DNP-835 Quality and Sustainability Paper

DNP-835 Quality and Sustainability Paper

DNP-835 Quality and Sustainability Paper

Quality and Sustainability Paper Part I

Healthcare entities strive to achieve various patient care goals. Central among them are patient safety and offering quality services. Therefore, stakeholders apply or use strategies that ensure safety and quality are achieved. However, there are different events and situations which threaten patient safety and compromise the quality of healthcare delivered to patients. For example, patient care settings usually experience various adverse events such as medication administration errors, patient falls, healthcare-acquired infections, and other non-intentional errors (Simsekler et al.,2019). Therefore, such events call for the formulation of sustainable quality improvement initiatives. As such, the purpose of this assignment is to explore a quality and safety issue in a healthcare entity. This purpose will be accomplished by discussing various aspects such as barriers and facilitators, identification of a healthcare entity, the specific contemporary safety issue, the current safety program in place, and a summary of variables to track.

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Definition of Quality and Safety Measures and Role in Nursing Practice

Quality can be defined as the achievement of established standards and requirements; therefore, if an organization has the ability to achieve such standards, then the organization achieves quality. On the other hand, safety measures involve approaches put in place by the organization to protect patients from harm. Quality is related to nursing practice today in that it is used as a measure of how well nursing practice related to patient outcomes in a particular organization is performed. Therefore, by exploring quality, it is possible to evaluate the level of nursing practice and make appropriate adjustments, such as improvement initiatives depending on the assessment (Rosen et al.,2018). Safety measures are also at the center of nursing practice today as various strategies have to be used to enhance the safety measures and ensure that the patients are protected from potential harm while in the care environment.

Barriers and Facilitators that Impact Patient Outcomes and Organizational Outcomes

The healthcare industry has evolved over the years and has become more complex and difficult to understand. However, the major focus remains to be improved patient and organizational outcomes. In most cases, there are both facilitators and barriers that impact patient and organizational outcomes. Among the barriers is insufficient to support by the management (Etchegaray et al.,2020). Positive patient outcomes need the contribution and support of every stakeholder, especially the management. However, in the event that the leadership and management do not offer adequate support towards patient outcomes improvement initiatives, then the outcomes are expected to dwindle. As such, it is important to address such a barrier as it is central to positive patient outcomes. One of the ways to address this barrier is by formulating quality improvement objectives that align with the goals, aims, and vision of the organization so that leaders can embrace the such project. It is also important to enhance the levels of participation of every employee for them to support such projects.

In most cases, enhanced patient and organizational outcomes may require a change process within the organization. However, such a change processes are usually not smooth since people are resistant. Therefore, another barrier is potential resistance to such change initiatives. The resistance to change by the employees can be due to fear of the unknown and the need to change their ways of operation (Nilsen et al.,2019). Therefore, such resistance may negatively impact the level of commitment of the employees hence acting as a barrier to better patient outcomes. Such a barrier can be solved by bringing the employees on board and using open communication. This will make them feel appreciated and part of the process hence supporting the change initiatives.

Collaboration is one of the facilitators that can impact patient outcomes, and organizational outcomes are a collaboration. Collaboration is key in every sector, healthcare organizations included. In most cases, solving patient problems may need an integration of various healthcare professionals to bring their expertise on board. For example, in solving a patient health problem, nurses may need to collaborate with other healthcare professionals such as physicians and pharmacists. Such collaboration efforts can effectively help in improving patient outcomes and solving problems that may come due to the feelings of being left out.

The Description of the Health Care Entity

The chosen healthcare entity is a medium-sized non-profit hospital that was established in the year 1920 based on Christian principles. While the hospital started as a small entity serving the local community, it has grown into a big hospital offering disease treatment, management, and rehabilitation patient care. The entity is also involved in education research and community outreach. The healthcare organization has various departments serving various patients, as well as a cancer referral center. Recently it expanded its pediatric department to serve more children as well as expanding the psychiatric department.

The Selected Safety Issue

As discussed earlier, the hospital has grown in size, infrastructure, and the number of people it serves. However, the growth has not been without challenges and obstacles. As such, one of the challenges the organization has been trying to measure is the rate of medication errors. While the organization had been fairing well in previous years, there was a time that they noticed that medication errors were on the rise, and therefore, the leaders came up with various strategies that could be used to curb the problem. Medication errors have been shown to lead to various negative impacts, such as illnesses, longer hospital stays, or even death (Hammoudi et al.,2018). In addition, medication errors can lead to negative impacts on the organization, such as litigations that end up tarnishing the organization’s reputation.

As the first step, the organization decided to measure the rates of medication errors and compare them with the benchmark values, such as state and federal averages for medication errors. This measure is also applied or implemented in nursing practice. For example, the rates of medication errors occurring in a healthcare entity can be used as a measure of quality. For instance, the rates of medication errors observed or recorded can be compared to the established benchmark to find out how well the organization is keeping its patients safe. Higher rates of medication errors would coincide with lower quality, while reduced rates of medication errors would be a measure of better patient care services (Hammoudi et al.,2018). In the case where the medication error rates are higher than those of the set benchmarks, then it means that the organization has to use appropriate strategies to reduce such rates.

The Current Programs for Safety

The tremendous growth of the organization has seen it serving an increased number of patients, which has also coincided with the problem of enhanced medication errors. Therefore, the organization has been embarking on various strategies to reduce medication errors and positively impact patient outcomes. Therefore, the organization has been leaning towards using emerging technology to address the situation. While the organization has been using electronic health records, the organization has recently embarked on the use of barcoding and automated dispensing machines to help curb the medication errors associated with medication administration. The barcoding approach is used to scan both the medication name and the patient’s identity. Consequently, the process avoids administering medications to the wrong patients or administering the wrong medication to patients (Zheng et al.,2021). Automated dispensing machines also help in preventing errors related to medication administration.

Various quality measures are currently being used to analyze the healthcare program’s outcome. One of the measures is the rate of use of automated dispensing machines and barcode system by the nurses to administer medications. The rate of use is a measure of acceptance of the technology use and, therefore, a measure of quality improvement.  The other component currently being used is the changes in the rates of medication errors related to medication administration. Reduced rates of errors are an indication that the intervention has had positive impacts (Assiri et al.,2018). Currently, things are working well, except that some nurses have been showing resistance to using the technology. However, their concerns are being addressed, such as some technicalities with the software user interface, which they, at times, claim to be hard to interact with.

The Specific Variable for Tracking the Improvement

It is important to track an implemented quality improvement program. Therefore, various variables are currently being used in the organization to track the quality improvement project. One of the variables is the number of adverse events in the patient care setting caused by medication errors. The adverse events include serious illness or death resulting from medication administration errors such as administering the wrong medication, administering the wrong medication dosage, or drug interactions caused by taking the wrong medications. Another variable used in tracking the quality improvement program is the total number of medication errors (Wheeler et al.,2018). As earlier indicated, medication errors have resulted in various undesirable outcomes; therefore, one of the major aims of implementing the solution was to reduce the number of medication errors. Therefore, this is a central variable in the tracking of the quality improvement project. Therefore, higher rates of medication errors mean that the project is not on the right path. On the other hand, if reduced cases of medication errors have been observed, then it is evident that the safety improvement initiative is working well and, therefore, should be supported.

Conclusion

Quality services to patients and patient safety is among the major focuses of healthcare entities. Therefore, they use various strategies to fulfill quality and safety goals. The chosen organization has been experiencing rising rates of medication errors which prompted the leaders to resort to technology to help curb the problem. It is important to monitor the progress of such initiatives using particular variables. Therefore, adverse events and the rates of medication errors have been applied.

References

Assiri, G. A., Shebl, N. A., Mahmoud, M. A., Aloudah, N., Grant, E., Aljadhey, H., & Sheikh, A. (2018). What is the epidemiology of medication errors, error-related adverse events, and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature. BMJ Open, 8(5), e019101. http://dx.doi.org/10.1136/bmjopen-2017-019101

Etchegaray, J. M., Ottosen, M. J., Dancsak, T., & Thomas, E. J. (2020). Barriers to speaking up about patient safety concerns. Journal of Patient Safety, 16(4), e230-e234. 10.1097/PTS.0000000000000334

Hammoudi, B. M., Ismaile, S., & Abu Yahya, O. (2018). Factors associated with medication administration errors and why nurses fail to report them. Scandinavian Journal of Caring Sciences, 32(3), 1038–1046. https://doi.org/10.1111/scs.12546

Nilsen, P., Schildmeijer, K., Ericsson, C., Seing, I., & Birken, S. (2019). Implementation of change in health care in Sweden: a qualitative study of professionals’ change responses. Implementation Science, 14(1), 1-11. https://doi.org/10.1186/s13012-019-0902-6

Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 73(4), 433. https://psycnet.apa.org/doi/10.1037/amp0000298

Simsekler, M. E., Gurses, A. P., Smith, B. E., & Ozonoff, A. (2019). Integration of multiple methods in identifying patient safety risks. Safety Science, 118, 530-537. https://doi.org/10.1016/j.ssci.2019.05.057

Wheeler, A. J., Scahill, S., Hopcroft, D., & Stapleton, H. (2018). Reducing medication errors at transitions of care is everyone’s business. Australian Prescriber, 41(3), 73. https://doi.org/10.18773%2Faustprescr.2018.021

Zheng, W. Y., Lichtner, V., Van Dort, B. A., & Baysari, M. T. (2021). The impact of introducing automated dispensing cabinets, barcode medication administration, and closed-loop electronic medication management systems on work processes and safety of controlled medications in hospitals: A systematic review. Research in Social and Administrative Pharmacy, 17(5), 832-841. https://doi.org/10.1016/j.sapharm.2020.08.001

Appendix

Barriers	Methods of Addressing the Barriers
Inadequate resources and limited staff training	More funding should be sourced from potential funders to equip the organization with the necessary equipment and expertise. A need assessment for training should also be conducted frequently to help identify when training should be done and help the staff keep pace with current and trending care services and expected outcomes.
Insufficient support from management	-This problem can be solved by creating projects that align with organizational vision, aim, and objective to obtain the leaders’ buy-in. This will ensure that the leaders offer appropriate support to the programs.
Resistance to change	Resistance to change can be experienced at all levels. Therefore, using effective communication can be in convincing every staff that there is a need for change and that they should support the proposed changes.

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Assessment Description

This assignment will be completed in two parts, which will be synthesized into a final paper.

The purpose of this assignment is to investigate a quality and/or safety issue in a health care entity. You will use the issue and health care entity that you select in this assignment for Part 2 of the paper and for the sustainability assignments. You may use an issue identified at the practice site in your DPI Project.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
This assignment requires that you support your position by referencing six to eight scholarly resources. At least three of your supporting references must be from scholarly sources other than the assigned readings.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Directions:

Write a paper (1,500-1,750 words) discussing the role of quality or safety in nursing practice. Include the following:

In your own words, define quality and safety measures and describe their relationship and role in nursing practice today.
Create a table that identifies three barriers, and three facilitators or methods for addressing the barriers, in today’s health care that impact both patient outcomes and organizational outcomes. Evaluate two of the barriers and provide solutions for how health care organizations can overcome them. Describe two of the facilitators or methods and explain how the facilitators or methods will assist overcoming or reducing barriers. Attach the table as an appendix to your paper.
Identify a health care entity. Provide an overall description of this entity without using the real name (e.g., location, size, profit or nonprofit, years in operation). In addition to not using the name of the health care entity, do not use the name of any person described.
Select a specific contemporary quality and/or safety issue that is measured at the health care entity and explain how that measure is applied in nursing practice. You will use this selected issue for all quality and sustainability assignments.
Describe the current quality and/or safety program the health care entity has in place to address the quality and/or safety issue you selected. Describe the key quality measures or components currently used to analyze the health care program’s outcome. Discuss what is working and what is not working.
Summarize the specific variables used to track improvement of the health care quality and/or safety program’s outcome.
Rubric Criteria
Total

125 points

Criterion

1. Unsatisfactory

2. Insufficient

3. Approaching

4. Acceptable

5. Target

Development, Structure, and Conclusion

Advances position or purpose throughout writing; conclusion aligns to and evolves from development.

0 points

No advancement of the thesis, position, or purpose is evident. Connections between paragraphs are missing or inappropriate. No conclusion is offered.

5 points

Limited advancement of thesis, position, or purpose is discernable. There are inconsistencies in organization or the relationship of ideas. Conclusion is simplistic and not fully aligned to the development of the purpose.

5.5 points

The thesis, position, or purpose is advanced in most aspects. Ideas clearly build on each other. Conclusion aligns to the development of the purpose.

5.75 points

The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and plausible conclusion aligns to the development of the purpose.

6.25 points

The thesis, position, or purpose is coherently and cohesively advanced throughout. The progression of ideas is coherent and unified. A convincing and unambiguous conclusion aligns to the development of the purpose.

Format/Documentation

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc.,

0 points

Appropriate format is not used. No documentation of sources is provided.

7 points

Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.

7.7 points

Appropriate format and documentation are used, although there are some obvious errors.

8.05 points

Appropriate format and documentation are used with only minor errors.

8.75 points

No errors in formatting or documentation are present. Selectivity in the use of direct quotations and synthesis of sources is demonstrated.

Mechanics of Writing

Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.

0 points

Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.

8 points

Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.

8.8 points

Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.

9.2 points

Few mechanical errors are present. Suitable language choice and sentence structure are used.

10 points

No mechanical errors are present. Skilled control of language choice and sentence structure are used throughout.

Variables for Tracking Improvement

Specific variables used to track improvement of heath care outcome.

0 points

The specific variables used to track improvement of the health care program outcome are not presented.

10 points

Variables used to track improvement of the health care program outcome are only partially presented.

11 points

General variables used to track improvement of the health care program outcome are presented. More information is needed. Some aspects are vague.

11.5 points

Variables used to track improvement of the health care program outcome are outlined. Some detail is needed for clarity.

12.5 points

The specific variables used to track improvement of the health care program outcome are clearly outlined.

Quality and/or Safety Measures

Define quality and safety measures. Describe relationship and role of measures in nursing practice.

0 points

Narrative does not utilize quality and safety; the relationship to nursing practice is not described.

10 points

The definition of quality and safety is inaccurate, incomplete, or lacks support. A relationship between quality and safety and nursing practice is not established. The narrative demonstrates a minimal understanding of quality and safety.

11 points

The representation of quality and safety is accurate but lacks specific elements important to quality and safety. A general relationship to nursing practice is established, but the role of quality and safety in nursing practice is unclear or does not represent nursing practice today.

11.5 points

Quality and safety are accurately described in the words of the learner. The role and relationship to nursing practice is adequately established. The narrative demonstrates an understanding of quality and safety.

12.5 points

Quality and safety are accurately and thoroughly described in the words of the learner. The role and relationship to nursing practice is clearly established. The narrative demonstrates a functional understanding of quality and safety.

Six to Eight Scholarly Research Sources

Six to Eight Scholarly Research Sources

0 points

None of the required elements (minimum of six topic-related scholarly research sources and six in-text citations) are present.

5 points

Not all required elements are present. One or more elements are missing, or included sources are not scholarly research or topic-related.

5.5 points

All required elements are present. Scholarly research sources are topic-related, but the source and quality of one or more references is questionable.

5.75 points

All required elements are present. Scholarly research sources are topic-related and obtained from reputable, professional sources.

6.25 points

All required elements are present. Scholarly research sources are topic-related and obtained from highly respected, professional, original sources.

Evidence

Selects and integrates evidence to support and advance position/purpose; considers other perspectives.

0 points

Evidence to support the thesis, position, or purpose is absent. The writing relies entirely on the perspective of the writer.

5 points

Evidence is used but is insufficient or of limited relevance. Simplistic explanation or integration of other perspectives is present.

5.5 points

Relevant evidence that includes other perspectives is used.

5.75 points

Specific and appropriate evidence is included. Other perspectives are integrated.

6.25 points

Comprehensive and compelling evidence is included. Multiple other perspectives are integrated effectively.

Contemporary Quality and/or Safety Issue at Health Care Entity

A contemporary quality or safety issue measured at the selected health care entity is identified. Explanation for how measure applies to nursing practice.

0 points

A contemporary quality and/or safety issue measured at the selected health care entity, and an explanation for how the measure apples to nursing practice, is omitted.

10 points

The quality and/or safety issue identified is not a relevant issue for contemporary nursing. The explanation for the identified quality and/or safety issue is incomplete.

11 points

A generally relevant contemporary quality and/or safety issue measured at the health care entity is selected. The issue is summarized but some aspects are vague. A general explanation for how the measure is applied in nursing practice is presented. There are some inaccuracies. More information is needed to adequately support the explanation.

11.5 points

A relevant contemporary quality and/or safety issue measured at the health care entity is selected; The issue is adequately described. An explanation for how the measure is applied in nursing practice is presented. Some detail is needed for clarity or accuracy.

12.5 points

A highly relevant contemporary quality and/or safety issue measured at the health care entity is selected; the issue is thoroughly described. A well-supported explanation for how the measure is applied in nursing practice is presented.

Thesis, Position, or Purpose

Communicates reason for writing and demonstrates awareness of audience.

0 points

The thesis, position, or purpose is not discernible. No awareness of the appropriate audience is evident.

5 points

The thesis, position, or purpose is discernable in most aspects but is occasionally weak or unclear. There is limited awareness of the appropriate audience.

5.5 points

The thesis, position, or purpose is adequately developed. An awareness of the appropriate audience is demonstrated.

5.75 points

The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.

6.25 points

The thesis, position, or purpose is persuasively developed throughout and skillfully directed to a specific audience.

Health Care Entity

Description of identified health care entity.

0 points

A health care entity is omitted.

10 points

A health care entity is vaguely identified; the name of the organization or individuals in the organization are used. The description of the entity is incomplete.

11 points

A health care entity is outlined without naming the entity or any individual. The outline includes general detail. More information is needed to adequately present the health care entity.

11.5 points

A health care entity is adequately described without naming the entity or any individual. The description includes many key details such as location, size, profit or nonprofit status, and years in operation. Some detail is needed for clarity or accuracy.

12.5 points

A health care entity is thoroughly described without naming the entity or any individual. The description includes location, size, profit or nonprofit status, years in operation, and other necessary details. The description provides insight into the health care entity.

Barriers and Facilitators/Methods Table

Three barriers and three facilitators or methods to address barriers in contemporary health care impacting both patient and organizational outcomes. Solutions for how organizations can overcome two of the barriers, and how two of the facilitators or methods will assist to reduce or overcome barriers. Table is attached in appendix to paper.

0 points

Three barriers, and three facilitators or methods to address the barriers, in contemporary health care impacting both patient and organizational outcomes are omitted.

10 points

The barriers, and facilitators or methods for addressing the barriers, are incomplete. Overall, these are not relevant to contemporary health care or they do not impact both patient and organizational outcomes. A table is not used to present the findings; or a table is used but is not attached in an appendix to the paper.

11 points

Three barriers and three facilitators or methods to address the barriers are identified, but one of the selected items is not relevant to contemporary nursing practice. Solutions for how organizations can overcome two of the barriers, and how two of the facilitators or methods will assist to reduce or overcome barriers, are summarized. A table is used to present the findings, but some aspects are vague. The table is attached in an appendix to the paper.

11.5 points

Three barriers and three facilitators or methods to address the barriers in contemporary health care impacting both patient and organizational outcomes are identified. Solutions for how organizations can overcome two of the barriers, and how two of the facilitators or methods will assist to reduce or overcome barriers, are adequately discussed. The barriers and facilitators or methods are generally relevant to contemporary nursing practice and are presented clearly on the table. The table is attached in an appendix to the paper.

12.5 points

Three barriers and three facilitators or methods to address the barriers in contemporary health care impacting both patient and organizational outcomes are clearly identified. Solutions for how organizations can overcome two of the barriers, and how two of the facilitators or methods will assist to reduce or overcome barriers, are thoroughly discussed. The barriers and facilitators or methods are highly relevant to contemporary nursing practice and are presented using a well-organized table. The table is attached in an appendix to the paper.

Current Quality and/or Safety Program at Health Care Entity and Quality Measured in Place

Current quality and/or safety program at heath care entity to address selected issue. Key quality measures and/or components needed to analyze health care program outcomes are described.

0 points

The current quality and/or safety program the heath care entity has in place to address the selected issue is not described. The description of the key quality measures and/or components needed to analyze the selected health care program outcomes is omitted.

15 points

The current quality and/or safety program the heath care entity has in place to address the selected issue is partially described. The description of the key quality measures and/or components needed to analyze the selected health care program outcomes is incomplete. It is unclear what is and what is not working.

16.5 points

The current quality and/or safety program the heath care entity has in place to address the selected issue is outlined. General quality measures and/or components needed to analyze the selected health care program outcomes is generally described. An outline of what is and is not working is presented. More information or rationale is needed.

17.25 points

The current quality and/or safety program the heath care entity has in place to address the selected issue is adequately described. Key quality measures and/or components needed to analyze the selected health care program outcomes are adequately described. A discussion of what is and is not working is presented. Some detail is needed for clarity or accuracy.

18.75 points

The current quality and/or safety program the heath care entity has in place to address the selected issue is thoroughly described. Key quality measures and/or components needed to analyze the selected health care program outcomes are thoroughly described. A discussion of what is and is not working is clearly presented. The narrative is well supported and provides rationale for the measures and/or components identified.