Homework Lance
Scenario
You are applying for the role of quality assurance manager at a large health care system. One of the job application requirements is to provide an example of the quality improvement process, from beginning to end, to demonstrate your understanding of how this process requires action at the clinical microsystem level. As a former bedside nurse, you have a wealth of experience to bring to this example and want to be sure to include how continuous quality improvement processes must be applied at this level of care.
Instructions
Consider one of the following to identify an example of how quality improvement must be applied to the clinical microsystem:
- HCAHPS Scores
- Medication Error Incident Reports
- A Sentinel Event (death or serious injury not related to the natural course of the client’s illness)
- A breach in protocol or standard of nursing practice
As you develop your example for your job application, include the following elements in a Word document:
- Mechanisms to identify a potential problem regarding quality of service delivery.
- Discuss techniques of data collection that may be required to illustrate the scope of the quality improvement process.
- Identify the structure, process, or outcomes standards to place this quality improvement initiative in a context for action.
- Identify the standards that will be used to gauge the effectiveness of the quality improvement effort.
- Describe steps the organization (system) could or should take to avoid this quality issue in the future.
- Provides stated ideas with professional language and attribution for credible sources with correct APA citation, spelling, and grammar.
Resources
Quality Improvement Process
Student’s Name
Institutional Affiliation
Quality Improvement Process
Mechanisms to Identify a Potential Problem
Problems regarding quality of service delivery may go unnoticed in the absence of the right mechanisms. One mechanism would be HCAHPS Score, which measures patient satisfaction with the quality of care they receive. Today, health care quality is measured through the voice of the patient, and HCAHPS gives patients an opportunity to express their views and perception on the care that they receive. Another mechanism is medication error reports that disclose all errors encountered. Medication error reporting assist in identifying causes of error and enable nurses to prioritize strategies for error prevention in primary care. Medication error reporting policy should encourage voluntary reporting by nurses and physicians. The reports should include data on drug handling, prescription, preparation, dispensation, administration, and monitoring. Besides, the identified error should be described and analyzed for cause, type, and possible prevention measures.
Another mechanism is sentinel event analysis to identify deaths or injury not related to a patient’s illness. Hospital-acquired infections are a common cause of illness and death among hospitalized patients(Locock et al., 2019). A sentinel event analysis can help a nurse to identify the cause of an injury or death. The last mechanism for identifying quality issues is checking for a breach in protocol or standard of nursing practice. It is vital to assess whether a patient fall, injury or death is due to failure to attend to the patient’s needs or are caused by failure to conduct hourly checks.
Data Collection Techniques
One of the effective data collection techniques for illustrating the scope of the quality improvement process is process mapping. Process mapping involves collecting data about a facility’s current processes by outlining and assessing the steps in existing processes. According to Pomare, Long, Churruca, Ellis, and Braithwaite (2019), process maps assist in confirming what is currently happening, identifying problems within the process, assessing how people interact with current systems and processes, and establishing the causes of the problems and opportunities for improvement. A cause and effect diagram can also be used to collect data on a quality improvement issue. The “five why” technique can be used by asking five “why” questions in succession where one each response generates another “why” question.
Additionally, data can be collected by conducting an audit of microsystem processes. An audit often describes a procedure by which an existing performance is measured against a given standard benchmark. The audit can be done at the diagnosis, impact, and sustainability phases of care by reviewing clinical records or observing service delivery such as washing of hands. Lastly, surveys and questionnaires can also be used to study attitudes and behaviors of nurses, physicians, and patients that may cause quality problems. The data collected using surveys and questionnaires can inform diagnosis and assess changes afteran intervention (Pomare et al., 2019).By using these data collection techniques, quality assurance professionals can understand the scope of the quality improvement process.
The Structure, Process or Outcomes Process
The quality improvement initiative focuses on eliminating or reducing medication errors in a nursing care setting. The quality improvement process would follow a Plan-Do-Study-Act cycle. The planning phase deals with preparing for change and examine possible interventions. Developing goals and action plan entails establishing improvement goals, identifying possible strategies, selecting interventions to implement, and prepare a written action plan for addressing the causes of medication errors (Woodcock et al., 2020). Possible strategies can be identified through workshops, academic literature, patients and their families, and government agencies. The specific interventions selected for intervention should be compatible with the healthcare organization and local culture, technically valid, and address the problem of errors.
The next step involves selecting measures for measuring progress then testing and refining actions. Quality measures should be aimed at testing acceptance of new practices, examining the impact of the new practices, and assessing improvement in patient experience of care. Conducting small tests can improve the process by allowing for incremental adjustments in interventions, reducing the risk of failures, and motivating the medical staff (Prybutok, 2018). In addition to this, it is important to expand the implementation for sustainable quality improvement. Adopting the selected intervention at various units and evaluating it against the established goals of the improvement can facilitate significant reductions in medication errors. Hence, addressing barriers, incorporating facilitators, harnessing social interaction, and communicating the change internally are effectiveimplementation strategies.
Standards for Measuring Quality Improvement
Quality assurance in nursing is about measuring the success of improvement efforts. One standard measure would be the level of acceptance or adherence to new practices. An increase in adherence to new practices would indicate that the selected intervention is achieving improvement goals. Another measure is the impact of the new practices on the delivery of patient-centered care. Patient-centered care centers on the provision of compassionate and humane care through empathic listening to patients’ needs and perceptions of the intervention being administered to them (Prybutok, 2018). Also, safety of care standards can be used to measure medical errors through outcomes such as skin breakdown and hospital acquired infections. Quality assurers should watch for these patient outcomes when gauging the success of an intervention for reducing medical errors.
Additional standards are readmission rates and patient experience. Readmission after hospitalization remains a vital standard as it is a costly experience that hospitals strive to avoid.A decrease in readmission rates could signify that medication errors have reduced following the intervention. Patient-reported outcome measures that reflect their experience and perception of the care delivered (Woodcock et al., 2020). Patient satisfaction results can be evaluates from HCAHPS scores. The last standard would be the effectiveness of care outcome measures that gauge the overall effectiveness of a hospital. An effective care complies with best practice care guidelines and achieve lower readmission rates for chronic diseases.
Steps the Organization Should Take to Avoid Medication Errors in the Future
The first step should be to constitute a multidisciplinary team for reinforcing medication errors reporting policy in the organization. The team should facilitate voluntary reporting by nurses and physicianswhile monitoring drug handling phases and reviewing files from patients. The practitioners should properly document all proceduresbased on predefined error phases during the pre-diagnosis stage. The next occurs in the intervention stagewhere the collected medication error reports are analyzed the root causes of errors.
Physicians and nurses should also be trained to enhance their awareness of the common causes of medication errors and the significance of the medical sheet. During the intervention stage, effective communication through visual displays is used to enhance patient safety. In the post-test stage, continuous monitoring should be done to recalculated and compare the incidence of medication errors to the pretest outcomes (Elden& Ismail, 2016). Therefore, these steps would not only enhance surveillance for medication errors and other quality problems but also inculcate a sense of accountability in nurses and physicians.
References
Elden, N. M. K., & Ismail, A. (2016). The importance of medication errors reporting in improving the quality of clinical care services. Global Journal of Health Science, 8(8), 243.
Locock, L., Kirkpatrick, S., Brading, L., Sturmey, G., Cornwell, J., Churchill, N., & Robert, G. (2019). Involving service users in the qualitative analysis of patient narratives to support healthcare quality improvement. Research Involvement and Engagement, 5(1), 1.
Pomare, C., Long, J. C., Churruca, K., Ellis, L. A., & Braithwaite, J. (2019). Social network research in health care settings: Design and data collection. Social Networks.
Prybutok, G. L. (2018). Ninety to nothing: A PDSA quality improvement project. International Journal of Health Care Quality Assurance.
Woodcock, T., Adeleke, Y., Goeschel, C., Pronovost, P., & Dixon-Woods, M. (2020). A modified Delphi study to identify the features of high quality measurement plans for healthcare improvement projects. BMC Medical Research Methodology, 20(1), 1-9.
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