Every health sector aims at improving quality services to patients. Quality services cater for safe, timely, effective and are recipient centered services. The home nursing care is a resident based service. Nurses are given the responsibility to take care of a particular patient at the comfort of their homes with their loved ones. This makes them become more familiar with the specific needs of a particular patient both, medically and emotionally. Most of the patients who benefit from these services are the elderly with chronic ailments like heart diseases, diabetes, blood pressure and stroke. The nurses are able to monitor sugar level of the blood, dress wounds, change urine and feeding tubes at the patient residential place.
This paper will look into some of the methods which can be used to improve that quality of such home-base care services. It will also give the use of information technology methods that are components of the management of quality improvement. Lastly, the paper will present the milestones and benchmarks that hinder the management of quality improvement.
The quality of nursing home is generally multi dimensional in nature as compared to institutional quality. The characteristics of the two are not the same in terms of the needs, the setting where the services are provided, the circumstances and the home. This therefore means that the methodologies to be considered in improving the quality of home nursing services will depend on several quality dimensions. The residents at nursing home vary from the type of care and the duration needed for medical care. Some of the patients require little amount of care. These are the independent ones who can do things on their own. While others may require daily assistance since they are physically disabled or mentally impaired.
Four methods can be used in improving the different needs and quality of service to the patients. First, there should be proper and adequate record keeping system for each patient that can be understood and used by every staff in the home nursing. This data should be collected and reviewed consistently. The data should aim at improving the quality of life in general and the quality of services offered by the home nursing which are markets -based incentives. The data collected should also include the kinds of inadequacies available which can help the nursing home to set goals that will see improvements for example improving the quality of services for the aged or the dinning services of the residents. Such goals assist the home nursing officials to address and prioritize on the required facilities which are resident focused that helps them meet their needs. Electronic means of storing such records have proven to be the source of accuracy and improved level of health care. The major disadvantage however, is that the patients records will lack privacy as compared to pen and paper recording. This is because all the records will be made accessible to any one at a central computer system. Another challenge with this is that it requires a high cost to start up such as system in the home nursing departments.
Secondly, There should be cooperation and participation of all caregivers of the home nursing since no single form of service is totally exclusive; for example through the nurses, the physicians are able to access information concerning a drug used on a patient so that if no desired results is achieved the dosage can be adjusted. The multidisciplinary teams will also be responsible for consistent review of information given by the residents and see all the improvement areas. A possible challenge that is expected in this method will be lack of adequate corporation. Since things will be done inform of team work, some may not corporate since they know if they don’t accomplish a duty some one will step in to save the team (Shorr, Fought & Ray 1994, pp 217).
Employee’s incentives are another aspect that has to be tackled by the nursing homes. Such incentives are not exclusive to financial benefits but mainly deal with staff support such as educative programs to enhance their skills. The management should be aware of employee’s problems and possibly come up with solutions to assist and address the challenges. The management should also record the performance rate of each staff member in which the best performing can be rewarded financially.
Finally, quality improvement mechanisms must be repetitious. The desired changes and improvement could be achieved but from time to time frequent analysis and changes must go on. This process will be a measuring tool to address any challenge that requires improvement. Therefore nursing homes should be part of this cycle that deals with problem identification and response. These frequent reviews might be a costly process for the home nursing health service provider (Institute of medicine 1996).
Computerized technologies have been used in the rating the quality and setting of nursing home services. The National Health Corporation established this patient assessment system that shows the profile data of each patient. Issues pertaining to eating, mobility, hygiene, dressing and position are recorded in this system. This system has worked in Hill haven Corporation nursing homes which are installed in over three hundred branches.
This system has helped with information required by Medicaid for the determination of payment to all its beneficiaries. It has been successful in Montana home nursing where various case-mix information is obtained.
The IT instrument has been beneficial for quality assurance for it makes it easy to classify patients with common need, health problem, and possible day of discharge and recovery chances. From the data, an analysis of motility risk can be found and represented on a longitudinal form.
Information technologies have also assisted in the improvement of pharmaceutical services in nursing homes. Te medication given to patents has been recorded and clearly shows how it is supposed to be dispensed, prescribed, administered and monitored. This is a type of an informatics system that has promoted safety in medicine handling among all home nursing
officials. Thus there is reduced and elimination of incidences of errors with medication such as prescribing wrong doses to patients. This system also allows providers to know patients’ recent results from the lab like allergy reaction (Dhall, Larrat & Lapane 2002 pp 88–96)
The information technology has been successful in home nursing in documenting all the clinical records and notes such as clinical visits, frequency attendants, authenticates corrects and addends. They have been used for assessing the performance of the nursing home as well as for effective communication and innervations within it. The records stored electronically have assisted home nursing officials to manage the census of all patients in various demographics. This software can solely be used to know when to transfer residents, discharge them and admit a patient. The management has also benefited from the software for it can easily schedule its staff and make payroll changes.
Potential benchmarks and milestones
The attainment of quality improvement in nursing homes is essential. However, fundamental challenges of most nursing homes root from the nature of services it provides. These changes have to consider opinions of residents and the voices from the family members which is not usually the case. They are the ones to determine and judge the qualities of services they are given, yet in the real world not all their grievances are fulfilled. The nursing home management mostly relies on the percentages of a certain problem where by the highly rated handled first. The low percentage problems are ignored. This therefore means that not all the needs of patients are satisfied. Having a remedy for this is almost next to impossible which will require totally new scope of knowledge and new approaches (Kane, et al. 2003, pp 58)
Also as each of the proposed methods of strategy has its own limitation, it becomes hard to actually say that such a method will be the only way forward. The improvements of home nursing quality will require several methodological approaches and considerations so as to minimize the disadvantages of one approach.
Measuring the performance of a strategy becomes a challenge. Many other mechanisms will have to be implement that will go hand in hand with the strategy. It therefore calls for health policy makers as well as the consumers to make nursing homes have a system of reporting all its activities either on state basis or national basis. Such a transformation will therefore be needed to happen across most nursing homes. Available information has shown that as the nursing homes adopt new models of care, most have not been fruitful since such changes require iterative examinations so as to achieve long term and sustainable high quality care (U.S. Government Accountability Office 2005, pp 117).
Institute of medicine (1996) improving the quality of care in nursing homes. Retrieved
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Kaiser Commission (2007) Medicaid and the uninsured. Medicaid and long-term care
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U.S. Government Accountability Office (2005) Nursing homes: despite increased
oversight, challenges remain in ensuring high-quality care and resident safety.
Washington (DC), Report no.6 pp117.
Shorr R, Fought L, & Ray W (1994) changes in antipsychotic drug use in nursing homes
during implementation of the OBRA-87 regulations. JAMA. Issue no 5, pp 271
Kane R, Kling C, Barshefsky B, Kane L, Giles K, Degenholtz B, et al (2003)Quality of
life measures for nursing home residents, third edition pp 58
Rahman N and Schnelle F (2008) the nursing home culture-change movement: recent
Past, present, and future directions for research. Pp 48
Dhall J, Larrat P, Lapane L. (2002) potentially inappropriate medication use in nursing
homes. First edition. Issue no 22, pp 88–96
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