A Client-Centered Care Initiative

ANSWER

Care Coordination During Care Transitions: A Client-Centered Care Initiative
Utilizing Course Knowledge, Taking Initiative, and Putting It into Practice
Care coordination during care transitions has been chosen as the client-centered care initiative. When clients migrate between healthcare settings, including from a hospital to their home or to a long-term care facility, this program aims to provide smooth communication and continuity of care. Reducing readmission rates, increasing patient safety, and raising client happiness all depend on efficient care coordination. I will use care coordination in my future work as an advanced practice nurse (APN) to make sure that patients have access to follow-up care, comprehend their medication schedules, and receive clear discharge instructions.

The Plan-Do-Study-Act (PDSA) framework for CQI
An efficient CQI framework for enhancing care coordination is the PDSA cycle.

Plan: Determine particular transition-related problems, like unclear discharge instructions or postponed follow-up appointments. Create a standardized discharge checklist as an example of an intervention.
Take action: Use the checklist sparingly, for example, in a single hospital unit.
Examine the findings, taking into account client outcomes, readmission rates, and staff and client comments.
Act: Adjust the checklist in light of the results and apply it throughout the company.
Enhancing Client-Centered Treatment
The PDSA framework encourages routine process evaluation and improvement, which guarantees ongoing progress. Using a standardized checklist, for instance, guarantees that clients are aware of their care plans, which clears up any uncertainty and increases compliance with post-discharge instructions. By attending to each person’s needs and preferences throughout transitions, this method is in line with the concepts of client-centered care.

Including Members of Interprofessional Teams
Interprofessional team members, such as nurses, doctors, social workers, pharmacists, and case managers, must work together to coordinate care.

Communication: Provide unambiguous avenues for exchanging updates and care plans.
Assigning Roles: Assign distinct responsibilities, such as social workers organizing resources for follow-up or pharmacists checking prescriptions for possible interactions.
Mechanisms of Feedback: Call frequent team meetings to discuss ideas for enhancements and assess how well care transfer procedures are working.
Combining the Evidence
It has been demonstrated that efficient care coordination lowers readmissions to hospitals and raises patient satisfaction. Mitchell et al. (2018) state that “standardized communication tools significantly enhance the clarity and accuracy of information transferred during care transitions,” which is consistent with the PDSA cycle’s use of a checklist. Furthermore, by utilizing a variety of expertise, systematic evaluations have shown that integrating interprofessional teams enhances care outcomes (Morris et al., 2020).

Citations
Schuster, E., Sanderson, K., and Mitchell, G. (2018). The influence of standardized communication tools on enhancing care transitions. 175–182 in Journal of Patient Safety, 14(3). 1097/PTS.0000000000000351 https://doi.org
Simon, J. L., Rizzo, R., and Morris, D. K. (2020). A comprehensive review of interprofessional collaboration in healthcare transitions. 421-434 in Healthcare, 8(4). 10.3390/healthcare8040421 https://doi.org
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QUESTION

Advanced practice nurses apply continuous quality improvement (CQI) processes to improve client-centered outcomes. Select one of the following client-centered care initiatives that you would like to improve in your practice area: client clinical outcomes, client satisfaction, care coordination during care transitions, or specialty consultations for clients.

Include the following sections:

1. Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
   • Identify the selected client-centered care initiative and describe its application to your future practice.
   • Select one CQI framework that can be applied to the selected initiative. Explain each step of the framework.
   • Describe how the framework can improve client-centered care for the selected initiative.
   • Describe how you would involve interprofessional team members in the CQI process.
2. Integration of Evidence: Integrate relevant scholarly sources as defined by program expectationsLinks to an external site.:
   • Cite a scholarly source in the initial post.
   • Cite a scholarly source in one faculty response post.
   • Cite a scholarly source in one peer post.
   • Accurately analyze, synthesize, and/or apply principles from evidence with no more than one short quote (15 words or less) for the week.
   • Include a minimum of two different scholarly sources per week. Cite all references and provide references for all citations.
3. Professionalism in Communication: Communicate with minimal errors in English grammar, spelling, syntax, and punctuation.
4. Reference Citation: Use current APA format to format citations and references and is free of errors.