D156 Updated HIP Paper Template for Nursing Weekly Assessment

D156 Updated HIP Paper Template for Nursing Weekly Assessment

Name

 Western Governors University

D156 Business Case Analysis for Healthcare Improvement

Prof. Name

Date

Healthcare Improvement Project: Introduction and Project Initiation

Organizational Problem

The focus of this healthcare improvement project is to develop a standardized weekly nursing assessment form tailored for acute psychiatric patients. This form aims to unify the collection of interdisciplinary information into a single comprehensive document, allowing nursing staff to provide regular updates on patient progress related to treatment goals and discharge readiness.

Currently, patient documentation is fragmented. Licensed nurses and mental health technicians document patient status separately: licensed nurses record direct one-on-one care and 15-minute observation statuses, while non-licensed staff complete notes for 60-minute observations. Although registered nurses conduct weekly head-to-toe physical assessments, the information passed to social workers—responsible for community placement referrals—is often based on non-licensed staff notes, which inadequately capture the clinical progress of patients. This fragmented approach complicates discharge planning and hampers communication between disciplines.

The new unified weekly assessment form will align with Centers for Medicare & Medicaid Services (CMS) requirements and improve interdisciplinary communication. It will summarize patient engagement, medication adherence, behaviors, and medical issues weekly, facilitating timely adjustments to treatment plans and better discharge coordination through more accurate clinical data capture.

Stakeholders

Who are the key stakeholders in this project, and what are their roles and influences?

Stakeholder Name	Role and Expertise	Influence and Power
Amanda Rivers, CNP	Clinical Nurse Practitioner	Influences clinical guidelines and treatment protocols
Maggie Donohue, RN, BSN	Registered Nurse	Provides frontline nursing insights and documentation expertise
Bobbie Steinle	Director of Social Services	Oversees discharge planning and acts as community liaison
Susan Lynch	Director of Nursing Education	Leads staff training and updates policies
Rachel Smith	NGMH Administrator	Holds authority over hospital policies and resource allocation

These individuals possess significant clinical expertise and organizational authority, ensuring the project’s alignment with hospital standards and operational objectives.

Project Team Roles and Responsibilities

What are the primary responsibilities of the project manager and other key team members?

The project manager plays a vital role with the following duties:

• Process Management: Identifying existing documentation issues, coordinating stakeholders, and guiding the implementation process to guarantee project success.
• Coaching: Promoting team development and fostering a culture of continuous improvement and patient-centered care.
• Communication: Ensuring transparent and continuous communication within the team, actively listening, and guiding collaborative efforts.
• Accountability: Monitoring task progress and holding team members responsible to prevent delays and maintain momentum.

Key skills brought by the project manager include active listening and analytical thinking. These abilities enable a precise understanding of departmental needs and ensure the documentation tool supports clinical and discharge decision-making effectively.

Susan Lynch, as Director of Nursing Education, significantly contributes by designing the nursing assessment template informed by clinical expertise, leading training initiatives, and revising policies to incorporate the new documentation system.

Needs Assessment

How was the root cause of poor nursing documentation identified, and what needs were highlighted?

The project team employed the “5 Whys” method to explore the causes of inadequate nursing documentation. They discovered that inconsistent patient behavior reporting was primarily due to non-licensed staff documenting daily progress, which often lacked clinical detail necessary for discharge planning. This inconsistency led to incomplete or inaccurate referral packets.

The assessment recommended developing a weekly comprehensive document that includes:

• Head-to-toe physical examinations
• Medication adherence and PRN (as-needed) medication usage
• Behavioral observations
• Support with activities of daily living (ADLs)

Such a document would meet both clinical and administrative requirements effectively.

SWOT Analysis

What strengths, weaknesses, opportunities, and threats were identified, and what strategies will mitigate challenges?

Category	Key Findings	Mitigation Strategies
Weaknesses	High number of agency staff; slow administrative processes	Partner with local colleges to recruit recent graduates; pilot project on one unit to expedite approval
Threats	Overwhelming departmental input; resistance to new documentation practices	Delegate input to workgroup representatives; Nurse Supervisors to provide education and audit compliance
Strengths	Experienced nurse supervisors; strong education department	Utilize supervisors for staff support and assessment audits; leverage education team for training development
Opportunities	Integration of CMS and Joint Commission guidelines	Embed regulatory standards into assessment tools and audits for continuous quality improvement

This analysis shaped the project’s implementation strategy by proactively addressing organizational challenges.

Impact Analysis

What are the anticipated benefits and risks of the project, and how do they compare?

Area	Benefits	Risks
Medication Monitoring	Enables timely adjustments; enhances provider oversight	Possible increase in medication error reports; staff morale may decline due to additional education or disciplinary measures
Nursing Documentation	Enhances interdisciplinary communication; ensures CMS compliance	Potential reduction in nurse-patient interaction time during documentation; risk of falsified records under workload stress

With a benefit-to-risk ratio of 1.57 (benefits score 11 vs. risks score 7), the project’s advantages in improving documentation and medication monitoring outweigh the potential drawbacks.

Justification and Project Purpose

Why is this project important, and what does it aim to achieve?

The project seeks to implement a consolidated weekly nursing assessment to enhance treatment monitoring and documentation quality for acute psychiatric patients. The form will:

• Monitor patient engagement, medication use, and medical concerns comprehensively
• Deliver accurate, interdisciplinary data to support clinical and discharge planning
• Ensure compliance with CMS and The Joint Commission standards, improving regulatory adherence and care quality

The availability of skilled nurse supervisors, an active nursing education department, and alignment with healthcare standards support the project’s feasibility and critical importance for improving patient outcomes.

Review of Relevant Scholarly Sources

What does the literature say about the need for improved nursing documentation in psychiatric care?

Several peer-reviewed studies emphasize the value of comprehensive nursing documentation:

• Wong and Muller (2023) highlight the significance of documenting PRN medication and patient behaviors to prevent excessive pharmacological intervention.
• Moldskred, Snibsøer, and Espehaug (2021) connect high-quality nursing documentation with better patient outcomes and discharge readiness.
• Ameel, Kontio, and Valimake (2019) discuss nursing interventions such as coping skills support, stressing the need for therapeutic engagement and proper documentation.
• Schoretsanitis et al. (2020) underline the necessity of monitoring lab results and antipsychotic drug levels to optimize treatment.
• Barr et al. (2019) demonstrate how strong nurse-patient rapport and consistent documentation contribute to treatment effectiveness and patient safety.

Together, these studies advocate for a standardized, comprehensive weekly nursing assessment to enhance care quality and discharge planning.

Project Environment

What external standards and guidelines influence the project’s design?

CMS guidelines require weekly documentation of patient progress in acute psychiatric settings (Centers for Medicare & Medicaid Services [CMS], 2024). This project integrates clinical evaluations, including physical assessments, medication adherence, behavioral observations, lab results, and discharge planning summaries to ensure documentation is holistic and compliant with regulatory expectations.

SMART Goal

What are the project’s specific, measurable, achievable, relevant, and time-bound objectives?

SMART Element	Description
Specific	Create and implement a weekly nursing assessment form covering physical, engagement, and medication data
Measurable	Reach a 95% completion rate for the assessment form by nursing staff for all patients by May 29, 2024
Achievable	Use support from nursing leadership, education, and supervisors to train staff and monitor compliance
Relevant	Enhance documentation quality to improve patient care, regulatory compliance, and discharge planning
Time-bound	Launch February 14, 2024, with full implementation by May 29, 2024

Project Management Lifecycle

How will the project be managed through its different phases?

The project will progress through these stages:

• Initiation: Define the problem and identify stakeholders.
• Planning: Develop timelines, assign roles, and gather necessary resources.
• Implementation: Train staff, introduce the assessment form, and begin its use.
• Evaluation and Closure: Assess outcomes against objectives and decide on adjustments or further actions.

This structured approach ensures continuous advancement toward sustainable improvements in nursing documentation and patient care.

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References

Ameel, M., Kontio, R., & Valimake, M. (2019). Interventions delivered by nurses in adult outpatient psychiatric care: An integrative review. Journal of Psychiatric and Mental Health Nursing, 26(9-10), 301–322. https://doi.org/10.1111/jpm.12543

American Nurses Association. (2010). ANA’s Principles for Nursing Documentation: Guidance for Registered Nurses. https://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/principles-of-nursing-documentation.pdf

Barr, L., Wynaden, D., & Heslop, K. (2019). Promoting positive and safe care in forensic mental health inpatient settings: Evaluating critical factors that assist nurses to reduce the use of restrictive practices. International Journal of Mental Health Nursing, 28(4), 793–1014. https://doi.org/10.1111/inm.12588

Centers for Medicare & Medicaid Services (CMS). (2024, July 21). State operations manual Appendix A: Survey protocol, regulations and interpretive guidelines for hospitals. https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/som107ap_a_hospitals.pdf

Hansmann, M. L. (2018, March 30). The top 8 skills every healthcare process improvement leader must have. HealthCatalyst. https://www.healthcatalyst.com/8-skills-needed-healthcare-process-improvement

Moldskred, P. S., Snibsøer, A. K., & Espehaug, B. (2021). Improving the quality of nursing documentation. BMC Nursing. https://doi.org/10.1186/s12912-021-00629-9

Schoretsanitis, G., Kane, J. M., Correll, C. U., Marder, S. R., Citrome, L., Newcomer, J. W., … Gründer, G. (2020). Blood levels to optimize antipsychotic treatment in clinical practice: A joint consensus statement. The Journal of Clinical Psychiatry, 81(3), e1–e12. https://legacy.psychiatrist.com/jcp/delivery/consensus-on-monitoringblood-antipsychotic-levels/

D156 Updated HIP Paper Template for Nursing Weekly Assessment

The Joint Commission. (2018). Behavioral Health Care Standards Sampler.

Wong, S., & Muller, A. (2023). Nurses’ use of pro re nata medication in adult acute mental healthcare settings: An integrative review. International Journal of Mental Health Nursing. https://doi.org/10.1111/inm.13148

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