NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

Name

Capella university

NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1

Prof. Name

Date

Abstract 

This quality improvement initiative, rooted in the Plan-Do-Check-Act (PDCA) cycle, addresses the intricate biopsychosocial complexities surrounding diabetes and renal failure management, with Mrs. Smith’s case as a focal point. The project aims to optimize patient outcomes through a collaborative approach involving Continuous Glucose Monitoring (CGM) implementation, comprehensive education, and financial aid strategies.

By integrating interprofessional teamwork, encompassing endocrinologists, nurses, dietitians, and social workers, the effectiveness and efficiency of the intervention are bolstered. The project anticipates benefits such as enhanced patient well-being, improved care quality, and streamlined healthcare processes, contributing to broader population health advancements. This initiative aims to drive sustained improvements in patient care and overall healthcare delivery through continuous assessment and adaptation.

Quality Improvement Methods

To promote continuous improvement in managing diabetes and renal failure, particularly for patients like Mrs. Smith, we propose utilizing the PDCA cycle. This method involves four key steps: planning the intervention, implementing the plan, checking the results, and acting on what is learned to refine the process. In Mrs. Smith’s case, PDCA can be applied to monitor and adjust her blood glucose levels and renal function. For instance, the initial plan may involve introducing CGM and diuretics (Yi et al., 2023).

The “do” phase would implement these interventions, while the “check” phase involves regular monitoring of blood glucose and renal function tests. The “act” phase would use the gathered data to tweak the intervention, ensuring continuous improvement. This cyclical approach ensures that adjustments can be made based on real-time data, thereby addressing her care’s physiological (biological) and behavioral (psychosocial) aspects. The PDCA cycle promotes continuous improvement by providing a structured yet flexible framework that can be repeatedly refined (Yi et al., 2023).

Limitations of PDCA

Despite its strengths, the PDCA cycle presents several challenges. One significant limitation is the potential for resistance to change, particularly from patients who may find new technologies like CGM intimidating or cumbersome. To mitigate this, comprehensive education and support systems need to be established. Patients should be thoroughly educated about the benefits and use of CGM, and support from healthcare professionals should be readily available to address any concerns (Sugandh et al., 2023). Additionally, financial barriers may hinder the consistent implementation of interventions, especially for patients like Mrs. Smith, who face economic constraints.

Connecting patients to financial assistance programs can help overcome this barrier (Du et al., 2022). Furthermore, adapting the PDCA cycle to manage biopsychosocial considerations requires a multidisciplinary approach, integrating input from endocrinologists, nephrologists, dietitians, and social workers to comprehensively address all aspects of the patient’s condition. This collaboration ensures that interventions are holistic and patient-centered. By anticipating these challenges and proactively developing strategies to address them, the PDCA cycle can effectively facilitate continuous quality improvement in managing complex conditions like diabetes and renal failure (Du et al., 2022).

Evidence-Supported QI Methods

Evidence supports the effectiveness of the PDCA cycle in managing diabetes and renal failure in patients like Mrs. Smith. CGM has been shown to significantly improve glycemic control by providing real-time feedback, enabling timely interventions and adjustments to insulin therapy (Martens et al., 2021). Studies demonstrate that CGM users experience fewer episodes of hypoglycemia and better overall glucose management, which directly supports the “check” and “act” phases of the PDCA cycle.

Furthermore, the use of diuretics to manage renal function is backed by guidelines from the American Diabetes Association (ADA), which recommends diuretics for patients with edema and early-stage renal damage to prevent further deterioration (Afify et al., 2023). This evidence reinforces the planning and implementation stages of the PDCA cycle, ensuring that the interventions are both evidence-based and practical.

The most valuable evidence for our project includes the ADA guidelines and the research by Martens et al. (2021), as these sources provide robust data supporting the integration of CGM and diuretics into the care plan. This evidence informs the specific QI approach by validating the chosen interventions and ensuring they are aligned with best practices for managing diabetes and renal failure, thereby enhancing patient outcomes like Mrs. Smith’s.

Identify Knowledge Gap 

While evidence supports the effectiveness of CGM and diuretics, there may be gaps in understanding how these interventions translate into long-term outcomes for patients like Mrs. Smith. Additionally, the optimal frequency and duration of CGM usage in managing blood glucose levels still need to be clarified in specific contexts. Further research could explore the impact of socioeconomic factors on medication adherence and its interaction with financial assistance programs in improving health outcomes for diabetic patients (Kvarnström et al., 2021). 

Change Strategy Foundation 

The project is anchored in successful change strategies such as CGM, financial assistance for medication adherence, diuretics, and comprehensive education (Kvarnström et al., 2021). These strategies are informed by evidence-based practices and guidelines from reputable sources like the ADA and NANDA (ADA, 2022; NANDA, 2020). Successful implementation of CGM and medication assistance programs has been demonstrated in similar QI projects, showcasing their effectiveness in improving patient outcomes.

For instance, CGM helps maintain blood glucose levels within the target range, reducing spikes from 200-350 mg/dL to 80-130 mg/dL fasting and less than 180 mg/dL postprandial (Lin et al., 2021). These strategies are relevant and appropriate for this QI project as they address specific clinical needs such as controlling blood glucose levels, managing renal function, and ensuring medication adherence in patients like Mrs. Smith, ensuring a comprehensive and evidence-based approach to quality improvement (Lin et al., 2021).

Potential Challenges and Solutions 

Implementing CGM and financial assistance programs faces challenges such as initial costs and patient acceptance. To address this, patients and healthcare providers will receive comprehensive training sessions and ongoing support. Collaborating with financial aid organizations and community organizations can help mitigate financial barriers. Resistance to change and adherence issues arise, requiring tailored educational interventions and close monitoring of patient progress. Regular feedback and quality improvement assessments will help identify and address emerging challenges throughout the implementation process (Lin et al., 2021).  

Effectiveness Of Interprofessional Teamwork 

The interprofessional team for this QI project will include endocrinologists, nurses, dietitians, social workers, and nephrologists. Collaboration among these diverse roles ensures a comprehensive approach to addressing the multifaceted needs of patients like Mrs. Smith, who presents with complex biopsychosocial considerations. By pooling their expertise, team members can contribute specialized knowledge and skills to develop tailored interventions for diabetes management and provide holistic care to renal failure patients like Mrs. Smith. This collaborative approach enhances the project’s quality and effectiveness and promotes a shared understanding of patient needs and goals, leading to more patient-centered care (Nurchis et al., 2022).

Additionally, interprofessional teamwork streamlines communication and coordination among team members, reducing duplication of efforts and enhancing project efficiency. By leveraging each team member’s strengths and resources, the project can achieve its objectives more swiftly and effectively, ultimately improving patient outcomes and satisfaction. Assumptions for the interprofessional teamwork approach include the availability and willingness of all team members to collaborate effectively. Additionally, it assumes adequate resources and support for interprofessional communication and coordination throughout the project. Finally, it presupposes that each team member possesses the necessary skills and expertise to contribute effectively to the diabetes management project’s goals for patients like Mrs. Smith  (Ernawati et al., 2021).

Overall project benefits 

The project benefits include improved patient outcomes through optimized management of diabetes and renal failure, leading to enhanced quality of life for individuals like Mrs. Smith. Additionally, the project fosters a culture of continuous improvement within the healthcare setting, promoting better patient safety and equity in care delivery. The project aims to reduce healthcare disparities and enhance overall population health by addressing biopsychosocial considerations comprehensively. Moreover, the project’s emphasis on interprofessional collaboration fosters a more cohesive healthcare team, leading to greater job satisfaction and professional development among staff (Ernawati et al., 2021). Ultimately, these collective improvements contribute to a more efficient and effective healthcare system, aiding patients like Mrs. Smith and healthcare providers.

References 

ADA. (2022). American diabetes association. Diabetes.org. https://diabetes.org/ 

Afify, H., Morales, U. G., Asmar, A., Alvarez, C. A., & Mansi, I. A. (2023). Association of thiazide diuretics with diabetes progression, kidney disease progression, cardiovascular outcomes, and death among patients with diabetes who initiate statins. The American Journal of Cardiology, 203, 274–284. https://doi.org/10.1016/j.amjcard.2023.07.057 

Du, Q., Liang, D., Zhang, L., Chen, G., & Li, X. (2022). Evaluation of functional magnetic resonance imaging under artificial intelligence algorithm on plan-do-check-action home nursing for patients with diabetic nephropathy. Contrast Media & Molecular Imaging, 2022, 1–8. https://doi.org/10.1155/2022/9882532 

Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021). Effectiveness of diabetes self-management education (DSME) in type 2 diabetes mellitus (T2DM) patients: Systematic literature review. Journal of Public Health Research, 10(2), 198–202. https://doi.org/10.4081/jphr.2021.2240 

Karakuş, K. E., Sakarya, S., Yeşiltepe Mutlu, G., Berkkan, M., Muradoğlu, S., Can, E., Gökçe, T., Eviz, E., & Hatun, Ş. (2021). Benefits and drawbacks of Continuous Glucose Monitoring (CGM) use in young children with type 1 diabetes: A qualitative study from a country where the CGM is not reimbursed. Journal of Patient Experience, 8(1). https://doi.org/10.1177/23743735211056523 

NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

Kvarnström, K., Westerholm, A., Airaksinen, M., & Liira, H. (2021). Factors contributing to medication adherence in patients with a chronic condition: A scoping review of qualitative research. Pharmaceutics, 13(7). https://doi.org/10.3390/pharmaceutics13071100 

Lin, R., Brown, F., James, S., Jones, J., & Ekinci, E. (2021). Continuous glucose monitoring: A review of the evidence in type 1 and 2 diabetes mellitus. Diabetic Medicine, 38(5). https://doi.org/10.1111/dme.14528 

Martens, T., Beck, R. W., Bailey, R., Ruedy, K. J., Calhoun, P., Peters, A. L., Pop-Busui, R., Philis-Tsimikas, A., Bao, S., Umpierrez, G., Davis, G., Kruger, D., Bhargava, A., Young, L., McGill, J. B., Aleppo, G., Nguyen, Q. T., Orozco, I., Biggs, W., & Lucas, K. J. (2021). Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with basal insulin. JAMA, 325(22). https://doi.org/10.1001/jama.2021.7444 

NANDA. (2020, October 6). NANDA International Nursing Diagnoses, Inc. NANDA. https://nanda.org/publications-resources/publications/nanda-international-nursing-diagnoses/ 

NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

Nurchis, M. C., Sessa, G., Pascucci, D., Sassano, M., Lombi, L., & Damiani, G. (2022). Interprofessional collaboration and diabetes management in primary care: A systematic review and meta-analysis of patient-reported outcomes. Journal of Personalized Medicine, 12(4). https://doi.org/10.3390/jpm12040643 

Sugandh, F. N. U., Chandio, M., Raveena, F. N. U., Kumar, L., Karishma, F. N. U., Khuwaja, S., Memon, U. A., Bai, K., Kashif, M., Varrassi, G., Khatri, M., Kumar, S., Sugandh, F., Chandio, M., Raveena, F. N. U., Kumar, L., Karishma, F. N. U., Khuwaja, S., Memon, U. A., & Bai, K. (2023). Advances in the management of diabetes mellitus: A focus on personalized medicine. Cureus, 15(8), 1–13. https://doi.org/10.7759/cureus.43697 

Yi, Z., Yunyi, G. a. O., Sheyu, L. I., Nanwei, T., Min, C., Dajiang, L. I., Yan, J., Weiyi, Z., & Xiangjun, C. (2023). Performance surveillance of active blood glucose management during hospitalization based on the PDCA Cycle: A practical study. Chinese General Practice, 26(15). https://doi.org/10.12114/j.issn.1007-9572.2022.0821