access to all individuals, reducing health disparities due to geographical and socioeconomic barriers. 

These strategies will enhance the frequency of foot examinations, ensuring compliance with benchmarks set by AHRQ. Moreover, by promoting evidence-based practices and quality care standards for diabetic foot examinations, we aim to meet guidelines by CDC and ADA. These strategies help providers align their practices with regulatory requirements, ensuring timely and comprehensive care delivery (Leonard, 2024). While these changes will improve collaboration, job satisfaction, and workflow efficiency, they may impact nurses’ work and job requirements by necessitating additional time and resources. Moreover, nurses may show potential resistance to change. Despite challenges, these practice changes have long-term benefits of improved patient outcomes and compliance with healthcare standards, contributing to enhanced organizational performance. 

Nurses’ Participation in Policies and Guidelines

Nurses are crucial in developing and implementing policies and practice guidelines within a healthcare organization. In MMC, their contribution is valuable in improving performance and increasing the rate of diabetic foot examinations. As frontline caregivers, nurses are responsible for conducting these tests and providing ongoing education and support to diabetic patients (Hidalgo-Ruiz et al., 2023). While nurses play a role in implementation, they are treasured for the development process as they provide frontline expertise, insights, and concerns.

Inayat et al. (2023) emphasize the involvement of nurses in policy development to gain firsthand knowledge of patient needs, clinical workflows, and potential barriers to implementation. According to the authors, nurses’ participation can help identify possible challenges and develop solutions that address these issues proactively, leading to a more robust and practical policy development. Thus, engaging nurses is crucial to fostering a sense of ownership, commitment, and buy-in, reducing resistance, and increasing acceptance and adherence to the policy and practice guidelines. 

Strategies for Collaborating with Nurses

Several key strategies are essential to engage nurses in the policy development and implementation process. Initially, seeking their input, feedback, and suggestions related to the policy and practice guidelines is imperative to ensure that the proposal reflects their needs and perspectives. Their engagement will ensure the proposal is practical and increase their acceptance of the proposed practices (Inayat et al., 2023). Additionally, comprehensive training and education sessions for nurses are vital. This strategy is essential to address potential objections related to increased workload and resistance to change.

The sessions will elaborate on the importance of policy development, equipping nurses with the knowledge and skills necessary to implement the guidelines effectively (Nickelsen & Bal, 2021). Thirdly, the organization should establish clear communication channels for ongoing feedback, support, and problem-solving, fostering a culture of collaboration and accountability. Lastly, recognize and celebrate nurses’ contributions to successful implementation, acknowledging their efforts and accomplishments to sustain motivation, address objections and contradictions, and sustain their engagement throughout the process (Yang et al., 2022). 

References

AHRQ. (n.d.). National Healthcare Quality and Disparities Reports (NHQDR). datatools.ahrq.gov.  https://datatools.ahrq.gov/nhqdr/?tab=state&dash=287

CDC. (2022, June 27). How to promote foot health for people with diabetes. www.cdc.gov. https://www.cdc.gov/diabetes/professional-info/health-care-pro/diabetes-podiatrist-health.html 

Greene, J., & Samuel-Jakubos, H. (2021). Building patient trust in hospitals: A combination of hospital-related factors and health care clinician behaviors. The Joint Commission Journal on Quality and Patient Safety, 47(12). https://doi.org/10.1016/j.jcjq.2021.09.003

Hidalgo-Ruiz, S., Ramírez-Durán, M. del V., Basilio-Fernández, B., Alfageme-García, P., Fabregat-Fernández, J., Jiménez-Cano, V. M., Clavijo-Chamorro, M. Z., & Gomez-Luque, A. (2023). Assessment of diabetic foot prevention by nurses. Nursing Reports, 13(1), 73–84. https://doi.org/10.3390/nursrep13010008 

Ibrahim, S. A., Reynolds, K. A., Poon, E., & Alam, M. (2022). The evidence base for US Joint Commission hospital accreditation standards: Cross-sectional study. BMJ, 377. https://doi.org/10.1136/bmj-2020-063064 

NHS FPX 6004 Assessment 2 Policy Proposal

Inayat, S., Younas, A., Andleeb, S., Rasheed, S. P., & Ali, P. (2023). Enhancing nurses’ involvement in policy-making: A qualitative study of nurse leaders. International Nursing Review, 70(3), 297–306. https://doi.org/10.1111/inr.12828 

Kansra, P., & Oberoi, S. (2023). Cost of diabetes and its complications: Results from a STEPS survey in Punjab, India. Global Health Research and Policy, 8(1), 11. https://doi.org/10.1186/s41256-023-00293-3

Leonard, V. S. (2024). Increasing diabetic foot exam rates in primary care via a toolkit for registered nurses. Clinical Diabetes. https://doi.org/10.2337/cd23-0103

Nickelsen, N. C. M., & Bal, R. (2021). Workshops as tools for developing collaborative practice across professional social worlds in telemonitoring. International Journal of Environmental Research and Public Health, 18(1), 181. https://doi.org/10.3390/ijerph18010181 

Spinner, J. R., Haynes, E., Nunez, C., Baskerville, S., Bravo, K., & Araojo, R. R. (2021). Enhancing FDA’s reach to minorities and under-represented groups through training: Developing culturally competent health education materials. Journal of Primary Care & Community Health, 12, 215013272110036. https://doi.org/10.1177/21501327211003688 

NHS FPX 6004 Assessment 2 Policy Proposal

Stancu, B., Ilyés, T., Farcas, M., Coman, H. F., Chiș, B. A., & Andercou, O. A. (2022). Diabetic foot complications: A retrospective cohort study. International Journal of Environmental Research and Public Health, 20(1), 187. https://doi.org/10.3390/ijerph20010187

Yang, T., Jiang, X., & Cheng, H. (2022). Employee recognition, task performance, and OCB: Mediated and Moderated by pride. Sustainability, 14(3), 1631. MDPI. https://www.mdpi.com/2071-1050/14/3/1631