The Joint Commission Core Measures, Research Paper Example

Outline

Introduction

• Identification and definition of issue.
• Discussion on why it was chosen and plan for developing the issue in this paper.
• Outline of how this issue directly or indirectly impacts health care policy.

Development of Issue

• Relationship to nursing.
• Influence on health care needs of clients and the nursing practice
• Implications for future nursing practice?
• Discussion on relevant associating health care policy.
• Present relevant literature/statistics that support your issue

Conclusion/Summary

Abstract

On November 30^th 2012 the Joint Commission reported an expansion of its performance measurement requirements from four to six in relation to how general medical/surgical hospitals are managed. The additional requirements will take effect from January 2014. This research will embrace a discussion on how core measures five is expected to impact hospital management in the near future (Zhani, 2012).

Introduction

This issue has been identified as the Joint Commission’s mandate of a fifth core measure for hospitals with 1,100 or more births per year. It can be described as the perinatal care measure enacted due to a consistent increase of births in the United States (four million per year) the need of hospitals’ accreditation since there has been an associating incidence of infant and maternal mortality also ( Joint Commission, 2013).

Joint Commission is expected to monitor the threshold of 1,100 births over the first four to eight quarters though data collection in a prior reassessment project research before implementation on January, 1 2014. This threshold is expected to be modified from time to time to include more hospitals in the mandatory requirements for functioning as accredited perinatal health care institutions (Joint Commission Core Measures, 2013).

A discussion on this issue was chosen because it impacts five core sub measures. They are those offering mandatory guidelines for elective deliveries (PC-01); cesarean sections (PC-02); administering antenatal steroids (PC-3); health care-associated bloodstream infections in newborns (PC-4) and exclusive breast milk feeding( PC-5) (Joint Commission Core Measures, 2013). It can be concluded that these are sensitive issues influencing quality ante/intra and postnatal care in America. The plan is to discuss of how PC-5 will affect maternal and child health care in the US.

This issue impacts health care policy directly and indirectly in a number of ways, which will be addressed in this research. First, with 4 million births per year in the US and 25,000 infants dying, hospitals will have to modify maternal and child health care policies to reduce these figures, which indicate that services are not of a very high quality. With regards to maternal mortality rate, figures are obscure since there have been irregularity in the data collection process However, to date United States of America is among 40 countries with the highest maternal death rate in the world. As such, this issue will influence the way hospitals manage their maternity patients and follow up on postnatal care for both infant and mother (CDC, 2013).

Development of Issue

PC-5; exclusive breast milk feeding relationship to nursing pertains to how nursing staff will have to follow specific guidelines in implementing breast feeding in hospital settings. When this measure takes effect in January, 2014 it is expected that hospitals implement evidence based practices that would encourage breast feeding. Immediately following delivery establishment of skin to skin mother/infant contact is mandated. During the first hour nurses will have to place infants at the mothers’ breast in initiating the process according to evidence based practice protocol. These various interventions would involve participation of labor, delivery, postpartum nursing managers as well as breast feeding educators. The rationale is to optimize chances for breast feeding when mothers return home with their infants (Dewey et.al, 2003).

The influences on health care needs of clients who are mothers and their infants as it relates to nursing practice are immense. Michael Baker and Kevin Milligan (2008) have conducted studies pertaining to ‘Maternal employment, breastfeeding, and health: Evidence from maternity leave mandates’ and confirmed that public health agencies internationally have combined efforts with hospitals to increase the incidence and duration of breastfeeding after child birth. Importantly, form their findings it reduces incidences of ‘diarrhea, otitis media (ear infections), gastro-intestinal diseases, asthma, lower respiratory infections, sudden infant death syndrome, lymphoma, and chronic digestive diseases’ (Baker & Milligan, 2008 p. 873). Besides, mothers benefit by easier uterine involution; quicker return to pregnancy weight; reduced risk of ovarian and premenopausal breast cancer as well as improved remineralization of bone marrow (Baker & Milligan, 2008).

Implications for future nursing practice pertain towards limiting the use of pacifiers and distribution of discharge packs containing infant formulas. Studies show where pacifiers inhibit the establishment of breast feeding and are not necessary immediately after birth. Regarding distribution of discharge packs with formulas is a way of marketing the product (Joint Commission Core Measure, 2013).

Relevant associating health care policy is related to designing a hospital breast feeding policy congruent with the Joint Commission core measure five PC- 5; extension of breast feeding protocol to public health agencies and non-profit organizations that participate in maternal and child health care. These include WIC and Planned Parenthood (Dewey et.al, 2001)

Supportive literature/statistics pertaining to PC-5 application indicate while breast feeding is now being advocated it might be that formula feeding was a promotion of the healthcare system itself when hospitals distributed discharge packets containing formula. Precisely, $3.6 billion could be saved in health care if only breast feeding was implemented nation-wide (Bartick & Reinhold, 2010). Further, statistics reveal the true impact of bottle feeding. 17 quantitative studies were reviewed evaluating mothers response to bottle feeding. They discovered that these mothers felt emotionally incapable due to lack of teaching on how to bottle feed their infants (Lakshman et.al, 2009).

Despite these findings in United States of America only 14.8 % of babies are exclusively breast fed during the first six months (Labbok, 2001). Subsequent studies also reveal that 90% of mothers in the United States of America are willing to breast feed exclusively for six months thereby saving $13 billion per year and reducing and preventing 911 infant deaths annually (Bartick and Reinhold, 2010).

Conclusion/ Summary

The foregoing research embraced the issue regarding implementation of the extended core measure five of the Joint Commission as part of perinatal hospital management across the country. This is expected to take effect January 1^st, 2014. A thorough review of PC-5 was undertaken. Its impact on health care as well as clients was fully researched and relevant data presented. In future it is recommended that a continuous evaluation of the core measure PC-5 be conducted to determine the influence of breast feeding on the quality of health care delivery in America.

References

Baker, M., & Milligan, K. (2008). Maternal employment, breastfeeding, and health: Evidence from maternity leave mandates. Journal of Health Economics, 27,871-887

Bartick, M., Reinhold, A (2010). The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. Pediatrics 125 ( 5), e1048 -e1056

Dewey, G. Nommsen-Rivers, L. Heinig, M., & Cohen, R. (2003). Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 112, 607-19.

Labbok, H. (2001). Effects of Breastfeeding on the Mother. Pediatric Clinics of North America 48 (1), 143-58.

Lakshman, R. Ogilvie, D., & Ong, K. (2009). Mothers’ experiences of bottle-feeding: a systematic review of qualitative and quantitative studies. Arch Dis Child, 94(8),596-601

Zhani, E. (November, 2012). The Joint Commission Expands Performance Measurement Requirements. News Item. The Joint Commission.