NURS 8302 Week 1 Discussion 1: Quality and Safety in Healthcare and Nursing Practice

NURS 8302 Week 1 Discussion 1: Quality and Safety in Healthcare and Nursing Practice

NURS 8302 Week 1 Discussion 1: Quality and Safety in Healthcare and Nursing Practice

Discussion 1: Quality and Safety in Healthcare and Nursing Practice

How will you, as a future DNP-prepared nurse, keep patients safe? This is a multi-layered question with many different answers. Yet, it is important to note that as the nurse leader, quality and safety measures are at the forefront of how you deliver nursing practice.

Measures of quality and safety are critical components of healthcare. “Around the end of the twentieth century and the beginning of the twenty-first century, a number of reports presented strong evidence of widespread quality deficiencies and highlighted a need for substantial change to ensure high-quality care for all patients,” Nash et al. (2019) write (p. 5). Given the prevalence of error, it is critical to consider your role as a DNP-prepared nurse.

Consider your experience with quality and safety in your nursing practice for this Discussion. Consider your experience and how your role can help to support quality and safety measures.

In the previous assignment, I discussed client M.N, a 46-year-old African American male diagnosed with Type 2 Diabetes.  Quality and safety are key aspects of diabetes care, which significantly determine patient outcomes. Cost is a major barrier in accessing health services and also determine patient outcomes. This essay aims to discuss the effect of Type 2 Diabetes on the quality of care, patient safety, and costs to the system and individual.

How Type 2 Diabetes Impacts the Quality of Care, Patient Safety, and Costs to the System and Individual

Type 2 Diabetes significantly impacts the quality of care provided to patients since health providers must provide aggressive and top-notch care to prevent the development of diabetes-related complications. Furthermore, health providers have to be alert to identify symptoms of low or very high blood glucose in diabetic patients (Nikitara et al., 2019). There has been a growing demand to enhance the quality of care for diabetes to more comprehensive health care that addresses the physical, social, and emotional challenges attributed to the condition (Nikitara et al., 2019). Health professionals are recommended to promote patient participation in decision-making regarding their care.

A report by the American Diabetes Association (ADA) reveals an estimated overall diabetes cost of $327 billion in 2017, with $237 billion used in direct medical costs and $90 billion in reduced productivity. The largest components of diabetes costs include hospital inpatient care and prescription treatments to treat complications, which account for 30% of the total medical cost each (ADA, 2018). Other components include antidiabetic agents and diabetes supplies, which account for 15%, and physician office visits at 13%. Diabetic patients incur an average medical cost of $16,752 annually, of which approximately $9,601 is used in diabetes care (ADA, 2018). On average, diabetic patients have medical costs roughly 2.3 times higher than what medical costs would be in the absence of diabetes.

How State Board Nursing Practice Standards and Governmental Policies Can Affect Type 2 Diabetes Impact on the Quality of Care, Patient Safety, and Costs to the System and Individual

State board nursing practice standards dictate how nursing care is provided and the quality of care for diabetic patients. The standards guide nurses to provide standard care to patients regardless of the healthcare setting (ADA, 2016). Consequently, nursing practice standards can positively impact the quality of diabetes care by guiding nurses in assessing and managing patients to provide the best quality care possible. Nursing practice standards also provide the minimum standards that nurses should meet when providing patient care to avoid complications and promote patient safety (ADA, 2016). Besides, they guide nurses on assessing for complications, evaluating the effectiveness of care, and providing patient education on preventing complications.

The standards guide nurses on how to provide quality care that will promote reduced complications, hospital stays and readmission rates and increase patient outcomes, thus reducing patient and hospital operational costs. Nursing standards direct nurses on the actions to take on each step of management to avoid unnecessary procedures, investigations, or treatments, thus reducing patient and operational costs (Nikitara et al., 2019). They direct the evaluation of the overall care given to patients for nurses to evaluate whether the care was cost-effective and, if not, how it can be improved to make it more efficient.

Government policies can significantly affect diabetes’ impact on the quality of care, patient safety, and costs to the system and individual. Policy actions can improve the availability and quality of care for diabetes and support persons to make healthier choices. According to Timpel et al. (2019), government policies can help eliminate two major health system obstacles to successful type 2 diabetes care and management: financial barriers for patients and limited access to health services and medication. Government policies can address health system factors to promote effective type 2 diabetes care and management (Timpel et al., 2019). These factors include the utilization of innovative care models, increased pharmacists’ inclusion in care delivery, and education programs facilitated by healthcare professionals.

Improving patient safety practices can support health care delivery systems and enhance health sector performance. Government policies can direct the adoption of strategies by health systems to promote quality improvement in the care of diabetic patients. According to El-Jardalim & Fadlallah (2017), government policies can introduce sets of standardized and applicable quality indicators for performance measurement and benchmark. Besides, they can direct the establishment of incentive systems that connect contractual agreements, accreditation, regulations, and performance indicators to improve patient care quality and safety (El-Jardalim & Fadlallah, 2017). Lastly, government policies can help establish a culture of continuous quality improvement in the health systems and support professional training in quality improvement and patient safety

_Reference:

_{Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press.}

To Prepare:

• Review the Learning Resources for this week.
• Reflect on your experience with nursing practice, specifically as it relates to the function of quality and safety. For example, consider whether your current organization supports quality and safety. How might your role help to support these measures in your organization or nursing practice?

By Day 3 of Week 1

Post a brief description of any previous experience with quality and safety. Then, explain how your role as the DNP-prepared nurse represents a function of quality and safety for nursing practice and healthcare delivery. Be specific and provide examples.

Professional nurses always play a significant role in the health, safety, and quality improvement especially when dealing with the patient population.  Some examples of ensuring safety to our patients include, medication safety, falls prevention, procedure safety measures such as site location for surgery, monitoring of patients while in our care, adequate staffing to ensure patients are safe and much more. The cultures of safety are essential in order for us to correct the issue of frequent error and harm before it effects the patient population.  To prevent errors, we need to investigate what causes them. An organization should always look for ways to improve quality and safety of health care. As a nurse in my clinical practice, I also strive to provide quality and safe care to my patient population to avoid harm.

APRNs understand principles of practice management, including conceptual and practical strategies for balancing productivity with quality of care. We can assess the impact of practice policies and procedures meeting the health needs of the patient populations with whom they practice. In Addition, as we are proficient in quality improvement strategies and in creating and sustaining changes at the organizational and policy levels (Dreher & Glasgow 2017).

Experience with Quality and safety

My most recent experience with Q & S was the during a medication reconciliation for a resident in a nursing home.  The patient was admitted to the facility over the weekend and his medication reconciliation was not completed right away.  This patient was diagnosed with a PE and was discharge on blood thinners (Xarelto).  Upon reviewing the patient’s chart, the weekend admitting nurse missed the medication because all the pages of the admission papers were not provided to her on her shift and the medication was not input on the patients MAR.  The medication was immediately called in to the Pharmacy and made available to the resident.  Of course, in-service education was completed with this nurse.  Incidences such as this one can happen in any organization where a medication is missed that is detrimental to the patient’s treatment.  These events provide for an opportunity for education on safety.

My role as a DNP in promoting quality and safety for nursing practice and healthcare delivery is to always seek ways to improve the delivery of safe and effective care to the patient.  To provide quality care that the patient needs in a safe manner always, patient -centered, affordable and without any discretion to religion, culture, socioeconomic status, race, or sexual preference. As a DNP I will always provide care based on evidence base delivery. Moreover, examples of promoting quality and safety are to always keep up with opportunities for continued education on how to be on the cutting edge of excellent delivery for better outcomes for the patient in my practice.  Identifying areas that may cause errors in treatment to patient and preventing opportunities for harm are some of the areas that will be of importance to me as a DNP while delivery care.

By Day 5 of Week 1

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding upon your colleague’s post or suggesting an additional alternative perspective on quality and safety.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion 1 Rubric

Post by Day 3 of Week 1 and Respond by Day 5 of Week 1

To Participate in this Discussion:

Read Also: NURS 8302 Week 1 Assignment: Foundations of Quality and Patient Safety in Healthcare

Week 1 Discussion 1

Rubric Detail

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Quality and safety are the driving force behind delivering and promoting optimal care (Stalter & Mota, 2018). My primary role as a clinical nurse is to provide high-quality, patient-centered care using evidence-based practice. Before giving any care or medication dispensing, I include EBP into the routine. In my current role, I noticed that my colleagues rely on post-education, and I feel that approach is integrated at the wrong time, which is usually after an incident or error has occurred. I strongly believe in pre-education and promoting evidence-based practice in nursing.

I work on a 23-bed Med-Surg unit, and Friday mornings are the busiest surgical days. On this morning, a nurse administered a patient scheduled for Coronary Artery Bypass Graft (CABG) 20 units of Aspart and 15 units of Regular for a blood sugar of 206. Unfortunately, the patient had been NPO after midnight before the day of surgery. In the meantime, as we continued to make rounds and administer morning medications on the unit, the nurse received a call from the telemetry unit that the patient heart rhythm converted from normal sinus rhythm to ventricular tachycardia. The staff quickly went to the bedside and noted the patient to be diaphoretic, lethargic with a heart rate sustaining in the 130-150’s.

Immediately we had to call the rapid response team for further assistance. After the team arrived and was given a full report on the patient, the team administered IV antiarrhythmic medication to aid with the heart rate and a bolus of IV fluids for the blood pressure. Then, of course, the surgery was postponed, and the patient was transported to the ICU for closer observation. At shift change, the nurses had to report on what happened and how the patient received such a high insulin dose. Any high-alert medications must have two verifiers; only one nurse verified and administered the drug, which led to the error above. After further investigation, it was a computer error because it did not prompt the alert box for an additional signer. In addition, the nurse who administered the medication was new to the unit. I’m not making any excuses; however, the nurse should have verified the insulin order with the charge nurse or the ordering provider. Also, the ordering provider should have discontinued the order before surgery, which could have prevented the error. Therefore, thorough education and the implementation of evidence-based practice are imperative in nursing.

Role as a DNP-Prepared Nurse

As a DNP-Prepared nurse, I intend to integrate evidence-based practice by developing our organizational culture that supports best practice and promotes opportunities for staff to enhance their clinical skills and knowledge. With the healthcare system being so complex, as a DNP-prepared nurse, promoting a healthy work environment is an effective solution to promoting quality improvement and being proactive in preventing errors or glitches before they occur (Abdul, Jarrar & Don, 2015). In addition, I would advocate for the implementation of evidence-based practice throughout the nursing unit and organization by educating nurses on skills, such as critical appraisal and translation of research findings into practice (Tu & Wang, 2011). Furthermore, in my role as a DNP-prepared nurse, I can use error prevention strategies by continuously monitoring outcomes and completing root cause analysis when errors occur, including the input from clinical staff and the leadership team.

References:

Abdul, R.H., Jarrar, M., & Don, M.S. (2015).  Nurse level of education, quality of care and

patient safety in the medical and surgical wards in Malaysian private hospitals: A cross-

sectional study. Global Journal of Health Sciences.7(6):331-337. doi: 10.5539/gjhs.v7n6p33.

Stalter, A., & Mota, A. (2018). Using systems thinking to envision quality and safety

in healthcare, Nursing Management. Volume 49(2): doi:

10.1097/01.NUMA.0000529925.66375.d0.

Tu, Y.C., & Wang, R.H. (2011). High-quality nursing health care environment: The patient

safety perspective. Hu Li Za Zhi 58(3): 93-8. https://pubmed.ncbi.nlm.nih.gov/21678259.

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Name: NURS_8302_Week1_Discussion2_Rubric

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		Excellent 90–100	Good 80–89	Fair 70–79	Poor : 0–69
Main Posting: Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.		40 (40%) – 44 (44%) Thoroughly responds to the Discussion question(s). Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources.	35 (35%) – 39 (39%) Responds to most of the Discussion question(s). Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of the post has exceptional depth and breadth. Supported by at least three credible references.	31 (31%) – 34 (34%) Responds to some of the Discussion question(s). One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Cited with fewer than two credible references.	0 (0%) – 30 (30%) Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references.
Main Posting: Writing		6 (6%) – 6 (6%) Written clearly and concisely. Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style.	5 (5%) – 5 (5%) Written concisely. May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style.	4 (4%) – 4 (4%) Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors.	0 (0%) – 3 (3%) Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Posting: Timely and full participation		9 (9%) – 10 (10%) Meets requirements for timely, full, and active participation. Posts main Discussion by due date.	8 (8%) – 8 (8%) Meets requirements for full participation. Posts main Discussion by due date.	7 (7%) – 7 (7%) Posts main Discussion by due date.	0 (0%) – 6 (6%) Does not meet requirements for full participation. Does not post main Discussion by due date.
First Response: Post to colleague’s main post that is reflective and justified with credible sources.		9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.	8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting.	7 (7%) – 7 (7%) Response is on topic and may have some depth.	0 (0%) – 6 (6%) Response may not be on topic and lacks depth.
First Response: Writing		6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English.	4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited.	0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited.
First Response: Timely and full participation		5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date.	4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date.	3 (3%) – 3 (3%) Posts by due date.	0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date.
Second Response: Post to colleague’s main post that is reflective and justified with credible sources.		9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.	8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting.	7 (7%) – 7 (7%) Response is on topic and may have some depth.	0 (0%) – 6 (6%) Response may not be on topic and lacks depth.
Second Response: Writing		6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English.	4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited.	0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited.
Second Response: Timely and full participation		5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date.	4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date.	3 (3%) – 3 (3%) Posts by due date.	0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date.
Total Points: 100

Name: NURS_8302_Week1_Discussion2_Rubric