NURS FPX 4020 Assessment 1 Enhancing Quality and Safety

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Enhancing Quality & Safety

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety

Medication errors are considered to be one of the serious adverse events that could take place in a healthcare facility. Medication errors show that the health care organization failed the patient which reduces the trust and satisfaction of the patient. It also causes distress among nurses in cases of accidental medication errors. Every year about 7,000 to 9,000 people lose their lives in the US due to medication errors (Tariq et al., 2022). It has been estimated that $40 billion is spent each year to look after the patient who suffered from medication errors as they then have to have prolonged stay at the hospital. There is a monetary cost as well as some major consequences like physical and psychological pain. Even though it is a serious adverse event but it is not unavoidable, with proper awareness, guidelines, interventions, and policies such adverse events can be prevented by enhancing patient safety quality by a greater range. This paper will be analyzing the elements of a successful quality improvement initiative, factors leading to patient safety risks, identifying the appropriate interventions, and the role of nurses to enhance safety as they are the largest number of healthcare professionals in the facility who work closely with the patients. 

The scenario that these analyses are based upon is from the experience of medication error where a 16-year-old boy named Sam who was diagnosed with cancer was admitted to the hospital for Total Parenteral Nutrition (TPN) infusion as he was not able to swallow food due to some problems with the digestive tract. Sam was given an infusion pump at the rate of 190 mL/hrs. but the correct rate is 125 mL/hr. This happened for the first 5 hours of the infusion after which the nurse realized the rate was inappropriate for the patient.

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Analyzing the Elements of a Successful Quality Improvement Initiative

The intervention that can deal with the factors of safety risks and avoid medication errors should be an electronic-based prescription that makes the reading easier (Roumeliotis et al., 2019). Staff should be trained in medication administration and they should know what the high-risk drugs are so there is more caution.  Collaboration and leadership roles should be given for effective communication so the tasks are divided easily and the work burden is reduced. 

A quality improvement initiative was taken that consisted of training of nurses and doctors, computer-generated prescriptions, a signature of healthcare personnel, and software-based prescriptions with new designs (Mondal et al., 2022). This initiative significantly reduced medication errors by reducing dosage errors, infusion of drugs rate, time, preparation, and interval. With better guidelines, training of nurses, teamwork, and collaboration, double-checking could have been a mandatory task and Sam would have gotten the accurate infusion pump rate. The electronic health record or printing system would have led the nurse to fill in the details of the treatment being provided to Sam which would have made her realize the mistake with the rate. The manual storage of data causes burnout in the nurses which leads to more errors. Technology would prevent this as everything would be automated.

Quality improvement initiatives are important to reduce medications error because not only do they pose harm to the patients, they impact the cost significantly. When such cases of medication error were reviewed it was found that the mean calculated cost was 1009.58 Euros per case (Kirwan et al., 2022). This shows the significance of the medication error and the loss that an organization has to go through for every individual impacted by medication error. 

Another effective evidence-based strategy for ensuring patient safety is the system of barcode medication administration which has proven to decrease errors per 100,000 cases from 0.65 to 0.29. A 55% of decreased was reported in the medication errors (Thompson et al., 2018). Bar code medication administration prevents error as it scans the patient id and the medication packaging before it is administered to make sure it is the right drug. The patient id consists of critical information related to the patient that the bar code system identifies and allows the nurses to be alarmed in case of any error. The cost of operating and implementing this system ranges from about $30,000 to $60,000 which has been concluded by several papers as cost-effective (Naidu & Alicia, 2019).

Analyzing Factors that Lead to Patient Safety Risks

Improvement initiatives should be taken to avoid any future medication errors so the quality of care being provided to the patients can improve. The factors that lead to such safety risks are the lack of training or knowledge of medication administration, interruption during medication administration, no guidelines for medication administration, and night duty shifts (Wondmieneh et al., 2020). Some other factors could also be ineligible writing for prescriptions, poor communication, poor medication packaging, unavailability or inaccurate patient information, failure of obtaining allergy history, and failure to track medication orders (Tariq et al., 2022). Shortage of staff and work burden is also an important to factor that should be considered.

With the scenario of Sam, it could be recognized that the nurse was either tired or overburdened during the night shift when this happened. The lack of guidelines for double-checking and lack of collaboration or communication with the staff led to the rate of infusion being kept incorrect for 5 hours. If there was proper leadership with responsibilities being divided and double-checking being mandatory, this could have been avoided. A study showed that 90% of the nurses in Massachusetts reported being unable to provide quality care to their patients due to burnout and 77% reported having so many patients under their care that it posed a threat to the safety of patients (Team, 2019). 

Organizational interventions to Promote Patient Safety

The use of automated dispensing systems, computerized prescription and medication dispensing systems, and pharmacist partnerships have been proven to be more successful organizational interventions to reduce medication error and increase patient safety than no intervention (Manias et al., 2020). The best intervention that an organization can make to help the nurses and patients is the electronic-based system that would notify the nurses of any dose changes or allergy history making sure the right medication is being provided. Follow-ups after drug intervention are highly important to make sure there are no unreported adverse events. And educational intervention is a must so the nurses stay aware (Khalil et al., 2017).

If a notification system was present in the case of Sam, he would have been given the correct infusion rate which wouldn’t have put his life in harm. Such systems would have alarmed the nurses immediately when the rate was set. As nurses work closely with patients, such organizational intervention can ensure patient safety in not just this case but in all future cases. There should also be a fear of being fined or getting punished by the organization so there’s a sense of accountability and carelessness can be avoided. 

The chances of medication errors were studied by associating them with the day and night shifts during the weekends or weekdays. The medication errors were reported to be more during the weekdays than on the weekend. Whereas, during the weekends more medication errors were reported during the night shift compared with the day shift (Aljunied et al., 2021). This study shows that considering the time of shits of medication error incidents is important to coordinate and enhance the quality. Timing is important to improve patient safety by avoiding medication errors by improving the process of medication administration during particular shifts with a high error margin. The specific cases related to the medication errors are mostly the incidents related to prescription, administration, and monitoring. There were life-threatening cases for the patients as they were either prescribed high doses of severe drugs, there was a lack of monitoring, or the treatment duration was inaccurate (Linden et al., 2021). The most common medicines involved in such error cases were antipsychotics, antithrombotic agents, opioids, diabetes related drugs, and cardiac therapy related drugs. There needs to be a way for the nurses to be skillful in order to determine these high alarming drugs to avoid such future cases. 

Nurse’s Role in Coordinating Care to Enhance Quality & Reduce Costs

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NURS FPX 4020 Assessment 1 Enhancing Quality and Safety

Many stakeholders should be recognized for enhancing the quality and improving patient risk at an organization. The stakeholders include educators, as they are responsible for providing guidelines and nurses who are administering medications, physicians, and nurses who work closely with the patients and have a crucial role, researchers who identify the prevalence outlining the problem, and professional bodies like the government and administrators approaching patient safety (Cho et al., 2020). These stakeholders are relevant because nurses are recognized to be the important stakeholders that work closely with the patient, and any move they make impacts the patient. They have to adhere to protocols, be transparent, and provide awareness to the patients to avoid errors. Educators provide the training nurses need to adhere to the safety protocols and guidelines to handle and maintain the devices they are using. Researchers are linked and are stakeholders as they provide studies for evidence-based practices for the nurses giving them data as evidence so they can prepare a patient care plan. Professional bodies like policymakers, administrators, and government help with allocating different resources and coming up with policies that work in favor of the patient increasing their satisfaction. All these stakeholders are not only relevant but also important as educators would work forward to improve the skills of the nurses so they recognize errors, avoid them, and handle technology. Whereas, the nurses and the policy makers would impact the patient satisfaction so they are really important to recognize issues and work closely with the patients to determine the right interventions.

Medication errors as discussed before cost billions of dollars every year. Nurses work closely with the patients and are such important stakeholders they should have the responsibility to adhere to the policies and guidelines and also recognize the strategies of the organization being able to identify risks and harms. They should offer the best assistance by making double-checking mandatory. Proper planning of care should be done by them, should be able to carry out surveillance activities, and be able to handle the electronic tools of intervention efficiently. Efficient communication skills should be acquired so there is a collaboration with other healthcare professionals (Vais et al., 2020). Such steps would reduce and cut down the costs that are spent on the prolonged stays of the patient at hospitals and the cost of treatment for patients who experience an adverse event like medication error. With proper training and adherence to the principles of patient safety, adverse events like the one with Sam could be easily avoided. 

Conclusion

Nurses have a crucial role when working with patients, it is their responsibility to not add to the stress of patients like Sam who have just been diagnosed with cancer. Proper interventions with electronic systems of medication administration and prescriptions should take place to alarm the nurse in case of any negligence. Workload should be reduced for the nurses by changing shift timings and assigning leadership roles to divide tasks. Nurses should adhere to protocols, make double-checking mandatory, and have effective communication, and collaboration.

References

Aljuaid, M., Alajman, N., Alsaadi, A., Alnajjar, F., & Alshaikh, M. (2021). medication error during the day and night shift on weekdays and weekends: A single teaching hospital experience in Riyadh, Saudi Arabia. Risk Management and Healthcare Policy, Volume 14, 2571–2578. https://doi.org/10.2147/rmhp.s311638

Cho, I., Lee, M., & Kim, Y. (2020). What are the main patient safety concerns of healthcare stakeholders: A mixed-method study of web-based text. International Journal of Medical Informatics, 140, 104162. https://doi.org/10.1016/j.ijmedinf.2020.104162

Khalil, H., Bell, B., Chambers, H., Sheikh, A., & Avery, A. J. (2017). Professional, structural and organizational interventions in primary care for reducing medication errors. Cochrane Database of Systematic Reviews, 2017(10). https://doi.org/10.1002/14651858.cd003942.pub3

Kirwan, G., O’Leary, A., Walsh, C., Briggs, R., Robinson, V., Rodzlan, R., Redmond, P., & Grimes, T. (2022). Potential costs and consequences associated with medication error at hospital discharge: An expert judgment study. European Journal of Hospital Pharmacy, EJHPharm-2021. https://doi.org/10.1136/ejhpharm-2021-002697

Linden-Lahti, C., Takala, A., Holmström, A. R., & Airaksinen, M. (2021, September 27). What severe medication errors reported to health care supervisory authority talk about medication safety? Journal of Patient Safety, 17(8), e1179–e1185. https://doi.org/10.1097/pts.0000000000000914

Manias, E., Kuljis, S., & Wu, A. (2020). Interventions to reduce medication errors in adult medical and surgical settings: A systematic review. Therapeutic Advances in Drug Safety, 11, 204209862096830. https://doi.org/10.1177/2042098620968309

Mondal, S., Banerjee, M., Mandal, S., Mallick, A., Das, N., Bassu, B., & Ghosh, R. (2022). An initiative to reduce medication errors in the neonatal care unit of a tertiary care hospital, Kolkata, West Bengal: a quality improvement report. BMJ Open Quality, 11(Suppl 1), e001468. https://doi.org/10.1136/bmjoq-2021-001468

NURS FPX 4020 Assessment 1 Enhancing Quality and Safety

Naidu, M., & Alicia, Y. L. Y. (2019). Impact of bar-code medication administration and electronic medication administration record system in clinical practice for an effective medication administration process. Health, 11(05), 511–526. https://doi.org/10.4236/health.2019.115044

Roumeliotis, N., Sniderman, J., Adams-Webber, T., Addo, N., Anand, V., Rochon, P., Taddio, A., & Parshuram, C. (2019). Effect of electronic prescribing strategies on medication error and harm in hospital: A systematic review and meta-analysis. Journal of General Internal Medicine, 34(10), 2210–2223. https://doi.org/10.1007/s11606-019-05236-8

Tariq, R., Vashisht, R., Sinha, A., & Scherban, Y. (2022). Medication dispensing errors and prevention [E-book]. Stat Pearls. https://www.ncbi.nlm.nih.gov/books/NBK519065/

Team, S. L. (2019, May 20). Overburdened nurses face burnout, raising the likelihood of medical errors. Sokolova Law. https://www.sokolovelaw.com/blog/overburdened-nurses-medical-errors/

Thompson, K. M., Swanson, K. M., Cox, D. L., Kirchner, R. B., Russell, J. J., Wermers, R. A., Storlie, C. B., Johnson, M. G., & Naessens, J. M. (2018b, December). Implementation of bar-code medication administration to reduce patient harm. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 2(4), 342–351. https://doi.org/10.1016/j.mayocpiqo.2018.09.001

Vais Moradi, M., Tella, S., A. Logan, P., Khakhra, J., & Vizcaya-Moreno, F. (2020). Nurses’ adherence to patient safety principles: A systematic review. International Journal of Environmental Research and Public Health, 17(6), 2028. https://doi.org/10.3390/ijerph17062028Wondmieneh, A., Alemu, W., Tadele, N., & Demis, A. (2020). Medication administration errors and contributing factors among nurses: A cross-sectional study in tertiary hospitals, Addis Ababa, Ethiopia. BMC Nursing, 19(1). https://doi.org/10.1186/s12912-020-0397-0