NURS 8302 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
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.
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
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.
Photo Credit: [Henglein and Steets]/[Cultura]/Getty Images
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.
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.
Quality and Safety in Nursing Practice and Healthcare
Safety and quality continue to be crucial elements in nursing practice and healthcare. Among other medical professionals, nurses are crucial to providing high-quality patient care.In order to guarantee that patients have the most excellent possible hospital experience, nurses must collaborate with interdisciplinary team members and make decisions based on predetermined goals (Dempsey & Assi, 2018). According to Hammersla et al. (2021), anticipating the best outcomes and facilitating the correct care for the right client at the right time are essential components of quality in healthcare. Healthcare safety is defined by Nash et al. (2019) as providing high-quality treatment free from medical errors and unwanted side effects. This essay considers how I want to represent safety and quality in nursing practice and healthcare delivery as a DNP-prepared nurse. The foundation of providing patients with high-quality care is safety. The adverse effects of care, including morbidity and mortality, are the main focus of the research that defines patient safety and harm prevention techniques.
Previous Experience with quality and safety
Throughout my nursing career, I have experienced safety and quality firsthand. Under the guidance of my superiors, I have been able to adhere to the use of evidence-based standard operating procedures (SOPs) throughout my career. This inspired me to provide my patients with efficient and timely care. One of my most significant accomplishments throughout my nursing practicum was enabling safe patient care while adhering to numerous patient safety guidelines. Lee et al. (2019) state that to deliver comprehensive, safe, and high-quality care, healthcare professionals should become familiar with these patient safety issues and acquire the necessary skills and knowledge.
In order to decrease the likelihood of unfavorable outcomes, nurses play a crucial role in monitoring and coordinating care (Sherwood & Barnsteiner, 2021). My prior experiences have leaned toward patient engagement because I work in a psychiatric mental health facility where safety is paramount. My areas of interest are providing high-quality healthcare, supporting recovery, and paying close attention to patients to improve their safety. Other categories include preventing health issues, and identifying disease causes and risk factors. Additionally, I have been instrumental in enhancing patients’ recuperation by educating and motivating them.
My role as a DNP-Prepared Nurse
Upon obtaining the DNP doctorate, I plan to take advantage of new opportunities to investigate and close the gap between healthy and unhealthy facilities and the gap between the best possible treatment and the quality and safety of the patients provided (Barkell & Synder, 2021). I will assist my facility in creating cohesive, healthy work environments that support patient safety and high-quality treatment. My primary goal as a nurse with a DNP is to provide patient-centered care. I have collaborated with other disciplinary teams in providing care. In addition, my duty as a DNP-prepared nurse is to understand and apply innovation to raise the standard of care provided. One of these is taking an active part in tech-driven advancements such as information systems and health informatics. Taking on leadership responsibilities in policy, education, and health care administration is another function of the DNP-prepared nurse. Mentoring nurses and improving their careers as educators are additional activities that reflect quality and safety for nursing practice and healthcare delivery (Trautman et al., 2018). Additionally, DNP nurses can assess practice and implement quality-improving measures. Also, nurses might strive to advocate for modifications and enhancements to various healthcare policies. My duty as a DNP-prepared nurse is to enforce adherence to the care services provided in my facility using methodical, evidence-based approaches. According to Dempsey and Assi (2018), the two main elements of evidence-based practice are patient safety and high-quality care. Completing my DNP program will allow me to provide better treatment, as evidenced by improved patient outcomes and safety. To increase safety and quality, I will support healthcare programs and advocate for the needs in this area.
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.
Quality and Safety in Health Care and Nursing Practice
In order to transition with the changing health care system and meet its demands as well as that of the patient and their families, it is of the utmost importance to acclimate to the demands for quality and cost containment to achieve improved outcomes, higher quality care delivery, patient safety and patient satisfaction. To address these areas necessitating improvement, it is imperative to identify and understand knowledge and practice gaps, integrating health information technology for the purpose of quality improvement and safety, developing a culture of quality care and service excellence and safety, reliability and value within the health care organization, focusing on population health, and engaging with the key players such as stakeholders, accrediting bodies, policy makers, health care providers, and patients/consumers (Nash et al., 2019). Improving patient safety continues to be of importance in the realm of public health issues (Lark et al., 2018). The ultimate health care goal is improved health care delivery and optimal patient outcomes.
Previous Experience with Quality and Safety
The patient safety is evident in every realm of medical practice without exception. Despite the fact that it is often times concentrated within the hospital setting, it is also pertinent in primary care. It has been reported that unsafe primary and ambulatory care incidents account for greater morbidity and higher health care use and expenditure due to unsafe medication practices and incorrect and/or delayed diagnosis which are the most common causes of patient harm (Kuriakose et al., 2020). As of yet, there seems to be a decreased understanding of how this situation can be remedied in the primary care setting since the bulk of the investigative work has been carried out to focus on hospital care (Kuriakose et al., 2020). Lawati et al. (2018) carried out a systematic review which identified primary care as an emerging field in research with a growing evidence base in western countries, and the results of the review identified that the most crucial first step in addressing this problem within the primary care setting was to establish and assess a culture of safety in order to create a basic and fundamental understanding to safety related perceptions of health care providers.
In terms of quality and safety in the primary care setting, the electronic medical record (EMR) system utilized in the primary care settings I am familiar with have proved to be a major factor in the increased safety and quality of care. There are safeguards with medication order entry as it pertains to patient medication allergies and careful attention is paid to dosages and look alike/sound alike medications. The EMR also has the capability to allow for electronic prescribing (e-prescribing) of medication(s) and this goes directly to the patient’s pharmacy at a much quicker rate, thus allowing for extra time for the pharmacy to ask questions and/or address concerns prior to the patient arriving at the pharmacy to retrieve their medication(s). The primary care setting is an area of medicine which serves as a health care systems entry point, and can have a great impact of a patient’s well-being and their need/willingness to utilize other health care resources (Kuriakose et al., 2020), and so this should encourage health care providers to support this setting as well as its accompanying challenges in order to research and grow the knowledge base necessary for disseminating relevant and pertinent information for improved quality of care and patient safety in order to decrease health care cost and achieve improved patient health care outcomes.
How the Role of the DNP Prepared Nurse Represents a Function of Quality and Safety for Nursing Practice and Health Care Delivery
The DNP prepared nurse is able to make very valuable contributions to the nursing practice and delivery of health care by way of the advanced training and education that the DNP education affords (Trautmen et al., 2018). The DNP prepared nurse serves as a leader in the field of nursing and possesses the highest level of nursing expertise and the adept knowledge garnered throughout the degree process allows for the DNP prepared nurse to influence health care outcomes through organizational leadership, health policy implementation, and direct patient care (LeVeck, 2021). The DNP prepared nurse is well versed in the utilization and implementation of evidence-based practices (EBP) and it is the DNP education which was generated for the purpose of meeting the current health care demands by being able to generate the comprehensive skills set and scientific knowledge, outcome measures, and leadership qualities to assure the highest quality patient safety outcomes (LeVeck, 2021). It is the degree of education attained by a DNP prepared nurse which makes this nurse more than capable of seeking best practice guidelines to implement the highest standards of patient care, quality, and safety, in order to achieve improved patient outcomes.
References
Kuriakose, R., Aggarwal, A., Sohi, R. K., Goel, R., Rashmi, N. C., & Gambhir, R. S. (2020). Patient safety in primary and outpatient health care. Journal of Family Medicine and Primary Care, 9(1), 7–11. https://doi.org/10.4103/jfmpc.jfmpc_837_19
Lark, M. E., Kirkpatrick, K., & Chung, K. C. (2018). Patient safety movement: History and future directions. The Journal of Hand Surgery, 43(2), 174–178. https://doi.org/10.1016/j.jhsa.2017.11.006
Lawati, M. H. A., Dennis, S., Short, S.D., & Abdulhadi, N. N. (2018). Patient safety and safety culture in primary health care: A systematic review. BMC Family Practice, 19(104). https://doi.org/10.1186/s12875-018-0793-7h
LeVeck, D. (2021). What is a DNP and is it worth it? https://nurse.org/articles/how-to-get-a-DNP-is-it-worth-it/
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.
Trautman, D. E., Idzik, S., Hammersla, M., Rosseter, R. (2018). Advancing scholarship through translational research: The role of the PhD and the DNP prepared nurses. OJIN The Online Journal of Issues in Nursing, 23(2), Manuscript 2. DOI: 10.3912/OJIN.Vol23No02Man02
Quality and Safety in Health Care and Nursing Practice
In order to transition with the changing health care system and meet its demands as well as that of the patient and their families, it is of the utmost importance to acclimate to the demands for quality and cost containment to achieve improved outcomes, higher quality care delivery, patient safety and patient satisfaction. To address these areas necessitating improvement, it is imperative to identify and understand knowledge and practice gaps, integrating health information technology for the purpose of quality improvement and safety, developing a culture of quality care and service excellence and safety, reliability and value within the health care organization, focusing on population health, and engaging with the key players such as stakeholders, accrediting bodies, policy makers, health care providers, and patients/consumers (Nash et al., 2019). Improving patient safety continues to be of importance in the realm of public health issues (Lark et al., 2018). The ultimate health care goal is improved health care delivery and optimal patient outcomes.
Previous Experience with Quality and Safety
The patient safety is evident in every realm of medical practice without exception. Despite the fact that it is often times concentrated within the hospital setting, it is also pertinent in primary care. It has been reported that unsafe primary and ambulatory care incidents account for greater morbidity and higher health care use and expenditure due to unsafe medication practices and incorrect and/or delayed diagnosis which are the most common causes of patient harm (Kuriakose et al., 2020). As of yet, there seems to be a decreased understanding of how this situation can be remedied in the primary care setting since the bulk of the investigative work has been carried out to focus on hospital care (Kuriakose et al., 2020). Lawati et al. (2018) carried out a systematic review which identified primary care as an emerging field in research with a growing evidence base in western countries, and the results of the review identified that the most crucial first step in addressing this problem within the primary care setting was to establish and assess a culture of safety in order to create a basic and fundamental understanding to safety related perceptions of health care providers.
In terms of quality and safety in the primary care setting, the electronic medical record (EMR) system utilized in the primary care settings I am familiar with have proved to be a major factor in the increased safety and quality of care. There are safeguards with medication order entry as it pertains to patient medication allergies and careful attention is paid to dosages and look alike/sound alike medications. The EMR also has the capability to allow for electronic prescribing (e-prescribing) of medication(s) and this goes directly to the patient’s pharmacy at a much quicker rate, thus allowing for extra time for the pharmacy to ask questions and/or address concerns prior to the patient arriving at the pharmacy to retrieve their medication(s). The primary care setting is an area of medicine which serves as a health care systems entry point, and can have a great impact of a patient’s well-being and their need/willingness to utilize other health care resources (Kuriakose et al., 2020), and so this should encourage health care providers to support this setting as well as its accompanying challenges in order to research and grow the knowledge base necessary for disseminating relevant and pertinent information for improved quality of care and patient safety in order to decrease health care cost and achieve improved patient health care outcomes.
How the Role of the DNP Prepared Nurse Represents a Function of Quality and Safety for Nursing Practice and Health Care Delivery
The DNP prepared nurse is able to make very valuable contributions to the nursing practice and delivery of health care by way of the advanced training and education that the DNP education affords (Trau