Please reply to each discussion separately #1 RR My small-scale change is to increase the knowledge of infection control discharge instructions for patients that are at risk of or those that have current infections to assist in decreasing admission and re-admission rates into the hospital. For my capstone project my short-term goal is to implement education with current nursing staff, EMT’s, techs, managers, and the CNO of the department with an in-service on healthcare acquired infections related to infection control at discharge. My desired outcome is to increase the knowledge of the staff to patients inside the hospital so at discharge the patient is more familiar with the infection control based on their current condition to better assist them to take care of themselves to decrease the number of readmission rates to the hospital. To date, I have been very lucky with all members of the interdisciplinary team. My CNO, department heads, and my team have been very willing to help in all aspects of my education for the staff to assist the hospital in not only decreasing costs for readmissions, but to willingly educate the patients inside their journey for selfcare. Looking at the long-term aspect of this process it will assist families and patients to better care for themselves during a time of struggle. Healthcare acquired infections and community acquired infections account for 72,000 deaths a year (2021). Also looking at it from a holistic standpoint families and patients alike will have a better quality of life without having to stay inside the hospital for prolonged times. I believe that the only barrier that will be is the future staff inside the hospital department. It will be difficult if the education is not put into a protocol or inside new hire packets. I believe that if the manager of the department sees that the education is beneficial that we will be able to implement this into new hire packets. Using evidence-based strategies, such as research, I will be able to show that education to staff is one of the first lines of defense against HAI’s in patient and infection control prevention. Centers for Disease Control and Prevention. (2021, October 27). Data Portal. Centers for Disease Control and Prevention. Retrieved May 27, 2022, from https://www.cdc.gov/hai/data/portal/index.html #2 KF For my capstone project, my goal is to reduce hospital readmissions for identified high utilizer patients by implementing a protocol for my team’s concurrent review nurses (utilization review) to follow for the identified patients. My short-term outcome is that my protocol is approved by supervisor and implemented (rolled out to team of 10 nurses via Zoom meeting) by week 4 & 5. My long-term outcome is that hospital readmissions, ER visits and financial penalties will reduce by 20% in 6 months. Reducing hospital readmissions is a companywide goal and have a multidisciplinary focus. Interdisciplinary team members, such as one of the complex discharge planning nurses, my supervisor and manager have influenced me to focus on this project with their full support. Because of the focus at a corporate level to reduce utilization of members and avoid readmissions, my developed protocol was quickly approved and able to be rolled out to my team of 10 nurses. The long-term outcomes of reducing hospital readmissions and ER visits for patients is a great benefit to patients and their healthcare. To meet this outcome, interventions are needed such as case management referrals/engagement, member monitoring, education, and finding resources that assist all members with various social determinant of health needs. Readmission reduction is particularly important for those populations that are high-risk with multiple comorbidities. Assigning a case manager to those patients in needs shows successful outcomes for those with social needs. According to Cardarelli et al (2018), utilizing a lay-health worker during hospital transitions of care to adjust education, education, and cost needs showed a 77% decrease in 30-day readmissions. One barrier I encountered is identifying a way to set an “alert” or note on a patient’s chart that can be seen when admitted to another hospital for auth review. Before rolling out a new protocol that involves recognizing a high-utilizer patient for case management needs and additional interventions, notification on the chart would be necessary to identify such members. By working with my preceptor, we were able to find a way to add a note on member’s landing page that would not require nurses to go to a different area of the chart. Reference: Cardarelli, R., Horsley, M., Ray, L., Maggard, N., Schilling, J., Weatherford, S., Feltner, F., & Gilliam, K. (2018). Reducing 30-Day readmission rates in a high-risk population using a lay-health worker model in Appalachia Kentucky. Health Education Research, 33(1), 73–80.