| Course | D026 Quality Outcomes in a Culture of Value-Based Nursing Care |
|---|---|
| Task | Task 2 |
| Paper type | Quality vulnerability and value-based strategy |
| Length | About 1,100 words, 4 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for D026 Task 2
A Quality Vulnerability and a Value-Based Response: Undertreated Malnutrition Among Older Medical Inpatients in a 310-Bed Community Hospital
Student Name
Leavitt School of Health, Western Governors University
D026: Quality Outcomes in a Culture of Value-Based Nursing Care, Task 2
Course Instructor
Month Day, Year
A Quality Vulnerability and a Value-Based Response: Undertreated Malnutrition Among Older Medical Inpatients in a 310-Bed Community Hospital
The Quality and Safety Vulnerability
The vulnerability in this composite 310-bed community hospital is that older medical inpatients at risk of malnutrition are identified but not treated in time. Nurses complete a nutrition screening tool on admission for every patient, and the electronic health record flags those at risk for a dietitian consult. In practice the flag creates a task in a queue shared by three dietitians covering the whole hospital. A three-month audit of 200 patients aged 65 and older on the medical units found that 34% screened at risk, but the median time from a positive screen to a dietitian assessment was 3.2 days, and only 41% of at-risk patients had any change to their diet or supplements before discharge. Meal intake was rarely documented.
This is a vulnerability because malnutrition is common, harmful and costly. In national hospital data from 2018, 8.9% of adult nonmaternal discharges carried a coded diagnosis of malnutrition, and those patients were older, stayed longer, cost more and had higher readmission and inpatient mortality rates than patients without it (Guenter et al., 2021). In an organization paid increasingly on outcomes and total cost, a gap between screening and treatment means paying for a process that produces no benefit.
Recommended Value-Based Care Strategy
The recommended strategy is a nurse-initiated nutrition care pathway for medical inpatients aged 65 and older who screen at risk. When a patient screens positive, the admitting nurse will start a standing protocol approved by the medical staff: oral nutritional supplements twice daily, a documented meal-intake record at every meal, and a referral that places the patient in a priority queue for a dietitian assessment within 24 hours. The dietitian then sets individual calorie and protein goals and adjusts the plan, and the discharge summary carries the nutrition diagnosis and plan to the primary care provider.
The evidence for individualized nutritional support is strong. In a randomized trial of 2,088 medical inpatients at nutritional risk, patients who received protocol-guided, individualized nutritional support had fewer adverse clinical outcomes at 30 days than those who received standard hospital food (23% vs 27%) and lower 30-day mortality (7% vs 10%), with no increase in side effects (Schuetz et al., 2019). The authors concluded that their findings support screening medical inpatients on admission and following a positive screen with assessment and individualized support. That is precisely the step this hospital is missing.
The strategy is value-based because it targets outcomes and cost together. It aims to reduce complications, mortality, length of stay and readmissions among at-risk older adults, which are the outcomes that matter to patients and the drivers of cost in episode-based and readmission-linked payment. The added costs, supplements and dietitian time, are small compared with the cost of a longer stay or a readmission for a frail older adult.
Three Interprofessional Colleagues
The first colleague is the registered dietitian. The dietitian leads the clinical content of the pathway, writes the standing protocol with the advanced professional nurse, completes priority assessments within 24 hours and trains nurses to recognize when intake records show the plan is not working. Without the dietitian's expertise, the pathway would be a supplement order rather than individualized support.
The second colleague is the hospitalist medical director, whose approval is needed for a nurse-initiated standing protocol and whose support will encourage physicians to respond to nutrition recommendations and document the diagnosis. Accurate documentation also matters for the hospital's coding and risk adjustment, which affect how its outcomes are compared under value-based programs.
The third colleague is the clinical informatics nurse, who will change the screening flag so it triggers the protocol and a priority queue instead of a general consult, build the meal-intake record into the nursing flowsheet and create a weekly report of time to assessment. The advanced professional nurse will coordinate the three colleagues through a short monthly meeting, drawing on the teamwork and collaboration element of the WGU Nursing Programs Conceptual Model, which asks nurses to engage colleagues across professions through honest communication and decisions made together (Western Governors University, n.d.).
Implementation and Barriers
The advanced professional nurse will lead implementation in three stages across about 16 weeks. During month one, the nurse and the dietitian will draft the standing protocol and meal-intake record, and the medical director will take the protocol through the medical executive committee. In the second month, the informatics nurse will build the priority queue and flowsheet changes and test them on one medical unit. In the third and fourth months, the pathway will go live on all three medical units after a 20-minute training session for nurses and nursing assistants, who record most meal intake.
Three barriers are likely. Nursing assistants and nurses already feel stretched, and a meal-intake record at every meal can feel like one more box; the record will be kept to a single tap per meal on the flowsheet, and the unit's practice council will review whether it is being used. Dietitian capacity is limited, so the priority queue will move routine consults, such as diet education for stable patients, to a later time slot rather than adding work. Finally, some physicians may be reluctant to accept a nurse-initiated protocol; the medical director's sponsorship and the strength of the trial evidence will be the main answers, and physicians will retain the ability to change or stop the protocol for any patient.
Measuring Success
The strategy will be judged on process, outcome and cost measures. Process measures are the proportion of at-risk patients with a dietitian assessment within 24 hours, aiming for 85%, and the share of those patients with documented meal intake at two of three meals each day. Outcome measures, compared with the previous year for the same age group, are length of stay, 30-day readmission and the coded rate of malnutrition diagnoses, which should rise at first as documentation improves. Cost will be estimated from the hospital's cost accounting data as the change in average cost per case for at-risk patients, set against the cost of supplements and dietitian time.
Conclusion
The hospital already screens older patients for malnutrition, but screening without timely treatment adds cost without adding value. A nurse-initiated nutrition pathway, grounded in trial evidence and built with a dietitian, a hospitalist leader and an informatics nurse, closes that gap and gives the organization a measurable way to improve outcomes for a group of patients who are easy to overlook.
References
Guenter, P., Abdelhadi, R., Anthony, P., Blackmer, A., Malone, A., Mirtallo, J. M., Phillips, W., & Resnick, H. E. (2021). Malnutrition diagnoses and associated outcomes in hospitalized patients: United States, 2018. Nutrition in Clinical Practice, 36(5), 957-969. https://doi.org/10.1002/ncp.10771
Schuetz, P., Fehr, R., Baechli, V., Geiser, M., Deiss, M., Gomes, F., Kutz, A., Tribolet, P., Bregenzer, T., Braun, N., Hoess, C., Pavlicek, V., Schmid, S., Bilz, S., Sigrist, S., Brändle, M., Benz, C., Henzen, C., Mattmann, S., . . . Mueller, B. (2019). Individualised nutritional support in medical inpatients at nutritional risk: A randomised clinical trial. The Lancet, 393(10188), 2312-2321. https://doi.org/10.1016/S0140-6736(18)32776-4
Western Governors University. (n.d.). Nursing programs conceptual model. WGU Community Nursing Student Handbook. https://cm.wgu.edu/t5/Nursing-Student-Handbook/Nursing-Programs-Conceptual-Model/ta-p/19
What the D026 Task 2 instructions ask
The second D026 task asks you to address a quality or safety vulnerability with a value-based strategy. Most versions ask you to describe the vulnerability, recommend a strategy that improves value, identify interprofessional colleagues and their roles, describe implementation and barriers, and explain how success will be measured. The vulnerability should be specific and supported by data. The evaluator reads for a strategy that improves outcomes relative to cost, colleagues whose roles are concrete, and measures that capture process, outcomes and cost rather than activity alone. The vulnerability should be one the hospital's own data could confirm. Most versions also ask how the strategy fits a value-based payment environment.
How this D026 Task 2 example is built
The paper opens with the vulnerability described as a gap between screening and treatment, with evidence of its consequences. The strategy is described in operational detail, including who triggers it and what happens next. Each of three colleagues has a paragraph describing their contribution. Implementation runs in stages over about 16 weeks, with barriers such as workload and order sets paired with responses. The measures section separates process, outcome and cost measures and draws on trial evidence for what improvement can be expected. The conclusion restates why screening without treatment adds cost without adding value. The pathway begins automatically when a patient screens positive.
Where the D026 Task 2 rubric puts the marks
Each D026 Task 2 aspect is judged competent, approaching competence or not evident. A vulnerability aspect checks that the quality or safety gap is specific and supported. A strategy aspect looks for a value-based response with evidence. A colleagues aspect wants three interprofessional roles described concretely. Implementation and barrier aspects look for realistic steps and responses. A measurement aspect asks for process, outcome and cost measures. Evaluators favor strategies grounded in current evidence and feasible for the setting. APA citations and professional writing are assessed throughout. Evaluators notice when each colleague's role is described as tasks within the pathway rather than as general support, and when the cost measure reflects the whole stay rather than supplies alone. Plans that name a realistic timeline also score better on feasibility.
D026 Task 2 help: what sends it back
The most frequent return is a vulnerability described too broadly, such as poor nutrition care. Narrow it to the specific gap, such as screening without timely treatment. Second, strategies are not clearly value-based. Explain how outcomes improve relative to cost. Third, interprofessional roles are listed without tasks. Describe what each colleague will do. Fourth, barriers are generic; name the obstacles likely on your unit and a response to each. Finally, measure more than activity. Counts of consults are process measures; include an outcome and a cost measure so the strategy's value can be judged. Show a baseline for each measure. Keep the pathway simple enough for night staff to follow.
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D026 Task 2 questions, answered
What counts as a quality or safety vulnerability in D026?
A weakness in how care is delivered that puts patients at risk or produces poorer outcomes, such as missed screening, delayed treatment, poor handoffs or preventable complications. Show that it exists in your organization with data or observations described in aggregate.
How do I make my D026 strategy value-based?
Link it to both outcomes and cost. Explain how the strategy would improve results that matter to patients and how it would reduce waste, complications, length of stay or readmissions, then say how you would measure both.
Which colleagues should D026 Task 2 include?
Colleagues whose work directly affects the vulnerability. For malnutrition, the sample includes a dietitian, a hospitalist and a pharmacist, each with a defined role in the pathway.
How do I measure a D026 strategy?
Use process, outcome and cost measures together. The sample tracks timely dietitian assessment, clinical outcomes such as complications and length of stay, and cost, so the value of the strategy can be judged.
Where can I find a free D026 Task 2 sample paper?
The whole vulnerability analysis and strategy are reproduced above with notes. For a strategy on your own unit's gap, send the D026 instructions and the first custom paper is free.