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NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation

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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

    Analyze a Current Quality Improvement Initiative

    Hospitals around the world face several healthcare issues which need some quality improvement (QI) initiatives so that effective healthcare is provided and positive patient outcomes are achieved. A similar QI initiative related to adverse drug events (ADEs) is established for the Vila Health facility. 

    In a study, researchers concluded that out of 100 patients, 16-18 encounter adverse events related to the drugs. Moreover, these ADEs significantly cause multiple complications for the patients which can ultimately lead to an increased mortality rate (8.8- 9.5%) (Sahilu et al., 2020). Another study conducted in two tertiary care hospitals estimated that the costs associated with ADEs around $5.6 million annually (Choi et al., 2022). Further research indicates that adverse drug events are found in about ¼ of the patients. It is concluded that the majority of these ADEs are avoidable and indicates that there are chances to improve patients’ safety (Ersulo et al., 2022).

    NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation

    These sources of evidence advocate the need for quality improvement initiatives to ensure medication safety as well as improve patients’ outcomes. The quality improvement plan established for Vila Health facility was implemented after the incidence of wrong administration of sound-alike drug as mentioned in assessment 1 (the nurse administered Metoprolol to the patient instead of Metoclopramide which significantly decreased the patient’s blood pressure eventually causing mortality). This QI plan is subdivided into two essential parts – training and education for healthcare professionals and the establishment of organizational policies of zero tolerance against medication negligence. 

    Although these two approaches assist the Vila Health facility’s staff and administration to create medication safety guidelines and interventions to promote a safety culture within the workplace, this initiative has a drawback that it does not address the issue of underreporting of adverse drug events. Moreover, the concern of staff shortage which is one of the most common risk factors for unsafe medication practices is not discussed in the quality improvement plan. 

    Evaluation of the Success of the Quality Improvement Initiative

    Every improvement plan or initiative requires monitoring and evaluation to measure the success or failure of the plan. Hence the administration of Vila Health facility also evaluated the QI initiative implemented in their hospital. According to the Agency for Healthcare Research and Quality (AHRQ), the three areas of evaluation of any QI initiative are

    1. Monitoring the adherence to the new practices
    2. Analyzing the extent to which the new practices are successful in delivering patient-centered care.
    3. Assessing the improvement in patients’ experiences and care quality (Agency for Healthcare Research and Quality, 2020). 

    The success of the QI initiative implemented at the Vila Health facility is based on above mentioned key indicators. This analysis is based on the number of patients admitted to a healthcare facility and the participants included in the implementation plan like nurses, doctors, pharmacists, and patients. It is evaluated that the two approaches of the QI initiative have significant positive impacts on the patient safety outcome concerning adverse drug events. Firstly, it is noticed that due to interprofessional education, healthcare professionals are working collaboratively to improve medication practices.

    The adherence to the education guidelines like appropriate prescribing, dispensing, and rights of medication administration framework significantly increased. The data collected revealed that from 50% of healthcare workers showing adherence, it raised to approximately 88% of healthcare workers following the standard guidelines. Moreover, the zero-tolerance policy against medication negligence enabled healthcare professionals to be vigilant during the entire medication process. This was evident by the reduced number of drug-related adverse events from 10/100 patients to 3/100 patients. Additionally, a survey collected from patients identified that 85% of patients responded with improved experiences related to the quality of care. 

    Interprofessional Perspectives and Actions

    Implementation of any quality improvement initiative requires a task force to collaboratively work together so that successful outcomes are obtained. Researchers identify that the frontline workforce is primarily responsible for effective collaboration with personnel from multiple professions (Brugman et al., 2022). Hence as frontline staff, nurses have this responsibility. The interprofessional team involved in the quality improvement plan at Vila Health facility comprised nurses, nurse managers, nurse educators, the quality control department, and the administration/policymakers of the hospital. The role played by each of the categories of the interprofessional team is

    • Nurses – As the implementation of the QI initiative in the Vila Health facility is based on adverse drug events due to nurses’ negligence, nurses have to improve their medication handling and administration practices to ensure patients’ safety. 
    • Nurse managers – They are responsible for encouraging efficient practices and discouraging malpractices by standardizing their units and effectively handling the challenges according to the hospital’s QI plan. 
    • Nurse educators – Their primary duty is to train healthcare professionals in the standard guidelines and practices and develop a continuous professional education curriculum. Moreover, timely testing of the knowledge is an essential part of their duty. 
    • Quality control – The quality control department is responsible for monitoring the progress and success of the QI initiative. 
    • Administration/Policymakers – Policymakers are mainly required to establish policies and protocols which every individual healthcare professional is obligated to follow. 

    The uncertain information of this analysis is whether there were any initiatives were taken for continuous monitoring of the adverse events. Moreover, no information is provided against the major risk factor of medication malpractices which is overburdened nurses due to a shortage of staff.

    Additional Recommendations

    The additional recommendation for improved outcomes of quality improvement initiatives is to use continuous monitoring using the PDSA cycle for effective outcomes. Moreover, clinical audits are essential for the continuous monitoring and sustainability of QI initiatives. 

    Continuous Quality Improvement (CQI) using the PDSA cycle: 

    The PDSA model is the most common model used in healthcare systems for the continuous improvement of quality care. The purpose of the PDSA cycle is to continuously collect data, plan interventions for smaller groups and use that data for revising interventions as per the need (Knudsen et al., 2019). The four parts of PDSA include

    1. PLAN: at this initial stage the problem is identified, an implementation team is established and some of the organization-specific interventions are planned 
    2. DO: This is the implementation phase where the intervention decided are executed but in smaller groups for test and trial purposes. 
    3. STUDY: The results of the small-scale study are monitored, evaluated, and examined for success and drawbacks. The interventions are revised at this stage if needed. 
    4. ACT: This is the final implementation stage of the cycle, however, the cycle is repeated for continuous improvement purposes. 

    Clinical audits:

    A clinical audit is a tool recommended for QI in clinical practices. It plays a significant role in improving outcomes and patients’ safety. The cycle of clinical audit involves analyzing practices, establishing standards, comparing the practices with the set standards, and finally improvising the practices with new strategies (Alyacoubi et al., 2021). Therefore it is recommended to have frequent clinical audits for observing staff’s practices related to medication safety and upon the data collected further improvements in the practices can be initiated. 

    There are various positives and negatives of these recommendations. The positives are that these recommendations will improve patient outcomes, help in continuous monitoring of setbacks, and enables healthcare professionals to realize the loopholes of the practices to improve timely. However, the cons of these recommendations are the establishment of an audit team will require more human resources thus adding an extra task for hospital administration. Moreover, the PDSA cycle being a continuous process is time-consuming which eventually is an extra workload for the existing employees. 

    Conclusion

    Quality improvement plans are significant for healthcare facilities because of the increasing prevalence of adverse events. Similarly, hospitals need to develop implementation plans for adverse drug events (ADEs) to improve patients’ safety. Implementation of the QI initiative alone is not enough, it is more important to evaluate its success and continuously improvise the plans. Thus, evidence-based strategies are essential for developing QI initiatives and evaluation metrics should be used for continuous improvement to ensure positive outcomes are obtained and patients’ safety is maintained. 

    References

    Alyacoubi, S., Albarqouni, L., Elessi, K., & Bottcher, B. (2021). The introduction of clinical audit as a Quality Improvement Tool in Gaza. Clinical AuditVolume 13, 15–19. https://doi.org/10.2147/ca.s262619  

    Brugman, I. M., Visser, A., Maaskant, J. M., Geerlings, S. E., & Eskes, A. M. (2022). The evaluation of an interprofessional qi program: A qualitative study. International Journal of Environmental Research and Public Health19(16), 10087. https://doi.org/10.3390/ijerph191610087  

    Choi, E., Kim, S., & Suh, H. S. (2022). Exploring the prevalence and characteristics of adverse drug events among older adults in South Korea using a National Health Insurance Database. Frontiers in Pharmacology13. https://doi.org/10.3389/fphar.2022.1047387  

    NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation

    Ersulo, T. A., Yizengaw, M. A., & Tesfaye, B. T. (2022). Incidence of adverse drug events in patients hospitalized in the medical wards of a teaching referral hospital in Ethiopia: A prospective observational study. BMC Pharmacology and Toxicology23(1). https://doi.org/10.1186/s40360-022-00570-w  

    Knudsen, S. V., Laursen, H. V., Johnsen, S. P., Bartels, P. D., Ehlers, L. H., & Mainz, J. (2019). Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-ACT projects. BMC Health Services Research19(1). https://doi.org/10.1186/s12913-019-4482-6  

    Sahilu, T., Getachew, M., Melaku, T., & Sheleme, T. (2020). Adverse drug events and contributing factors among hospitalized adult patients at Jimma Medical Center, southwest Ethiopia: A prospective observational study. Current Therapeutic Research93, 100611. https://doi.org/10.1016/j.curtheres.2020.100611  

    Agency for Healthcare Research and Quality. (2020). Section 4: Ways to approach the quality improvement process. Retrieved March 18, 2023, from https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi-process/index.html