NURS 595LA-B Weekly Nurse Leader Practicum Activity Summary/Reflection Log
Weekly practicum activity summaries and reflections to be submitted for review are to be typed, grammatically correct, and error free.
Weekly practicum activity summaries should include:
Students will receive feedback from faculty regarding their weekly personal learning objectives, activities, and reflections.
| Template for Weekly Practicum Activity Summary
Directions: Submit a three- to five-page summary of each weeks activities using the template below. If an interview is conducted, also attach the list of interview questions used. |
| Name: |
| Week #_ Focus: |
| 1. My personal learning objectives this week (list):
a. Attend the facility monthly Quality Assurance meeting to ensure care improvement. b. To identify if the facility has improvements on the Psychotropic drugs GDR. c. To analyze whether the facility is expected to better or deteriorate future outcomes as per the recent situation. d. To evaluate the improvement of patient record documentation in CPRS.
My preceptor and I attended the facility Monthly improvement meeting with the interdisciplinary team, pharmacy co0nsultants, Psychiatric ARNP, and the Psychiatrist. I found that the facility applied the Centers for Medicare and Medicaid Services (CMS) guidelines as the accepted community standard to prescribe psychotropic treatments, and the certifying departments expected compliance with the guidelines. After reviewing the facility’s guidelines, we found that they recommend the possible lowest dose prescription for antipsychotics for a short time while having a continuous gradual dose reduction (GDR). I was also focused on finding whether that facility was performing the psychotropic use irregularly or regularly. However, after reviewing psychotropics in the facility, I found that it was performed regularly. During the meeting, the care plan was reviewed, including the pain management strategies.
e. To discuss patient safety and efficiency of psychotropic medication.
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| 2. Summary of planned/completed activities:
My preceptor and I attended the facility Monthly improvement meeting with the interdisciplinary team, pharmacy co0nsultants, Psychiatric ARNP, and the Psychiatrist. I found that the facility applied the Centers for Medicare and Medicaid Services (CMS) guidelines as the accepted community standard to prescribe psychotropic treatments, and the certifying departments expected compliance with the guidelines. After reviewing the facility’s guidelines, we found that they recommend the possible lowest dose prescription for antipsychotics for a short time while having a continuous gradual dose reduction (GDR). I was also focused on finding whether that facility was performing the psychotropic use irregularly or regularly. However, after reviewing psychotropics in the facility, I found that it was performed regularly. During the meeting, the care plan was reviewed, including the pain management strategies.
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The discussion of psychotropic use emerged to be beneficial because there was immediate input and feedback among the attendees and other healthcare team associates in uncovering whether there are changes required in the psychotropic medication. I identified the facility used a cluster randomized-controlled trial (RCT), thus introducing a Focused Intervention Training Support (FITS) program to minimize the psychotropic dosages by providing patient-centered interventions. The patient record documentation was also improved by implementing the education of the facility staff and employing an electronic template for the health caregivers to record the psychotropic medication management and GDRs of the patients. During the meeting, we accounted for local variations by focusing on the local requirements. We used a tailored strategy to advance local healthcare practices and created a framework to allow a generalizability degree. The Executive Director who chaired the meeting provided the meeting with tailored information on the facility’s problems handling the psychotropic drug use and possible strategies that can be used to implement beneficial interventions to improve the care. We provided the facility with coaching to facilitate the implementation whereby the coach would be determined to help draft and implement an intervention plan while paying maximum concentration on the local context of the psychotropic medications.
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| 3. Discussion of projects, procedures, evidence-based practice, policy, technology, staff education and communication, committees, quality improvement, and other leadership role activities completed during the week: (Include two or more citations from relevant literature using APA 6th ed. format.)
This week, my project was to attend the facility Monthly improvement meeting, previously known as Quality Assurance Meeting. I was accompanied by my preceptor, who would meet with the interdisciplinary team, pharmacy co0nsultants, Psychiatric ARNP, and the Psychiatrist. The meeting explored how psychotropic medications are administered to elderly patients to facilitate behavior management and psychiatric symptoms. However, much of the utilization of psychotropic dosage focus among older individuals is determined by their usage in the nursing home setting. Still, the project discussion is also based on identifying how psychotropic use is somehow customary among older patients with or without dementia. Within the facility, I identified that the GDR is vital in geriatric residents at greater risks of getting adverse side effects linked to psychotropic medications. Since the meeting had various attendee, professionals in the healthcare setting within the facility, I then had time to ask various questions regarding the psychotropic drugs GDR. The pharmacy department provided medication reviews showing how the patients were gradually reducing the dose. I reviewed past objectives of the facility regarding the GDR on psychotropic drugs against the recent goals. In the past, the facility had the GDR being needed for antipsychotic medication, while recently, the facility has focused on the GDR for all the psychotropic medications. The evidence-based practices involved the stepwise tapering of the psychotropic medication to identify whether the risks, conditions, and symptoms could be managed by lowering the doses gradually or abruptly. GDR efforts were being made on psychotropic medications, including anxiolytics, antidepressants, sedatives/hypnotics, and antipsychotics.
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| The care staff personnel were educated to know the psychotropic GDR to enhance their development on interacting with the resident. This strategy enables the facility to prevent under-stimulation with the application of role modeling. Notably, quantitative and qualitative evaluation measures were applied to compare the pre-training and post-training scores. Basing on the policy, I identified that the clinicians in this facility are well trained to abide by the CMS’s gradual dose reduction regulations. They also followed the required protocol in our standardized procedures to manifest the GDR operations. I made sure that the GDR operations were being carried out properly, leading to effective finalization. I also reviewed the documents to ensure that the GDR attempts were recorded in the patients’ medical records. The technology I identified the facility had implemented is using the Computerized Patient Record System (CPRS) to store all the chart notes and documentations. The purpose of the CPRS is to ensure systematically directed certification in an easy-to-use format that can get desegregated smoothly into the existing systems (Ghairatmal, Sabai & Peri 2020). The template utilization proved to advance the recording of the treatment reconciliation and VA health network coding. Through reviewing the CPRS, I found that the facility had a template existing for recording initiation psychotropic medications and gradual dose reduction. The facility staff was educated on conducting psychotropic medication GDR and recording the documentation in the Computerized Patient Record System. According to Mathew and Hobbs (2015), prosperous GDR highly dependent on the clinicians’ ability to get a detailed history of the patients and present behavioral patterns. They are educated on when to start and stop the GDR process, considering the behaviors or symptoms. The committee included an interdisciplinary team, pharmacy consultants, Psychiatric ARNP, the Psychiatrist, my preceptor, and I. We reviewed the quality improvement in the facility as far as psychotropic drugs gradual dose reduction. As the leader of the meeting, the executive director led the committee on identifying the stats of the care improvements of the facility.
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| 5. Reflection on your own learning and implications for future leadership role and/or implications on health care delivery and outcomes:
The week was set purposely for holding a meeting to determine how the facility had improved care. I realized that the objective of recommending psychotropic medication in individuals is to offer high-quality living standards to those who have mental health disorders with no or with other treatment comorbidities. However, I recommend a guideline as a discretionary consideration to some psychotropic patients considering the side effects. I also realized that following the CMS guidelines might be challenging to the clinicians, and it requires the health caregivers to familiarize themselves with the relevant clinical shreds of evidence. As a future leader, I will ensure that the clinicians have standardized practice to psychotropic medications with a suitable professional rationale to decrease the medication. My future concern will be to advance the standards of recording documentation in the CPRS. Therefore, to ensure an improved healthcare delivery system and outcome, I will implement staff education. All the details of all the psychotropic patient GDR will document in the CPRS. I will be leading a discussion that involves physicians and other clinicians regarding the effectiveness and safety of psychotropic medication GDR. However, before conducting this meeting, I did not know practical strategies to offset the patients’ agitated behavior when reducing the psychotropic medications. A cycle of unsuitable was identified to have resumed after the clinicians pursued new orders for similar doses to pacify them from their recurrent agitated behaviors. When holding future meetings, I would ensure that I have suitable tools to help communicate about the inductions that facilitate undesirable behaviors.
I will find the data to describe the antecedent circumstances which lead the residents to express those behaviors. The patient record documentation was also improved by implementing the education of the facility staff and employing an electronic template for the health caregivers to record the psychotropic medication management and GDRs of the patients. During the meeting, we accounted for local variations by focusing on the local requirements, in which we used a tailored strategy to advance local healthcare practices and created a framework to allow generalizability degree. The Executive Director who chaired the meeting provided the meeting with tailored information on the facility’s problems handling the psychotropic drug use and possible strategies that can be used to implement beneficial interventions to improve the care. We provided the facility with coaching to facilitate the implementation whereby the coach would be determined to help draft and implement an intervention plan while paying maximum concentration on the local context of the psychotropic medications.
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| References
Ghairatmal, M., Sabai, M., & Peri, F. (2020). GRADUAL DOSE REDUCTION (GDR) CONCERNS IN GERIATRIC PATIENTS WITH MENTAL HEALTH DISORDERS LIVING IN LONG-TERM CARE FACILITIES. The American Journal of Geriatric Psychiatry,28(4), S132-S133. Retrieved from Mathew, R., & Hobbs, C. D. (2015). An Electronic Template to Improve Psychotropic Medication Review and Gradual Dose-Reduction Documentation An electronic template helped health care providers comply with psychotropic medication regulatory guidelines and improve patient care. Retrieved from
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