Development of an academic-practice partnership model to anchor care coordination and population health.

The National Academy of Medicine's The Future of Nursing 2020-2030 recommends the expansion of the role of nurses throughout the continuum of health care in an effort to improve the health of the nation while decreasing costs. To accomplish this goal, nursing students and nurses must be well prepared to perform at their highest capacity to meet health care demands. Currently the U.S. health care delivery system is undergoing rapid changes that affect approaches to delivering care services. These changes call for education and practice reforms in nursing. This article introduces an innovative academic-practice partnership model (the University of Maryland Nursing [UMNursing] Care Coordination Implementation Collaborative), including its background, development, and blueprint for a large implementation project. The implementation model integrates nursing education and practice in areas of care co-ordination and population health, which have a significant impact on the Triple Aim of health. The project also uniquely integrates education, practice, and research, with the ultimate outcome of higher quality patient care.

Outcomes of a Simplified Ultrasound-Guided Intravenous Training Course for Emergency Nurses.

INTRODUCTION: Various medical or anatomical conditions can lead to difficult intravenous access (DIVA) in the emergency department. It was hypothesized that developing an emergency nurse-training program could reduce IV attempts in the emergency department, improving throughput and patient care. METHODS: Emergency nurses completed a 4-hour ultrasound-guided intravenous (USGIV) access course and achieved competency after 10 successful supervised USGIV insertions on patients. Data were collected from a nurse-completed USGIV log and the electronic medical record. Experience levels, rates of completion, rates of success, and the effects on attempts of IV access were analyzed. RESULTS: Thirty-four emergency nurses enrolled in the study over 9 months, and 12 (35%) developed competency. Successful cannulation rates improved from 81% for procedure attempts 1 to 10, to 96% for attempts 21 to 30. Overall IV attempts by nurses and physicians (n = 24,471) decreased by 2%, P = 0.013. DIVA IV attempts (n = 1,366) decreased by 7%, P = 0.003. DISCUSSION: USGIV training programs can decrease total number of IV attempts. A simplified and economical USGIV training program for emergency nurses can be successful and may be dependent on emergency nurse experience levels and initiative.

Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

Postoperative Delirium Prevention in the Older Adult: An Evidence-Based Process Improvement Project.

Postoperative delirium is a major complication in hospitalized older adults. Implementation of a screening tool and evidence-based delirium-prevention protocol on a surgical unit increased nurses' knowledge regarding delirium, increased identification of delirium, and produced medical treatment alterations leading to positive patient outcomes.

Developing the value proposition for the role of the registered nurse in care coordination and transition nagement in ambulatory care settings.

The Patient Protection and Affordable Care Act (2010) established clear provisions for Patient-Centered Medical Homes and Accountable Care Organizations. In both, care coordination and transition management are methods to provide safe, high-quality care to at-risk populations such as patients with multiple chronic conditions. The emphasis on care coordination and transition management offers opportunities for nurses to work at their full potential as an integral part of the interprofessional team. Development of a model for the registered nurse in care coordination and transition management provides nurses the opportunity to develop the knowledge, skills, and attitudes to be a resource to the team and to patients, and to contribute to high-quality patient and organization outcomes.

Developing ambulatory care registered nurse competencies for care coordination and transition management.

The need for care coordination and management of transitions between Patient-Centered Medical Home providers, outpatient and community settings, including the Accountable Care Organization is often overlooked, episodic, and accountability for coordinating care and managing transitions between providers and services is lacking. Recognizing the potential of the RN to contribute to enhanced quality, cost effectiveness, and access to care in ambulatory settings, the Board of Directors of the American Academy of Ambulatory Care Nursing (AAACN) created a care coordination competencies action plan with three phases to delineate RN competencies and develop an education program for care coordination and transition management in ambulatory care. The first Expert Panel completed a comprehensive, interdisciplinary literature review and analysis focused on care coordination and transition management. The second Expert Panel--representing nu rsing, medicine, and pharmacy--defined the dimensions, identified core competencies, and described the activities linked with each competency for care coordination and transition management in ambulatory settings. The third Expert Panel reviewed, confirmed, and created a table of dimensions, activities, and competencies (including knowledge, skills, attitudes) for ambulatory care RN care coordination and transition management.

Health care reform: current updates and future initiatives for ambulatory care nursing.

While the signing of the Patient Protection and Affordable Care Act was a historical event marking the beginning of health care reform in the United States, it signaled the start of a golden age for ambulatory care nursing. Ambulatory care RNs are well-positioned to fully participate in health care reform initiatives. RNs are well-positioned to lead, facilitate, and/or participate in all patient care medical homes' and accountable care organizations' quality and safety initiatives through enhanced use of major ambulatory care RN role dimensions such as advocacy, telehealth, patient education, care coordination and transitional care, and community outreach. RNs are also well-positioned to provide patient-centered care, coordinate care, and manage transitions across ambulatory care settings. For the golden age of ambulatory care nursing to become a reality, initiatives surrounding competencies, education modules, and leadership must be addressed immediately.

Ambulatory care registered nurse performance measurement.

On March 1-2, 2010, a state-of-the-science invitational conference titled "Ambulatory Care Registered Nurse Performance Measurement" was held to focus on measuring quality at the RN provider level in ambulatory care. The conference was devoted to ambulatory care RN performance measurement and quality of health care. The specific emphasis was on formulating a research agenda and developing a strategy to study the testable components of the RN role related to care coordination and care transitions, improving patient outcomes, decreasing health care costs, and promoting sustainable system change. The objectives were achieved through presentations and discussion among expert inter-professional participants from nursing, public health, managed care, research, practice, and policy. Conference speakers identified priority areas for a unified practice, policy, and research agenda. Crucial elements of the strategic dialogue focused on issues and implications for nursing and inter-professional practice, quality, and pay-for-performance.

Priming the pipeline: creating aspirations for new graduate nurses to enter ambulatory care nursing roles.

The magnitude and projected length of the nursing shortage coupled with the increasing demand for ambulatory care nurses requires that novel strategies to attract and recruit new ambulatory care nurses be implemented. Planning and implementation strategies aimed at the current pool of student nurses are discussed in detail. Initiatives to elicit support of current ambulatory care nurses, deans, directors and faculty of schools of nursing are also presented along with options for evaluation of such initiatives.

Resourcing evidence-based practice in ambulatory care nursing.

Ambulatory care nurses may benefit from not only developing knowledge and skills in evidence-based practice (EBP), but also in identifying and providing sufficient resources for EBP to be implemented and sustained. Organizations should select one of the five conceptual models available in the literature to guide development and implementation of EBP. Costs of implementing and sustaining EBP include expert consultation, facilitators, staff time, informatician time, and data management. Benefits of EBP include improvements in patient care quality and safety, as well as regulatory compliance and risk management. Resources supporting EBP include professional literature available via the Internet and databases or agencies, such as ARHQ, professional organizations, and funding through grants.

Palliative Nursing Summit: Nurses Leading Change and Transforming Care: The Nurse's Role in Coordination of Care and Transition Management.

The Hospice and Palliative Nurses Association Palliative Nursing Summit (Summit) "Nurses Leading Change and Transforming Care" brought nurses from numerous specialties together to discuss collaboration in advancing primary palliative nursing. Nursing leadership was highlighted, and the future of integrating primary palliative care was emphasized. Three workshop groups held discussions on key collaborative topics of communication/advance care planning, pain and symptom management, and coordination of care/transition management (CCTM). Nursing has historically led the way in CCTM, especially in acute- and long-term-care settings. The philosophy and principles of CCTM are in direct alignment with the values and guidelines for quality palliative care. Goals of CCTM include the achievement of optimal health, equal access to care, and appropriate utilization of health care resources, balanced with the patient's right to self-determination. This article presents an overview of the patient and family outcomes and nursing actions identified by the group regarding CCTM.

Addressing spiritual leadership: an organizational model.

The Joint Commission requires health systems to address spiritual care. Research indicates that spirituality is associated with better physical, psychological, and social health and that culturally diverse populations and individuals at end-of-life often request spiritual care. The authors report the results of a consensus conference of 21 executives representing 10 large faith-based health systems who discussed the input, process, and outcomes of a corporate model for spiritual leadership. Specific initiatives are highlighted.