Week 7 Assignment: Textbook Problems:
Create Attribute Control Charts

Due 10/6/2018

As a current or future health care administration leader, you will likely engage in creating and presenting attribute control charts for your health services organization. As you have examined in this course, the use of attribute control charts will depend on the specific processes in your health services organization that require monitoring and oversight. Apart from interpreting and understanding the results of control charts for ensuring that processes are in control, developing skills in creating attribute variable control charts is necessary for health care administration practice.

For this Assignment, review the resources for this week that are specific to attribute control charts. You should focus on mimicking the development of p and np charts as demonstrated in the readings for this week.

The Assignment: (3– pages)

· Using SPSS and Microsoft Word, complete problems 1 through 5 on pages 297–299 in the Ross textbook. Show all work. Submit both your SPSS and Word files for grading.

ROBLEMS

1. A hospital is analyzing nosocomial infections and wants to reduce their infection rate below the national average of 2.0%. They have sampled 40 cases every week for the last 20 weeks. The data are shown below. Create p and np control charts. Interpret the graphs. How is the hospital performing in relation to its stated goal?

1 2 11 3

2 1 12 4

3 1 13 2

4 2 14 3

5 1 15 4

6 1 16 5

7 3 17 3

8 2 18 4

9 1 19 5

10 2 20 6

2. Walter Shewhart ([1931] 1980) presented the following data in his classic Economic Control of Quality of Manufactured Product. Create a p chart for each machine. Does either of the two machines show evidence of special cause variation?

MACHINE A

MACHINE B

MACHINE B

Month

Defective

Inspected

Defective

Inspected

Jan 4 527

Feb 5 610

Mar 5 428

Apr 2 400

May 15 498

Jun 3 500

Jul 3 395

Aug 2 393

Sep 3 625

Oct 13 465

Nov 5 446

Dec 3 510

Average 5.25 483.08

1 169

3 99

1 208

1 196

1 132

1 89

1 167

2 200

1 171

1 122

3 107

1 132

1.42 149.33

3. From January 1846 through December 1848 Semmelweis ([1860] 1983) recorded births and the number that resulted in the death of the mother at his hospital. The data is available in the Chapter07.xls file, in the Problem07–03 tab. Create a p chart to analyze performance. Interpret the chart. Was the system stable?

4. Postsurgical infections have been reported to affect 2% to 5% of the 16 million patients who undergo surgery in U.S. hospitals. Infections increase the chance of complications and death. Antibiotics given one hour prior to surgery have been shown to reduce the probabil- ity of infection. The director of quality improvement has sampled 20 patients per week over the preceding 25 weeks. The data is available in the Chapter07.xls file in the Problem07–04 tab. The data collected records whether a patient contracted an infection after surgery. Create a p chart to analyze performance. Interpret the hospital’s performance based on your control chart and identify any issues that should be investigated. Assuming the aver- age rate of infection is 3.5%, is the hospital doing a good job?

5. Readmission rates within one year for congestive heart failure have been documented at 35%. A local heart program wants to assess its performance against this standard. The pro- gram has randomly selected ten patients per month over a 24-month period for review. The data is available in the Chapter07.xls file, in the Problem07–05 tab. Some of the patients were deleted from the sample due to death, relocation, or other reasons that preclude follow-up. Create a p chart. Is the process stable? How is the program performing relative to the documented standard? Since not all months have 10 observations, either use 10 as the sample size or use the average sample size to calculate the control limits.

APA format 3 peer references needs to review case study and document on differential diagnosis as to agreeing or disagreeing  Due October 20.2018 at 5pm

 

Episodic/Focused SOAP Note Template

Patient Information:

A.S., 46 F, Caucasain

S.

CC “ankle pain in both ankles; worse in right ankle, after hearing ‘pop’ while playing soccer.”

HPI: A.S. is a 46 year old Caucasian female who presents with bilateral ankle pain which she describes as chronic for the last 3 months. She acutely injured her right ankle 3 days ago while playing soccer. The pain is described as aching with intermittent sharp characteristics. Associated symptoms include limited ROM. The pain is worse with weight bearing and OTC pain medications have included alternating doses of Tylenol and Motrin with moderate relief.

Current Medications:

Motrin 200 mg by mouth every 4-6 hours as needed for pain

Hydrochlorothiazide 12.5mg by mouth daily for 6 months for HTN

Allergies: PCN- rash, no known food/environmental allergies

PMHx: HTN; immunizations are up to date- last tetanus 12/2017; flu shot 10/2018 cholecystectomy 2015

Soc Hx: A.S. is employed as a Registered Nurse and remains active by playing soccer three times a week. She is married with two teenage daughters. She denies tobacco and alcohol use.

Fam Hx: Maternal grandmother deceased at age 56 from MI. Maternal father deceased at age 75 from complications of COPD. Paternal grandparents unknown. Father history is unknown. Mother is alive with type 2 diabetes that is well controlled with oral agents. Sibling age 43 alive and well. Children are alive and well with no medical hx.

ROS:.

GENERAL:  No weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat.

SKIN:  No rash or itching.

CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema,

RESPIRATORY:  No shortness of breath, cough or sputum.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  No burning on urination.

NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: pain and swelling to right ankle, limited weight bearing and ROM in b/l ankles, worse in the right ankle. No muscle cramping.  No back pain.

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  No history of depression or anxiety.

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  No history of asthma, hives, eczema or rhinitis.

O.

GENERAL:  AAOx 3, limping gait, no distress. No fever.  Skin is warm, dry, and intact. Skin of the lower extremities is warm and pink in color.

CARDIOVASCULAR: chest is symmetric with symmetrical expansion, PMI noted at fifth intercostal space at the midclavicular line, normal S1 and S2, no m/r/g, no edema in legs, dorsalis pedis 2/4 bilaterally, normal hair distribution in legs and no pigmentation of b/l legs.

MUSCULOSKELETAL: limited ROM and weight bearing in b/l ankles, worse in right ankle. No clubbing, cyanosis, or edema.

NEUROLOGICAL: mood and affect appropriate, CN II-XII intact. Motor: 5/5 in upper and lower extremities, DTRs 2+ bilaterally.

Diagnostic results:

Ankle x-ray- If the Ottawa ankle rule is positive (bone tenderness at posterior malleolus, bone tenderness at posterior medial malleolus, or inability to bear weigh > 4 steps) ankle radiographs are indicated (Polzer, Kanz,  Prall, Haasters, Ockert, Mutschler, & Grote, 2012).

If ankle radiographs negative- assess ligament in affected extremity as compared to un-injured extremity by doing the crossed leg test, squeeze test, external rotation test, anterior drawer test, and talar tilt test. These tests will assist in determining the need for an MRI and also grading the sprain  (Polzer, Kanz,  Prall, Haasters, Ockert, Mutschler, & Grote, 2012).

Labs may include a uric acid level which is elevated with gout and a WBC which would be elevated with  osteomyelitis. MRI imaging may also be indicted.

A.

Sprain- because the patient heard the “pop” sound, her injury is likely related to an ankle sprain in which the ligaments and tissue that surround the bones of the ankle are injured causing swelling, pain, and limited ROM  (PubMed Health, 2018).

Fracture- a fracture would be unlikely if the patient was able to bear weight after the injury. The area would also become ecchymotic with limited to no ROM (PubMed Health, 2018).

Osteomyelitis- the extremity would be warm, erythematous, not usually associated with an acute injury, potential fever present, usually associated with a systemic infection or a wound (Ball, Dains, Flynn, Solomon, & Stewart, 2015)

Gout- associated with hot, swollen joints, pain and limited ROM (Ball, Dains, Flynn, Solomon, & Stewart, 2015)

Bursitis- limited ROM, swelling, pain, warmth, and point tenderness (Ball, Dains, Flynn, Solomon, & Stewart, 2015)

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide  to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Polzer, H., Kanz, K. G., Prall, W. C., Haasters, F., Ockert, B., Mutschler, W., & Grote, S. (2012).

Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthopedic Reviews, 4(1), e5. http://doi.org/10.4081/or.2012.e5

PubMed Health. (2018). Ankle sprains: overview. Retrieved from

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072736/