Policy Proposal

Mercy Medical Center is one of Villa Health’s top choices for high-quality care. However, underperformances have been reported in various metrics after the evaluation of the Public Health Dashboard-Diabetes. Underperformances were noted in the number of foot exams, Hgb1Ac measurements, and eye exams. This can predispose patients to microvascular and macrovascular diabetic complications. This paper explains the need for creating policy and practice guidelines, recommends evidence-based practice guidelines, analyzes the effects of environmental factors on practice guidelines, and explains the need for stakeholder involvement in developing and implementing the practice guidelines.

Need for Policy and Practice Guidelines

The medical center recorded an underperformance in foot exams, Hgb1Ac measurements, and eye exams. An evaluation of data on Hgb1Ac measurements revealed a decline in tests in the last three quarters of 2019. In 2018, the tests conducted in the four quarters were 1, 11, 23, and 87, respectively. In the first quarter of 2019, 123 tests were conducted (Villa Health, n.d.). Thereafter, they declined to 32, 13, and 6 tests in the second, third, and fourth quarters, respectively.

Data on foot examinations conducted at the medical center indicated an underperformance in 2019. A decline in the number of foot exams was noted in the second, third, and fourth quarters. The tests reported were 73, 62, 7, and 3, respectively in the quarters of 2019. Data on the dashboard indicated fluctuations in the number of eye exams in 2018 and 2019. The number of eye exams over the eight quarters of the two consecutive years is 4, 16, 7, 33, 41, 28, 16, and 27, respectively (Villa Health, n.d.). The fluctuations raise concern over the consistency in conducting eye exams on the diabetic population at the healthcare facility.

A comparison with the State and Federal government indicated that Mercy Medical Center recorded subpar percentages in performance. The percentage of the population who have received the tests in the medical center is 6 percent, 0.7 percent, and 1.5 percent for eye exams, foot exams, and HgbA1c, respectively (Villa Health, n.d.). This is in contrast to the State’s 78.5 percent, 80.9 percent, and 75.7 percent for eye exams, foot exams, and HgbA1c measurements, respectively, in 2018 (Report, 2020). In 2019, the State’s data were 78.7, 81.9, and 75.8 for eye, foot, and measurements of HgbA1c levels, respectively. National data indicates that in 2018, 75, 62, and 67 percent of the population received HgbA1c, eye, and foot exams, respectively (Report, 2020). In 2019, the percentages reported were 75.2, 62.8, and 68 for HgbA1c, eye, and foot exams, respectively.

The underperformance of these metrics indicates a decrease in the quality of services and predisposes patients to diabetic complications. Regular foot and eye exams enable healthcare providers to detect complications in their early stages (Zie et al., 2020). Early diagnosis forms the basis for prompt initiation of treatment and management. This is associated with a better prognosis of the disease. Hgb1Ac measurements monitor the progress of diabetes treatment. High levels of Hgb1Ac indicate poor control of blood sugar and a high risk of developing complications.

Subpar foot exams, Hgb1Ac tests, and fluctuations in eye exams at the medical center are likely to cause an increase in the incidences of retinopathy, foot ulcers, and other microvascular and macrovascular complications. This increases the morbidity and mortality rates of diabetic patients. A lot of costs are incurred in the management of the complications. This puts a financial strain on the patients and the healthcare facility. Therefore, an organizational policy to address the underperforming metrics should be developed. The policy will mitigate the development of complications, reduce morbidity and mortality rates and reduce costs incurred on the management of complications.

Policy and Practice Guidelines for the Improvement of the Performance Metrics

Policy Statement

Foot exams, eye exams, and Hgb1Ac measurements are important in the effective management of diabetic patients. Foot and eye exams help to detect early signs and symptoms of complications. Hgb1Ac measurement helps monitor treatment progress (Ceriello, 2020). This policy is a guide for healthcare providers to enable them to conduct examinations and tests consistently based on the patient population. The practice guidelines will facilitate the improvement of the underperforming metrics: foot exams, Hgb1Ac measurements, and eye exams.

Scope

The policy applies to the interprofessional team involved in the management of diabetic patients. These healthcare providers include nurses, physicians, pharmacists, dieticians, and other team members such as counselors.

Practice Guidelines

The interprofessional team should conduct regular screening of diabetic patients. The screening should include eye exams, foot exams, and measurements of Hgb1Ac. Studies have reported that patients aged 40 years and above and those who have been diabetic for more than 7 years are at the greatest risk of developing complications (Report, 2020). The interprofessional team should target this patient population. All patients aged 40 years and above should receive at least 1 foot and eye exam annually. All patients who have been diabetic for more than 7 years should receive at least 1 foot and eye exam annually (Skaggs et al., 2017). All diabetic patients, regardless of their age, should have their Hgb1Ac levels measured quarterly (Skaggs et al., 2017). All eye exams, foot exams, and Hgb1Ac measurements should be appropriately documented, indicating the time, date, and the patient served.

The interprofessional team should provide adequate and regular patient education on the importance of foot exams, eye exams, and Hgb1Ac measurements. Each patient should be given a schedule indicating the dates of planned exams and tests. All team members should make patient follow-ups, monitor their progress, and remind them of their scheduled visits. The program will be overseen by the management of the facility and will involve sending emails, text messages, and phone calls. The interprofessional team will conduct regular training sessions to improve their professional skills in conducting the examinations and tests.

Strict adherence to these practice guidelines by the interprofessional team at Mercy Medical Center will lead to an increase in foot, eye exams and Hgb1Ac measurements. Patient education will increase patient compliance with the scheduled visits and help to increase the performance of the metrics. To ensure cultural inclusivity and ethical practices, healthcare providers will uphold health ethics such as justice and beneficence. Justice will ensure that services are provided fairly regardless of cultural background (Gillon, 2015). Beneficence advocates for healthcare providers providing services that benefit the patients.

Effects of Environmental Factors

Environmental factors may affect the practice guideline recommendations. Poor documentation and record-keeping hinder the adherence to the guidelines. During the enrollment of new patients, details such as the age and the duration of which the patient has been diabetic should be documented (Smith & Parkhouse, 2017). These two parameters form the basis of conducting eye and foot examinations. Omission or wrong entry of these details can hinder strict adherence to the guidelines. Poor documentation can also entail not recording the type of test or examination done on a specific patient (Smith & Parkhouse, 2017). This can lead to confusion and poor scheduling of patients’ visits. Consequently, some patients will not receive the examination and tests as stipulated by the practice guideline. The interprofessional team should uphold a good documentation practice. The records should reflect the total number of diabetic patients, their accurate age, duration which they have been diabetic and their next scheduled visits.

Staff shortage can also affect the implementation of the practice guidelines. A low ratio of healthcare providers to patients can lead to burnout and decreased productivity (Drennan & Ross, 2019). Healthcare providers are most likely to be overwhelmed by the workload. Consequently, they are most likely to reschedule some appointments to minimize their workloads. This will hinder the strict adherence to the provisions of the practice guidelines. Rescheduling can make some patients fail to fulfill the set threshold of at least one foot and eye exam annually. Therefore, underperformance in the metric will be reported.

Stakeholder Involvement in Implementing Proposed Strategy

The implementation of the proposed practice guidelines will come to fruition with the support of the hospital management. The hospital management should monitor the adherence to the practice policy by analyzing the performance of staff quarterly and annually. The management should ensure problems such as staff shortages are addressed promptly because they can hinder the success of the proposed strategy. The management should oversee patient follow-ups by availing resources to staff. Such resources facilitate sending emails, text messages, and phone calls to patients to monitor their progress and remind them of their scheduled visits.

The hospital management should work in concert with the heads of different departments to enforce accountability. Healthcare providers should be accountable for all actions taken. Heads of departments should evaluate the performance of healthcare providers regularly. This will increase documentation accuracy and quality of service delivery to the patient. Furthermore, accountability will increase adherence to the set practice guidelines and facilitate successful implementation. Therefore, the involvement of the hospital management, head of departments, and healthcare providers will enable a successful implementation of the practice guidelines.

Conclusion

Underperformance in eye exams, foot exams, and Hgb1Ac measurements can predispose the patient to diabetic complications. They delay the identification of complications and worsen their prognosis. A policy that requires healthcare providers to conduct at least one eye exam and foot exam on a specific group of patients will increase the number of examinations and facilitate early detection of complications. Hgb1Ac levels should be measured quarterly. A culture of accountability at Mercy Medical Center and support from the management will help to bring the proposed policy to fruition.

References

Ceriello, A. (2020). Glucose Variability and Diabetic Complications: Is it Time to Treat? Diabetes Care, 43(6), 1169–1171. https://doi.org/10.2337/dci20-0012

Drennan, V. M., & Ross, F. (2019). Global Nurse Shortages – The Facts, The Impact, and Action for Change. British Medical Bulletin, 130(1), 25–37. https://doi.org/10.1093/bmb/ldz014

Gillon, R. (2015). Defending the Four Principles Approach as a Good Basis for Good Medical Practice and Therefore for Good Medical Ethics. Journal of Medical Ethics, 41(1), 111–116. https://doi.org/10.1136/medethics-2014-102282

Report, N. D. S. (2020). National Diabetes Statistics Report. National Diabetes Statistics Report, 2.

Skaggs, J. B., Zhang, X., Olson, D. J., Garg, S., & Davis, R. M. (2017). Screening for Diabetic Retinopathy: Strategies for Improving Patient Follow-up. North Carolina Medical Journal, 78(2), 121–123. https://doi.org/10.18043/ncm.78.2.121

Smith, A., & Parkhouse, J. (2017). Legal Spheres of Accountability: Documentation and Healthcare. Nursing and Residential Care, 19(10), 576–578. https://doi.org/10.12968/nrec.2017.19.10.576

Villa Health. (n.d.). Dashboard and Health Care Benchmark Evaluation.

Zie, G., Kerr, Z. Y., & Moore, J. B. (2020). Universal Healthcare in the United States of America : A Healthy Debate. 1–7.

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