NURS-FPX4020 Assessment 1: Enhancing Quality and Safety

Enhancing Quality and Safety

A medication error is any preventable incident that may cause or result in inappropriate use of medication or patient harm when the medication is controlled by a health care provider, patient, or consumer. Medication errors result in undesirable outcomes, including drug-drug interactions, adverse drug reactions, treatment inefficacy, suboptimal patient adherence, poor patient experience, and poor quality of life (Risør et al., 2018). These often have considerable health and economic consequences. The purpose of this paper is to explore factors contributing to patient-safety risk in medication administration, evidence-based solutions, and coordination of care to enhance patient safety. 

Factors Leading to a Specific Patient-Safety Risk Focusing on Medication Administration

When working in the medical-surgical unit, a new grad nurse administered the wrong drug (Heparin) to the wrong patient. Two patients in their 60s shared the same names, and the nurse only called the patient’s first name. When she got to the rightful patient, she realized the mistake after the patient asked her if the injection drug he gets three times a day had been canceled. The nurse reported the incident to me, and we administered protamine sulfate. Numerous factors cause medication errors and are associated with the provider, patient, healthcare team, work environment, and computerized information systems. Factors related to providers include inadequate therapeutic training (Mendes et al., 2018). Besides, inadequate drug knowledge and experience, patient knowledge, and perception of risk related to medication errors contribute to increased incidences (Mendes et al., 2018). High workload and fatigue among providers, especially nurses, often lead to physical and emotional health issues, which limit their ability to provide quality care resulting in medication errors. Poor communication between providers and patients also results in errors of wrongful drug administration.

Medication errors are related to patient factors, including low literacy and language barriers. Besides, the complexity of patient cases like multiple illnesses, polypharmacy, and high-risk medications increase the risk for medication errors. Factors in the work environment include high workload, time pressures, and distractions and interruptions from the staff and patients (Mendes et al., 2018). High workloads create work pressure and burnout, which create room for errors. Besides, lack of standardized protocols and procedures, inadequate resources, and a poor physical work environment contribute to errors. Furthermore, poor naming of medicines, labeling, and packaging can result in the wrong drug, dosage, or route (Mendes et al., 2018). Factors connected with computerized information systems include difficult processes for generating prescriptions, inaccuracy of patient records, and poor system designs that creates room for human error.

Evidence-Based and Best-Practice Solutions to Improve Patient Safety

Various studies have explored measures to improve the quality of medication administration to improve patient outcomes and lower healthcare costs. Adopting automated information systems is a major solution to reducing medication errors. Studies establish that computerized interventions reduce medication errors. For example, the computerized provider order entry (CPOE) has decision support that gives clinicians computerized advice on drug dosage, potentially reducing inappropriate medications (Risør et al., 2018). Barcode medication administration (BCMA) technology is also established to improve patient identification and helps nurses ensure that they administer the right drug to the right patient.

Medication reviews and reconciliation is yet another solution to improve patient safety related to medication administration. Medication review entails the evaluation of patients` medicines to mitigate drug-related problems and improve health outcomes. According to Ceschi et al. (2021), the most successful interventions entail a medication review carried out by a clinical pharmacist or other clinicians or centered on multicomponent interventions with a medication review by a primary care provider. Staff training is a best-practice solution to reduce medication errors. Continuous training of healthcare providers is a key factor in improving safety (Gillani et al., 2021). It has been associated with reduced medication errors where education is part of multicomponent interventions.

How Nurses Can Help Coordinate Care to Increase Patient Safety with Medication Administration and Reduce Costs

Coordination of care helps to reduce incidences of uncontrolled polypharmacy and patient safety risks and lowers health costs. Nurses can help coordinate patient care, especially through transitional care programs. Mardani et al. (2020) explain that transitional care programs can help to decrease medication-related problems, improve patient’s access to medication therapy, provide comprehensive medication counseling, and bridge gaps in medication care after discharge. Nevertheless, patients in transitional care are at risk of medication errors because of the lack of effective communication between providers, inadequate education and training, inadequate medication reconciliation, inappropriate follow-up, and failure to engage patients and family caregivers in medicines management.

Nurses can play a crucial role in care coordination by evaluating patients’ transitional care plans, identifying potential problems, and addressing them to improve patient safety. Besides, nurses can take part in medicine management, which helps with access to care, especially among patients with fragmented care (Mardani et al., 2020). Their role in the care coordination also includes medication reconciliation, which entails identifying and documenting a harmonious, definitive list of a patient’s drugs across transitions of care and rectifying any discrepancies. Through medication reconciliation, nurses can reduce medication discrepancies and actual and potential adverse drug events (Ceschi et al., 2021). Nurses’ role in coordinating care can enhance the workflow for referring physicians and support navigation of care back to community healthcare providers through medication self-management and patient education.

Stakeholders with Whom Nurses Would Coordinate To Drive Safety Enhancements

Nurses can coordinate with various stakeholders, including physicians, clinical pharmacists, and patients, to promote safety with drug administration. They need to coordinate physicians and ensure they write clear prescriptions, write patients’ ages and diagnoses in prescriptions, and avoid using abbreviations (Gillani et al., 2021). The nurse can ensure that the physician orders the necessary drug monitoring tests like liver and renal function tests and follow-up patients appropriately. In addition, the nurse would coordinate the pharmacists by ensuring they countercheck prescriptions before dispensing to identify discrepancies in drug dosages, contraindications, allergies, and drug interactions. The nurse can also ensure the pharmacists provide patients with drug information, including indications, contraindications, and potential side effects (Gillani et al., 2021). Furthermore, nurses should coordinate with patients by teaching them about their medications and informing them to seek medical attention when they experience adverse effects.

Conclusion

Medication errors are a major healthcare issue since they result in poor health outcomes, readmissions, mortalities, and high healthcare costs; various factors contribute to medication errors, including those pertinent to the providers, patients, working environment, medicines, and computerized information systems. Reducing medication errors can include adopting computerized systems, medication reviews and reconciliation, and training healthcare providers. Nurses can help coordinate patient care through transitional care programs.

References

Ceschi, A., Noseda, R., Pironi, M., Lazzeri, N., Eberhardt-Gianella, O., Imelli, S., … & Ferrari, P. (2021). Effect of medication reconciliation at hospital admission on 30-day returns to hospital: a randomized clinical trial. JAMA network open, 4(9), e2124672-e2124672. https://doi.org/10.1001/jamanetworkopen.2021.24672

Gillani, S. W., Gulam, S. M., Thomas, D., Gebreighziabher, F. B., Al-Salloum, J., Assadi, R. A., & Sam, K. G. (2021). Role and Services of a Pharmacist in the Prevention of Medication Errors: A Systematic Review. Current Drug Safety, 16(3), 322-328. https://doi.org/10.2174/1574886315666201002124713

Mardani, A., Griffiths, P., & Vaismoradi, M. (2020). The Role of the Nurse in the Management of Medicines During Transitional Care: A Systematic Review. Journal of multidisciplinary healthcare, 13, 1347–1361. https://doi.org/10.2147/JMDH.S276061

Mendes, J. R., Lopes, M. C. B. T., Vancini-Campanharo, C. R., Okuno, M. F. P., & Batista, R. E. A. (2018). Types and frequency of errors in the preparation and administration of drugs. Einstein (São Paulo), 16. https://doi.org/10.1590/S1679-45082018AO4146

Risør, B. W., Lisby, M., & Sørensen, J. (2018). Complex automated medication systems reduce medication administration errors in a Danish acute medical unit. International Journal for Quality in Health Care, 30(6), 457-465. https://doi.org/10.1093/intqhc/mzy042

NURS-FPX4020 Assessment 1: Enhancing Quality and Safety

For this assessment, you will develop a 3-5 page paper that examines a safety quality issue pertaining to medication administration in a health care setting. You will analyze the issue and examine potential evidence-based and best-practice solutions from the literature as well as the role of nurses and other stakeholders in addressing the issue.

Health care organizations and professionals strive to create safe environments for patients; however, due to the complexity of the health care system, maintaining safety can be a challenge. Since nurses comprise the largest group of health care professionals, a great deal of responsibility falls in the hands of practicing nurses. Quality improvement (QI) measures and safety improvement plans are effective interventions to reduce medical errors and sentinel events such as medication errors, falls, infections, and deaths. A 2000 Institute of Medicine (IOM) report indicated that almost one million people are harmed annually in the United States, (Kohn et al., 2000) and 210,000–440,000 die as a result of medical errors (Allen, 2013).

The role of the baccalaureate nurse includes identifying and explaining specific patient risk factors, incorporating evidence-based solutions to improving patient safety and coordinating care. A solid foundation of knowledge and understanding of safety organizations such as Quality and Safety Education for Nurses (QSEN), the Institute of Medicine (IOM), and The Joint Commission and its National Patient Safety Goals (NPSGs) program is vital to practicing nurses with regard to providing and promoting safe and effective patient care.

You are encouraged to complete the Identifying Safety Risks and Solutions activity. This activity offers an opportunity to review a case study and practice identifying safety risks and possible solutions. We have found that learners who complete course activities and review resources are more successful with first submissions. Completing course activities is also a way to demonstrate course engagement.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Analyze the elements of a successful quality improvement initiative.
  • Explain evidence-based and best-practice solutions to improve patient safety focusing on medication administration and reducing costs.
• Competency 2: Analyze factors that lead to patient safety risks.
  • Explain factors leading to a specific patient-safety risk focusing on medication administration.
• Competency 4: Explain the nurse’s role in coordinating care to enhance quality and reduce costs.
  • Explain how nurses can help coordinate care to increase patient safety with medication administration and reduce costs.
  • Identify stakeholders with whom nurses would need to coordinate to drive quality and safety enhancements with medication administration.
• Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.
  • Organize content so ideas flow logically with smooth transitions; contains few errors in grammar or punctuation, word choice, and spelling.
  • Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.

References

Allen, M. (2013). How many die from medical mistakes in U.S. hospitals? Retrieved from https://www.npr.org/sections/health-shots/2013/09/20/224507654/how-many-die-from-medical-mistakes-in-u-s-hospitals.

Kohn, L. T., Corrigan, J., & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for implementing quality improvement (QI) and patient safety measures in health care settings. Effective quality improvement measures result in systemic and organizational changes, ultimately leading to the development of a patient safety culture.

Scenario

Consider a previous experience or hypothetical situation pertaining to medication errors, and consider how the error could have been prevented or alleviated with the use of evidence-based guidelines.

Choose a specific condition of interest surrounding a medication administration safety risk and incorporate evidence-based strategies to support communication and ensure safe and effective care.   

For this assessment:

• Analyze a current issue or experience in clinical practice surrounding a medication administration safety risk and identify a quality improvement (QI) initiative in the health care setting.

Instructions

The purpose of this assessment is to better understand the role of the baccalaureate-prepared nurse in enhancing quality improvement (QI) measures that address a medication administration safety risk. This will be within the specific context of patient safety risks at a health care setting of your choice. You will do this by exploring the professional guidelines and best practices for improving and maintaining patient safety in health care settings from organizations such as QSEN and the IOM. Looking through the lens of these professional best practices to examine the current policies and procedures currently in place at your chosen organization and the impact on safety measures for patients surrounding medication administration, you will consider the role of the nurse in driving quality and safety improvements. You will identify stakeholders in QI improvement and safety measures as well as consider evidence-based strategies to enhance quality of care and promote medication administration safety in the context of your chosen health care setting.

Be sure that your plan addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so that you know what is needed for a distinguished score.

• Explain factors leading to a specific patient-safety risk focusing on medication administration.
• Explain evidence-based and best-practice solutions to improve patient safety focusing on medication administration and reducing costs.
• Explain how nurses can help coordinate care to increase patient safety with medication administration and reduce costs.
• Identify stakeholders with whom nurses would coordinate to drive safety enhancements with medication administration.
• Communicate using writing that is clear, logical, and professional, with correct grammar and spelling, using current APA style.

Additional Requirements

• Length of submission: 3–5 pages, plus title and reference pages.
• Number of references: Cite a minimum of 4 sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.
• APA formatting: References and citations are formatted according to current APA style.

Enhancing Quality and Safety Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Explain factors leading to a specific patient-safety risk focusing on medication administration.	Does not identify factors leading to a specific patient-safety risk focusing on medication administration.	Identifies factors leading to a specific patient-safety risk focusing on medication administration.	Explains factors leading to a specific patient-safety risk focusing on medication administration.	Explains factors leading to a specific patient-safety risk focusing on medication administration. Makes reference to specific data, evidence, or standards to illustrate the safety risk.
Explain evidence-based and best-practice solutions to improve patient safety focusing on medication administration and reducing costs.	Does not identify evidence-based and best-practice solutions to improve patient safety focusing on medication administration and reducing costs.	Identifies evidence-based and best-practice solutions to improve patient safety focusing on medication administration and/or discusses reducing costs but not both.	Explains evidence-based and best-practice solutions to improve patient safety focusing on medication administration and reducing costs.	Explains evidence-based and best practice solutions to improve patient safety focusing on medication administration and reducing costs. Makes explicit reference to scholarly or professional resources to support explanation.
Explain how nurses can help coordinate care to increase patient safety with medication administration and reduce costs.	Does not identify how nurses can help coordinate care to increase patient safety with medication administration and reduce costs.	Identifies how nurses can help coordinate care to increase patient safety with medication administration and/or how to reduce costs but not both.	Explains how nurses can help coordinate care to increase patient safety with medication administration and reduce costs.	Explains how nurses can help coordinate care to increase patient safety with medication administration and reduce costs, providing specific examples related to a patient safety risk.
Identify stakeholders with whom nurses would need to coordinate to drive quality and safety enhancements with medication administration.	Does not identify stakeholders with whom nurses would need to coordinate to drive quality and safety enhancements with medication administration.	Identifies stakeholders, but their relevance to collaboration with nurses or their ability to drive quality and safety enhancements with medication administration is unclear.	Identifies stakeholders with whom nurses would need to coordinate to drive quality and safety enhancements with medication administration.	Identifies stakeholders with whom nurses would need to coordinate to drive quality and safety enhancements with medication administration, noting the relevance and potential importance of the stakeholders.
Organize content so ideas flow logically with smooth transitions; contains few errors in grammar or punctuation, word choice, and spelling.	Does not organize content for ideas. Lacks logical flow and smooth transitions.	Organizes content with some logical flow and smooth transitions. Contains errors in grammar or punctuation, word choice, and spelling.	Organizes content so ideas flow logically with smooth transitions; contains few errors in grammar or punctuation, word choice, and spelling.	Organizes content with a clear purpose. Content flows logically with smooth transitions using coherent paragraphs, correct grammar or punctuation, word choice, and free of spelling errors.
Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.	Does not apply APA formatting to headings, in-text citations, and references. Does not use quotes or paraphrase correctly.	Applies APA formatting to in-text citations, headings and references incorrectly or inconsistently, detracting noticeably from the content. Inconsistently uses headings, quotes or paraphrasing.	Applies APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.	Exhibits strict and flawless adherence to APA formatting of headings, in-text citations, and references. Quotes and paraphrases correctly.