Answer 2 for NURS FPX 4030 Assessment 3 PICO(T) Questions and an Evidence-Based Approach

Thank you for submitting your 3rd assessment! I hope you enjoyed applying the PICO(T) framework to your research question and found that it expedited the search process while giving you a systemic method. You probably discovered that word choice regarding what terminology to include in the research process is vital. I hope that this lesson will greatly benefit you in the future when the need to locate relevant and pertinent findings is required. Nurses are the catalysts of and for change. You are learning the necessary tools to be successful with this responsibility. Kudos to you! You will do great things for our profession! Do you already see yourself making changes in practice? If so, are you learning how best to achieve this? As you move on to the next assessment, please look at the scoring guide criterion that asks you to identify a specific evidence-based model to explain how the steps/stages/phases can be used to incorporate evidence-based changes into practice. Here are two links that will take you to the nursing evidence-based models from which to select from:  https://www.kau.edu.sa/Files/0004020/Subjects/EBP%20Changes%20project.pdf  https://connect.springerpub.com/content/book/978-0-8261-2759-4/back-matter/bmatter1

Sample Answer 3 for NURS FPX 4030 Assessment 3 PICO(T) Questions and an Evidence-Based Approach

Chronic Obstructive Pulmonary Disease (COPD) is a common, avoidable, and manageable condition that is marked by ongoing respiratory symptoms and restricted airflow caused by anomalies in the airways or air sacs. According to Michas et al. (2020), around 30 million Americans are afflicted by this condition, making it the fourth most significant cause of mortality in the United States. The occurrence of severe worsening of COPD is a significant cause of hospitalization and subsequent return to the hospital, affecting both patients and the healthcare system. Implementing a discharge care bundle may effectively minimize the occurrence of Acute exacerbation of COPD and substantially decrease hospital readmissions. The objective of this paper is to formulate a PICOT Question that will serve as a guiding principle for researching the effects of discharge care bundle on patients with COPD.

PICOT Approach

The PICOT Question that will guide this study is: In individuals 65 years of age or older who are hospitalized in a hospital’s acute care unit due to a sudden worsening of their COPD (P), does a protocol and discharge care bundle (I) compared to no protocol and no discharge care bundle (C) lower the 30-day readmission rate for COPD in hospitals (O) within eight weeks (T)? The objective of this research is to decrease the number of hospital readmissions for COPD in persons aged 65 and above who are hospitalized in a hospital acute care unit due to an acute exacerbation of their condition (Kendra et al., 2022). The intervention entails the implementation of a protocol and discharge care bundle, which has the potential to decrease readmissions substantially. The main objective is to achieve a decrease in the incidence of readmissions within 30 days. Additional objectives include promoting the use of smoking cessation and pulmonary rehabilitation programs, as well as enhancing patient education and inhaler technique. The project will be executed within eight weeks.

Identification of Sources of Evidence

An extensive review of existing literature will be undertaken to examine the effects of implementing a protocol and discharge care bundle on the percentage of senior patients (65 years of age or older) admitted to an acute care unit at a hospital for an acute exacerbation of COPD within 30 days. The study will utilize databases such as CINAHL, PubMed, and Ovid Emcare to conduct a comprehensive search for articles pertaining to rehospitalization or readmission, care bundle, and COPD (Zafar et al., 2019). Our selection criteria will only include research articles that have undergone the peer-review process and have been published in the English language. This study’s inclusion criteria will include publications that used a care bundle intervention with the goal of lowering readmission rates. On the other hand, duplicate publications or papers that did not support the intervention and did not center on COPD will be disregarded.

Findings from Articles

According to Michas et al. (2020), the research revealed that care complexity plays a crucial role in the successful implementation of COPD discharge bundles. Initiating early interaction between healthcare personnel and patients, along with effective communication across acute and post-acute care settings, may significantly improve the effectiveness of the bundle. In addition, the research conducted by Kendra et al. (2022) discovered that implementing both pre-intervention and post-intervention treatment resulted in a substantial decrease in readmission rates within 30 days, 60 days, and 90 days, as well as total readmission rates. The results indicate that implementing a care bundle is a very efficient and economical approach for institutions to ensure the delivery of consistent and high-quality healthcare. According to the research conducted by Zafar et al. (2019), it was discovered that after six months of repeated plan-do-study-act cycles, compliance with a COPD treatment bundle reached 90%. As a result, there was a decrease in the incidence of patients returning to the emergency department within 30 days from 49% to 30%. However, there was no notable change in the rate of hospitalization from the emergency department observation unit. The subject features were consistent across the baseline and post-bundle periods.

Kendra et al. (2023) conducted research that revealed that a care bundle for chronic obstructive pulmonary disease (COPD), led by an interprofessional team, resulted in a substantial decrease in hospital readmissions for any reason within 30, 60, and 90 days. The research further discovered that chemists provided consultation services to 68.5% of participants and facilitated access to outpatient drugs in 45.7% of participants in the COPD care bundle group. Finally, according to the research conducted by Shaw et al. (2020), healthcare workers typically have a favorable view of care bundles as they help standardize working methods and patient care. The likelihood of successful use was higher when there was a clinical champion and activities based on the system. Nevertheless, difficulties in precisely identifying COPD hindered the use of bundles. The research indicates that bundles may improve the overall experience of staff members. However, their effect on patient outcomes is yet unclear.

Relevance of Findings from Articles

According to the studies, rehospitalization for COPD is identified as one of the top costly and avoidable readmissions. Additionally, the hospital is not meeting the CMS benchmarks for 30-day COPD readmissions. According to a wealth of studies, patients who are having an acute exacerbation of COPD may benefit from a discharge care bundle, which may successfully reduce 30-day readmissions (Zafar et al., 2019). The adoption of a discharge care bundle improves patient care efficiency and has a favorable effect on this metric, according to the current research. The hospital is advised to implement this bundle in order to enhance the efficiency of patient care.

Utilizing a select few evidence-based interventions can yield greater effectiveness and efficiency compared to employing a multitude of techniques. These interventions encompass various aspects of treatment, such as proper inhaler technique, educational resources, personalized action plans, pulmonary rehabilitation programs, support for smoking cessation, and scheduled follow-up visits. Proper inhaler technique is crucial for patients to prevent future readmissions due to exacerbation of COPD. Patients can gain a better understanding of their disease and recognize their baseline symptoms through self-management education and the implementation of an action plan (Kendra et al., 2023). Participation in a pulmonary rehabilitation program enables the opportunity to make necessary medication adjustments in order to avoid future readmissions. Quitting smoking is highly effective and efficient in preventing COPD exacerbations and readmissions. An early follow-up visit after discharge allows for reassessment of health status, management of medications, and continuation of care.

Conclusion

The project investigates the effects of a protocol and discharge care bundle on the rate of hospital readmission within 30 days for adult patients aged 65 or older with COPD. The study concludes that the complexity of care plays a crucial role in the successful implementation of COPD discharge bundles. Additionally, establishing early engagement between healthcare providers and patients can significantly improve the effectiveness of these bundles. Readmission rates significantly decreased as a result of the use of both pre-and post-intervention treatment. Hospital readmissions for all causes decreased as a consequence of the interprofessional team-led COPD treatment bundle. The likelihood of success increased when there was a clinical champion and system-based initiatives in place.

References

Kendra, M. E., Kakwani, A., Uppala, A., Mansukhani, R., Pigott, D. K., Soubra, M., Jacobson, J., Cerrone, F., Farrell, M., Chiu, S., Lieder, K., Tonzola, D., Shah, C. V., & Cherian, S. (2023). Impact of a COPD care bundle on hospital readmission rates. Journal of the American Pharmacists Association, 63(1), 269–274. https://doi.org/10.1016/j.japh.2022.10.002