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Capella 4900 Assessment 2

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    Capella 4900 Assessment 2

    Capella 4900 Assessment 2 Assessing the Problem: Quality, Safety, and Cost Consideration

    Student Name

    Capella University

    NURS-FPX 4900 Capstone Project for Nursing

    Prof. Name


    Identified Health Problem

    The identified health problem in this capstone project is Chronic Obstructive Pulmonary Disease (COPD) which 45-year-old John is suffering from. His entire life of tobacco smoking led to the onset of this disease. Despite his smoking cessation, the lungs have been damaged enough to leave John in this state where he often experiences exacerbations with difficulty in breathing. This paper is focused on assessing COPD from a quality, safety, and cost considerations perspective. 

    Impact of COPD on Quality, Safety, and Cost

    COPD is a group of diseases that cause blockage of airflow resulting in breathing-related problems. This includes emphysema and chronic bronchitis. About 16 million people in America confront breathing difficulties as a result of COPD (Centers for Disease Control and Prevention, 2019). Million other Americans have suffered from COPD without knowing of having acquired it. Hence, they remain untreated and further COPD-associated health consequences come forward. The presence of COPD results in acute exacerbation also known as flare-up, and presents with an increased level of dyspnea and worsening of chronic cough. 

    The prevalence of exacerbations is high, as 50% of patients with COPD experience exacerbations according to multiple long-term studies. These exacerbations due to COPD impact the quality of care as sometimes prompt care treatment is required and hospital readmission may take place (Hurst et al., 2020). Patients suffering from COPD also have a significant comorbid disease burden such as cardiovascular disease, metabolic disorders, osteoporosis, skeletal muscle dysfunction, anxiety, depression, and gastrointestinal diseases.

    This additionally impacts the quality of care as the health professional need to manage COPD along with comorbidities (Robert A. Wise, 2022). In John’s case, his poor management of COPD due to frequent exacerbations was obvious as the healthcare workforce was unable to cope with his exacerbations due to the negligent behavior of health professionals and long-waiting times. Therefore, it is essential to have a system or strategies developed for exacerbated COPD patients in hospitals so that immediate relief can be provided to these patients and the quality of care can be improved.

    Capella 4900 Assessment 2

    Another aspect that is impacted due to COPD is patient safety. This is one of the significant targets for all healthcare systems and patients also deem it as their desired and expected outcome and right to be fulfilled by hospital teams. Chronic obstructive pulmonary disease impacts patient safety as when the patient with COPD experiences exacerbations and is unable to acquire proper care, it may lead to further complications like rapid disease progression, fatigue, muscle weakness, loss of physical activity, the decline in lung functions, and mortality (Machado et al., 2022).

    This shows that COPD impacts patient safety and enhances the chances of mortality when it is not treated and managed on time. Healthcare organizations must consider patient safety an important factor to improve patient safety. In the case of John, his disease progression with no improvement and multiple hospital visits showed that patient safety of John was highly impacted by COPD.

    Capella 4900 Assessment 2

    The American Lung Association (ALA) states the total economic cost of COPD is nearly $50 billion every year. The $29.5 billion are utilized for direct healthcare expenditures and $12.4 billion are expended on direct mortality costs. Furthermore, $8 billion costs are related to indirect morbidity costs (American Lung Association, n.d.). These valuable statistics show that COPD impacts both the system and the individual’s cost. In the case of John, the costs incurred by him due to COPD are too much to afford as his financial resources are not sufficient to cope with his conditions.

    Therefore, his symptoms are worsened and hospital revisits do not reduce. In our nursing practice at hospitals, the COPD burden is high and there is poor management of patients with COPD as described in supporting evidence with increasing costs incurred on systems and individuals. Hence, patient safety is compromised as well in our hospital.      

    The Nursing State Board Practices, Governmental and Organizational Policies 

    The American Nursing Association provides standard guidelines for nurses so that nurses perform their duties up to mark and improve the quality of care and patient safety. The ANA states that various organizational involvement can contribute towards enhanced quality of care provided to patients and patient safety (American Nurses Association, n.d.). In the case of COPD, nurses can engage with COPD-associated organizations to improve the quality of care treatment delivery to patients with COPD and enhance patient safety.

    For example, nurses in concordance with American Lungs Association (ALA) guidelines can augment the quality of care treatment and enhance patient safety. For instance, the ALA guidelines on raising awareness about COPD among community members and designing educational programs to improve the quality of care can be done with the collaborative effort of nurses and other health professionals.  

    Several governmental organizations have provided standard practices on COPD that impact the quality of care, patient safety, and costs incurred to both the systems and individuals. One of these organizations is American Lung Association. The Lung Association advocates for policies that will improve COPD and prevent it. For example, increasing access to pulmonary rehabilitation services for COPD patients, promoting public awareness of COPD, increasing cigarette taxes, comprehensive smoke-free indoor air laws, and promoting fully-funded tobacco and smoking cessation programs (American Lung Association, 2023). These government-based interventions and policies give a positive impact on improving quality of care and patient safety.

    Capella 4900 Assessment 2

    Another governmental policy The Affordable Care Act impacts the costs incurred to patients with COPD. The ACA reduces the cost burden of all chronic diseases including COPD as US-based COPD patients can not be rejected or charged high for health insurance on the marketplace. The expansion programs i.e. Centers for Medicare and Medicaid Services (CMS) have further eased low-income patients in getting affordable and quality coverage of health treatments. Furthermore, young patients of COPD under the age of 26 can utilize their parents’ health insurance plan making treatment and management for young people with COPD easier to access. Therefore, this policy is helpful for COPD patients in reducing costs as a result of their disease burden (American Lung Association, 2022). 

    These policies affect the nursing scope of practice by providing various nursing standard practicing guidelines to enhance their knowledge and wisdom. By implementing these standard guidelines from all the aforementioned organizations and policies, nursing will be better health professionals in providing quality care and enhancing patient safety which are the key aspects of nursing scope and practice. 

    Strategies to Improve Quality, Patient Safety, and Reduce Costs

    Several strategies can be employed by health professionals to improve the quality of care, increase patient safety, and reduce costs to both the systems and the individuals for COPD patients. The major strategies to treat and manage COPD as a chronic condition are medication therapy, supporting prevention efforts to manage the progression of COPD such as smoking cessation, and non-pharmacological therapy (Vu et al., 2020).

    In the case of John, some of the strategies that can improve his quality of care and safety and reduce costs incurred due to revisiting hospitals in times of exacerbations and related factors are as follows: 

    Capella 4900 Assessment 2

    • Following the ABCD strategy of the Global Initiative for Chronic Obstructive Lung Disease for initial pharmacological therapy for patients who are diagnosed with COPD to ensure the condition is managed by first-line therapy and then going ahead with management pharmacotherapy. When nurses will follow these strategies of GOLD, effective outcomes will result as the quality of care will be improved. Hence, patient safety will be enhanced (Singh et al., 2019).
    • Utilizing telehealth-based COPD treatment and management for John to reduce the costs of commuting to hospitals while improving the quality of care and patient safety. As John confronted the issue of long waiting hours, telehealth can be an effective strategy to improve his symptoms of COPD. In telehealth, the patient and care provider will interact online as they do in the clinical setting of a hospital. Physicians and nurses can provide telehealth to patients by video-conferencing or using social apps and patient portals of hospitals. They can exchange information on symptoms, exacerbations, medication adherence, and related queries. Health professionals can conduct the session as taken in clinical offices in hospitals and guide patients on COPD without traveling (Sculley et al., 2021). This strategy will improve the quality of care as John will be able to interact with healthcare staff through one-on-one sessions with intricate and keen attention and follow guidelines accordingly enhancing patient safety.

    Capella 4900 Assessment 2

    •  Another strategy that can improve quality of care, patient safety and reduce costs is education and self-management on lifestyle modification and preventive measures to manage COPD worsening symptoms and exacerbation which will ultimately reduce hospital revisits and readmission. Moreover, costs will be reduced as a result of managed COPD. This strategy includes physical activity, a healthy diet, getting an influenza vaccine every year, avoiding tobacco and smoking environment, medication adherence, living in a clean environment with clean air, etc. (Ambrosino & Bertella, 2018). As John is tackling the issue of poor management which caused further exacerbation, this strategy will improve his condition and quality of care. Furthermore, patient safety for John will be enhanced. 

    All the aforementioned strategies will be effective in the case of John as his COPD will be well managed by implementing these strategies. The sources of relevant benchmark data such as improved symptoms and reduced exacerbation frequency, patient satisfaction can be patient reviews and statistics from governmental health organizations like CDC, WHO, ALA, etc. The two-hour practicum hours spent with John have been documented in CORE ELMS Volunteer Experience Form and can be further evaluated.  


    John, a 45-year-old COPD patient was unable to cope with his condition and experienced several exacerbations and hospital revisits and readmissions. Several factors contributed to the worsening of his condition including the damaging effects on his lungs due to long-term smoking, non-adherence to medication, and unaffordability of treatment due to financial incapability. This calls for an improvement strategy that can improve the quality of care, safety and reduce costs. Several organizational policies have been mentioned that impact the quality of care, patient safety, and costs to the system and individuals. Furthermore, telehealth, education on lifestyle modification, and following GOLD strategies of medication treatment are proposed strategies for John suffering from COPD.


    Ambrosino, N., & Bertella, E. (2018). Lifestyle interventions in prevention and comprehensive management of COPD. Breathe, 14(3), 186–194. 

    American Lung Association. (n.d.). COPD burden. 

    American Lung Association. (2022, November 17). Top 10 lung health benefits from the affordable care act. 

    American Lung Association. (2023, March 1). COPD advocacy. 

    American Nurses Association. (n.d.). Quality improvement in nursing | ANA enterprise. 

    Centers for Disease Control and Prevention. (2019). Chronic obstructive pulmonary disease (COPD). 

    Hurst, J. R., Skolnik, N., Hansen, G. J., Anzueto, A., Donaldson, G. C., Dransfield, M. T., & Varghese, P. (2020). Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life. European Journal of Internal Medicine, 73, 1–6. 

    Machado, A., Barusso, M., De Brandt, J., Quadflieg, K., Haesevoets, S., Daenen, M., Thomeer, M., Ruttens, D., Marques, A., & Burtin, C. (2022). Impact of acute exacerbations of COPD on patients’ health status beyond pulmonary function: A scoping review. Pulmonology. 

    Capella 4900 Assessment 2

    Robert A. Wise, M. D. (2022). The quality of care and economic burden of COPD in the united states: Considerations for managing patients and improving outcomes. American Health and Drug Benefits, 15(2). 

    Sculley, J. A., Musick, H., & Krishnan, J. A. (2021). Telehealth in chronic obstructive pulmonary disease: Before, during, and after the coronavirus disease 2019 pandemic. Current Opinion in Pulmonary Medicine, 28(2), 93–98. 

    Singh, D., Agusti, A., Anzueto, A., Barnes, P. J., Bourbeau, J., Celli, B. R., Criner, G. J., Frith, P., Halpin, David M. G., Han, M., López Varela, M. V., Martinez, F., Montes de Oca, M., Papi, A., Pavord, I. D., Roche, N., Sin, D. D., Stockley, R., Vestbo, J., & Wedzicha, Jadwiga A. (2019). Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: The GOLD science committee report 2019. European Respiratory Journal, 53(5), 1900164. 

    Vu, G. V., Ha, G. H., Nguyen, C. T., Vu, G. T., Pham, H. Q., Latkin, C. A., Tran, B. X., Ho, R. C. M., & Ho, C. S. H. (2020). Interventions to improve the quality of life of patients with chronic obstructive pulmonary disease: A global mapping during 1990–2018. International Journal of Environmental Research and Public Health, 17(9).