Acute Exacerbations in Chronic Respiratory Illness

Introduction

The problem under consideration is the prevention of hospital readmission rates for acute exacerbations in children with chronic respiratory illnesses. The potential solution to this issue is providing additional education for patients and their parents with the aim of their better awareness of potential complications (Banks, 2013). The nursing focused plan consists of a change model overview, evidence of the problem, a plan for implementation, and a conclusion. The plan of evaluating the outcomes and reporting the results are also included.

Change Model Overview

The ACE Star model is designed for a better understanding of the character and peculiarities of the knowledge used in a variety of situations of evidence-based practice (EBP) (“The ACE Star model,” n.d.). The benefit of this model is that it arranges both traditional and new ideas of care enhancement into one common system and creates a framework that promotes the systematization of EBP approaches and operations. The ACE Star model comprises five elements: “discovery research,” “evidence summary,” “translation to guidelines,” “practice integration,” and “process, outcome evaluation” (“The ACE Star model,” n.d.). Nurses should use this model as a guide to facilitate change since it contains every aspect of the successful management of clinical problems.

Define the Scope of the EBP

The practice issue is the prevention of hospital readmission rates for acute exacerbations in children with chronic respiratory illness. According to the statistics, as many as 18% of children suffering from chronic respiratory illnesses are admitted to hospitals (Hall, Chang, & O’Grady, 2016). Because of inappropriate knowledge about the management of complications, patients are frequently readmitted soon after leaving a hospital. The problem impacts the families of children ill with chronic respiratory illnesses because they are not able to return to a normal lifestyle due to frequent readmissions. Their parents also need to spend extra time and money on treatment. On a broader scale, the problem impacts the whole healthcare system because of extra resources wasted and the burden posed on healthcare workers.

Stakeholders

Apart from the leader of the team, the project will engage several stakeholders:

  • a psychologist;
  • a pharmacist;
  • a physical therapist;
  • a charge nurse;
  • three nurses.

Determine Responsibility of Team Members

Although the functions of the stakeholders are different, each of them will play a key role in reaching the success of a project. The psychologist will arrange consultations with the patients and their parents to explain the social and psychological peculiarities of children’s health conditions. Also, this specialist will encourage the participants to obtain knowledge and apply it in practice in order to reduce the readmission rate and arrange the most comfortable conditions for the children who have chronic respiratory illnesses.

The pharmacist and physical therapist will choose the most appropriate treatment and physical exercises for the children. The charge nurse will be responsible for the coordination between all the stakeholders. Nurses will check whether the recommendations of specialists are being followed and will provide additional help if needed.

Evidence

There is much evidence of the prospects of the plan’s success in the research literature. Hall et al. (2013) outline the clinical practice guidelines in their intervention protocol on hospital readmission prevention plan. Perotin et al. (2013) and Wark, Tooze, Powell, and Parsons (2013) suggest quality improvement data based on the research of the infections’ impact on the health conditions of patients with chronic obstructive pulmonary disease. Wark et al. (2013) also emphasize that infections may increase the risk of readmission. The strength of the current research is that it will use the evidence from other sources as well as an education plan to decrease the rate of readmissions and arrange the most comfortable conditions for patients and their families.

Summarize the Evidence

In their article, Hall et al. (2016) suggest the adoption of personified caseworker-assigned discharge plans for patients having chronic conditions. Additionally, the authors outline the activities that might be performed by caseworkers to enhance patient condition and outcomes. Hall et al. (2016) provide a discharge plan with suggestions from relevant healthcare institutions. The outcomes that the authors plan to measure in their final paper are the frequency and rate of readmissions, the percentage of unscheduled doctor visits, the cost-effectiveness of the measures suggested, and the post-discharge mortality rate. The evidence-based interventions suggested by Hall et al. (2016) include the following:

  • the enhancement of communication between patients and service providers,
  • the realization of the existing types of hospital services with the aim of improving the level of care;
  • the coordination of care provided at the hospital and at home;
  • the improvement of health education.

Develop Recommendations for Change Based on Evidence

Based on the evidence, the recommendation is to arrange the educational program for children and their parents with the help of which they will know how to manage the children’s health condition better. The program will eliminate the readmission rate and improve the patients’ health outcomes.

Translation

Action Plan

The plan for implementation will consist of the following steps:

  1. Preparing educational materials for the participants. This will be the responsibility of the project’s leader and all the stakeholders. Every member of the team will be given a task to prepare some part of the educational material pack.
  2. Choosing the participants and inviting them to join the program. This will be done with the help of the hospital’s database.
  3. The introduction of the pilot study.
  4. Collecting evidence on the results and evaluating outcomes. The process of evaluation will involve the comparison of readmission rates during the intervention and within a chosen time period from the past.

The method of reporting the results will be a report prepared by the project leader.

Regarding the timeline, the project will last several months and will consist of the following milestones:

  1. gathering the materials and preparing the educational program: 1 month;
  2. performing the intervention: 4 months;
  3. analyzing the outcomes and confirming or rejecting the effectiveness of the project: 2 weeks;
  4. preparing a final report and disseminating findings: 3 weeks.

Process, Outcomes Evaluation and Reporting

The desired outcomes are the reduction of hospital readmission rates and the improvement of patients’ health and lifestyle. To measure the outcomes, a comparison of readmission rates will be performed. The stakeholders will be informed about the results through a report prepared by the project leader.

Identify Next Steps

To implement the project on a larger scale, it will be necessary to prepare educational programs for other manageable health conditions and arrange interventions to check the programs’ success. It will be better to apply the project to separate units rather than the hospital as a whole since there are departments the patients in which cannot be helped by home care. To ensure that the implementation becomes permanent, it will be necessary to make educational programs a rule rather than an experiment.

Disseminate Findings

Within the organization, findings will be distributed through a report. Externally, a report also may be shared, but it will be accompanied by a rationale, suggestions, and an invitation to inquire about any additional information.

Conclusion

The project is focused on lowering the rate of acute exacerbation readmissions among the children with chronic respiratory illness. The intervention will help hospitals and families to combine their efforts and eliminate the need for additional stay at hospitals. The most crucial aspects of the ACE Star change model included in the project are “discovery research,” “evidence summary,” and “translation to guidelines” (“The ACE Star model,” n.d.). The ways of maintaining the change plan include careful following of the agenda and control over the stakeholders’ dedication to the project as well as patients’ responsiveness.

References

The ACE Star model. (n.d.). Web.

Hall, K. K., Chang, A. B., & O’Grady, K. F. (2016). Discharge plans to prevent hospital readmission for acute exasperations in children with chronic respiratory illness (Protocol). Cochrane Database of Systematic Reviews, 8, 1-9.

Perotin, J.-M., Dury, S., Renois, F., Deslee, G., Wolak, A., Duval, V., … Andreoletti, L. (2013). Detection of multiple viral and bacterial infections in acute exacerbation of chronic obstructive pulmonary disease: A pilot prospective study. Journal of Medical Virology, 85(5), 866-873.

Wark, P. A. B., Tooze, M., Powell, H., & Parsons, K. (2013). Viral and bacterial infection in acute asthma and chronic obstructive pulmonary disease increases the risk of readmission. Respirology, 18(6), 996-1002.

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