NURS 8302 Discussion Quality Improvement Initiative

Healthcare organizations are constantly engaging in performance improvement initiatives with the aim of improving the patients’ experiences and outcomes. Quality care delivery results in quick recovery to the patients as well as reduced medical costs because of the reduced hospital stay period. Quality improvement initiatives focus on measuring the patients’ outcomes and develop new strategies to address the existing gaps and improve the efficiency of the healthcare delivery processes (Joshi, Ransom, Nash, & Ransom, 2014). Various quality indicators are considered in the improved process, and they include reduced hospital readmissions, proper waste management and disposal, patients’ data management and reducing the turnaround time. Proper data management is an important quality indicator that many hospitals focus on currently. In as much as there are other quality indicators, data management has been prioritized in the hospital set-up and thus will be the main focus of analysis in the paper.

Quality Improvement Initiative

As mentioned, the present health care setting focuses on data management as its quality improvement initiative. This focus has occurred in cognizance of the essence of having proper data management system given the technological pervasion of the health care industry. Poor data management results in communication errors between the healthcare providers, and prolonged patients’ stay in the hospital due to data unavailability. Indeed, Clarke and Persaud (2011) have implied that the absence of proper data management structures have led to the existence of certain adverse events in health care. Therefore, improving the patients’ data management is essential in the realization of high quality delivery of health care services. Patients’ data are collected from the time they get to the outpatient department. Hence, this data should be made readily available for proper management of the patients until the time they leave the hospital. Also, such records should be kept for easy monitoring and follow-up of patients with chronic diseases.

Furthermore, proper data management means that healthcare providers in a hospital institution. The senior leader in the institution works to ensure that the patient’s flow is improved and enhance the coordination among the various healthcare providers as advised by Clarke and Persaud (2011). Proper data management helps in easy sharing of vital information among healthcare providers and thus reducing patients’ movements within the hospital may help reduce their predisposition to hospital-acquired infections.

Adverse Events

Furthermore, incidences of medical errors such as medication errors have increased. According to M. Ransom, S. Ransom, and Nash (2014), these incidences are majorly caused by wrong data entry or poor management and storage of the patients’ data among other factors. Therefore, addressing the problems caused by poor data management would facilitate the realization of quality care delivery and improve patients’ experiences significantly. Having considered all these factors, the institution leaders were convinced enough to prioritize this quality improvement initiative. Unpredictable discharge and prolonged delays in the discharge process are major roadblocks to the realization of efficient patient flow. Improving the discharge process can only be achieved first by ensuring the patients’ data can be easily retrieved, and billing is done promptly. Furthermore, the nurses can easily monitor their patients and determine whether they are ready for discharge through an efficient health information management system.

Moreover, the management ensures the existence of an organizational culture that has familiarity with the tools of data management quality improvement. These ensures that the responsible hospital staff understand their roles properly with regards to the collection and dissemination of collected data for purposes of improving the quality of care. Further, an implementation of a systematic data collection methodology ensued when an adverse health event occurred at the setting. The uniformity evidenced in the categories of data collected by the hospital ensures that accuracy is maintained and validity of the data is guaranteed in consistence with M. Ransom, S. Ransom, and Nash (2014) assertion. By doing this, the hospital has proactively implemented internal mechanisms to address the issue of adverse events hence improvement of quality.

Scholarly Article

Adverse events have received significant coverage in both scholarly and public press spaces. Medication errors forms one of the most highly discussed issues as regards this phenomenon. Keers, Williams, Cooke, and Ashcroft (2013) conducted a scholarly analysis of medication errors and the attendant underlying system factors that have led to the existence of such errors. The article highlighted issues such as lapses and slips, deliberate violations, and knowledge-based mistakes as the main culprits in the existence of these errors. Moreover, inadequate written communication, high perceived workload, pharmacy dispensing errors also contribute to medication errors (Keers et al., 2013). Indeed, when an evaluation was conducted in my present health care setting concerning the causes of medication errors, some consistency with the factors outlined by the above authors occurred. The hospital discovered that staffing shortage leading to increased workload as well as pharmacy dispensing errors majorly contributed to these errors at the hospital.

Conclusion

Therefore, hospitals constantly grapple with adverse events issues. As a result, they adopt multifarious quality improvement initiatives to ensure high-quality delivery of services to patients. These undertakings lead to mitigation of these adverse events thus resulting in improved perception of facilities by patients. Scholars as well as public press have also addressed the issues of medical adverse events. The exposure offered by these media permit health care settings to constantly work towards eliminating them hence improving the quality of their services.

Your organization has recently discovered there have been too frequent errors in medication distribution. After launching an investigation in the matter, and discovering the reasons for the errors, your organization is ready to launch a quality improvement initiative. What might this initiative entail? What is included, and how will it assist in eliminating these errors?

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The purpose of the Quality Improvement (QI) Plan is to provide a formal ongoing process by which the organization and stakeholders utilize objective measures to monitor and evaluate the quality of services—both clinical and operational—provided to the patients. The QI Plan, which often addresses general medical behavioral health and oral healthcare and services, defines and facilitates a systematic approach to identify and pursue opportunities to improve services and resolve identified problems (Health Resources and Services Administration, 2011).

For this Discussion, review the Learning Resources. Then, reflect on how adverse events impact your organization and/or nursing practice. Consider the use of quality improvement initiative in the error rate, using scholarly articles to analyze.

_{Reference:

U. S. Department of Health and Human Services Health Resources and Services Administration. (2011). Developing and implementing a QI plan. https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/developingqiplan.pdf}

To Prepare:

Review the Learning Resources for this week, and reflect on the types of quality improvement (QI) initiatives that might be mostrelevant to your healthcare organization or nursing practice.
Select a QI initiative, you are most familiar with, that has received support from your senior leaders in your healthcare organization or nursing practice.
Consider how adverse events are handled in your healthcare organization or nursing practice. Reflect on how this may impact the public—as well as the internal—perspective on healthcare quality.
Find a scholarly article or one from the public press, published within the last 5 years, that recounts a serious error. Reflect on this error, and consider how it may relate to your healthcare organization or nursing practice.

By Day 3 of Week 6

Post a brief explanation of the QI initiative you selected, and why. Be specific. Explain how adverse events are handled in your healthcare organization or nursing practice, including an explanation of how this may impact both public and internal perspectives on healthcare quality. Then, briefly describe the error rate from the article you selected, and explain how this may relate to your healthcare organization or nursing practice. Be specific and provide examples.

By Day 6 of Week 6

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 offering an alternative interpretation of the error rate described by your colleague.

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!

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Week 6 Discussion Rubric

Post by Day 3 of Week 6 and Respond by Day 6 of Week 6

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Week 6 Discussion

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Quality improvement aims to understand the complex healthcare environment, apply a systematic approach, and design, test, and implement modifications using real-time measurement to improve safety, effectiveness, and care experience (Jones et al., 2019). It is an opportunity to address concerns about how care processes and systems are delivered. Quality improvement (QI) is a team activity that collaborates with other disciplines, including patients, to improve care processes (Jones et al., 2019). Done well, QI is a valuable process, enabling clinicians to deliver actual change to benefit themselves, their organizations, and their patients (Jones et al., 2019). This week’s discussion will focus on a quality improvement initiative, how adverse events are handled at my organization and impact public and internal perspectives on healthcare quality, and review a scholarly article where a serious error occurred and how this may relate to my organization.

QI Initiative Selected

I have been the co-chair of the Fall Prevention Quality Improvement Team for the network for several years. My co-chair and I have led many fall prevention initiatives, including Dr. Patricia Quigley and Dr. Amy Hester’s (Hester Davis Scale for fall risk assessment) on-site visits to educate the network on fall prevention. I am fortunate to have met both fall prevention experts.

The QI initiative selected is a Fall Prevention Agreement to reduce fall events. I chose this QI initiative because I am passionate about fall prevention. This QI initiative was initially a Nurse Residency evidence-based project in 2018 and then expanded network-wide. Most patients are unaware of their fall risk. The Fall Prevention Agreement provides a standard format for communication between nursing staff and the patient, increasing patients’ knowledge of their fall risk factors. It is a two-sided agreement with specific fall prevention interventions and things the patient can do to prevent a fall. The nurse reviews the Fall Prevention Agreement on admission, and then after review, the patient and nurse sign/date the agreement. It is scanned into the electronic health record, being a permanent part of the electronic health record.

Adverse Events in My Healthcare Organizations

My organization supports a just culture where colleagues are encouraged to do the right thing. It is a culture that promotes reporting and open discussion when adverse events occur. The aim is to avoid similar adverse events. Frontline staff is included in root cause analysis meetings to learn and discuss adverse events, identify opportunities for improvement, and implement action items to improve safety and quality of care. Research has shown that in units where feedback about adverse events is routinely given, staff have positive views on patient safety and are more apt to report adverse events (Liukka et al., 2017).

Leadership and the organizational structure play a vital role in developing and implementing QI plans (U.S. Department of Health and Human Services Health Resources and Services Administration, 2011). In my organization, senior leadership acknowledges the importance of discussing adverse events and encouraging frontline staff involvement in decision-making and policy development, positively impacting public and internal healthcare quality perspectives. I believe it is crucial to include frontline staff to gain a firsthand perspective on potential solutions. When firsthand perspectives are not discussed in the aspects of QI planning, the QI initiative may fail.

Published Scholarly Article that Recounts a Serious Error

Medication reconciliation is an essential component of patient safety. The scholarly article I selected refers to a 71-year old female who accidentally received Navane, an antipsychotic medication, instead of her anti-hypertensive drug Norvasc for three months (da Silva & Krishnamurthy, 2016). She sustained physical and psychological harm, including ambulatory dysfunction, tremors, mood swings, and personality changes (da Silva & Krishnamurthy, 2016). Unfortunately, multiple healthcare providers overlooked her symptoms (da Silva & Krishnamurthy, 2016). Errors occurred at numerous levels, including prescribing, pharmacy dispensation, hospitalization, and outpatient follow-up. (da Silva & Krishnamurthy, 2016). The outpatient pharmacy accidentally dispensed Navan instead of Norvasc (da Silva & Krishnamurthy, 2016). Navane/Norvasc is one of many sound-alikes, look-alike drug names (da Silva & Krishnamurthy, 2016). “It is believed that preventable medication errors impact more than seven million patients and cost almost $21 billion annually across all care settings” (da Silva & Krishnamurthy, 2016, p. 1).

Related to My Healthcare Organization

Unfortunately, this alarming medication error can occur in any healthcare organization. At my organization, medications added to the formulary are evaluated for a look-alike, sound-alike potential with other products, and then appropriate safeguard education to staff. Look-alike and sound-alike medications are stored in red bins and different locations in the pharmacy. The regularly updated list appears in the policy manual and the pharmacy website. When possible, the electronic medical record system will place a warning comment and tall man letterings such as DOPAmine and DOBUTamine. My organization has developed a series of procedures to identify look-alike and sound-alike medications to prevent medication errors from these mix-ups. Medication errors are low but still occur. By creating a culture of teamwork and communication, we learn from our mistakes and aim to decrease preventable medication errors.

References

da Silva, B. A., & Krishnamurthy, M. (2016). The alarming reality of medication error: A patient case and review of Pennsylvania and national data. Journal of Community Hospital Internal Medicine Perspectives, 6(4), 31758. https://doi.org/10.3402/jchimp.v6.31758

Jones, B., Vaux, E., & Olsson-Brown, A. (2019). How to get started in quality improvement. BMJ, k5408. https://doi.org/10.1136/bmj.k5437

Liukka, M., Hupli, M., & Turunen, H. (2017). How transformational leadership appears in action with adverse events? A study for finnish nurse manager. Journal of Nursing Management, 26(6), 639–646. https://doi.org/10.1111/jonm.12592

U.S. Department of Health and Human Services Health Resources and Services Administration. (2011). Developing and implementing a QI plan. Retrieved October 3, 2021, from https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/developingqiplan.p

Content

Name: NURS_8302_Week6_Discussion_Rubric

	Excellent 90–100	Good 80–89	Fair 70–79	Poor : 0–69
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.	Points Range: 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.	Points Range: 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.	Points Range: 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.	Points Range: 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	Points Range: 6 (6%) – 6 (6%) Written clearly and concisely. Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style.	Points Range: 5 (5%) – 5 (5%) Written concisely. May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style.	Points Range: 4 (4%) – 4 (4%) Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors.	Points Range: 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	Points Range: 9 (9%) – 10 (10%) Meets requirements for timely, full, and active participation. Posts main Discussion by due date.	Points Range: 8 (8%) – 8 (8%) Meets requirements for full participation. Posts main Discussion by due date.	Points Range: 7 (7%) – 7 (7%) Posts main Discussion by due date.	Points Range: 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.	Points Range: 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.	Points Range: 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting.	Points Range: 7 (7%) – 7 (7%) Response is on topic and may have some depth.	Points Range: 0 (0%) – 6 (6%) Response may not be on topic and lacks depth.
First Response: Writing	Points Range: 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.	Points Range: 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.	Points Range: 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.	Points Range: 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	Points Range: 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date.	Points Range: 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date.	Points Range: 3 (3%) – 3 (3%) Posts by due date.	Points Range: 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.	Points Range: 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.	Points Range: 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting.	Points Range: 7 (7%) – 7 (7%) Response is on topic and may have some depth.	Points Range: 0 (0%) – 6 (6%) Response may not be on topic and lacks depth.
Second Response: Writing	Points Range: 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.	Points Range: 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.	Points Range: 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.	Points Range: 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	Points Range: 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date.	Points Range: 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date.	Points Range: 3 (3%) – 3 (3%) Posts by due date.	Points Range: 0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date.
Total Points: 100

Excellent

90–100

Good

80–89

Fair

70–79

Poor

: 0–69

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.

Points Range: 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.

Points Range: 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.

Points Range: 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.

Points Range: 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

Points Range: 6 (6%) – 6 (6%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

Points Range: 5 (5%) – 5 (5%)

Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

Points Range: 4 (4%) – 4 (4%)

Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 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

Points Range: 9 (9%) – 10 (10%)

Meets requirements for timely, full, and active participation.

Posts main Discussion by due date.

Points Range: 8 (8%) – 8 (8%)

Meets requirements for full participation.

Posts main Discussion by due date.

Points Range: 7 (7%) – 7 (7%)

Posts main Discussion by due date.

Points Range: 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.

Points Range: 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.

Points Range: 8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

Points Range: 7 (7%) – 7 (7%)

Response is on topic and may have some depth.

Points Range: 0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.

First Response:
Writing

Points Range: 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.

Points Range: 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.

Points Range: 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.

Points Range: 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

Points Range: 5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

Points Range: 4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

Points Range: 3 (3%) – 3 (3%)

Posts by due date.

Points Range: 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.

Points Range: 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.

Points Range: 8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

Points Range: 7 (7%) – 7 (7%)

Response is on topic and may have some depth.

Points Range: 0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.

Second Response:
Writing

Points Range: 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.

Points Range: 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.

Points Range: 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.

Points Range: 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

Points Range: 5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

Points Range: 4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

Points Range: 3 (3%) – 3 (3%)

Posts by due date.

Points Range: 0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Total Points: 100