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Organizational Strategic Plan

Angela Dushane, Carola Schlatter, Cheryl Veres, Jamie Ziemba, Kaylee Sullivan, Tonya Allendorfer, and Tracy James

Quality Improvement Education Program (QIEP)

Spectrum Health Butterworth Hospital NEW Hospital-Affiliated Service

What is QIEP all about?

Primary Focus
Heart Failure (HF) treatment and rehabilitation through education to improve client outcomes and prevent hospital readmissions


HF is a major clinical and public health problem, and leading cause of hospitalization and health costs in the United States (AHRQ, 2013).

Forces and Trends

In 2010, the Patient Protection and Affordable Care Act 25 authorized financial penalties for hospitals with the highest risk-adjusted readmission during the first 30 days after discharge (AHRQ, 2013).
20% of hospitalized clients with HF are readmitted

HF is the most common discharge diagnosis for Medicare clients.

By 2025, over 18% of the population will be over 65 years of age Research and Evidence-Based Practice reveals new ways to treat HF.

Whats different about QIEP?

The QIEP is diseasespecific.
Flat Organizational Structure

Hospitalist Physician Group

Director of Nursing QI Nurse Manager QI Nurse Educators Administrative Assistant

QIEP Mission Statement

The Quality Improvement Education programs purpose is to

begin EDUCATING CLIENTS with HF prior to discharge from

the acute care setting. Our commitment is to

INDIVIDUALIZE THE PLAN OF CARE for our clients and their family support. It is designed to follow the guidelines of

the American Heart Association and the American College of


QIEP Philosophy

Our program values competent, high-quality care that is delivered in a safe and comfortable environment for our clients. We are confident that the key to the success of our program will be from early follow up and frequent education from our Quality Improvement nursing staff.

Primary Organizational Goals

ACUTE CARE SETTING - prior to discharge Initiate QIEP protocol Assess client motivation and support person(s) Discharge instructions to include follow-up appts CLIENT HOME ENVIRONMENT Home safety inspection & HF kit evaluation Weekly visits X 4 wks - individualized plan of care TELEPHONE INTERVIEWS weekly phone calls X 4 weeks to reinforce teaching BI-MONTHLY SUPPORT GROUP MEETINGS For all HF clients To promote community awareness

Primary Organizational Objectives

To reduce readmission rates within 30 days for greater than 20% of clients discharged with a diagnosis of HF. To educate clients on reducing own risk factors for HF prior to hospital discharge. To promote self care as evidenced by clients daily documentation of weight, HR, BP, and I/O during home visits. To have clients verbalize daily regimen and heart failure zones weekly for 4-week duration of rehabilitation period.

Quality Improvement Nurse Educator

Are you ready to take your nursing career to the next level? If you want to work in a fulfilling and dynamic environment providing quality care and education to patients we would love for you to join our team today. Position Overview:
To promote education for self-care in Heart Failure (HF) treatment regimen. Nursing process will be utilized through collaboration with physicians to prevent hospital readmissions.

QIEP Service Implemented

Focus of Education - HF Zones (to include daily regimen, green/yellow/red zones) Daily Regimen ****** Weight before breakfast, documented and compared to yesterdays weight. Take medication as directed. Check for swelling to feet, ankles, legs, and stomach. Eat a low sodium diet, and follow fluid restriction.

Balance rest and activity.

Green Zone

o No shortness of breath o Weight gain of less than 2 lbs./day o No swelling or chest pain o Able to do normal activities

Yellow Zone
WARNING - CALL DR. IF: o Weight gain > 2 lbs/day or more than 5 lbs/wk o Increased shortness of breath. o More swelling of feet, ankles, legs, or stomach. o Feeling more tired or no energy. o Dry, hacking cough. o Dizziness. o More difficulty breathing with lying down, or need to sleep in chair.

Red Zone

o Struggling to breathe. o Chest pain, tightness, or pressure. o Confusion or cant think clearly.

Whats the bottom line?

Our budget is simple.. We need 2 good nurses, a basic office, and a few supplies.

Budget Proposal

REVENUE - Hospital Reimbursement

QIEP will indirectly increase revenue and HCAHPS scores. Centers for Medicare & Medicaid Services (CMS)
Medicare hospital inpatient prospective payment systems (IPPS) under the Affordable Care Act states that these changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule (CMS, 2013).

QIEP innovative service will help Spectrum Health stay ahead of the curve.
Many third-party payers are following the CMS lead in withholding payment for preventable complications of care (Yoder-Wise, 2011, p. 404).

Agency for Healthcare Research and Quality [AHRQ]. (2013, June 10). Evidence-based Practice Center Systematic Review Protocol. Retrieved November 30, 2013, from http://effectivehealthcare.ahrq.gov/ehc/products/510/1409/heart-failure-readmission-protocol-130610.pdf Centers for Medicare & Medicaid Services [CMS]. (2013, August 19). Acute Inpatient PPS. Baltimore, MD. Retrieved November 15, 2013, from http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY-2014-IPPS-Final-Rule-Home-PageItems/FY-2014-IPPS-Final-Rule-CMS-1599-F-Regulations.html
Google Drive Stock Photo, (n.d.). [Untitled photograph of man.] Retrieved December 4, 2013, from https://docs.google.com/a/ferris.edu/presentation/d/1AIZNVxAuQbieLEuhvW9K7aHTbv5u5ngHJ47LEcklCY/edit?usp=sharing#slide=id.g2569de0c7_41

Heart Failure Poster. (n.d.) Retrieved November 30, 2013, from https://www.google.com/search?q=heart+failure&source=lnms&tbm=isch&sa=X&ei=q4icUsb6PKWGyAGF54CoCw&sqi=2&ve d=0CAcQ_AUoAQ&biw=1280&bih=6 Heart Failure Zones. (2012). Retrieved October 9, 2013, from http://www.stmarys.org/documents/Heart/Heart_Failure_Packet.pd Job Advertisement Image. (n.d.) Retrieved November 30, 2013, from https://docs.google.com/a/ferris.edu/document/d/1xoTrHF_lOu3yt0cj5TQ0bQIL388704LGPFeYFV3_IX0/edit

References Contd . . .
Spectrum Health Butterworth Hospital. (n.d.) [photograph of lobby.] Retrieved November 30, 2013, from https://www.google.com/search?q=spectrum+health+butterworth&source=lnms&tbm=isch&sa=X&ei=wYGcUtnkFqSwyQGz_IC oDA&ved=0CAcQ_AUoAQ&biw=1280&bih=665 Traffic Light. (n.d.) Retrieved November 30, 2013, from https://www.google.com/search?q=traffic+light+invention&stick=H4sIAAAAAAAAAGOovnz8BQMDAy8HixKnfq6&source=lnms&tbm=isch&sa=X&ei=AZOfUulmyIjIAdj9gcgE&ved=0CAkQ_AUoAQ&biw=1280&bih=638&dpr Yoder-Wise, P. S. (2011). Leading and managing in nursing (5th ed. p.404). St. Louis, MO: Elsevier