1a.

• Review the CPE requirements for all three phases
• Pace your work by completing the CPE Schedule Table in the Supporting Documents.
• The table will include:

• All deliverables required for the e-portfolio
• Anticipated completion date for each deliverable
• Estimated time (in hours and minutes) to complete each deliverable

1b.

• Review the
• Briefly discuss the HRRP in one paragraph including the following:
  • Purpose of the plan
  • Conditions and surgical procedures included in the plan
  • How the advanced professional nurse utilizes the CMS Hospital-Specific Report (HSR) to promote health outcomes
• To begin the transition of care plan, go to the task Supporting Documents CDM2 Patient Case Scenarios.
  • Select one patient case scenario to complete a comprehensive review and provide the following information:
    • Describe the pre-existing conditions that predisposed the patient to the condition or surgical procedure.
  • Review
    • Discuss one actual or potential SDOH that could impact the patient condition.

1c.

• Describe one intervention that addresses the identified SDOH to prevent readmission within 30 days or less

2a.

In the next step of the transition of care plan for the selected patient case scenario in Phase 1, research evidence-based practices that reduce hospital readmissions.

Note: information is located in Unit 2 of the course of study or search other scholarly sources.

• Describe one evidence-based practice that could prevent hospital readmission for the selected patient case scenario in Phase 1.

2b.

• Review
  • Identify and describe one public health intervention for your selected patient within each level of practice:
    • Individual/family-focused population based practice
    • Community-focused population based practice
    • Systems-focused population based practice
• Individual/family-focused population based practice.
• Community-focused population based practice.
• Systems-focused population based practice.

3a.

• In the final step of the transition of care plan for your selected patient case scenario from Phase 1:
• Focus on Standard 5: Communicate Essential Care Transition Information to Key Stakeholder Across the Continuum of Care. For the selected patient case scenario
  • identify 3 relevant stakeholders and
  • describe what should be communicated to each

• Review the five standards from Transitions of Care Standards: A New Way Forward at
  • Briefly describe each the five standards (approximately 200-300 words).

3b.

identified stakeholder about the selected patient.

3c.

• Record and post one 35 minute
• Watch two peers videos and provide them encouraging and constructive feedback.
• Take a screenshot of your video including your name and your peers videos with your comments and paste them into your document prior to the references.

• one screenshot of your video, including your name.
• two screenshots of your peers’ videos with your written feedback.

• Discuss what you accomplished and learned from each of the three phases of the CPE.

3d.

• Write a brief reflection summary of your GoReact video discussing what you accomplished and learned from each of the three phases of the CPE.