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NURS FPX 4020 Assessment 1 Enhancing Quality and Safety JJ

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety JJ

Introduction

The Health care system is responsible for providing efficient, safe and optimal health care measures to the patients. Nowadays health care system is facing multidisciplinary nature of complications leading to poor performance and patient health outcomes. Medication administration error is one of the major issues that question the professionalism and provision of safe and efficient health care measures to the patients. The high prevalence of the reported clinical risks has increased concerns regarding the challenges of the health care system and require immediate addressing of the organizational, management, staff, and patient concerns to rehabilitate the performance of the health care system.

Scenario experienced related to a medication administration error

Martha, 45 years old woman, suffering from possible angina pains was admitted to the hospital in the critical care unit. The patient was admitted at night shift, the physician prescribed the dose of anticoagulant and beta-blockers because of the hypertensive history and current high blood pressure. Later that night the patient was observed for further symptoms and diagnosed with the implications of epigastric discomfort. She was shifted to the respective ward but the notes on the bed were not changed. In the morning the new patient Lucy, 51 years old was admitted with hyperventilation with underlying history of hypertension, diabetes and cardiac implications on the same bed. The nurse in the morning shift administered the doses prescribed to Martha to Lucy which later presented in the form of diarrhea, vomiting, and low blood pressure. This issue was faced because of the miscoordination of the nursing staff and negligence of the replacement of the notes.

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety JJ

Elements of quality improvement initiatives

In the current situation, the elements responsible for the medication error are lack of coordination and wrong dose administration which is frequently observed in the hospital care units. Quality of health is a multidimensional concept that addresses the safe, efficient, effective health care services available for the patients needed and satisfaction according to the clinical guidelines (Chassin, and Loeb, 2013). The delivery of quality and safe health care measures is the objective of all the health care settings around the globe. Several factors at the health care units integrated and affect the quality-of-service provisions including, organizational, individual and environmental factors (Taylor, et al., 2014). The organizational factors can be mitigated by assessment and initiatives to drive quality care. Comprehensively elements of the quality improvement at health care settings can be categorized as efficient record keeping and documentation for the patient’s history, proper diagnostic and timely treatment measures, safe and quality health provisions, patient-centered care and patient satisfaction.

Explain evidence-based and best-practice solutions to improve patient safety

To improve the safety of patients regarding the prevention of medication administration errors as experienced in this case nurses coordination and safe medication should be promoted. The quality enhancement initiatives must be centered around improving health care services, quality, safety, easy access, effectiveness, cost, time, efficiency, equity of health is service and patient-centered (Barker et al., 2015). Quality health care initiatives must be patient-centered, cost-effective, loyal with high productivity. As a result, health care organizations are considered as the strategic differential for sustainable health care growth and improving the quality of services. The health care quality health provisions in the frozen time only managed to provide 50-60% of the care with evidence-based consensus and guidelines. The waste of medication was observed to be one-third of the consumption with large expenditure losses (Braithwaite, 2018). Quality improvement collaborative initiative was implemented globally that tend to produce high-quality service with targeted clinical processes and patient outcomes (Wells, et al., 2018). 

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety JJ

Researchers have reported that the impact of multimorbidity increases the cost of the health care system and resource consumption that varies across the regions. The individual or patient-centered actors are more important considerations that need to be addressed in health care service planning. However, the economic evaluations of the intervention’s strategies can provide an efficient health service and reduce the burden of diseases (McPhail, 2016). In South Africa, the implementation of National Health Insurance programs enhanced the access of patients with chronic diseases non-communicable and communicable diseases, to medicines and health services. It also improved the quality of care at the hospitals (Meyer, et al., 2017)

Risk factors of patient’s safety in medication errors

Several organizational, individual and environmental, technology tasks, tools factors affect the medicine administration safety. The personal patient-centered characteristics may include the age, type of medication, type and number of affected comorbidities. The occasional medication administration errors include wrong route, oral or intravenous, wrong timing of the drug, poor record-keeping of the medication prescription, wrong infusion rate, drug reaction neglection, poor communication between the staff members etc. In organizational factors, the knowledge and skill of staff, interprofessional coordination, accessibility of physicians and pharmacists, ratio of staff residents, job satisfaction of the staff are associated with the effective medication administration at the health care units (Al-Jumaili and Doucette, 2017). Lack of coordination in the staff leads to poorly planned medication errors and poor procedural outcomes (Swan, et al., 2019). It has been suggested that using technology, increased staff recruitment, frequent pieces of training and skill enhancement decreasing the workload and enhancing the ability and task performance can mitigate such risk factors (Joo and Liu, 2017). Medication administration and incorporation errors are common in hospitals that can be prevented by technological measures like electronic medication administration system (bar-code-Emar) which reduces the rate of errors in medication administration as well as potential adverse effects of the drugs (Poon et al., 2010). The imbalance of the staff and workload, working environment, nurse satisfaction to the job and work influencing factors interfere with the quality of service at health care (Boamah, et al., 2017).

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety JJ

Role of nurses in enhancing the quality of health provisions

The nursing leadership and working staff hold an immense crucial position in health care planning, strategic improvement, identifying the risk factors and opportunity margins. The most critical task of the leadership is to establish the mindset of the organizational units and make them function by infusing a culture of excellence and quality provision throughout the organization (Bentkover, 2012). The coordination of the nursing staff and physicians can effectively reduce the cost of the health care system. Nurses are leading the transformational changes at the hospital care units. It has been reported by several researchers of the change that greater coordination in the working staff for care provision across the provider settings will tend to improve the quality of care, outcomes of patient health, reduce the expenditure of medication and treatment, reduce unnecessary hospitalization, prevent repeated medical history cycles multiple prescriptions and drug resistance and interaction effects (Salmond and Echevarria, 2017). 

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety JJ

Medical leadership and management have also described that engagement of doctors and nurses in the leadership and organizational work can enhance the organizational and patient care in the system they work in (Till et al., 2020). In primary health care settings, communication and coordination is a crucial part of quality care as reported by the literature. Strategic coordination promotes staff engagement, adequate power distribution, job satisfaction, continuity of assessment and learning, creates a collaborative relationship culture (Willis et al., 2018). Evidence has suggested that nurses coordinating with each other, perceive feedback, communicating about the errors, and work in teams for common goals in hospital units tends to have a high perception of the patient’s safety (Ammouri et al., 2015). Availability for safe, efficient and quality care at hospitals would reduce the risk of medication errors and a hospital stay of the patients which can be cost-effective for the individual expenses as well as overall health care costs (Fay et al., 2019). 

The burnout of physicians and nurses causes emotional exhaustion, feeling of less accomplishment and depolarization at the workplace that effectively interferes with the quality health provisions including medicine administration (Patel, et al., 2018). The nursing staff, health care workers are the key stakeholders that are in direct contact with the patient, the organizational staff can be the management responsible for keeping the environment of the workplace and regulate job incentives (Martischang et al., 2018). A difficulty to stakeholder analysis is that not all demands of the stakeholders can be met (Missonier and Loufrani-Fedida, 2014). Nurses being the main stakeholders of the hospital culture implementation plays a crucial role in the provision of safe and quality health. The nurse leadership can provide physician collaborative skill and knowledge enhancement training and sessions, weekly or monthly (Simone et al., 2018). A nurse leader can provide practical knowledge of medication administration guidelines and policies to the working nurses and evaluate the implementation (Vogelsmeier et al., 2011). The transformational leadership style of a nurse leader can motivate and deeply strengthen the change of culture in hospital settings (Lappalainen et al., 2020).

Strategies for safe and effective patient care

The safe administration measures, frequent evaluation of the medication and patient outcomes can minimize the risk of medication errors. The disparities of the poor-quality health provisions will require complex interrelated mitigations in financial, educational, skill, organizational, and environmental factors. Skill building and leadership development should be an important priority of the health care system. The organizational managers should address the needs and issues of the working staff, empowering a healthy work environment. The resource insufficiency must be addressed to provide on-time cost-effective treatment to the patients The coordination and interpersonal relationship building must be encouraged to accomplish the health care provisions and effective treatment strategies. The recruitment of the staff and nurses can decrease the load of the work and promote a healthy work environment (Kieft et al., 2019). The incorporation of self-scheduling and flexible working schedules can implement the promotion of engagement in work timings and enhance patient care (Boamah et al., 2017). The improvement of the self-efficiency of nurses and a professional working environment will reduce nurse burnout and enhance job satisfaction. Implementation of interventions, training, groups and individuals, can enhance work efficiency (Patel, et al., 2018). 

Timely communication and interdisciplinary teamwork and coordination are strongly linked to the health care staff job satisfaction and quality patient care. Communication is the key in the hospital environment transferring the relative information medication strategy can enhance the patient-centred care provisions (Gausvik, et al., 2015). Proper effective training educational programs enhance the communication in healthcare organizations thus improving the patient’s safety and satisfaction from the care provisions (Burgener, 2020).

Conclusion

The health care system is facing multiple issues of management and health care provisions. The raising issue of medicine administration errors has been addressed by the World Health Organization as the immediate concern of the safe, efficient and patient-centred health care provisions. Several risk factors regarding nurses, management and environment of the working place interfere with any compromised activity at the hospital staff. However, the sustainable earnings communication, coordination of the staff members and individual engagement of the nurses under leadership and management models can enhance the quality health standards and patient satisfaction of the health care provisions.

Reference

Chassin, M.R. and Loeb, J.M., (2013). High‐reliability health care: getting there from here. The     Milbank Quarterly91(3), pp.459-490. https://doi.org/10.1111/1468-0009.12023

Taylor, M.J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D. and Reed, J.E., (2014). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ quality & safety23(4), pp.290-298. http://dx.doi.org/10.1136/bmjqs-2013-001862

Barker, P.M., Reid, A. and Schall, M.W., (2015). A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implementation Science11(1), pp.1-11. https://doi.org/10.1186/s13012-016-0374-x

Wells, S., Tamir, O., Gray, J., Naidoo, D., Bekhit, M. and Goldmann, D., (2018). Are quality improvement collaboratives effective? A systematic review. BMJ quality & safety27(3), pp.226-240. http://dx.doi.org/10.1136/bmjqs-2017-006926

McPhail, S.M., (2016). Multimorbidity in chronic disease: impact on health care resources and costs. Risk management and healthcare policy9, p.143. doi: 10.2147/RMHP.S97248

Meyer, J.C., Schellack, N., Stokes, J., Lancaster, R., Zeeman, H., Defty, D., Godman, B. and Steel, G., (2017). Ongoing initiatives to improve the quality and efficiency of medicine use within the public healthcare system in South Africa; a preliminary study. Frontiers in pharmacology8, p.751. https://doi.org/10.3389/fphar.2017.00751

Braithwaite, J., (2018). Changing how we think about healthcare improvement. bmj361. https://doi.org/10.1136/bmj.k2014

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety JJ

Salmond, S.W. and Echevarria, M., (2017). Healthcare transformation and changing roles for nursing. Orthopedic nursing36(1), p.12. 10.1097/NOR.0000000000000308

Willis, C.D., Saul, J., Bevan, H., Scheirer, M.A., Best, A., Greenhalgh, T., Mannion, R., Cornelissen, E., Howland, D., Jenkins, E. and Bitz, J., (2016). Sustaining organizational culture change in health systems. Journal of health organization and management. https://doi.org/10.1108/JHOM-07-2014-0117

Poon, E.G., Keohane, C.A., Yoon, C.S., Ditmore, M., Bane, A., Levtzion-Korach, O., Moniz, T., Rothschild, J.M., Kachalia, A.B., Hayes, J. and Churchill, W.W., (2010). Effect of bar-code technology on the safety of medication administration. New England Journal of Medicine362(18), pp.1698-1707. 10.1056/NEJMsa0907115

Ammouri, A.A., Tailakh, A.K., Muliira, J.K., Geethakrishnan, R. and Al Kindi, S.N., 2015. Patient safety culture among nurses. International nursing review, 62(1), pp.102-110.

Al-Jumaili, A.A. and Doucette, W.R., (2017). Comprehensive literature review of factors influencing medication safety in nursing homes: using a systems model. Journal of the American Medical Directors Association18(6), pp.470-488. https://doi.org/10.1016/j.jamda.2016.12.069

Swan, B.A., Haas, S. and Jessie, A.T., (2019). Care coordination: roles of registered nurses across the care continuum. Nursing Economics37(6), pp.317-323.

Joo, J.Y. and Liu, M.F., (2017). Case management effectiveness in reducing hospital use: a systematic review. International nursing review64(2), pp.296-308. https://doi.org/10.1111/inr.12335

Patel, R.S., Bachu, R., Adikey, A., Malik, M. and Shah, M., (2018). Factors related to physician burnout and its consequences: a review. Behavioral sciences8(11), p.98. https://doi.org/10.3390/bs8110098

Boamah, S.A., Read, E.A. and Spence Laschinger, H.K., (2017). Factors influencing new graduate nurse burnout development, job satisfaction and patient care quality: a time‐lagged study. Journal of advanced nursing73(5), pp.1182-1195. https://doi.org/10.1111/jan.13215

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety JJ

Gausvik, C., Lautar, A., Miller, L., Pallerla, H. and Schlaudecker, J., (2015). Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. Journal of multidisciplinary healthcare8, p.33. 10.2147/JMDH.S72623

Burgener, A.M., (2020). Enhancing communication to improve patient safety and to increase patient satisfaction. The health care manager39(3), pp.128-132. 10.1097/HCM.0000000000000298

Fay, E.E., Hitti, J.E., Delgado, C.M., Savitsky, L.M., Mills, E.B., Slater, J.L. and Bollag, L.A. (2019). Enhanced recovery after surgery pathway for cesarean delivery decreases hospital stay and cost. American journal of obstetrics and gynecology, 221(4), pp.349-e1.

Vogelsmeier, A. and Scott-Cawiezell, J. (2011). Achieving quality improvement in the nursing home: influence of nursing leadership on communication and teamwork. Journal of nursing care quality, 26(3), pp.236-242.

Di Simone, E., Giannetta, N., Auddino, F., Cicotto, A., Grilli, D. and Di Muzio, M. (2018). Medication errors in the emergency department: Knowledge, attitude, behavior, and training needs of nurses. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 22(5), p.346.

Lappalainen, M., Härkänen, M. and Kvist, T. (2020). The relationship between nurse manager’s transformational leadership style and medication safety. Scandinavian journal of caring sciences, 34(2), pp.357-369.

Kieft, R.A., de Brouwer, B.B., Francke, A.L. and Delnoij, D.M. (2014). How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC health services research, 14(1), pp.1-10.

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