C815
Quality and Performance Management and Methods
TASK 1 – Passed
Evaluating Quality Improvement Programs in an HIM Department
Western Governors University
, A1.
One quality improvement (QI) initiative Fielder Medical has implemented is reducing
catheter-associated urinary tract infections (CAUTI). Fielder has educated its doctors and nurses
on best practices associated with catheter use. The goal is to remove the catheter as quickly as
possible, find alternative methods for urine evacuation, and improve sterile techniques when
inserting catheters.
This is a crucial QI initiative as it helps to prevent kidney and bladder infections that
could ultimately lead to sepsis in patients. It also reduces the use of antibiotics and the risk of
producing antibiotic resistance in the bacteria associated with CAUTIs.
Another QI initiative that Fielder has implemented is rescuing patients with severe sepsis/septic
shock. Fielder joined with state agencies to identify best practice “bundles” to reduce the
mortality rate of patients who have developed sepsis while already an inpatient or are septic upon
admission.
Fielder has implemented this important QI initiative to help save their patients' lives.
They can also share their best practices with other facilities to help reduce the mortality rate at
those facilities.
One last QI initiative Fielder has implemented in their facility is reducing the readmission
rate. Fielder Medical staff do this by identifying patients who are at risk for readmission, such as
those who have been readmitted in the past or have certain health conditions. Staff can reduce
readmissions by providing better healthcare and education to patients and their families.
This QI initiative is essential as it helps reduce the emotional and financial burden on the
hospital's most vulnerable population. It also helps reduce the financial burden on the facility and
insurance companies.
A2.
The CAUTI initiative does follow Fielder Medical’s current process. The program builds
upon the success of other infection prevention initiatives that Fielder has implemented, such as
the CLABSI initiative and ventilator-associated pneumonia.
Fielder Medical’s best practice “bundles,” as well as monitoring patients and collecting data on
their patients with sepsis, has shown a significant reduction in the mortality rate of those patients.
This suggests that the doctors and nurses who follow the sepsis protocols put in place by Fielder
Medical are effectively saving lives.
Fielder Medical’s readmission initiative, which provides patients with better care and
education, helps patients transition to either the home or nursing facility after discharge and
prevents readmissions. Identifying at-risk patients and providing a strong education to the patient
and family members has been shown to help lower 30-day readmission rates.
A3.
CMS implemented a Hospital-Acquired Condition Reduction Program (HAC) as part of
its Value-Based Payment program. CAUTI is one such infection that, if a patient should acquire
during their stay, the hospital will receive a reduced payment. Fielder Medical Center does
comply with CMS in the CAUTI reduction initiative by promoting patient safety by
This study source was downloaded by 100000902171055 from CourseHero.com on 11-05-2025 19:33:58 GMT -06:00
https://www.coursehero.com/file/248801699/Task-1-C815doc/
Quality and Performance Management and Methods
TASK 1 – Passed
Evaluating Quality Improvement Programs in an HIM Department
Western Governors University
, A1.
One quality improvement (QI) initiative Fielder Medical has implemented is reducing
catheter-associated urinary tract infections (CAUTI). Fielder has educated its doctors and nurses
on best practices associated with catheter use. The goal is to remove the catheter as quickly as
possible, find alternative methods for urine evacuation, and improve sterile techniques when
inserting catheters.
This is a crucial QI initiative as it helps to prevent kidney and bladder infections that
could ultimately lead to sepsis in patients. It also reduces the use of antibiotics and the risk of
producing antibiotic resistance in the bacteria associated with CAUTIs.
Another QI initiative that Fielder has implemented is rescuing patients with severe sepsis/septic
shock. Fielder joined with state agencies to identify best practice “bundles” to reduce the
mortality rate of patients who have developed sepsis while already an inpatient or are septic upon
admission.
Fielder has implemented this important QI initiative to help save their patients' lives.
They can also share their best practices with other facilities to help reduce the mortality rate at
those facilities.
One last QI initiative Fielder has implemented in their facility is reducing the readmission
rate. Fielder Medical staff do this by identifying patients who are at risk for readmission, such as
those who have been readmitted in the past or have certain health conditions. Staff can reduce
readmissions by providing better healthcare and education to patients and their families.
This QI initiative is essential as it helps reduce the emotional and financial burden on the
hospital's most vulnerable population. It also helps reduce the financial burden on the facility and
insurance companies.
A2.
The CAUTI initiative does follow Fielder Medical’s current process. The program builds
upon the success of other infection prevention initiatives that Fielder has implemented, such as
the CLABSI initiative and ventilator-associated pneumonia.
Fielder Medical’s best practice “bundles,” as well as monitoring patients and collecting data on
their patients with sepsis, has shown a significant reduction in the mortality rate of those patients.
This suggests that the doctors and nurses who follow the sepsis protocols put in place by Fielder
Medical are effectively saving lives.
Fielder Medical’s readmission initiative, which provides patients with better care and
education, helps patients transition to either the home or nursing facility after discharge and
prevents readmissions. Identifying at-risk patients and providing a strong education to the patient
and family members has been shown to help lower 30-day readmission rates.
A3.
CMS implemented a Hospital-Acquired Condition Reduction Program (HAC) as part of
its Value-Based Payment program. CAUTI is one such infection that, if a patient should acquire
during their stay, the hospital will receive a reduced payment. Fielder Medical Center does
comply with CMS in the CAUTI reduction initiative by promoting patient safety by
This study source was downloaded by 100000902171055 from CourseHero.com on 11-05-2025 19:33:58 GMT -06:00
https://www.coursehero.com/file/248801699/Task-1-C815doc/
