NURS FPX 4020 Assessment 1 Enhancing Quality and Safety CF

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety CF

Enhancing Quality and Safety

The beginning of 2020 took a turn for the worst with the outbreak of the Corona Virus. Within weeks this virus swept through our country and wreaked havoc. People were confused, uncertain and scared of what the Corona Virus truly was. Furthermore, there was just as much uncertainly and confusion on how to treat patients and at the same time protect ourselves as essential workers. When the first case was confirmed to my hospital, people understandably so panicked. The fear of the unknown caused tension, nurses afraid of contracting what is now known as Covid-19, put masks on. Administration then forced nurses to remove their masks because they felt that is was scaring the patients. Just a short time later, about two to three weeks’, masks became essential. Then there was the confusion of how staff was to wear masks, the guidelines of a new mask for every patient room that you enter were gone. Hospital staff were given two surgical masks to wear for an entire week, along with a brown paper bag. One mask was your “clean” mask the the other “dirty” which was to be wore in patient’s room. These two masks were to be taken on and off according to entering and exiting a room. Masks were just the beginning of a long road of confusion and chaos that made room for more stress in the work place and with more stress more mistakes.

In the midst of the pandemics second wave while being very busy and behind on a morning medication pass, I needed a coworker to give me a witness for administering morphine in a Covid -19 positive patients room. On my cart, I also had potassium and magnesium, both of these medications also require a witness when administrating. I called my coworker who came to help me, my coworker cosigned for the morphine but did not read the screen on what was being witnessed. In the midst of a very hectic morning my coworker thought that I was asking for a witness for the potassium for another patient in the next room. This person trying to be helpful and get me caught up went into the next patient’s room and started to hang and run the potassium. As I came out of my Covid-19 patient’s room, my coworker told me that the potassium was hung and was there anything else to help with. This is when the medication administration mistake was caught, and medication was immediately stopped. The patient’s intravenous line was flushed with normal saline and then the covering doctor was informed. 

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety CF

The factors that lead to this medication administration error were several things. The job of a nurse is very stressful in general, the pandemic only added to the stress and chaos in the hospital. Many staff members contracted the Covid-19 virus and therefore were out of work, this lead to staffing issues. All the levels of care in the hospitals were made differently. Stepdown units were getting ICU patients; acute level floors were getting patients that were stepdown level of care. The ratios of patients to nurse were not being changed either to balance out the acuity of care that the patients needed. Now, there is an increase of sick patients with higher acuity levels and a decrease of nurses. This led to increase of stress and with that people can be anxious and flustered and mistakes are made. Second cause of this medication administration error was lack of communication between myself and my coworker. The both of us should have had clearer communication as to what medication I needed a witness for. Instead of me calling and saying “Can you come here to give me a witness” I could have improved by stating “I need a witness for morphine for my patient in 265, I will then need another witness for my next patient room, can you please wait for me.”. My coworker was simply trying to help, but with all the factors stated above, a mistake was made.

Over 400,000 Americans die each year due to health care provider errors. This is a cause for concern as the number of deaths from medical errors supersedes that of acquired immunodeficiency syndrome, breast cancer, and motor vehicle accidents combined. Moreover, the financial impact of such avoidable errors both in the outpatient and acute care setting in the United States is projected to be 17.1 billion dollars.( Lyle-Edrosolo&Waxman, 2016) . A part of these deaths or injuries are medication administration errors. Medications pose significant patient risk if administered incorrectly. To eliminate this potential for harm, facility personnel must ensure that a safe and effective medication-management system is in place. Assessing trends in medication errors or investigating processes involved with medication management. (Allison, 2016).

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety CF

A useful resource that can be used to help better improve the medical field and patient safety is to use Quality and Safety Education for Nurses [QSEN]. QSEN is a guide that uses six competencies to help nurses deliver the best quality nursing possible. The six competencies are patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. Patient-centered care involves working with patients to coordinate care based on patient preferences, values, and needs. Teamwork and collaboration require health care provider teams to function effectively using open communication, mutual respect, and shared decision making to achieve quality patient care (Allison, 2016). This is a tool that is most relevant in my particular situation. Although we were exercising teamwork, open communication could have been improved in this instance. Safety focuses on minimizing risk to patients and increasing individual and system-level performance and accountability. Informatics applies current technology to communicate, manage knowledge, mitigate error, and support decision making. QSEN can be implemented and used in the hospital setting to help educate nurses. (Stalter & Mota, 2017)

Nurses can minimize error and achieve improved patient outcomes with the identification and application of best practices. One example for achieving this is with academic-clinical partnerships, where education informs clinicians about best practice recommendations to transform the health care delivery system. The adoption of total system transformation to reduce errors begins with mutually defined practice competencies to measure results. Use of a common language across academic practice settings is ideal for integrating best practice recommendations and maintaining compliance for improved outcomes ( Lyle-Edrosolo & Waxman, 2016 ). This is a good opportunity for coordinating of care with nursing staff, management and/or clinical outcomes managers to formulate a plan of action.

Another approach is to use Kouzes and Posner’s five fundamental practices of exemplary leadership that informed the categorization of core behaviors associated with clinical leadership attributes, such as clinical expertise, collaboration, coordination, interpersonal understanding, and effective communication. These five leadership practices comprise of the following components: “Challenging the process” which describes a staff nurse’s ability to seek out opportunities for change, think creatively, question the status quo, and negotiate the best care for their patients. “Inspiring a shared vision” refers to a staff nurse’s ability to communicate effectively, influence, and empower others to advocate for high-quality patient care “Enabling others to act” reflects the nurse’s behaviors of collaboration, relationship building, sharing information, and working effectively with colleagues. “Modeling the way” is a visible leadership practice which reflects the nurse’s ability to set an example, articulate professional standards and values, and create standards of excellence in their practice. And finally, “Encouraging the heart” reflects the core behaviors of the staff nurse recognizing individual contributions of the team, providing support, encouragement, and feedback and celebrating accomplishments showed that the core practices of exemplary leadership, discussed above, align with the leadership practices in (Boomah, 2018).

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety CF

The use of these competencies and fundamentals can help the different levels of nursing care come together and formulate plans that work best to improve patient care and safety. An example could be for managers to work with administrations to improve with staffing issues. another example is for mangers to try and ensure that patients are being accepted into the proper units according to their acuity of care that is needed. Management can then work with nurses and assist units by making sure recourses are available while at work. This could be ensuring that there is an assistant manager or charge nurse available during all shifts. This person can extend out a helping hand to people that are in need of help or questions with policies or procedures to assist in alleviating some stress and pressure that occur regularly in the medical field.

Nursing is all about teamwork, if you don’t have it then things will quickly fall apart. This is why being able to have all levels of management and care working together is important to help a unit run like a fine tuned machine. These coordination plans will not only improve patient safety but lower costs for hospitals; whether it be the cost of a drug that would have to be wasted or saved money from legal costs. But, most importantly, patients will be taken care of better and that is truly what it is all about.

References

Lyle-Edrosolo, G., & Waxman, K. T. (2016). Aligning hHealthcare sSafety and qQuality cCompetencies: Quality and Safety Education for Nurses (QSEN), The Joint Commission, and American Nurses Credentialing Center (ANCC) Magnet® Standards Crosswalk. Nurse Leader, 14(1), 70–75. https://doi.org/10.1016/j.mnl.2015.08.005 

Stalter, A. M., & Mota, A. (2017). Recommendations for pPromoting qQuality and sSafety in hHealth cCare sSystems. The Journal of Continuing Education in Nursing, 48(7), 295–297. https://doi.org/10.3928/00220124-20170616-04 

Boamah, S. A. (2018). Emergence of informal clinical leadership as a catalyst for improving patient care quality and job satisfaction. Journal of Advanced Nursing, 75(5), 1000–1009. https://doi.org/10.1111/jan.13895 

Allison, J. (2016). Ideas and aApproaches for qQuality-aAssessment and pPerformance-iImprovement pProjects in aAmbulatory sSurgery cCenters. AORN Journal, 103(5), 483–488. https://doi.org/10.1016/j.aorn.2016.02.014 

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