NURS 8302 Discussion 1 Week 1: Quality and Safety in Healthcare and Nursing Practice
Discussion 1: Quality and Safety in Healthcare and Nursing Practice (300 WORDS, 4 REFERENCES, DEADLINE: TUESDAY AT 4 PM)
How will you, as a future DNP-prepared nurse, keep patients safe? This is a multi-layered question with many different answers. Yet, it is important to note that as the nurse leader, quality and safety measures are at the forefront of how you deliver nursing practice.
Quality and safety measures are integral components in healthcare. According to Nash et al. (2019), “Around the end of the twentieth century and the start of the twenty-first, a number of reports presented strong evidence of widespread quality deficiencies and highlighted a need for substantial change to ensure high-quality care for all patients” (p. 5). Understanding the prominence of error, it is important to consider your role as a DNP-prepared nurse.
For this Discussion, take a moment to consider your experience with quality and safety in your nursing practice. Reflect on your experience and consider how your role may support quality and safety measures.
NURS 8302 Discussion 1 Week 1: Quality And Safety In Healthcare And Nursing Practice Reference:
Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press.
To Prepare:
- Review the Learning Resources for this week.
- Reflect on your experience with nursing practice, specifically as it relates to the function of quality and safety. For example, consider whether your current organization supports quality and safety. How might your role help to support these measures in your organization or nursing practice?
By Day 3 of Week 1
Post a brief description of any previous experience with quality and safety. Then, explain how your role as the DNP-prepared nurse represents a function of quality and safety for nursing practice and healthcare delivery. Be specific and provide examples.
By Day 5 of Week 1
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding upon your colleague’s post or suggesting an additional alternative perspective on quality and safety.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
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Week 1 Discussion 1 Rubric
Post by Day 3 of Week 1 and Respond by Day 5 of Week 1
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NURS 8302 Discussion 1 Week 1: Quality And Safety In Healthcare And Nursing Practice Rubric Detail
The promotion of safety and quality is important in the provision of nursing care. Safety and quality in healthcare enhances the realization of optimum health outcomes in patient care. Nurses and other healthcare providers utilize sources of evidence-based data and practice guidelines to ensure safety and quality in their care. They also adopt best leadership models that will drive consistency in the provision of excellent care to patients. Therefore, this paper explores the issue of surgical site infections, best practices for its prevention, proposed project to address it and its evaluation. It also explores an effective leadership model that can be adopted to address the problem.
Best Practices or Recommended Guidelines
The selected issue from the Institute for Healthcare Improvement (IHI) that is relevant to my organization is surgical site infections. Surgical site infections comprise a critical public health concern that causes significant mortality, morbidity and increased cost of care. Surgical site infections are preventable, with the adoption of evidence-based interventions. A number best practices and recommended guidelines have been developed for prevention of surgical site infections. One of them is the World Health Organization (WHO) Surgical Safety Checklist and Getting Started Kit. The kit was developed to improve the quality and safety of patients undergoing surgeries globally. The tool reinforces the accepted safety principles and enhances the quality of teamwork and communication between clinical teams involved in surgical procedures and care of patients requiring and after surgeries. The other guideline that can be adopted to prevent surgical site infections is the How-to-Guide by IHI. The tool provides guidelines for use in the prevention of surgical site infections, implementation of recommended strategies and measures for assessing improvements (IHI, n.d.). Sources of evidence-based data show that best practices exist for use in prevention of surgical site infections. They include the use of aseptic techniques, negative pressure wound therapy, surgical bundles of safety and quality improvement, perioperative antibiotic prophylaxis, and reducing the duration of surgical procedure reduces and minimizes the rate of surgical site infections in a hospital setting (Allegranzi et al., 2018; Balch et al., 2017; Cheng et al., 2017; Javed et al., 2019).
Financial Impact
Surgical site infections have adverse financial implications. The existing evidence shows that surgical site infections cost the US about $3.5 to $10 billion on an annual basis. Additional statistics shows that surgical site infections increase the costs of care for commercial payers to a range of $36249 to $144809 and $17551 to $102280 for Medicare users in the US. The increase in the cost of care is attributable to factors such as prolonged hospitalization; intensive care unit stays, increased rates of hospital readmission, lost productive days, and need for additional care in the community (Leaper et al., 2020). Surgical site infections also increase the need for re-operations, reduced quality of life for patients and increased risk of mortality. The intangible costs that patients incur due to the infections such as anxiety, pain, and delayed wound healing that can cause complications including bacteremia (Badia et al., 2017). Healthcare institutions also suffer from the problem due to increased costs of patient care and resource utilization in the promotion of the optimum health and wellbeing of the patients.
Implementing the Project
The Plan-Do-Study-Act model can be applied in implementing my project. The model can be used to facilitate accelerated improvement in project processes. The PDSA model informs the strategies utilized in the change initiative. It also guides the development of a team that would lead the implementation process. The components of the model such as planning enable the project managers to understand the needs of the organization and the implementers of the project and ways of addressing them. The effective use of the model enables the systematic implementation of change initiatives in a project. Through it, organizations benefit from the gradual and organization wide successful implementation of a project (Newcombe & Fry-Bowers, 2018). Therefore, the PDSA model is applicable to my project, as it will minimize the risk of resistance from the adopters and failure due to ineffective processes.
Project to Address the Problem
A project that I could implement to address the issue of surgical sites infection in the institution is antibiotic prophylaxis. The administration of antibiotic prior to surgery has been shown to reduce the risk and rate of surgical site infections. The type of surgery determines largely the prophylactic antibiotics that patients should receive (Balch et al., 2017). The development and implementation of an antibiotic prophylactic protocol for use in the organization may therefore reduce the vulnerability of post-surgical patients to surgical site infections.
The PDSA model can be applied in the implementation of the prophylactic antibiotic protocol to be used in the organization. Activities such as recruiting a team to implement the project will be undertaken in the planning stage. The team will develop the mission and vision of the project in facilitating the realization of the desired safety and quality goals in the organization. The team will also develop an aim statement that would guide the development of the strategies. They will determine the causes of the problem and alternative interventions that can be used to address the problem. The team will lead the implementation of the selected alternatives in the do phase. They will embrace interventions such as training the healthcare providers about the implementation of the protocol and guiding its use in practice. The team will also collect data related to the effectiveness of the adopted strategies and consistency of protocol use by the staffs in this phase (Newcombe & Fry-Bowers, 2018). The assessment data informs the improvement strategies utilized to ensure the successful and organization wide implementation of the project.
The team evaluates whether the data answers the aim statement in the study phase. They utilize the results obtained in the do phase to evaluate the effectiveness of the project in reducing surgical site infections and improvement strategies that are needed in the organization. The implementation of organization wide use of the protocol occurs in the act phase. The phase occurs if the team determines the protocol to be effective in addressing the critical safety and quality needs in the organization (Katowa-Mukwato et al., 2021). They also communicate the success of the project to the organizational stakeholders, including the nurses and physicians.
Quality Improvement Measures
Quality improvement measures provide insights into the effectiveness of a project in delivering its expected outcomes. Outcome and process measures will be used to track improvement in the project. Outcome measures will focus on the evaluation of whether the desired results of the project were achieved or not. Outcome measures reflect the effectiveness of the adopted strategies in project implementation. Some of the outcome measures that will be used to track improvement will include the rate of surgical site infections, average hospital stay an costs incurred by patients in the organization. Process measures will facilitate the tracking of the effectiveness of the strategies used to achieve the project outcomes. It will focus on the effectiveness of strategies such as training, coaching, mentoring, and institutional support in ensuring the success of the project. Tools such as interviews and surveys will be used to obtain provider insights into the effectiveness of the strategies that were used in the implementation of the project (Zywot et al., 2017). The consistency of use of the protocol by the healthcare providers will also be used as a way of tracking the effectiveness of the project.
Quality Improvement Tools
A flow chart will be used for analyzing and monitoring the effectiveness of the project in addressing the issue of surgical site infections in the organization. A flow chart will be desirable, as it will provide efficient tracking of the project activities. It will also facilitate the determination of effective and ineffective strategies in the implementation of the project. Through it, redundancies and duplication of processes and roles will be eliminated. A flow chart is also desirable, as it will facilitate effective ordering and organizing of the activities needed to achieve the desired project objectives.
Leadership Theory
The leadership theory that would be applied in the implementation of the project is servant leadership theory. Servant leadership theory is a model where leaders aim at serving and meeting the needs of those they lead. Leaders focus on creating a synergistic relationship with those they lead that than controlling relationship. The leaders recognize the need for the prioritization of the needs of those they lead in project implementation. As a result, they motivate them to play a proactive role in the different phases of project implementation such as assessment, planning, monitoring, and evaluation. Servant leaders also aim at promoting innovation. They encourage their followers to explore effective ways in which optimum outcomes in strategy implementation can be achieved (Best, 2020). They also empower their followers by encouraging their active participation in the project initiatives. Servant leaders also promote open communication between and among the followers. They recognize the importance of openness in communication in fostering trust and honesty among the project members (Neville et al., 2021). Therefore, I believe that servant leadership will facilitate the realization of optimum outcomes in the implementation of the protocol to reduce surgical site infections in the organization.
NURS 8302 Discussion 1 Week 1: Quality And Safety In Healthcare And Nursing Practice Conclusion
Overall, surgical site infections comprise a critical issue in healthcare organizations. Surgical site infections are attributable to organizational factors that can be controlled. The financial impacts of surgical site infections to patients and healthcare institutions are enormous. Protocols such as prophylactic administration of antibiotics are effective in preventing and minimizing surgical site infections. The PDSA model can be used in the implementation of a project aiming at the use of the protocol in the institution. The model guides systematic implementation of the project with a focus on minimizing resistance from the staffs. Servant leadership should therefore be applied to ensure the realization of the desired institutional outcomes in the prevention and minimizing of surgical site infections using the protocol.
NURS 8302 Discussion 1 Week 1: Quality And Safety In Healthcare And Nursing Practice References
Allegranzi, B., Aiken, A. M., Zeynep Kubilay, N., Nthumba, P., Barasa, J., Okumu, G., Mugarura, R., Elobu, A., Jombwe, J., Maimbo, M., Musowoya, J., Gayet-Ageron, A., & Berenholtz, S. M. (2018). A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: A multicentre, before–after, cohort study. The Lancet Infectious Diseases, 18(5), 507–515. https://doi.org/10.1016/S1473-3099(18)30107-5
Badia, J. M., Casey, A. L., Petrosillo, N., Hudson, P. M., Mitchell, S. A., & Crosby, C. (2017). Impact of surgical site infection on healthcare costs and patient outcomes: A systematic review in six European countries. Journal of Hospital Infection, 96(1), 1–15. https://doi.org/10.1016/j.jhin.2017.03.004
Balch, A., Wendelboe, A. M., Vesely, S. K., & Bratzler, D. W. (2017). Antibiotic prophylaxis for surgical site infections as a risk factor for infection with Clostridium difficile. PLOS ONE, 12(6), e0179117. https://doi.org/10.1371/journal.pone.0179117
Best, C. (2020). Is there a place for servant leadership in nursing? Practice Nursing, 31(3), 128–132. https://doi.org/10.12968/pnur.2020.31.3.128
Cheng, H., Chen, B. P.-H., Soleas, I. M., Ferko, N. C., Cameron, C. G., & Hinoul, P. (2017). Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surgical Infections, 18(6), 722–735. https://doi.org/10.1089/sur.2017.089
IHI. (n.d.). Surgical Site Infection | IHI – Institute for Healthcare Improvement. Retrieved October 23, 2021, from http://www.ihi.org:80/Topics/SSI/Pages/default.aspx
Javed, A. A., Teinor, J., Wright, M., Ding, D., Burkhart, R. A., Hundt, J., Cameron, J. L., Makary, M. A., He, J., Eckhauser, F. E., Wolfgang, C. L., & Weiss, M. J. (2019). Negative Pressure Wound Therapy for Surgical-site Infections: A Randomized Trial. Annals of Surgery, 269(6), 1034–1040. https://doi.org/10.1097/SLA.0000000000003056
Katowa-Mukwato, P., Mwiinga-Kalusopa, V., Chitundu, K., Kanyanta, M., Chanda, D., Mbewe Mwelwa, M., Ruth, W., Mundia, P., & Carrier, J. (2021). Implementing Evidence Based Practice nursing using the PDSA model: Process, lessons and implications. International Journal of Africa Nursing Sciences, 14, 100261. https://doi.org/10.1016/j.ijans.2020.100261
Leaper, D. J., Holy, C. E., Spencer, M., Chitnis, A., Hogan, A., Wright, G. W. J., Po-Han Chen, B., & Edmiston, C. E. J. (2020). Assessment of the Risk and Economic Burden of Surgical Site Infection Following Colorectal Surgery Using a US Longitudinal Database: Is There a Role for Innovative Antimicrobial Wound Closure Technology to Reduce the Risk of Infection? Diseases of the Colon & Rectum, 63(12), 1628–1638. https://doi.org/10.1097/DCR.0000000000001799
Neville, K., Conway, K., Maglione, J., Connolly, K. A., Foley, M., & Re, S. (2021). Understanding Servant Leadership in Nursing: A Concept Analysis. International Journal for Human Caring. https://doi.org/10.20467/HumanCaring-D-20-00022
Newcombe, J., & Fry-Bowers, E. (2018). Improving Postoperative Neonatal Nutritional Practices in an Intensive Care Unit Using the PDSA Cycle. Journal of Pediatric Health Care, 32(5), 426–434. https://doi.org/10.1016/j.pedhc.2018.03.004
Zywot, A., Lau, C. S. M., Stephen Fletcher, H., & Paul, S. (2017). Bundles Prevent Surgical Site Infections After Colorectal Surgery: Meta-analysis and Systematic Review. Journal of Gastrointestinal Surgery, 21(11), 1915–1930. https://doi.org/10.1007/s11605-017-3465-3
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NURS 8302 Discussion 1 Week 1: Quality And Safety In Healthcare And Nursing Practice Rubric
| Excellent
90–100 |
Good
80–89 |
Fair
70–79 |
Poor
: 0–69 |
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| Main Posting:
Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. |
40 (40%) – 44 (44%)
Thoroughly responds to the Discussion question(s). Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources. |
35 (35%) – 39 (39%)
Responds to most of the Discussion question(s). Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of the post has exceptional depth and breadth. Supported by at least three credible references. |
31 (31%) – 34 (34%)
Responds to some of the Discussion question(s). One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Cited with fewer than two credible references. |
0 (0%) – 30 (30%)
Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references. |
||
| Main Posting:
Writing |
6 (6%) – 6 (6%)
Written clearly and concisely. Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style. |
5 (5%) – 5 (5%)
Written concisely. May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style. |
4 (4%) – 4 (4%)
Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors. |
0 (0%) – 3 (3%)
Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. |
||
| Main Posting:
Timely and full participation |
9 (9%) – 10 (10%)
Meets requirements for timely, full, and active participation. Posts main Discussion by due date. |
8 (8%) – 8 (8%)
Meets requirements for full participation. Posts main Discussion by due date. |
7 (7%) – 7 (7%)
Posts main Discussion by due date. |
0 (0%) – 6 (6%)
Does not meet requirements for full participation. Does not post main Discussion by due date. |
||
| First Response:
Post to colleague’s main post that is reflective and justified with credible sources. |
9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. |
8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting. |
7 (7%) – 7 (7%)
Response is on topic and may have some depth. |
0 (0%) – 6 (6%)
Response may not be on topic and lacks depth. |
||
| First Response: Writing |
6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. |
5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. |
4 (4%) – 4 (4%)
Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. |
0 (0%) – 3 (3%)
Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. |
||
| First Response: Timely and full participation |
5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation. Posts by due date. |
4 (4%) – 4 (4%)
Meets requirements for full participation. Posts by due date. |
3 (3%) – 3 (3%)
Posts by due date. |
0 (0%) – 2 (2%)
Does not meet requirements for full participation. Does not post by due date. |
||
| Second Response: Post to colleague’s main post that is reflective and justified with credible sources. |
9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. |
8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting. |
7 (7%) – 7 (7%)
Response is on topic and may have some depth. |
0 (0%) – 6 (6%)
Response may not be on topic and lacks depth. |
||
| Second Response: Writing |
6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. |
5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. |
4 (4%) – 4 (4%)
Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. |
0 (0%) – 3 (3%)
Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. |
||
| Second Response: Timely and full participation |
5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation. Posts by due date. |
4 (4%) – 4 (4%)
Meets requirements for full participation. Posts by due date. |
3 (3%) – 3 (3%)
Posts by due date. |
0 (0%) – 2 (2%)
Does not meet requirements for full participation. Does not post by due date. |
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| Total Points: 100 | ||||||