NURS FPX 4020 Assessment 1 Enhancing Quality and Safety NR

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety NR

Enhancing Quality and Safety

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety NR

Quality improvement (QI) should be a focal point that every healthcare professional prioritizes. Like a revolving door, QI should be an ever-evolving process that health care facilities continue to update and tweak as necessary. For QI to be successful, it is essential to go back to the basics. The hierarchy of QI begins with the customer since, at its root, health care is a customer service industry that services patients. When patients arrive at a hospital, they assume that they are in good hands but sadly, this is not always the case. Unsafe medication practices are the leading cause of avoidable patient harm in healthcare systems worldwide (Wondmieneh et al., 2020). In recognizing this issue, healthcare systems must investigate the underlying causes and potential solutions to fixing the problems that lead to these unintentional events.

Patient Safety Risks

Some of the leading causes of medication errors (ME) are dosage calculation errors, overworked hospital units, employee fatigue, insufficient knowledge, and unsuitable environmental conditions (Wondmieneh et al., 2020). In almost all medication administration processes, nurses are the last checkpoint before patients receive medication. Since nursing is the nation’s largest healthcare profession, with more than 3.8 million registered nurses (RNs) nationwide (Rosseter, 2019), They play a significant role in the occurrence as well as the prevention of medication administration errors (Wondmieneh et al., 2020). When considering the profession’s current issues, including shortages, burnout, and unsafe patient ratios, the need for safe medication administration becomes obvious. Minimal interruptions, adequate time, and multiple checkpoints are crucial to avoiding adverse drug events (ADE).

As we acknowledge the conditions that play a role in the lead-up to an ADE, we must recognize the post ADE conditions. In many circumstances, uncaught MEs go unreported. This underreporting is partly due to the fear of retaliation by the hospital administration or lawsuits by the patients themselves. Health care professionals experience profound psychological effects such as anger, guilt, inadequacy, depression, and suicide due to actual or perceived errors (Rodziewicz, 2022). This fear system creates a cyclical problem due to underreporting, making it hard to carry out a root cause analysis since the issue’s prevalence is downplayed. While nurses care about the safety of their patients,  they also fear losing their jobs if they report an incident (Rodziewicz, 2022).

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety NR

Distractions and interruptions are another leading cause of MEs at higher rates in acute care settings such as the emergency department. High patient ratios combined with high acuity patients create the perfect environment for ADEs, even more so when staffing shortages occur. Under these stressful conditions, it is easy to neglect the five rights of medication administration. These five rights include the right patient, right drug, right route, right time, and right dose (Hanson, 2021). It takes time to verify these five rights before safe medication administration and having no interruptions during the process can contribute to better safety.

Elements of a Successful Quality Improvement Initiative

QI is a collective initiative that requires buy-in from staff and management at all levels. Since the primary stakeholders are nurses and their patients regarding medication administration specifically, management must make the necessary changes to facilitate nurses’ needs to implement the needed safety changes successfully. MEs will continue until contributing factors are acknowledged and addressed first. According to Harvard School of Public Health, 2017, “before you can begin to make improvements in health care, you first need to know what opportunities exist for improvement and then establish baseline outcomes. Next, look at trends and statistics from electronic health records, outcomes studies, and other data sources to identify key areas in need of improvement.”

           Before carrying out this critical first step, it will be impossible to carry out any QI initiative as no areas of improvement would have been identified. It is crucial to gather information from staff during the discovery process to leave no stone unturned. Before you can begin to improve health care, you first need to know what opportunities exist for improvement and then establish baseline outcomes. Next, look at trends and statistics from electronic health records, outcomes studies, and other data sources to identify critical areas needing improvement (Harvard, 2017). It is then necessary to set concrete and measurable goals in the areas you identify as most needing improvement. These should be precise and quantitative (Harvard 2021). 

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety NR

           It is essential to use a systematic approach to track, measure, adjust, and repeat the changes when executing a QI plan. The Plan-Do-Study-Act (PDSA) cycle would be an excellent choice for these purposes. The Institute for Healthcare Improvement advocates plan-do-study-act (PDSA) cycles to plan, test, observe an intervention’s results and act on what was learned (Ho & Burger, 2020). One can discern which changes are effective by planning, then enacting a change, observing results, and acting on what is learned. This cycle essentially mimics the steps of the scientific method but is adapted for action-oriented learning (Harvard 2021).

Nurses’ Role in Reducing Cost

ADEs reportedly result in more than 770,000 injuries or deaths in US hospitals each year and are responsible for an estimated hospital expense of $1.56 to $5.6 billion annually (Hanson, 2021). These costs are associated with extended hospital stays due to ADEs and lawsuits filed by injured patients. In acknowledging the significant expenses incurred by healthcare systems due to ADEs, nurses must be given adequate time to carefully go through the five rights mentioned above of medication administration to avoid MEs. In surgical situations or when patients need sedation, timeouts need to occur to ensure the correct site, correct procedure, and correct patient, as this will minimize costly mistakes (Rodziewicz, 2022).

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety NR

When it comes to reducing costs and avoiding medication errors, various stakeholders play a role. These include physicians and nurses, educators, administrators, researchers, professional bodies, governments, legislative bodies, and accrediting agencies (Cho et al., 2020). Clear communication between physicians and nurses will help reduce errors in order placement and delivery of medications. Educators play a crucial role in ensuring that the nurses are well educated on the common meds they dispense based on unit and specialty. Finally, continued regulation and updates by governing bodies and researchers will further inform the healthcare industry. Interprofessional collaboration amongst these stakeholders can significantly reduce the occurrences of ADEs, leading to lowered damage control costs.

Conclusion

While seeking a healthcare experience where MEs are nonexistent may be wishful, it is undoubtedly an ideal that healthcare systems should pursue. Multiple studies have identified that if error-prone situations are managed by a modification of the system, a decrease in the frequency of the error and concomitant errors associated with it will occur (Rodziewicz, 2022). A significant reduction in MEs will contribute to higher trust levels, reduced costs, and, most importantly, safer patient environments. Providing nurses with enough time, fewer distractions, better education, and support instead of retaliation will lead to a safer, more efficient healthcare industry as a whole.

References

Rodziewicz, T. L. (2022, January 4). Medical error reduction and prevention. StatPearls [Internet]. Retrieved January 28, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK499956/ 

Wondmieneh, A., Alemu, W., Tadele, N., & Demis, A. (2020, January 13). Medication administration errors and contributing factors among nurses: A cross sectional study in tertiary hospitals, Addis Ababa, Ethiopia – BMC Nursing. BioMed Central. Retrieved January 28, 2022, from https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-020-0397-0 

Rosseter, R. (n.d.). News & information. American Association of Colleges of Nursing: The Voice of Academic Nursing. Retrieved April 1, 2019, from https://www.aacnnursing.org/news-Information/fact-sheets/nursing-fact-sheet 

Hanson, A. (2021, September 12). Nursing rights of medication administration. StatPearls [Internet]. Retrieved February 15, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK560654/ 

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety NR

Harvard T.H. Chan School of Public Health. (2017, February 2). 8 Healthcare Quality Improvement Tips. Executive and Continuing Professional Education. Retrieved February 15, 2022, from https://www.hsph.harvard.edu/ecpe/8-healthcare-quality-improvement-tips/ 

Ho, J., & Burger, D. (2020, September). Improving medication safety practice at a Community Hospital: A focus on bar code medication administration scanning and pain reassessment. BMJ open quality. 

Retrieved February 15, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507888/ 

Cho, I., Lee, M., & Kim, Y. (2020). What are the main patient safety concerns of healthcare stakeholders: a mixed-method study of Web-based text. International journal of medical informatics140, 104162. https://doi.org/10.1016/j.ijmedinf.2020.104162

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