Floyd Valley Community Health, a certified Home Health agency and the Local Public Health Office for Plymouth County has showcased the transformative impact of its nurse residency program through a recent quality improvement project. This initiative, spearheaded by a dedicated nurse resident, has significantly enhanced patient outcomes in the agency’s dyspnea management.

According to Laura Weiler, BSN, RN, Floyd Valley Community Health Manager, “The agency, which submits quality measures to CMS, identified a consistent shortfall in its “Managing Pain and Treating Symptoms” category, particularly in dyspnea management. At the project’s inception, Floyd Valley’s dyspnea measure was at 76.9%, trailing behind the state average of 80.8% and the national average of 86.7%.” To address this, the nurse resident undertook a comprehensive review of the dyspnea assessment process. This included analyzing the Oasis assessment questions, possible responses, and patient coding. The review revealed that case manager RNs were often coding dyspnea incorrectly. The nurse resident, alongside the health manager, educated the case manager RNs on proper coding and assessment techniques. A “real-time” audit system was introduced, where patient progress from the start of care to discharge was monitored. Patients showing improvement were marked in green, no improvement in yellow, and worsening in red. This system ensured accurate coding and highlighted areas needing attention.

Beyond coding corrections, the nurse resident introduced breathing exercises such as pursed-lip and deep breathing techniques. The agency also began providing incentive spirometers to patients with higher dyspnea ratings, a cost-effective measure to prevent pneumonia and worsening symptoms. These combined efforts significantly improved the agency’s dyspnea quality measure, which rose to 83.3% by June 2023. This brought Floyd Valley closer to the state average of 82.2%, though still short of the national benchmark of 87.8%. The agency’s Care Compare prediction for October 2024 is an impressive 92.3%, placing it in the “positive” ranking percentage of 63%.

The success of this project underscores the vital role of nurse residency programs in driving quality improvements within healthcare organizations. Floyd Valley Community Health’s experience demonstrates how integrating a professional experience to engage new graduates in improvement initiatives can substantially enhance patient care and outcomes.

Laura Weiler RN, BSN, Manager, Floyd Valley Community Health

Interested in our residency program? Contact nicole-weathers@uiowa.edu for more information or schedule a time to visit 1:1 to learn more.

IONRP Manager Nicole Weathers, MSN, RN, NPD-BC