15 Aug Resource Management in Primary Care
I need the peer response for the discussion.
Resource Management in Primary Care
In October of 2008, the Centers for Medicare and Medicaid Services (CMS) created a policy that foregoes reimbursement for several hospital-acquired conditions (HAC), not present on admission, to improve quality health care for patients (Joel, 2018). The list of HAC are entirely preventable and should never occur for any patient receiving care, which are deemed “never events” by CMS (Joel, 2018, p. 168). Advanced practice nurses (APNs) play a significant role in most “never events” since they are responsible for physical assessment, direct patient care, and education. If preexisting conditions are missed before admission, this can be very costly to any institution that cares for patients. Some of the most common HAC include falls and catheter-associated urinary tract infections (CAUTI). Most patients are admitted by the emergency department (ED), where initial assessment takes place. As an APN, it is essential to assess your patient’s fall risk and screen for urinary tract infections before placing a foley catheter, if indicated.
Falls are the most often reported incidents during hospitalizations, and when a fall results in injury, hospitals can no longer receive payment for services (Bargmann & Brundrett, 2020). “Falls during hospitalizations are a safety concern, resulting in added healthcare costs, increased length of stay, and increased disability rates”(Bargmann & Brundrett, 2020, p. 28). Falls are preventable. Most institutions have policies to protect their patients from falls, which entail a fall risk assessment, mobility score, patient education, and a patient fall safety agreement. Nursing conducts a fall risk assessment at my institution, implements a fall risk plan of care, and utilizes yellow socks and door placards if indicated for moderate to high fall risk. When a patient falls, a fall huddle is initiated. Also, in Labor and Delivery, after delivery, the mother is assisted to the bathroom for the first time using a Sara Steady to help prevent fall after birth. As an APN in the ED, it is critical to assess patient fall risk and mobility score so that the appropriate plan of care can be set into place and interventions are implemented.
If a foley catheter is indicated on admission, it is essential to collect a urine specimen at the time of insertion to assess whether a patient already has a UTI. “CAUTIs, urinary tract infections (UTIs) related to the placement of indwelling urinary catheters, are caused by bacteria typically originating from within the perineal or colonic flora by transfer from the hands of a caregiver”(McNeill, 2017, p. 204). Indwelling foley catheters are the most common cause of UTI in the hospital setting (McNeill, 2017). “Approximately 70% of CAUTIs are preventable by using evidence-based prevention measures, indicating that nearly 380,000 infections and potentially 9,000 deaths per year could be prevented” (McNeill, 2017, p. 204). APNs can educate nursing staff about CAUTI regarding unwarranted placement, sterile technique, management, and early removal when no longer indicated (McNeill, 2017).
APNs in the ED can help prevent hospitals from losing astronomical amounts of reimbursement through careful assessment and education of nursing staff. Since initial assessment is typically conducted in the ED before admission, APNs can help determine preexisting conditions and implement appropriate care plans regarding reducing patient falls and CAUTI if a foley catheter is indicated. This is especially important since commercial health care plans are pursuing to hold hospitals financially liable for preventable conditions (Joel, 2018).
References
Bargmann, A. L., & Brundrett, S. M. (2020). Implementation of a multicomponent fall prevention program: Contracting with patients for fall safety. Military Medicine, 185(Supplement_2), 2834. Retrieved August 12, 2021, from
Joel, L. A. (2018). Advanced practice nursing: Essentials for role development (4th ed.). F A Davis.
McNeill, L. (2017). Back to basics – how evidence-based nursing practice can prevent catheter-associated urinary tract infections. Urologic Nursing, 37(4), 204206. Retrieved August 12, 2021, from
