NURS FPX 6016 Assessment 3

NURS FPX 6016 Assessment 3

NURS FPX 6016 Assessment 3 Data Analysis and Quality Improvement Initiative Proposal

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With the innovations shared in the health care system, data mining is critical for gaps and setting quality improvement initiatives. This proposal is centered on investigating information concerning readmission cases of patients suffering from chronic conditions in hospitals and constructing a plan of action to improve the quality of hospital services. This shortcoming area will be identified through the data study and the reference to the national standards framework, and the strategies to achieve the desired outcomes and high customer satisfaction will also be formulated (Young & Smith, 2022). We are focused on the successful partnership of the care teams and the active implementation of evidence-based tools to ensure the readmission rates are under control, care coordination is maximized, and which approach is compliant, cost-saving, and patient-centered. The subsequent paragraph gives an analysis of the data, evaluates the results, and introduces a plan for a comprehensive Quality improvement plan.

Identification of Healthcare Issues

Conducting a data analysis about the number of patient readmissions in a certain hospital reveals a troubling tendency. The information shows that the re-admission rates of patients with chronic diseases such as congestive heart failure, chronic obstructive pulmonary disease (COPD), and diabetes disorders are significantly higher than the national benchmark and the accreditation criteria.

Data Analysis

The following table outlines the readmission rates for patients with chronic conditions at the hospital, along with the national benchmarks and accreditation requirements: The following table outlines the readmission rates for patients with chronic conditions at the hospital, along with the national benchmarks and accreditation requirements:

Chronic Condition Hospital Readmission Rate National Benchmark Accreditation Requirement
Heart Failure 25% 20% ≤ 20%
COPD 30% 25% ≤ 25%
Diabetes 20% 15% ≤ 15%

Evaluation of Data Quality

The data is viable and valid since it comes from the hospital’s EHR systems, which record readmissions, discharge, and readmission. Moreover, the data conforms to national standards and other accreditation necessities, a good indicator of data reliability. Nevertheless, it must be very accurately recorded, and it may serve as an indicator of whether readmissions or revisits within the facility or not. Patients with chronic conditions returning to the hospital hint at areas where the hospital could have done better and processes that were not adequately dealt with, such as care coordination, discharge planning, and post-discharge follow-up (Sara et al., 2023). To address this issurecordmproadmissiones, the hosp admissions consider implementing the following measures: To address this issue and improve patient outcomes, the hospital should consider implementing the following measures:

NURS FPX 6016 Assessment 3 Data Analysis and Quality Improvement Initiative Proposal

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Strive to strengthen care coordination among healed patients for proper treatment, transition from management after discharge, and establish thorough discharge plans based on the needs of patients suffering from chronic conditions. Including medication reconciliation, patient education, and, where necessary, referral to service providers for the required ongoing care (Lester et al., 2019). Reinforce post-discharge follow-up mechanisms, e.g., telehealth facilities, home visits, and remote medical monitoring, to closely oversee patients’ progress, spot problems, and deal with them appropriately. Admission rates should be monitored regularly in tabs, and performance reviews should be held periodically to assess the service aspect of this performance and make continuous improvements. Applying these proposals will help the hospital eliminate the problem under study as it should answer virtually all questions posed by state, national, and accreditation bodies within the hospital (Vali et al., 2020). Moreover, it will positively influence the quality of presented care by improving patient outcome indicators and overall satisfaction with the healthcare services.

Quality Improvement Initiative

Patients’ signific, spot problems, and patients with chronic disease readmission rates should be monitored regularly. This expresses the need to launch quality regulations for the HPCC and successive post-discharge management. The proposal aims to remedy the noted healthcare problem and affect people’s well-being within the hospital. The principal goal of the quality improvement project is to lower the readmission rate among patients with chronic conditions. Every institutional data, including readmissions of patients with long-term illnesses like heart failure, COPD, and diabetes, could help existing performance goals and help the institution obtain the desired ratings and accreditations (Alvarez-Romero et al., 2022). Besides that, the project’s main objective is to improve health facility admission, discharge planning, and post-discharge check-up procedures, thus ensuring the required case transitions and treatment input consistency.

Bring a multidisciplinary approach to care coordination and involve physicians, nurses, case managers, pharmacists, and other healthcare staff. This also enhances the crew members’ interaction and teamwork and better addresses their patients’ complex problems. Structure discharge plans based on patient needs professionally, use standard guidelines to guide those with chronic conditions, and prevent repeat hospitalizations. These protocols will involve medication reconciliation, patient education, individualized care planning, and arranging the needed services to ensure the patients are well (Stolldorf et al., 2021). Implement social work through post-discharge follow-up initiatives, telehealth, remote monitoring, and home visits that provide the managers with pharmacists who are present and ready with the necessary solutions. The objective of these initiatives will be to ensure that complications, medication non-adherence, and patient self-management are considered. The quality improvement undertaking will benefit from constant assessment and supervision to help evaluate its effectiveness and identify points for targeted improvement. The leading performance indicators (KPIs) that will be periodically monitored include readmission rates, patient satisfaction scores, and medication compliance. This will allow the program’s effectiveness to be assessed.

Knowledge Gaps and Areas of Uncertainty:

While identifying the interventions, a few things still need clarification, and areas of concern remain unclear. Additional studies are required to distinguish socioeconomic factors that play a role in the high readmission rates provided to patients with chronic diseases and their access to services after leaving the hospital. Undertaking further research is a crucial step toward determining the capability of telehealth and remote monitoring to lower readmission rates and improve patient outcomes. Among the primary research directions, system performance and patient characteristics such as preferences and resources need to be investigated, and the appropriate regimes of care coordination should be identified for different chronic illnesses (Foo et al., 2023). The policy process should involve resetting those knowledge gaps, amplifying the high readmission initiative, and improving patient care and outcomes.

NURS FPX 6016 Assessment 3

Inter-professional Perspectives

Collaboration of health care professionals in the monitoring and treatment process is crucial to guarantee the continuity of care and patient safety. Interprofessional teams can identify and lessen the risk of unsafe procedures, for example, incorrect medication administration, hospital-acquired infections, and falls, by devoting their considerable resources and views (Wondmieneh et al., 2020). Pharmacists can supervise the initiative’s effectiveness and improve patient care and outcomes reading of infectious disease outcomes. Physicians’ primary duty is to take responsibility for overseeing and handling patients directly and coordinating interventions to rule out safety hazards.

Sharing the pains of humanity’s interprofessional collaboration in healthcare also facilitates economic care by optimizing the use of resources and minimizing unjustified healthcare expenses. Jointly with care planning and shared decision-making, healthcare teams can ensure that specially customized interventions can ease the needs of patients with chronic conditions (Menear et al., 2022). For example, by actively dealing with chronic diseases and the vagaries of complications, the interdisciplinary teams lower hospital readmissions since they curb the overutilization of costly emergency departments. Furthermore, pharmacists can be involved in this operation by ensuring exceptionally functional prescription plans at more affordable prices.

NURS FPX 6016 Assessment 3 Data Analysis and Quality Improvement Initiative Proposal

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Interprofessional collaboration is the most effective means of positively impacting the work-life quality of healthcare because teamwork gives workplace security and encourages collaborative work. In the long run, this will minimize the workloads by sharing tasks and employing the advantage of one another. Moreover, effective communication and teamwork among the group members create a feeling of life satisfaction and yield professional success. For instance, the nurses’ sense of power can be reinforced by giving them a chance to input on the care plans and their acknowledgment of the significant contributions of the team.

Needed Actions

  1. Establish Interprofessional Teams: Write and participate in interprofessional teams that include physicians, nurses, pharmacists, social workers, etc., who work together to care for patients.
  2. Implement Collaborative Care Planning: Standard discussion systems should be designed to foster coordinated team planning. These should include regular team meetings, care conferences with shared discussions, and joint decision-making.
  3. Promote Communication and Information Sharing: From electronic health records (EHRs) and communication platforms to information sharing and communication tools, real-time technology solutions will help team members work together.
  4. Provide Interprofessional Education and Training: Develop interprofessional education and training programs for the workers to improve teamwork, collaboration, more suitable communication strategies, and their perceptions of each other’s positions and responsibilities.


Healthcare organizations would recognize the benefit they derive from staff collaboration in improving patient results, cost reduction, job satisfaction, and a general enhancement of the health professionals’ well-being. Moreover, other conditions are being spelled out, which are there to facilitate the effective implementation of interprofessional initiatives if they involve organizational support, resources and infrastructure, technology, and staff training programs (efforts).

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Collaboration Strategies

Keeping communication channels transparent with known regular meetings, huddles, and electronic communication platforms helps interprofessional team members discuss their ideas publicly. This ensures that everyone is notified, even on the most trivial matter, and is always on the line and on the same page regarding patient care planning, goals, and interventions. By clearly articulating the duties and responsibilities of everyone on the interdisciplinary team, chances of doing things twice over or any member contributing less to the treatment are avoided (Brown et al., 2023). These disclosures foster responsibility and help workers comprehend how their contribution perfectly fits into an overall plan. Sustainable land use approaches prioritizing conservation and restoration are crucial for preserving ecosystems and biodiversity.

It is fundamental for a healthy team culture to implement mutual respect and honesty among team members to achieve high-quality collaboration. The ability to identify, appreciate, and use everyone’s knowledge, unique perspectives, and contributions makes for an improved teamwork environment. Eventually, it leads to a supportive work environment where the workers feel empowered to speak their minds and raise ideas and concerns. On the whole, bringing together the whole interdisciplinary group in the shared choice and arranging care services proceeds with the exact improvement of the result for patients and providing them with their recommendations and requirements (Bendowska & Baum, 2023). This cooperative approach allows healthcare providers and patients to collaborate and deliver better patient outcomes.


Such strategies are built upon the assumption that healthcare organizations consider interprofessional collaboration significant and are ready to dedicate resources to facilitate its functioning. It is among the considerable assumptions that there is the political will or driving leadership and cooperation from all the organizational levels to perfect the strategies. In addition to this, it is believed that team members are ready to work and share their knowledge with the capability to create a good communication network and personal interaction necessary for cooperation. Consequently, these require clinical settings to have the appropriate time, essential resources, and enough support to promote collaboration among professionals and make implementing improvement initiatives as easy as possible.


The conclusion is that the statistics showed a sad side to readmission rates of patients with chronic illnesses, and they made a case for proper coordination of care post-discharge. Such quality improvement work can tackle the problem areas and lead to safe patients, cost-effectiveness, and an improved working environment for health staff. We can achieve the expected results through effective interprofessional collaborations, undisputable communications, and evidence-based interventions and fit this medical center with the national standards and accreditation requirements. Accurate time monitoring and evaluation will be the key to following the progress since interventions can be customized to account for the issues that emerge through the process, and the ultimate aim will be to get patients better outcomes and healthcare quality.


Alvarez-Romero, C., Martinez-Garcia, A., Vega, J. T., Díaz-Jimènez, P., Jimènez-Juan, C., Nieto-Martín, M. D., Villarán, E. R., Kovacevic, T., Bokan, D., Hromis, S., Malbasa, J. D., Beslać, S., Zaric, B., Gencturk, M., Sinaci, A. A., Baturone, M. O., & Calderón, C. L. P. (2022). Predicting 30-day readmission risk for chronic obstructive pulmonary disease patients through a federated machine learning architecture on findable, accessible, interoperable, and reusable (FAIR) data: Development and validation study. JMIR Medical Informatics, 10(6).

Bendowska, A., & Baum, E. (2023). The significance of cooperation in interdisciplinary health care teams as perceived by Polish medical students. International Journal of Environmental Research and Public Health, 20(2), 954.

Brown, S.-A., Sparapani, R., Osinski, K., Zhang, J., Blessing, J., Cheng, F., Hamid, A., Mehri Bagheri MohamadiPour, Jessica Castrillon Lal, Kothari, A. N., Caraballo, P., Noseworthy, P., Johnson, R. H., Hansen, K., Sun, L. Y., Crotty, B., Yee Chung Cheng, Gift E., Doshi, K., & Olson, J. (2023). Team principles for successful interdisciplinary research teams. American Heart Journal Plus: Cardiology Research and Practice, 32(4), 100306–100306.

Foo, C. D., Yan, J. Y., Chan, A. S. L., & Yap, J. C. H. (2023). Identifying key themes of care coordination for patients with chronic conditions in Singapore: A scoping review. Healthcare, 11(11), 1546.

Lester, P., Sahansra, S., Shen, M., Becker, M., & Islam, S. (2019). Medication reconciliation: An educational module. MedEdPORTAL, 15(4).

Menear, M., Girard, A., Dugas, M., Gervais, M., Gilbert, M., & Gagnon, M.-P. (2022). Personalized care planning and shared decision making in collaborative care programs for depression and anxiety disorders: A systematic review. PLOS ONE, 17(6).

Sara Maria Barbosa, Costa, F., Tatiele Estefâni Schönholzer, Diene Monique Carlos, Estela, M., Silvia Helena Valente, Luciana Aparecida Fabriz, & Ione Carvalho Pinto. (2023). Hospital discharge planning in care transition of patients with chronic noncommunicable diseases. Revista Brasileira de Enfermagem, 76(6).

Stolldorf, D. P., Ridner, S. H., Vogus, T. J., Roumie, C. L., Schnipper, J. L., Dietrich, M. S., Schlundt, D. G., & Kripalani, S. (2021). Implementation strategies in the context of medication reconciliation: A qualitative study. Implementation Science Communications, 2(1).

Vali, L., Mehrolhasani, M. H., Mirzaei, S., & Oroomiei, N. (2020). Challenges of implementing the accreditation model in military and university hospitals in Iran: A qualitative study. BMC Health Services Research, 20(1).

Wondmieneh, A., Alemu, W., Tadele, N., & Demis, A. (2020). Medication administration errors and contributing factors among nurses: A cross-sectional study in tertiary hospitals, Addis Ababa, Ethiopia. BMC Nursing, 19(4), 1–9.

Young, M., & Smith, M. A. (2022, December 13). Standards and evaluation of healthcare quality, safety, and person centered care. PubMed; StatPearls Publishing.

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