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Change Proposal D226 Capstone
Capstone Task 2 (DYT2)
Western Governors University
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Comprehensive Healthcare Change Proposal XXXXXXX College of Health Professions, Western Governors University D226: BSNU Capstone XXXXXX Date 8/4/
A1. Innovative Change The implementation of whiteboards in patients’ rooms in rehabilitation/Long-term care facilities is an innovative and value-based change that would increase residents’/patients’ satisfaction and improve health outcomes. Patients do not know the names of their care providers, who are their nurses, and who is helping with the activities of daily life. As every eight hours staff changes and new people from agencies also work, old residents/patients feel confused about the names of their care providers. New care providers do not know about the needs of residents/patients they are taking care of, whether they are one-person assist or two- person assist. Whether they can use a straw to drink or not, whether they need help with food or not, and whether they need their medication crushed or not. When is their shower/weight day? Sometimes they just have a concern about their care provider. Goyal et al., (2020) suggest that whiteboards help facilitate communication and information sharing. Trojano et al. also recommend using whiteboards in patients’ rooms as it enhances patient-centered care and improves patient satisfaction and patient-provider communication (2022). A1a. Authorized Proposed Change ‘See attached Verification Form’. A1b. Organizational Sponsor Discussion The main points discussed with my organizational sponsor included a review of the five- star/point rating system on the internet. The NursingHomeDatabase (2023) showed one star/point out of five for our facility. This rating is provided by the Centers for Medicare and Medicaid (CMS) for nursing homes and is based on inspections and resident surveys. This is based on the prior three years' weighted average. The five-star rating system helps consumers, their families, and caregivers compare nursing homes easily – nursing homes with five stars are considered to
could bring the satisfaction score of residents/patients up, which can bring more residents/patients in, and the facility could run up to 95% capacity thus bringing in more revenue. A2. Data to Support the Need for Change In this era, all nursing care is patient-centered – to involve the patient in their care. In a nursing home, it is their home. They are there but that does not mean that families have abandoned them. Families expect the best possible care for their loved ones. When they see their loved ones are not getting what they expected, they feel frustrated and try to find another place for their loved ones which places have better ratings, and they get patient-centered care, and their expectations are met. Trajano et al. recommend the use of whiteboards as they help in the identification of their care providers and plan of the day and improve resident/patient satisfaction because their use implies patient-centered care (2022). Patient-centered care brings the rating score up and means that residents/patients are satisfied, and their families are satisfied. A high rating means more people will trust you with the care of their family members and which means better revenue. CDC recommends the use of Nursing Home Care compare web which features a quality rating system and gives each nursing home a rating of one to five stars. People can compare and choose the one with a higher rating for their loved ones (n.). A3. Change Barriers The first barrier is price, each board costs at least thirty-five dollars, and the cost to install in each room. This is a big facility with approximately one hundred rooms. One white plain solid
magnetic whiteboard cost thirty-five dollars, but it can go up for a more convenient layout such as with pre-printed stuff on it. Therefore, the cost could be around $6,000. The other barrier to whiteboard use is the time burden that it imposes on healthcare staff (Trajano et al., 2022). The staff is already busy with the intervention to be performed on the residents/patients. In the long-term care unit nurse-patient ratio is 1:25 to 1:28 and in the rehabilitation unit 1:15 where nurses pass medicines as well. The nurse aids are busy helping residents/patients with activities of daily life such as bathing, providing drinking water, and feeding. Therefore, they feel the constraint of writing on whiteboards. A4. Potential Negative Outcome The whiteboard’s main purpose is communication – communication between the care providers and residents/patient or their families where residents/patients cannot communicate for themselves. The whiteboard can also communicate among various healthcare providers such as instructions to collect a urine/stool sample or to crush the medicine or if the patient is on aspiration precautions, etc. Sometimes residents/patients are on a fasting schedule for a test or surgery, but a healthcare worker not aware of that can serve the food and which can spoil the schedule and can need to be rescheduled. If instead of crushed medicine, the resident/patient gets uncrushed medicine, they can choke and die. If the incoming healthcare worker does not the physiological status of the resident/patient – whether the person is independent, one-person assist, two-person assist, or needs a mechanical lift – both the resident/patient and the healthcare worker can get injured. A4a. Potential Action
spending time on this issue can read the whiteboard and can get straight into providing care, saving time, and not getting frustrated. Healthcare workers working in one unit feel reluctant to work in other units because they do not know the residents/patients well enough to work with them. But giving a snapshot of the residents/patients in their rooms will make them less hesitant to accept work in new units. This way there will not be a shortage of staff, work will run smoothly – workers satisfied, and less turnover of staff – less new orientation – money saved. Satisfied workers in turn will make the residents/patients satisfied. Worker satisfaction will bring good workers to the facility as well because workers also want a work environment where they are not stressed, and the day goes smoothly. A6. Key Stakeholder Identification In my opinion, everyone in the facility is a stakeholder. The resident/patient – knows their caretakers and their needs and plans are literally written on the wall. They are protected from the choking of swallowing whole pills when they need crushed medicine. They are protected from aspirating when they are on thin/thick liquids and the use of straw is prohibited. They have their sample taken when it needs and are fasting when they are required to. They are sitting in a chair instead of laying in bed when that’s the activity for them. Families – are happy when their loved ones are getting care according to the plan discussed with them. They can see what the plan is and are cared for accordingly. Nurse-aids – Know what the resident/patient needs are and work on that directly without searching around where to get information about the resident/patient, know the name of the nurse if she needs to convey any information regarding the status of the resident/patient.
Nurses – they will not spend time on things that are written on the wall such as whether this patient takes crushed medicine or uncrushed, whether this patient is on a finger stick or not. This will help nurses do their work more efficiently. Human resources – When healthcare workers are less stressed, work is running efficiently, staff will stay and there will be less turn over which means they have fewer new employees to orient which is financially big. Director of Nursing – identified the need for the project based on evidence-based suggestions about its benefits and use. They must evaluate if the money is well spent, and if is it being used efficiently. Owner of the facility – when work is done efficiently, the point/star rating can go up which can bring in more profits and at the same time satisfaction with well-done work. A6a. Stakeholder Collaboration The best approach to collaboration will be to have a meeting with some of the stakeholders like nurses, nurse aides, and any other people caring for them, and then discuss it with the Director of nursing. It will be important to discuss what things can go up the board as it will become useless if it is all written down and it will lose its purpose. Only important information such as finger stick status, crushed/uncrushed medicine, aspiration precaution, and one-person/two-person/mechanical lift status, etc. can go up the board, but important information must be conveyed verbally as the others may not read it on time, and miss the opportunity to help. The residents/patients and their families can be oriented to the whiteboard on a one-on-one basis. B1. Implementation Resources
The overall timeline for the project is not very lengthy. It starts with planning- this phase has already begun with the proposal discussion with the facility sponsor (Supervisor). This phase may last 2-3 weeks and involves meeting with quality assurance and performance improvement personnel to introduce the project to the main stakeholders – nurse representatives, supervisors, the Director of Nursing, and decision-makers at the corporate level. Milestones – the installation of the whiteboards in resident/patient rooms – a meeting with supervisors, nurses, and nurse aides on how to use it (what information goes in writing on the board, color codes for specific interventions, and what information goes verbally among the care providers). Implementation – after the installation and a meeting dry erase pens will be distributed along with a format that will be kept common in the whole facility with color codes such as fingerstick in red, aspiration precaution in blue, etc. Evaluation- after two or three weeks this project will be evaluated along with suggestions if anyone has for it. It will be evaluated how communication is improving among healthcare providers and how it is improving resident/patient satisfaction scores. B5. Implementation Data The success of the project will be measured based on the satisfaction score provided by the care providers, residents/patient, and their family members in cases where residents/patients are unable to give a satisfaction rating. Improvement will be based on the suggestions and satisfaction scores. B6a. Financial Benefits Nurses will be able to spend at least ten to fifteen minutes less during the end-of-shift reports which saves about ten dollars per shift for one employee, and nurses at the end of the shift are eager to leave. So, the facility saves money, and nurses leave early that’s what they want. The resident/patient satisfaction score goes up, the rating goes up, more people trust the
facility, and more revenue. Nurses and nurse aides do not go around to get the information, more work is done in the same time – residents/patients are satisfied. Nurses and nurse aides do not feel frustrated, more staff stays in the facility, less turnover, and money is saved in fewer new employee orientations. B6b. Ethical Implications There is no ethical implication with the use of a whiteboard except the privacy and confidentiality to be written on the wall. But in weighing safety and privacy, sometimes privacy must be ignored such as getting choked with whole pills in comparison to taking crushed medicine. On the other hand, in not using a whiteboard, care providers do use unethical practices. When the resident/patient can sit in a chair and the care plan is to put the resident/patient in a chair, the nurse aides do not put them in a chair because that sometimes takes a little effort and tell a lie that for safety reason resident/patient stays in the bed and this is their plan for the day. Some residents/patients have concerns about the care providers not treating them right, some names they do not understand because these days the staff is from different nationalities and verbally, they cannot understand and remember their names, but when they are written down on the board, they can recognize it and can report about their concern. B7. Technology Integration Once the whiteboard is installed, it is simple to use – it may have a pre-printed layout – where nurses/nurse aides/others can fill out the information about the resident/patient or they can use a permanent marker for the permanent words such as date, nurse, nurse aide, etc. and fill up changing words with dry erase pens every day such as August 15, Amanda, or Peter, etc. B8. Measure Success
whiteboard to enhance communication, save time, improve resident/patient scores, increase satisfaction scores among staff, improve rating, and increase revenue overall. The installation of boards will make sure that residents'/patients’ needs are met, and people trust the facility to leave their loved ones in it to be cared for.
References CMS. (n.). Five-star quality rating system. CMS. cms/Medicare/Provider-Enrollment-and- Certification/CertificationandComplianc/FSQRS Goyal, A., Glanzman, H., Quinn, M., Tur, K., Singh, S., Winter, S., Snyder, A., & Chopra, V. (2020). Do bedside whiteboards enhance communication in hospitals? An exploratory multimethod study of patient and nurse perspectives. BMJ quality & safety, 29 (10), 1–2. doi/10.1136/bmjqs-2019- NursingHomeDatabase (2023) Sterling Care Bel Air: Data Analysis and ratings, Crucial, Up-to- date Data for Sterling Care Bel Air, Review & Ratings. Available at: nursinghomedatabase/home/MD/BEL%20AIR/21014/bel-air-health- and-rehabilitation-center (Accessed: 02 August 2023). Trojano, M. L., Rucker, G., & McGillen, B. (2022). Using Standardized Whiteboards to Improve Patient Engagement. Journal of patient experience, 9 , 23743735221103030. doi/10.1177/
Change Proposal D226 Capstone
Course: Capstone Task 2 (DYT2)
University: Western Governors University
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