This a 2-part assignment. Part 1 is comprised of the introduction and the table and they already been done. I will be attaching the finished introduction and table part along.

-WITH THIS, YOU WILL BE WRITING FROM THE PRACTISE OF STANDARD TO THE CONCLUSION.
PLEASE KINDLY SEND ME EMAIL WITH ANY QUESTION IF CONFUSED.
-FOLLOW THE APA-TEMPLATE SHEET, USE THE EXCEL SPREADSHEET AND THE INSTRUCTION ATTACHED.

QA/QI Quality Across Models Comparative Analysis

Student’s Name

Institutional Affiliations

QA/QI Quality Across Models Comparative Analysis

Quality Assurance and Quality Improvement (QA/QI) play an imperative role in promoting compliance against certain standards and safety as well as improvement of process-focused care on the system. According to the FNU model 2 reading, the basis of quality assurance is the systems-level data collection and analysis.  It is important to recognize the role of Advanced Practice in the implementation and improvement of QA/QI in healthcare. Advanced Practice Nurse (APN) maintains a high level of safe, effective, patient-centered, timely, and high-quality care in healthcare (Woo et al., 2017). APNs have played vital roles in collaboration with other healthcare workers in maintaining safety standards and improving the quality of care thus the importance of highlighting their roles.

The current analysis will focus on the survey results of practice-level quality assurance and quality improvement activity based on the National Quality Strategy (NQS) Levers and standards set by two accrediting bodies: The Commission for the Accreditation of Birth Centers (CABC) and The Joint Commission that was completed by FNU students in a prior year of PC713. The APRN-led model provides caseload care unless the client requires a physician consult. The combined practice model provides care in combination with physicians so that women may receive care from APRNs or physicians (Registered Nurses Association of Ontario, n.d.). The shared practice model is care provided by APRNs and physicians but there is an exclusive APRN caseload distinguished from the physician caseload.

Other findings from the survey include the practice setting, practice location frequencies, and percentages results. The practice setting is made up of outpatient practice (n = 7, 46.7%), community-based hospital (n = 3, 20%), and tertiary care hospital (n = 2, 13.3%). The practice location is made up of Metropolitan (n = 7, 46.7%), urban (n=5, 33.3%), and rural (n=3, 20%) locations as shown in Table 1 in the Appendix section. The survey was met with an overall compliance of 12 (80%) which also exceeded the 50% benchmark. Based on the survey, CABC accredited birth center using an APRN-led model and located in the urban has the highest overall compliance of 93%.

Practice Standards

The fact that nurses are unique in their own professional capacities calls for the need for relevant agencies to develop standards of practice to ensure uniformity and prevent inconsistencies that might occur in the nature of care that is delivered to patients. Oldland et al. (2020) define practice standards as the general guidelines that define what nurses should do as well as what they should not do in their professional practice with patients. They exist to ensure standardization and minimize variations in health care. The purpose of practice standards is to help nurses to maintain quality and to understand how payers and accrediting agencies make decisions regarding the care provided by nurses.  They play an essential role in quality improvement by directing healthcare organizations to strive to achieve the quality and safety measures set by relevant agencies (The Joint Commission, 2022). With practice standards in place, healthcare professionals are able to reduce the risk of adverse events thereby improving the quality of care.

Commission for the Accreditation of Birth Centers Standards

The CABC is the agency that offers accreditation to birth centers irrespective of the type of practice setting, practice location, practice model, and the types of patient populations served. The agency has developed standards with which all birth centers are expected to ensure compliance in order to maintain high-quality care to patients (Commission for the Accreditation of Birth Centers, 2022). From the Excel data, an organization that has achieved 100% compliance with CABC standards is an APRN-led CABC-Accredited birth center located in the urban. The facility met all the criteria set for Questions 6, 7, and 8. The respondents that attained poor performance on CABC standards is a community-based hospital that is using a combined practice model and located in the rural area, achieving compliance of 9%. The facility has never conducted a provider or interdisciplinary team meeting focused on a clinical issue in the past year (standard/question 6). The practice does not follow numerous criteria related to standard/question 7 except for conducting regular reviews of all transfers of care between healthcare providers, and it does not monitor and promote quality of care through an effective system of data collection and analysis (standard/question 8). When compared with other models of care, APRN-led models attained the highest CABC compliance (n=4, 100%) followed by combined practice models (n=4, 66.7%), and finally shared practice models (n=3, 60%) as shown in table 1.

Joint Commission Standards

The Joint Commission offers accreditation to different types of healthcare organizations and it is committed to ensuring that these facilities provide care that leads to zero harm. Facilities that have attained the required compliance levels with the standards set by the Joint Commission are eligible for accreditation (The Joint Commission, 2022). As presented in the Excel data, two organizations achieved the highest Joint Commission compliance of 88%. One of these facilities is a Tertiary Care Hospital that is located in the metropolitan (suburban) and which utilizes a combined practice model. The other facility is a CABC Accredited Birth Center that is located in the urban area and that utilizes an APRN-led model. The two respondents met all the criteria related to question/standard 9 by participating in various types of ‘tracers’ created by the Joint Commission. Although they performed relatively well in relation to standard/questions 10 and 11, the combined practice model does not proactively evaluate compliance with prevention/screening and the APRN-led facility does not conduct disease management audits. The respondents that attained the least compliance with the Joint Commission standards (44% compliance) are an outpatient practice located in the urban and a community-based hospital located in the rural both utilizing a combined practice model. When compared with other models of care, APRN-led models attained the highest Joint Commission compliance (n=4, 100%) followed by shared practice models (n=4, 80%), and finally combined practice models (n=3, 66.7%) as shown in table 1.

Priorities for Full Compliance

Nurse leaders identify and implement quality improvement activities in their organizations in order to improve the quality of care and optimize patient outcomes. They should strive to attain compliance with both the CABC and the Joint Commission standards. As an APRN leader for all of the surveyed sites, the item to prioritize from Question 6, 7, and 8 that requires 100% with the CABC standards across all sites is ‘participation in a data registry such as an electronic data collection system that would allow the facilities to monitor quality measures and participate in benchmarking (Question 8, criteria 2)’. This issue has been selected as a priority across sites because most of the facilities do not comply with this requirement yet literature supports the importance of compliance in this area (Dash et al., 2019).

The item to prioritize from Question 9, 10, and 11 that requires 100% compliance with the Joint Commission Standards across all the sites is ‘proactively evaluate compliance with prevention/screening in relation to annual visits, breast cancer, cervical cancer, and colon cancer (Question 10, criteria 4)’. The reason for choosing this issue as a priority across sites is that most of the facilities do not comply with this requirement yet literature supports the importance of compliance in this area (Loomans-Kropp & Umar, 2019).

Toolkit

The Quality Improvement toolkit to be implemented across sites is the Cancer Screening Quality Improvement Toolkit. This toolkit is specifically related to one of the leadership priorities for attaining 100% compliance with the Joint Commission Standard aligned with ‘proactively evaluation of compliance with prevention/screening in relation to annual visits, breast cancer, cervical cancer, and colon cancer (Question 10, criteria 4)’. The elements of the toolkit that make it relevant for achieving the said leadership priority concern emphasis on quality improvement planning, choosing the right model for quality improvement, improving participation in cancer screening, measuring progress over time, utilizing a team-based approach to improving cancer screening, and developing a culture of continuous quality improvement (Victoria State Government, 2019). The rationale for selecting this toolkit is that it will improve the quality of care delivered across settings related to cancer screening.

Conclusion

Advanced practice nurses play a key role in quality improvement and in helping practice settings to meet compliance with various standards set by accrediting organizations. Through a practice survey, nurses can understand which settings have met compliance with relevant standards including the CABC and the Joint Commission Standards. As leaders, advanced practice nurses should set their leadership priorities to target criteria in which a practice setting has performed the worst.

References

Commission for the Accreditation of Birth Centers. (2022). About the CABC. https://birthcenteraccreditation.org/about-commission-accreditation-birth-centers/?sfw=pass1643870500

Dash, S., Shakyawar, S.K., Sharma, M. & Kaushik, S. (2019). Big data in healthcare: management, analysis and future prospects. Journal of Big Data, 6, 54. https://doi.org/10.1186/s40537-019-0217-0

Loomans-Kropp, H. A., & Umar, A. (2019). Cancer prevention and screening: the next step in the era of precision medicine. NPJ Precision Oncology, 3, 3. https://doi.org/10.1038/s41698-018-0075-9

Oldland, E., Botti, M., Hutchinson, A., & Redley, B. (2020). A framework of nurses’ responsibilities for quality healthcare: Exploration of content validity. Collegian, 27(2), 150-163. ISSN 1322-7696. https://doi.org/10.1016/j.colegn.2019.07.007.

Registered Nurses Association of Ontario. (n.d.). Nurse practitioner utilization toolkit: Models of care. https://nptoolkit.rnao.ca/why-nps-make-sense/deploy-hospital/models

The Joint Commission. (2022). Standards. https://www.jointcommission.org/standards/

Victoria State Government. (2019). Cancer Screening Quality Improvement Toolkit. https://nwmphn.org.au/wp-content/uploads/2020/12/Cancer-Screening-QI-Toolkit.pdf

Woo, B., Lee, J., & Tam, W. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human resources for health, 15(1), 63. https://doi.org/10.1186/s12960-017-0237-9

 

Appendix

Table 1

Title (N = sample size)

Characteristic	Frequency (%)	Overall Compliance Frequency (%)	Compliance with CABC Standards Frequency (%)*	Compliance with JC Standards Frequency (%)*
Practice Model
APRN-led	4(26.6)	4(100)	4(100)	4(100)
Combined	6(40)	4(66.7)	4(66.7)	4(66.7)
Shared	5(33.3)	4(80)	3(60)	4(80)
Location
Urban	5(33.3)	4(80)	3(60)	4(80)
Metropolitan	7(46.7)	6(85.7)	6(85.7)	5(71.4)
Rural	3(20)	2(66.7)	2(66.7)	2(66.7)
Site/Setting
Outpatient practice	7(46.7)	5(71.4)	5(71.4)	4(57.1)
Community-based	3(20)	2(66.7)	2(66.7)	2(66.7)
Hospital
Tertiary care hospital	2(13.3)	2(100)	2(100)	2(100)
CABC accredited Birth Center	3(20)	3(100)	2(66.7)	3(100)
*Benchmark for overall compliance is meeting at least 50% of criteria