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NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation

Student Name

Capella University

NURS-FPX 6016 Quality Improvement of Inter-professional Care

Prof. Name

Date

Introduction 

Errors in medication have a significant impact on addressing the issues of how people perceive medical care and how they think the quality of care will be provided to them in times of distress. Healthcare and the services that are being rendered by the companies have a significant impact on the perception that people have toward medical care. Errors in medication have a significant impact on the perception that people have toward medical care. Medication errors are one of the most significant and common errors in medical practice and have been prevalent across the world.

It is the 3rd leading cause of death in the United States, and approximately 100,000 deaths are accounted for in the name of medication errors in the United States every year (Cha, 2016). Medication error is not solely based on having medication at the wrong time or accidentally doubling up the dosage; rather, it occurs at different stages of the medication use process and can result from other factors such as issues in medication systems, issues of medication management, or human error such as reliability mistakes, fatigue, a poor environment, or a staff shortage (World Health Organization, 2018). 

NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation

Likewise, the management of a patient with heart failure is one of the most complex medical situations that requires effective and active care, and errors in medication in such a condition can have a significant impact on the individual’s health or may lead to life-and-death circumstances. Errors in medication can have very significant as well as fatal consequences (Tariq et al., 2020). These may include things like passing away, being in a life-threatening scenario, being hospitalized, being disabled, or having birth defects (FDA, 2019).

In rare instances, mistakes made with medication might result in the development of a new condition, which may be either temporary or permanent, such as itching, rashes, or a disfigurement of the skin (qlicksmart_admin, 2017). Medication errors can cause patients to suffer not just physically but also emotionally and psychologically. Medication errors have a number of negative effects, the most significant of which are a decline in patients’ levels of contentment and an erosion of their faith in the medical system (Tariq et al., 2020). 

The aim of the current essay is to evaluate the quality improvement initiative, how the suggested changes aim to bring about change, and what can be done to outdo the lags in the suggested changes while evaluating the suggested changes efficiency altogether.

Current Quality Care Initiative

For enhancing medication safety and reducing medication errors, it is important to come up with ideas that may encourage thinking outside the box and thinking through while ensuring there’s no loophole missed. The suggested quality care initiative attempts to provide a plan that can help in resolving the issue by making sure that the medication is provided in safe hands. The case suggested that the error in medication led to an adverse event for the heart patient undergoing the surgery; thus, the first and foremost quality improvement step suggested was to enhance the medication’s safety by using a patient entry order that sorts medications alphabetically by their formula names rather than their brand names.

Other methods could be using the barcodes or identifying specific medical dispensaries where people can buy those medications. This allows for a universal medication to be available regardless of the brand, allowing the patient to not get confused over which brand is best and get mugged for high prices.

Learning about the medication that you take and asking questions regarding medication or sharing concerns allows the patient to understand their own medical conditions and associated risk, thus making them more serious in taking care of themselves (Mayo Clinic Q&A: Reducing the Risk of Medication Errors, n.d.; Manias et al., 2020). Similarly, having communication within the team with standardized protocols that allow it would also help in establishing clear and guided communication and information exchange, which increases patient safety and the quality of care that is being provided.

NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation

Similarly, promoting effective teamwork and communication among other healthcare providers, such as nurses, doctors, and pharmacists, can increase the safety of medication. By increasing the medication communication and ensuring that all the members are on board for the medication that is being given to the patient, it reduces the likelihood of the patient being maltreated while reducing the risk of an adverse event.

Along with this, other strategies that were suggested were engaging patients and using technology to keep records. Studies have highlighted that maintaining and engaging the patient in their own care can have beneficial results for the patient as well as the healthcare provider. Engaging the patient in their own care can have beneficial results for the patient as well as the healthcare provider. Improving healthcare practices can be done by engaging patients and educating them so that they become capable of taking care of their medication and reduce the risk of error on their part.

NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation

Such as teaching them regarding when to take which medication, the timing of medication, and techniques of medication adherence. This can also encourage them to take initiative and express their concern regarding medication. Having programs regarding health literacy can help in understanding the educational materials and instructions, reduce medical errors, and teach what to do in an emergency. It is important to understand that involving patients in their care while ensuring end-to-end effective communication and utilizing the technology that allows to keep the record online and electronically manage the lab reports, medication details, and other information

To better understand the origins and results of the initiatives, pertinent information is required from the hospital’s database whereby information about the prevalence of the medication errors, the hospital’s immediate actions to minimize complications, and the positive outcomes of these initiatives (reduced cases of medication errors and positive patient outcomes) will further support the analysis of before and after of the aforementioned strategies and advocates the implementation of the current initiative in other healthcare practice settings as well. The missing information about the organization’s focus on staff training on medication administration, physician training on medication prescribing, and patient involvement in their healthcare, specifically related to medication practices could have further improved the understanding of the current problem. 

Current Initiative Success

The current initiative that was suggested to bring about change in the wrong prescription and transcription of medication The overall statistics of the decrease in the annual percentage of hazards and medication errors can gauge the effectiveness of the intervention. Currently, the statistics of medication errors in the US are high, thus the overall reduction in cases and indecent reports associated with medication errors.

Likewise, other methods, such as hospital statistics, such as how many cases of medication errors have been reported in the last 6 months, and patient and family feedback, can help in addressing the efficacy associated with queries about the quality care plan. The Agency for Healthcare Research and Quality (AHRQ) presents three specific outcome measures that should be used to evaluate the success of QI initiatives. These are; a) monitoring staff adherence and compliance to the new practices, b) the extent to which new practices successfully attained the desired goals, and c) monitoring the performance dashboards for patients’ experiences and healthcare quality (Agency for Healthcare Research and Quality, 2020). 

The results of these outcome measures should be evaluated against the national benchmarks to check if the organization is fulfilling the criteria successfully or require further improvements. Other ways to monitor the success are monitoring patient turnover and regulating a medication complaint cell that addresses issues of being prescribed the wrong medication and takes strict action against the pharmacist or doctors who have prescribed the wrong medications. The assessment of the success of the intervention can be measured through all of these; however, one of the most effective and efficient ways to measure the success is to compare the statistics graphs regarding the pre-plan implementation and post-plan implementation.

Interpersonal Perspective on the Plan

The interpersonal aspect of any plan plays a vital role in its implementation and success. The ability of a team to come together and learn through rigorous training and an open mindset while encouraging people to open up and raise their concerns has a significant impact on building relationships. Interpersonal skills are woodworkers’ best friends when it comes to the implementation of any plan. The collaboration in the team, along with the individual aspect of any team, brings life to any plan. Being able to openly discuss flaws, having two-way efficacy, and having active communication with patients while addressing their concerns allows the team to come up with better combating plans that allow them to bring change within the system and themselves. The ability to actively listen to concerns and effectively communicate is one of the most significant interpersonal skills that are required for the success of the QI plan.

Similarly, another significant factor is that patient-centered care allows the patient to better engage and become more open to their experiences while taking responsibility for handling and transcribing medication and sharing the burden of care with their physician. An attentive mind and clear detailing of the patient’s history, as well as the ability to objectively write about the experiences and concerns of patients, are two of the interpersonal qualities highlighted that help combat the issue. Therefore, it is important for the nurses to write and enter the details, medical histories, and prescribed medications accurately so that no error occurs while effectively conversing with the patient and their families.

Recommended Additional Indicators and Protocols

Additional protocols that can be part of the quality improvement plan are:

  • Technology use on the part of nurses can help in recording the health data accurately while taking notes of allergies, health issues, and medications that might be potentially harmful, especially if the patient has an underlying diagnosed disease as well. For example, the QI plan would be different for a diabetic heart patient than a stroke patient.
  • Guidelines and evaluation protocols Having checks and balances can play a vital role in monitoring progress, such as providing training, addressing issues of medication error, and setting a complaint to strict action policy protocols so that the healthcare professional is well-aware of their consequences.
  • Patient education and engagement At times, the patient is on self-medication; therefore, educating people regarding the use and misuse of medication, the right dosage, and medication adherence tactics can go a long way.
  • Feedback. Providing feedback and taking the patient’s feedback on medication and its impact can help in maintaining and planning an effective care plan for the patient.

Conclusion

In conclusion, a quality improvement plan enables risk management for adverse events and near misses by providing healthcare providers, managers, and patients with an evidence-based practice protocol that raises awareness of the action plan and prepares them to put it into effect when necessary. The present plan was intended to be practical, workable, and effective with an open approach to change. It is based on being attentive and present throughout the practice. Evaluation of the current plan shows the strength of the plan, while success management and interpersonal skills allow a peek at what is required, and utilization of user-friendly technologies can help in maintaining the care.

References

Agency for Healthcare Research and Quality. (2020). Section 4: Ways to approach the quality improvement processhttps://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi-process/index.html

Cha, A. E. (2016). Researchers: Medical errors now third leading cause of death in the United States. Washingtonpost.com.

FDA. (2019). Working to Reduce Medication Errors. FDAhttps://www.fda.gov/drugs/information-consumers-and-patients-drugs/working-reduce-medication-errors 

Ledlie, S., Gomes, T., Dolovich, L., Bailey, C., Lallani, S., Frigault, D. S., & Tadrous, M. (2023). Medication errors in community pharmacies: Evaluation of a standardized safety program. Exploratory Research in Clinical and Social Pharmacy9, 100218.

Mayo Clinic Q&A: Reducing the risk of medication errors. (n.d.). MSN. Retrieved May 25, 2023, from https://www.msn.com/en-us/health/medical/mayo-clinic-qanda-reducing-the-risk-of-medication-errors/ar-AA10v08f

NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation

Manias, E., Kusljic, S., & Wu, A. (2020). Interventions to reduce medication errors in adult medical and surgical settings: A systematic review. Therapeutic Advances in Drug Safety11(1), 1–29. https://doi.org/10.1177/2042098620968309

Implement strategies to prevent persistent medication errors and hazards. (2023, March 21). Institute for Safe Medication Practices. https://www.ismp.org/resources/implement-strategies-prevent-persistent-medication-errors-and-hazards

Tariq, R. A., Vashisht, R., Sinha, A., & Scherbak, Y. (2020). Medication Dispensing Errors And Prevention. PubMed; StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/30085607/

qlicksmart_admin. (2017, May 31). Impact of Medication Errors on Patients, Healthcare workers, and Hospitals. Qlicksmart – Sharps Safety Solutions for Surgical and Medical Professionals. https://www.qlicksmart.com/impact-medication-errors/?v=d71bdd22c8bb

World Health Organization. (2018). Medication Without Harm. Www.who.int. https://www.who.int/initiatives/medication-without-harm

NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation