FOUNDATIONS OF QUALITY AND PATIENT SAFETY IN HEALTHCARE NURS 8302
FOUNDATIONS OF QUALITY AND PATIENT SAFETY IN HEALTHCARE NURS 8302
FOUNDATIONS OF QUALITY AND PATIENT SAFETY IN HEALTHCARE NURS 8302
Experience with Quality and Safety
Quality and safety are the driving force behind delivering and promoting optimal care (Stalter & Mota, 2018). My primary role as a clinical nurse is to provide high-quality, patient-centered care using evidence-based practice. Before giving any care or medication dispensing, I include EBP into the routine. In my current role, I noticed that my colleagues rely on post-education, and I feel that approach is integrated at the wrong time, which is usually after an incident or error has occurred. I strongly believe in pre-education and promoting evidence-based practice in nursing.
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I work on a 23-bed Med-Surg unit, and Friday mornings are the busiest surgical days. On this morning, a nurse administered a patient scheduled for Coronary Artery Bypass Graft (CABG) 20 units of Aspart and 15 units of Regular for a blood sugar of 206. Unfortunately, the patient had been NPO after midnight before the day of surgery. In the meantime, as we continued to make rounds and administer morning medications on the unit, the nurse received a call from the telemetry unit that the patient heart rhythm converted from normal sinus rhythm to ventricular tachycardia. The staff quickly went to the bedside and noted the patient to be diaphoretic, lethargic with a heart rate sustaining in the 130-150’s.
Immediately we had to call the rapid response team for further assistance. After the team arrived and was given a full report on the patient, the team administered IV antiarrhythmic medication to aid with the heart rate and a bolus of IV fluids for the blood pressure. Then, of course, the surgery was postponed, and the patient was transported to the ICU for closer observation. At shift change, the nurses had to report on what happened and how the patient received such a high insulin dose. Any high-alert medications must have two verifiers; only one nurse verified and administered the drug, which led to the error above. After further investigation, it was a computer error because it did not prompt the alert box for an additional signer. In addition, the nurse who administered the medication was new to the unit. I’m not making any excuses; however, the nurse should have verified the insulin order with the charge nurse or the ordering provider. Also, the ordering provider should have discontinued the order before surgery, which could have prevented the error. Therefore, thorough education and the implementation of evidence-based practice are imperative in nursing.
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Role as a DNP-Prepared Nurse
As a DNP-Prepared nurse, I intend to integrate evidence-based practice by developing our organizational culture that supports best practice and promotes opportunities for staff to enhance their clinical skills and knowledge. With the healthcare system being so complex, as a DNP-prepared nurse, promoting a healthy work environment is an effective solution to promoting quality improvement and being proactive in preventing errors or glitches before they occur (Abdul, Jarrar & Don, 2015). In addition, I would advocate for the implementation of evidence-based practice throughout the nursing unit and organization by educating nurses on skills, such as critical appraisal and translation of research findings into practice (Tu & Wang, 2011). Furthermore, in my role as a DNP-prepared nurse, I can use error prevention strategies by continuously monitoring outcomes and completing root cause analysis when errors occur, including the input from clinical staff and the leadership team.
References:
Abdul, R.H., Jarrar, M., & Don, M.S. (2015). Nurse level of education, quality of care and
patient safety in the medical and surgical wards in Malaysian private hospitals: A cross-
sectional study. Global Journal of Health Sciences.7(6):331-337. doi: 10.5539/gjhs.v7n6p33.
Stalter, A., & Mota, A. (2018). Using systems thinking to envision quality and safety
in healthcare, Nursing Management. Volume 49(2): doi:
10.1097/01.NUMA.0000529925.66375.d0.
Tu, Y.C., & Wang, R.H. (2011). High-quality nursing health care environment: The patient
safety perspective. Hu Li Za Zhi 58(3): 93-8. https://pubmed.ncbi.nlm.nih.gov/21678259.
In the previous assignment, I discussed client M.N, a 46-year-old African American male diagnosed with Type 2 Diabetes. Quality and safety are key aspects of diabetes care, which significantly determine patient outcomes. Cost is a major barrier in accessing health services and also determine patient outcomes. This essay aims to discuss the effect of Type 2 Diabetes on the quality of care, patient safety, and costs to the system and individual.
How Type 2 Diabetes Impacts the Quality of Care, Patient Safety, and Costs to the System and Individual
Type 2 Diabetes significantly impacts the quality of care provided to patients since health providers must provide aggressive and top-notch care to prevent the development of diabetes-related complications. Furthermore, health providers have to be alert to identify symptoms of low or very high blood glucose in diabetic patients (Nikitara et al., 2019). There has been a growing demand to enhance the quality of care for diabetes to more comprehensive health care that addresses the physical, social, and emotional challenges attributed to the condition (Nikitara et al., 2019). Health professionals are recommended to promote patient participation in decision-making regarding their care.
A report by the American Diabetes Association (ADA) reveals an estimated overall diabetes cost of $327 billion in 2017, with $237 billion used in direct medical costs and $90 billion in reduced productivity. The largest components of diabetes costs include hospital inpatient care and prescription treatments to treat complications, which account for 30% of the total medical cost each (ADA, 2018). Other components include antidiabetic agents and diabetes supplies, which account for 15%, and physician office visits at 13%. Diabetic patients incur an average medical cost of $16,752 annually, of which approximately $9,601 is used in diabetes care (ADA, 2018). On average, diabetic patients have medical costs roughly 2.3 times higher than what medical costs would be in the absence of diabetes.
How State Board Nursing Practice Standards and Governmental Policies Can Affect Type 2 Diabetes Impact on the Quality of Care, Patient Safety, and Costs to the System and Individual
State board nursing practice standards dictate how nursing care is provided and the quality of care for diabetic patients. The standards guide nurses to provide standard care to patients regardless of the healthcare setting (ADA, 2016). Consequently, nursing practice standards can positively impact the quality of diabetes care by guiding nurses in assessing and managing patients to provide the best quality care possible. Nursing practice standards also provide the minimum standards that nurses should meet when providing patient care to avoid complications and promote patient safety (ADA, 2016). Besides, they guide nurses on assessing for complications, evaluating the effectiveness of care, and providing patient education on preventing complications.
The standards guide nurses on how to provide quality care that will promote reduced complications, hospital stays and readmission rates and increase patient outcomes, thus reducing patient and hospital operational costs. Nursing standards direct nurses on the actions to take on each step of management to avoid unnecessary procedures, investigations, or treatments, thus reducing patient and operational costs (Nikitara et al., 2019). They direct the evaluation of the overall care given to patients for nurses to evaluate whether the care was cost-effective and, if not, how it can be improved to make it more efficient.
Government policies can significantly affect diabetes’ impact on the quality of care, patient safety, and costs to the system and individual. Policy actions can improve the availability and quality of care for diabetes and support persons to make healthier choices. According to Timpel et al. (2019), government policies can help eliminate two major health system obstacles to successful type 2 diabetes care and management: financial barriers for patients and limited access to health services and medication. Government policies can address health system factors to promote effective type 2 diabetes care and management (Timpel et al., 2019). These factors include the utilization of innovative care models, increased pharmacists’ inclusion in care delivery, and education programs facilitated by healthcare professionals.
Improving patient safety practices can support health care delivery systems and enhance health sector performance. Government policies can direct the adoption of strategies by health systems to promote quality improvement in the care of diabetic patients. According to El-Jardalim & Fadlallah (2017), government policies can introduce sets of standardized and applicable quality indicators for performance measurement and benchmark. Besides, they can direct the establishment of incentive systems that connect contractual agreements, accreditation, regulations, and performance indicators to improve patient care quality and safety (El-Jardalim & Fadlallah, 2017). Lastly, government policies can help establish a culture of continuous quality improvement in the health systems and support professional training in quality improvement and patient safety.
The cost of diabetes care, particularly medication, is a critical factor, especially for elderly patients. Government policy strategies can impact patient costs by reducing or eliminating out-of-pocket costs for diabetes medication and self-management supplies (Timpel et al., 2019). Furthermore, policies can direct more resources to diabetes preventive services since disease prevention promotes healthcare efficiency and cost-savings (Timpel et al., 2019). To the health system, government policies can reduce or eliminate taxes on diabetes medications and diagnostic supplies to make medications more affordable for patients and reduce the hospital’s operational costs.
Strategies to Improve the Quality of Care, Enhance Patient Safety, and Reduce Costs to the System and Individual
The priority of all health systems caring for patients with diabetes should be to provide high-quality care. The quality of care for diabetic patients can be improved by determining care interventions through evidence-based guidelines to promote the best possible outcomes (ADA, 2016). Nurses and physicians can ensure that the interventions selected in the care of diabetic patients are based on evidence-based research that has proved to increase patient outcomes and safety. Besides, hospitals can expand healthcare teams’ functions to carry out more intensive diabetes management strategies to enhance the quality of care and patient outcomes (ADA, 2016). By expanding the team’s role, health providers will be able to take immediate action without having to follow a protocol.
Quality of care can also be enhanced by providers increasing the processes of care for diabetic patients. This includes periodic testing of hemoglobin A1C, urinary albumin, and lipids levels (ADA, 2016). Providers can ensure that patients have a periodic examination of the retina and feet as per the ADA guidelines for early detection and management of eye and foot complications. Patient education resources and formal case management can be used to influence providers to enhance processes of care.
Patient safety can be enhanced by the need for adequate resources by hospitals adhering to the recommended nurse-patient ratios so that nurses can have sufficient time to assess clinical problems and potential complications. Increasing nursing staffing will also prevent medication errors and incidences of missed nursing care, which compromise patient safety (ADA, 2016). Embracing technology in the care of diabetic patients can improve safety by reducing medical errors (Dhatariya et al., 2020). For instance, hospitals can use network glucose monitoring, enabling providers to focus on patients who have severe or recurrent hypoglycemia and hyperglycemia and enable providers to target limited resources appropriately. Health costs associated with Diabetes care can be reduced by eliminating financial barriers and reducing patient out-of-pocket costs for eye exams, self-monitoring of blood glucose, diabetes education, and medications.
Conclusion
Diabetes impacts the quality of care since it is associated with never-ending demands such as daily monitoring blood glucose, nutrition counseling, creating exercise programs, and monthly or bimonthly assessment and review of patients’ treatment plans. Associated safety concerns include the risk of hypoglycemia and hyperglycemia, hospital-acquired foot ulcers, medication errors, and mortality. Diabetes is also associated with high inpatient care costs, purchase of medications, antidiabetic agents and diabetes, and physician office visits. The quality of diabetic care can be enhanced by using evidence-based guidelines, increasing processes of care, and expanding the functions of health teams. Patient safety can be enhanced by increasing staffing ratio and using technology, while costs can be reduced by eliminating financial barriers and reducing out-of-pocket costs.
References
American Diabetes Association (2018). Economic Costs of Diabetes in the US in 2017. Diabetes care, 41, 917. https://doi.org/10.2337/dci18-0007
American Diabetes Association. (2016). Standards of medical care in Diabetes-2017, Classification, and Diagnosis of Diabetes. https://doi.org/10.2337/dc16-S004
Dhatariya, K., Mustafa, O. G., & Rayman, G. (2020). Safe care for people with diabetes in the hospital. Clinical medicine (London, England), 20(1), 21–27. https://doi.org/10.7861/clinmed.2019-0255
El-Jardali, F., & Fadlallah, R. (2017). A review of national policies and strategies to improve the quality of health care and patient safety: a case study from Lebanon and Jordan. BMC health services research, 17(1), 568. https://doi.org/10.1186/s12913-017-2528-1
Nikitara, M., Constantinou, C. S., Andreou, E., & Diomidous, M. (2019). The Role of Nurses and the Facilitators and Barriers in Diabetes Care: A Mixed-Methods Systematic Literature Review. Behavioral sciences (Basel, Switzerland), 9(6), 61. https://doi.org/10.3390/bs9060061
Timpel, P., Harst, L., Reifegerste, D., Weihrauch-Blüher, S., & Schwarz, P. E. (2019). What should governments be doing to prevent diabetes throughout the life course?.Diabetologia, 1-12. https://doi.org/10.1007/s00125-019-4941-y
You are a DNP-prepared nurse working in the ICU of your local hospital. A patient is struggling with balance, and you indicate this patient is a “fall risk” in your charts. However, after a long night, caring for many patients, you forget to indicate this risk on the patient’s door, which is procedure at the hospital. You complete your shift and go home for the night.
The scenario presented highlights how easy it is for an error to occur in healthcare. Humans are prone to error, and DNP-prepared nurses are no exception; however, certain policies and procedures can be enacted to improve patient safety and minimize errors.
Almost all occupational fields rely on safety and quality practices to ensure employees, customers, etc., are in a safe environment. These quality and safety practices help organizations to limit errors and improve performance; the field of nursing is no different. It is important for the nurse leader to recognize that quality and safety measures help to improve patient safety by installing processes and workflows into nursing practice that may result in fewer errors.
This week, you will examine foundations of quality improvement in healthcare, as well as explore patient safety. You will also review your experience with these practices and consider your role as a future DNP-prepared nurse.
Learning Objectives
Students will:
- Analyze quality and safety for nursing practice
- Analyze quality and safety for healthcare delivery
- Analyze the role of the DNP-prepared nurse as a function of quality and safety
- Analyze the concept of just culture in healthcare organizations
- Analyze how a just culture impacts healthcare organizations
- Analyze the role of the DNP-prepared nurse in supporting environments for just culture in healthcare organizations
Learning Resources
Required Readings (click to expand/reduce)
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.
- Chapter 1, “Overview of Healthcare Quality” (pp. 5–47)
- Chapter 2, “History and the Quality Landscape” (pp. 49–74)
Institute for Healthcare Improvement. (2021). https://www.ihi.org
I do agree with you that professional nurses play a significant role towards the delivery of quality care and improved patient satisfaction. There are a number of factors that are considered to be of quality care. This include; timely response to the patient’s needs, proper diagnosis, improved safety measures during surgical procedures, adequate staffing that is well trained on the specific care procedures. These factors help healthcare organizations achieve significant reduction in cases of medical or nursing errors, readmission and recurrence of some of the diseases (Rodziewicz & Hipskind, 2020). Organizational culture is another key determinant of the quality of care offered. Healthcare organizations that promote teamwork, collaboration, effective communication, adopting to the change process and allowing continuous education are bound to achieve higher levels of patient safety hence guaranteed satisfaction (Luconi et al., 2019). DNPs in healthcare systems who value patient satisfaction emphasize on the need for affordable care that meets the expectation of the patients. Moreover, it is imperative for such organization to strictly adhere to the ethical and cultural consideration of the care services. This is one of the issues that makes patients feel safer and accepted within the healthcare organizations hence promote satisfaction (Kadivar et al., 2017).
References
Kadivar, M., Manookian, A., Asghari, F., Niknafs, N., Okazi, A., & Zarvani, A. (2017). Ethical and legal aspects of patient’s safety: a clinical case report. Journal of Medical Ethics and History of Medicine, 10(15), 15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150915/
Luconi, F., Boillat, M., Mak, S., Chartrand, D., Korah, N., Daly, M., Teferra, M., & Gutberg, J. (2019). Patient Safety and Quality of Care are Everybody’s Business: Evaluating the Impact of a Continuing Professional Development Program beyond Satisfaction. MedEdPublish, 8(1). https://doi.org/10.15694/mep.2019.000046.1
Rodziewicz, T. L., & Hipskind, J. E. (2020, May 5). Medical Error Prevention. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499956/