Enhancing Quality and Safety

Posted on: 11th May 2023

Question

For this assessment, you will develop a 3-5 page paper that examines a safety quality issue pertaining to medication administration in a health care setting. You will analyze the issue and examine potential evidence-based and best-practice solutions from the literature as well as the role of nurses and other stakeholders in addressing the issue.

Health care organizations and professionals strive to create safe environments for patients; however, due to the complexity of the health care system, maintaining safety can be a challenge. Since nurses comprise the largest group of health care professionals, a great deal of responsibility falls in the hands of practicing nurses. Quality improvement (QI) measures and safety improvement plans are effective interventions to reduce medical errors and sentinel events such as medication errors, falls, infections, and deaths. A 2000 Institute of Medicine (IOM) report indicated that almost one million people are harmed annually in the United States, (Kohn et al., 2000) and 210,000–440,000 die as a result of medical errors (Allen, 2013).

The role of the baccalaureate nurse includes identifying and explaining specific patient risk factors, incorporating evidence-based solutions to improving patient safety and coordinating care. A solid foundation of knowledge and understanding of safety organizations such as Quality and Safety Education for Nurses (QSEN), the Institute of Medicine (IOM), and The Joint Commission and its National Patient Safety Goals (NPSGs) program is vital to practicing nurses with regard to providing and promoting safe and effective patient care.

You are encouraged to complete the Identifying Safety Risks and Solutions activity. This activity offers an opportunity to review a case study and practice identifying safety risks and possible solutions. We have found that learners who complete course activities and review resources are more successful with first submissions. Completing course activities is also a way to demonstrate course engagement.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 1: Analyze the elements of a successful quality improvement initiative.

Explain evidence-based and best-practice solutions to improve patient safety focusing on medication administration and reducing costs.

Competency 2: Analyze factors that lead to patient safety risks.

Explain factors leading to a specific patient-safety risk focusing on medication administration.

Competency 4: Explain the nurse’s role in coordinating care to enhance quality and reduce costs.

Explain how nurses can help coordinate care to increase patient safety with medication administration and reduce costs.

Identify stakeholders with whom nurses would need to coordinate to drive quality and safety enhancements with medication administration.

Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.

Organize content so ideas flow logically with smooth transitions; contains few errors in grammar or punctuation, word choice, and spelling.

Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.

References

Allen, M. (2013). How many die from medical mistakes in U.S. hospitals? Retrieved from https://www.npr.org/sections/health-shots/2013/09/20/224507654/how-many-die-from-medical-mistakes-in-u-s-hospitals.

Kohn, L. T., Corrigan, J., & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for implementing quality improvement (QI) and patient safety measures in health care settings. Effective quality improvement measures result in systemic and organizational changes, ultimately leading to the development of a patient safety culture.

Scenario

Consider a previous experience or hypothetical situation pertaining to medication errors, and consider how the error could have been prevented or alleviated with the use of evidence-based guidelines.

Choose a specific condition of interest surrounding a medication administration safety risk and incorporate evidence-based strategies to support communication and ensure safe and effective care.

For this assessment:

Analyze a current issue or experience in clinical practice surrounding a medication administration safety risk and identify a quality improvement (QI) initiative in the health care setting.

Instructions

The purpose of this assessment is to better understand the role of the baccalaureate-prepared nurse in enhancing quality improvement (QI) measures that address a medication administration safety risk. This will be within the specific context of patient safety risks at a health care setting of your choice. You will do this by exploring the professional guidelines and best practices for improving and maintaining patient safety in health care settings from organizations such as QSEN and the IOM. Looking through the lens of these professional best practices to examine the current policies and procedures currently in place at your chosen organization and the impact on safety measures for patients surrounding medication administration, you will consider the role of the nurse in driving quality and safety improvements. You will identify stakeholders in QI improvement and safety measures as well as consider evidence-based strategies to enhance quality of care and promote medication administration safety in the context of your chosen health care setting.

Be sure that your plan addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so that you know what is needed for a distinguished score.

Explain factors leading to a specific patient-safety risk focusing on medication administration.

Explain evidence-based and best-practice solutions to improve patient safety focusing on medication administration and reducing costs.

Explain how nurses can help coordinate care to increase patient safety with medication administration and reduce costs.

Identify stakeholders with whom nurses would coordinate to drive safety enhancements with medication administration.

Communicate using writing that is clear, logical, and professional, with correct grammar and spelling, using current APA style.

Additional Requirements

Length of submission: 3–5 pages, plus title and reference pages.

Number of references: Cite a minimum of 4 sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.

APA formatting: References and citations are formatted according to current APA style.

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Solution

Enhancing Quality and Safety

Most medication administration errors lead to death in outpatient and inpatient settings. In hospitals, there are many risks that patients face. Some of these risks can cause death, while others may lead to injuries. These injuries often happen because of medication administration errors, like prescribing the wrong drug or prescribing the wrong drug to the wrong patient. According to different studies, it has been found that the most common medication errors are nurses prescribing the wrong medicine to patients (Nkurunziza et al., 2019). Many people die every year because of the wrong prescription of drugs. This happens when doctors give patients the wrong medicine or the wrong dose. Many things can cause this, including using medical abbreviations and poor communication in health facilities. Because patients are at risk of dying or getting injured because of mistakes, nurses and other people who work in health facilities need to develop a system to reduce the number of times patients are given the wrong medication. 

Nurses in a healthcare facility are responsible for ensuring that each patient gets the right medication. This can help reduce the risk of something going wrong, like a wrong medical prescription. Nurses can take various precautions measures, including giving them the reason for being on medication and educating them on their medication. For example, nurses can educate patients about their medications. This will help reduce the chances of medication errors because patients will identify their medications and whether they are meant for their current condition (van der Veen et al., 2017). This means that if patients are educated about contraindications in prescriptions, they will be able to identify any drugs that could harm them and refuse to take them. Additionally, using technology in prescription drug administration can help reduce medication errors during patient treatment. Using Barcode medication Administration technology can help nurses avoid giving patients the wrong dosage. This is because the technology can be used to confirm that the prescribed drug is right for the patient. So health facilities need to implement technologies like this, as they will likely improve patient safety and reduce risks associated with medication errors. 

Nurses play an important role in ensuring that patients are safe and receive affordable healthcare services. One way they do this is by managing medication costs. Although various factors can lead to nurses making medication administration errors, like prescribing the wrong drugs (Alemu, Belachew & Yimam, 2017). Nurses need to identify ways to improve their services to reduce the risk of making mistakes that can be dangerous for patients. For example, nurses have a lot of say in what medications patients should take. They might advocate for some medications or go against other medications. Nurses who push for their facilities to offer unnecessary medications help manage the cost of medications for patients. This is important as it makes healthcare services accessible and affordable to patients. To ensure that patients can afford their medication, medication administration must remain affordable. This will maintain a high quality of treatment service within the facility (Farzi et al., 2017). Making sure nurses offer quality medication and services in a hospital is important. The nurses need to provide good service, so patients don't get hurt. This means that nurses need to be careful when giving out medication because if they're not careful, it could lead to serious problems for the patients, like death or getting injured. 

Nurses can work with different people at the healthcare facility to ensure that patients are safe during treatment. This includes pharmacists, physicians, and patients themselves. By working together, nurses can improve service delivery at their health centers, hopefully encouraging more people to visit (Farzi et al., 2017). For instance, patients are the most important people in the treatment process. Nurses need to listen to them and take their opinions into account when it comes to their care. That will help reduce the risk of making mistakes when giving medication. One way to help reduce medication administration errors is good communication between physicians and nurses. They need to work together well to provide the best care for patients. Pharmacists are also important, as they play a key role in patient safety by ensuring that the correct medications are prescribed. 

 In conclusion, medication errors cause injuries and death to patients within the health facility. Nurses and other stakeholders can reduce the risks patients face within the facility. For instance, nurses sometimes give the wrong prescriptions to patients, leading to their death. To ensure this doesn't happen, nurses and other stakeholders need to work together to ensure patients are given the best possible healthcare. This includes making sure nurses are careful when giving out medication and have good communication with other people at the healthcare facility. Patients also need to be active in their treatment to help identify risks associated with their care. By working together, nurses, pharmacists, physicians, and patients can all make sure that patients are safe and receive the best possible care. 

References

Alemu, W., Belachew, T., & Yimam, I. (2017). Medication administration errors and contributing factors: A cross-sectional study in two public hospitals in Southern Ethiopia. International journal of Africa nursing sciences, 7, 68-74.

Farzi, S., Irajpour, A., Saghaei, M., & Ravaghi, H. (2017). Causes of medication errors in intensive care units from the perspective of healthcare professionals. Journal of research in pharmacy practice, 6(3), 158.

Nkurunziza, A., Chironda, G., Mukeshimana, M., Uwamahoro, M. C., Umwangange, M. L., & Ngendahayo, F. (2019). Factors contributing to medication administration errors and barriers to self-reporting among nurses: a literature review. Rwanda Journal of Medicine and Health Sciences, 2(3), 294-303. https://www.ajol.info/index.php/rjmhs/article/view/192883

van der Veen, W., van den Bemt, P. M., Bijlsma, M., de Gier, H. J., & Taxis, K. (2017). Association between workarounds and medication administration errors in bar code-assisted medication administration: protocol of a Multicenter Study. JMIR research protocols, 6(4), e7060. https://www.researchprotocols.org/2017/4/e74/

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