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Data Analysis

Brandi Parker

School of Health Professions and Wellness, Jacksonville State University

NU 716: Interprofessional Healthcare and Informatics

Dr. Jolie Wildinger

July 13, 2023

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Identified Gap

Unnecessary hospice patient revocations cause a significant impact on patient care; unplanned

patient discharges from hospice are caused by a multitude of factors. Hospice interventions address acute

medical crises, provide more intensive palliation, and maintain continuity while avoiding poor care

transitions (Phongtankuel et al., 2016). This student has identified a gap in practice; January 1, 2023

through March 31, 2023, 78% of the patients who revoked their hospice benefit and sought symptom

management did not have comfort medications in their homes. Comfort medications can be combined in

small amounts in a comfort medication kit; these are vital for symptom management at the end of life.

Collaboration, consultation, physician availability, and pharmacy resource availability are critical in

implementing comfort medication kits (Staats et al., 2018). This student has identified a direct correlation

between the lack of comfort medication kits in homes and increased patient revocations for symptom

management.

The Doctorate of Nurse Practitioner (DNP) project this student wants to propose is the

implementation of comfort medication kits in the patients’ homes and analyze the effects of this on

reducing revocations. Multiple data types must be obtained to perform a detailed project analysis. “Will

implementing a comfort medication kit in patient homes over eight weeks reduce patient revocation rates

in the home hospice setting?” is this student's PICOT question. This student looked at data on patient

discharges for the first quarter of 2023 in the hospice agency where this student works. A list was

compiled of patients who revoked their hospice benefit to seek symptom management elsewhere; this

student then performed individual chart audits of patient medications. At that time, it was identified that

only four of the eighteen patients who revoked their hospice benefit to seek symptom management had

comfort medication kits in the home. This data was used to develop a gap analysis and plan for a

proposed DNP project. It is currently recognized that more research and data collection is needed using

comfort medication kits for symptom management in the hospice setting (Leigh et al., 2011).
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Data Needs

The data this student will collect for the proposed project must reflect accurate and detailed

patient information. First, this student will identify patients identified as high-risk for revocation by a tool

already in use at the hospice organization. This student will also gather evidence-based data on comfort

medications and individual use for symptom management. Staff education sessions will be completed in

person, and evidence-based data will be presented. This student will keep detailed records of these

education records and the information presented. This will be one portion of the data this student will

maintain. The medical director and interdisciplinary group will be consulted to determine the medications

placed in the kit. The medications will be placed in small amounts in a kit by a pharmacy per the

physician’s order. Patients at high risk for revocation will have comfort medication kits placed in their

homes. In addition to these patients, those with a prognosis of two weeks or less will also have comfort

medication kits placed in the home. This student will work with the quality assurance team to keep

detailed records of each patient receiving a comfort medication kit at home, consisting of the second part

of the data collected.

Initially, this student recommended observing the project for six weeks; this student

acknowledges that it may serve better if observed for eight weeks. The next part of the data set this

student will collect is all patients who are discharged from hospice services. This student will look at all

hospice discharges over the designated period and narrow the data to revocations from hospice services.

Once the revocations for the time are identified, the individual patient medication records will be

reviewed to identify whether the patient had a comfort medication kit in the home. The data gathered over

the designated period will be reviewed, analyzed, and compared to the data collected from the First

Quarter of 2023. The data comparison between the project time frame and the First Quarter of 2023 will

measure the effectiveness of the project.

Data Pathways

Electronic health records are utilized at the hospice agency where this student resides and works.

The electronic health record (EHR) system that the agency currently utilizes is Consolo, by Wellsky.
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WellSky has been in the healthcare record business for forty years and has healthcare technology

expertise to assist its clients in successful patient care (Wellsky, 2023). There are reports in Wellsky’s

system, Consolo that compile patient discharge information based on dates, type of discharge, and patient

status. There are also medication reports where the individual patient’s record may be pulled to review.

This author has access to these medical records and reporting systems. This student has also anticipated

the EHR changeover occurring in October 2023. Homecare Homebase will replace the current system.

Homecare Homebase will enable data retrieval on a more accessible level; this author has past hospice

experience with the system. Homecare Homebase is real-time reporting, encompassing patient-centered

care (Homecare Homebase, 2023). The important thing is that this student will be able to run reports on

each system that will be comparable to one another, therefore keeping past and current data retrieval

intact. Both systems gather report information from data entry selections completed by field staff. One

reason education is the first thing to be instituted is to ensure that the proper codes are selected for patient

discharges and that all medications, including comfort medications, are entered into the system.

The Centers for Medicare and Medicaid Services (CMS) have a hospice survey and rating

system, the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey (CMS,

2022). This system includes a measure that reflects the education and provision of comfort medications a

hospice provides to the patient and family. This student will utilize this survey to assist with staff

education and comfort kit development. Incorporating what is vital to the patient’s families into this

project is essential. Along with the CAHPS Survey, clinical quality assurance data will track and trend

patient interventions and outcomes. This student will work closely with the Quality Assurance (QA)Team

to implement, gather, and analyze patient data. The QA Team will institute a performance improvement

project (PIP), and the Plan, Do, Study, Act (PDSA) model will be used to evaluate the effectiveness of

this student’s project. Staff satisfaction and input will also be considered and recorded by this author. The

administrator and clinical managers will meet with this student to review team engagement in the project

and satisfaction with the progress of the project. This student will keep detailed records of all the

collected data; security will be discussed further.

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Data Security

One of the challenges that will be faced is the security of all collected data within this project.

Confidentiality, availability, and integrity are three primary areas of secure network information

(McGonigle & Mastrian, 2021). Employee authentication, individualized employee password assignment

with unique identifiers, and firewall protection are some security measures utilized at this author’s

hospice company. Internal security threats are more critical and challenging to manage than external ones

(Habib et al., 2019). Regardless, patient data security is a priority in this DNP Project. An encrypted

software program protects the digital data this student will collect. Citrix is a software program that

provides secure login in the secure company-protected devices this student’s company provides. The

information technology (IT) department has secure servers set up, and there is multiple-step verification

that this student’s company requires for data retrieval and storage. A virtual private network (VPN)

system is in place at the hospice organization; this allows the user to access data remotely and securely.

VPNs must be used to ensure that all transmitted data transmitted on networks are encrypted (McGonigle

& Mastrian, 2021). Homecare Homebase utilizes a cloud storage system to maintain patient records, and

if a device is lost or stolen, data can be remotely wiped from the device (Homecare Homebase, 2023).

Any hard copy of data information will be stored in a double-secured area in the hospice agency office

per state and regulatory guidelines. This student is an agency employee with access to patient information

and files; the IT department oversees security. The project data that will be presented will not contain

patient identifiers; this is another measure to ensure patient security and privacy is not compromised.
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References

Habib, M. A., Faisal, C. M. N., Sarwar, S., Latif, M. A., Aadil, F., Ahmad, M., Ashraf, R., & Maqsood,

M. (2019). Privacy-based medical data protection against internal security threats in

heterogeneous Internet of Medical Things. International Journal of Distributed Sensor

Networks, 15(9), 155014771987565. 10.1177/1550147719875653

Homecare Homebase. (2023, Software for Hospice Agencies. https://hchb.com. Retrieved 7/12/2023,

from https://hchb.com/hospice

Leigh, A., MD, Bailey, F. A., MD FACP FAAHPM, Burgio, K., PhD, & Williams, B., PhD. (2011). A

hospice emergency kit (HEK): Evaluation of effectiveness by retrospective chart review and

hospice nurse questionnaires (738). Journal of Pain and Symptom Management, 41(1), 295.

10.1016/j.jpainsymman.2010.10.217

McGonigle, D., & Mastrian, K. G. (2021). Nursing Informatics and the Foundation of Knowledge (5th

ed.). Jones & Bartlett Learning.

Phongtankuel, V., Scherban, B. A., Reid, M. C., Finley, A., Martin, A., Dennis, J., & Adelman, R. D.

(2016). Why do home hospice patients return to the hospital? A study of hospice provider

perspectives. Journal of Palliative Medicine, 19(1), 51-56. 10.1089/jpm.2015.0178

Staats, K., Tranvåg, O., & Grov, E. K. (2018). Home-Care nurses’ experience with medication kit in

palliative care. Journal of Hospice and Palliative Nursing, 20(6), E1-E9.

10.1097/NJH.0000000000000518

Wellsky. (2023, About Wellsky. https://wellsky.com/. Retrieved 7/13/2023,

from https://wellsky.com/about-us/