Tristan is the director of patient safety for a 350-bed county hospital located in a large city. The patient population is largely uninsured and underserved. He meets with the hospital CEO weekly to review the hospital’s patient safety dashboard. One of the indicators the patient safety dashboard tracks is the hospital’s re-admission rates. Hospital re-admission rates are important because they are associated with unfavorable patient outcomes and high financial costs. The Hospital Readmissions Reductions Program (HRRP), created as part of the Affordable Care Act, penalizes acute-care hospitals when Medicare patients return for a new admission within 30 days of a hospital discharge.
Tristan noticed the readmission rate for diabetic patients had increased in the last quarter with an average length of stay (LOS) of 10 days. Each readmission cost an average of 18,000.00 dollars which Medicare will not cover. Tristan pulled together a team to come up with a plan to reduce re-admissions. He included the directors of Pharmacy, Nutrition, Nursing, and Case Management to investigate the increased readmission rate. Each team member had a role in the care of the hospital’s diabetic patient population. He asked each director to review how their department contributed to diabetic care.
The pharmacy director reviewed all the medication orders providers placed for diabetic patients. There were no new diabetic drugs added in the last year and no adverse reactions were recorded, however the price of insulin did go up. The pharmacy director has heard stories of patients skipping doses to make their medication last.
The director of case management noticed that there had been patient complaints about electronic prescriiptions issued at discharge not getting routed to the patient’s home pharmacy. Resulting in the patient being without medication until they could get an appointment to see their provider. There were additional reports of a cost increase of diabetic testing supplies and syringes.
The director of the hospital’s clinical nutritional services reviewed the number of consults that she had received for diabetic nutritional counseling. It was way below the number of new diabetics that had been seen in the last quarter. The registered dietician’s (RD) who consult with diabetic patients had just started a new program with the nursing department to educate patients on how to count calories and give themselves insulin based on the calorie count. In a test of the program, the RD’s realized the patients were having a hard time reading food labels.
The director of nursing reported that the hospital had two certified diabetic nurse educators (CDE) who saw patients during the day. The CDE’s could not cover all the diabetic patients in the hospital. The nursing director and CDE’s were planning to educate the nursing staff to deliver standardized patient education from the American diabetes association (ADA).
Instructions:
After reading the assignment rubric answer the following questions using the scenario above to complete this competency. You may copy and paste this assignment into a word document, answer the questions, then either paste it into the text box or upload it as a word document.
Questions:
1. Identify and assess three risks hospital readmissions pose to the hospital and patients.
2. Describe how each risk you selected can be controlled.
3. Describe your risk review process for the risks you selected.
4. Create a Swiss cheese model for increased diabetic readmissions.
5. Tristan calls the director of quality improvement to discuss an improvement plan. They agree upon using the Plan-Do-Study-Act approach:
a. What is your plan for improvement? Start with a small change.
b. What process and outcome measures will you use?
c. Describe your PDSA.
6. The team Tristin assembled has decided to create a diabetic education bundle for patients. Education will begin upon admission and be reviewed at discharge:
a. What do you think should be included in the diabetic education bundle?
b. Use Kotter’s eight-step method to describe how you would lead this diabetic education bundle change.
c. Describe how the four principles of healthcare ethics impact this scenario.
Swiss cheese model video link

Question #6 Links
https://www.cdc.gov/diabetes/managing/index.html
https://diabetes.org/diabetes/type-2
https://www.diabeteseducator.org/living-with-diabetes/Tools-and-Resources
Ethics of Healthcare link
https://www.karger.com/Article/Pdf/509119