Assignment: Quality Or Patient Safety Concern Paper

Assignment: Quality Or Patient Safety Concern Paper

Assignment: Quality Or Patient Safety Concern Paper

            Safety and quality issues in healthcare have significant effect on patient care outcomes and patient experiences with the care process. The issues often arise because of factors such as patient, provider, or institutional factors. Nurses and other healthcare providers should implement interventions that prevent the potentials of safety and quality issues in their practice. Evidence-based strategies have proven effective in enabling healthcare providers to achieve outcomes such as enhanced quality, safety, and efficiency in the care process (Domin, 2022). Therefore, the purpose of this paper is to examine a safety issue I experienced in my practice, application of EBP, PT, and QI, data sources utilized, capturing and disseminating data, and organizational culture considerations.

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Explanation of the Issue and Associated Challenges

            The selected safety issue that I am familiar with and have encountered in the healthcare environment is patient falls. I have witnessed an elderly patient suffer from falling. The fall led to significant injuries that affected his mobility and ability to engage in most of his activities of daily living. A patient fall has been defined as the abrupt unintentional descent of a patient from a resting position to the floor or against a surface. Patient falls may or may not be associated with injuries (Hill et al., 2019). Patient falls are considered crucial indicators of safety in an organization. They possess significant health challenges to the patients. Falls increase the risk of injuries such as fractures and premature mortalities. Falls also lower the patients’ quality of life, as evidenced by the patients’ inability to engage in their social or occupational activities because of the complications of falls (Heng et al., 2020). Falls also increase healthcare costs that patients incur. Accordingly, complications such as fractures require specialized care as well as prolonged hospital stays. As a result, the costs that patients incur in treating their health problems rise significantly, leading to a high disease burden for the affected populations (Lopez-Jeng & Eberth, 2020). Therefore, patient falls cause considerable challenges, increasing the need for the adoption of effective strategies for early identification and prevention of their occurrences.

How EBP, Research and Process Improvement Could be Utilized to Address the Issue

            Evidence-based practice, research, and process improvement could be utilized to address the issue of patient falls. Evidence-based practice entails the utilization of best practice evidence obtained from research, provider expertise, and patient values in making care decisions. Nurses can utilize best practice interventions from research to implement change initiatives that prevent future occurrences of falls. They can also utilize evidence-based practices to transform the existing organizational culture (Francis-Coad et al., 2018). In this case, they can adopt best practices for advocating transformation of the organization’s culture.

            Research can also be utilized to address the issue. Accordingly, nurses can adopt systematic approaches obtained from either quantitative or qualitative studies to investigate the cause-effect relationship between and among variables. Nurses can undertake researches aiming at identifying patient, provider, or organizational factors that may have contributed to the fall. The research results will inform the strategies adopted in the organization to improve safety and quality of patient care (Heng et al., 2020). Process improvement can also be utilized to address the issue. Nurses and other healthcare providers may collaborate in examining the existing systems and processes utilized to ensure safety and quality in the patient care process. The analysis will reveal weaknesses in the existing systems and processes and guide the adoption of improvement strategies to improve safety and quality (Melin, 2018). Therefore, evidence-based practice, process improvement, and research can be utilized to address the problem.

PI or QI I Applied

            Process improvement is an essential business asset. It helps organizations to identify, analyze, and improve their existing processes to ensure safety, quality, and efficiency. The process improvement that I could adopt to address the issue of patient falls has some steps. The first one is mapping the current processes in the organization. Process mapping helps develop an accurate picture of the undertaking of the organizational things. The mapping will enable me to identify the inefficiencies, redundancies, and duplications that may be affecting efficiency of service delivery in the organization. The second step in the process is selecting a team. I will select a team to collaborate with in identifying potential areas of improvement to address patient falls (Sherwood & Barnsteiner, 2021). Once this is done, the next step will be implementing the identified changes to improve organizational systems and processes. This will be a collaborative process to minimize potentials of resistance to change from the staff. The other step will be monitoring and providing feedback to the implementors of the change initiative. Monitoring will provide insights into the areas of performance that should be improved to enhance safety and quality in the organization. The last step will be evaluation to determine if the adopted changes in the existing systems were effective or not (Janes & Delves-Yates, 2022). Evaluation will inform the staff the needed behaviors and strategies to ensure the absolute elimination of safety and quality issues in the patient care processes. The diagram below summarizes the approach to process improvement that will be adopted.

Data Sources

            The data sources for the safety issue in the organization are varied. They include patient records, incident reports, rates of falls in the hospital, and findings of investigated incidences. It also includes the hospital’s policies, guidelines and regulations that relate to patient falls. The other source includes the healthcare providers. Healthcare providers can provide information about their experiences with patient falls, contributing factors, effects, and potential strategies that can be adopted to prevent their occurrence in the organization. Outcome data can also be obtained from the finance department. The department can provide an analyzed cost of hospitalization for all the patients that suffered from hospital falls for comparison with the costs incurred by other patients that did not suffer falls. The data will be analyzed to have detailed insights into the causes and potential strategies that can be adopted for patient safety.

Capturing and Disseminating Data

            Some options will be considered for capturing the above data. One of them will be manual data capture. The data will be keyed manually into input devices such as Excel program to enable easy analysis. The other approach will be the use of optical character recognition. This will be considered when capturing data contained in image files or pdf files for easy analysis. Data dissemination will be important in addressing the issue of patient falls. The dissemination will adopt strategies that include presenting results of the change in conferences, to the staff, and publishing an article on it. The staff will be informed about the project outcomes through a formal meeting at the boardroom. They will also be provided with printed copies of the initiative for their use. Conference presentations will also provide platforms for reaching wider audience to influence practice (Domin, 2022). A publication will also be made to increase the audience reached and for use to inform practice.

Organizational Culture Considerations

            Organizational culture will influence the success of the process improvement initiative to address the issue of patient falls. One of them is leadership. Effective leadership styles and approaches are essential for the success of change initiatives in healthcare. Nurse leaders and managers should adopt approaches such as open communication and active stakeholder involvement to enhance the successful adoption of the change initiative. The other organizational culture aspect is teamwork. Organizational staff should work as a team in the implementation of change initiatives to address patient falls. Teamwork provides multiple perspectives of achieving optimum outcomes in the process and quality improvement initiative. It also strengthens the adoption of interventions that are likely to be sustainable due to the incorporation of tie diverse views of the stakeholders in strategy development (Sherwood & Barnsteiner, 2021). The other aspect of organizational culture is the promotion of staff development. The staff involved in implementing initiatives to address patient falls should be competent. Strategies that include training them and providing coaching, mentorship, and frequent feedback should be adopted to ensure success of the process (Domin, 2022). Therefore, these aspects of the organization’s culture should be considered for the successful implementation of change strategies to address patient falls and other safety and quality issues in the organization.

Conclusion

            The identified issue that I have experienced in my practice as a nurse is patient falls. Patient falls are a crucial safety concern in healthcare due to their associated adverse health effects on the patients. Evidence-based practice, research, and process improvement can be adopted to address the issue of patient falls. The process improvement approach that I would adopt to prevent and reduce risk of patient falls in the organization comprises of steps such as process mapping, selection of a team, problem identification, and implementation of strategies to address the problem. Data sources to inform the need for change in the organization will include healthcare providers, organization’s statistics on patient falls, and incident reports. Dissemination will adopt strategies such as conferences, brochures for the staff, and publications to expand the population reached by the results of the initiative. The organizational culture should be transformed to support evidence-based practice, process and quality improvement, and prioritization of safety and quality initiatives for optimum health of the patients.

References

Domin, K. (2022). Evidence-Based: Practice in Nursing & Healthcare 2022-2023. Amazon Digital Services LLC – Kdp.

Francis-Coad, J., Etherton-Beer, C., Burton, E., Naseri, C., & Hill, A.-M. (2018). Effectiveness of complex falls prevention interventions in residential aged care settings: A systematic review. JBI Evidence Synthesis, 16(4), 973–1002. https://doi.org/10.11124/JBISRIR-2017-003485

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A.-M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20(1), 140. https://doi.org/10.1186/s12877-020-01515-w

Hill, A.-M., McPhail, S. M., Haines, T. P., Morris, M. E., Etherton-Beer, C., Shorr, R., Flicker, L., Bulsara, M., Waldron, N., Lee, D.-C. A., Francis-Coad, J., & Boudville, A. (2019). Falls After Hospital Discharge: A Randomized Clinical Trial of Individualized Multimodal Falls Prevention Education. The Journals of Gerontology: Series A, 74(9), 1511–1517. https://doi.org/10.1093/gerona/glz026

Janes, G., & Delves-Yates, C. (2022). Quality Improvement in Nursing. SAGE.

Lopez-Jeng, C., & Eberth, S. D. (2020). Improving Hospital Safety Culture for Falls Prevention Through Interdisciplinary Health Education. Health Promotion Practice, 21(6), 918–925. https://doi.org/10.1177/1524839919840337

Melin, C. M. (2018). Reducing falls in the inpatient hospital setting. International Journal of Evidence-Based Healthcare, 16(1), 25–31. https://doi.org/10.1097/XEB.0000000000000115

Sherwood, G., & Barnsteiner, J. (2021). Quality and Safety in Nursing: A Competency Approach to Improving Outcomes. John Wiley & Sons.

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Assessment Description
This assignment aims to apply the concepts you have learned in this course to a situation you have encountered. Choose one quality or patient safety concern with which you are familiar and that you have not yet discussed in this course, (Diagnostic errors ). In a 1,250-1,500-word essay, reflect on what you have learned in this course by applying the concepts to the quality or patient safety concern you have selected. Include the following in your essay:

Briefly describe the issue and associated challenges.
Explain how EBP, research, and PI would be utilized to address the issue.
Explain the PI or QI process you would apply and discuss why you chose it.
Describe your data sources, including outcome and process data.
Explain how the data will be captured and disseminated.
Discuss which organizational culture considerations will be essential to the success of your work. This assignment uses a rubric.
Use a minimum of four peer-reviewed, scholarly sources as evidence.

Overview of Quality in Health Care

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

. Description of Issue and Challenges

5. Target

14 points

A description of the issue and associated challenges is present and thorough.

Utilizing EBP, Research, and PI

5. Target

16.8 points

An explanation of how EBP, research, and PI will be utilized is present and thorough.

PI and QI Process

5. Target

16.8 points

An explanation of the PI or QI process that would be applied and a discussion of why it was chosen are present and thorough.

Data Sources

5. Target

16.8 points

An explanation of data sources, including outcome and process data, is present and thorough.

Capturing and Disseminating Data

5. Target

16.8 points

An explanation of how the data will be captured and disseminated is present and thorough.

Organizational Culture Considerations

5. Target

16.8 points

A discussion of which organizational culture considerations will be essential to the success of the work is present and thorough.

Communicates reason for writing and demonstrates awareness of audience.

5. Target

9.8 points

The thesis, position, or purpose is persuasively developed throughout and skillfully directed to a specific audience.

Advances position or purpose throughout writing; conclusion aligns to and evolves from development.

5. Target

11.2 points

The thesis, position, or purpose is coherently and cohesively advanced throughout. The progression of ideas is coherent and unified. A convincing and unambiguous conclusion aligns to the development of the purpose.

Criteria Description

Selects and integrates evidence to support and advance position/purpose; considers other perspectives.

5. Target

7 points

Comprehensive and compelling evidence is included. Multiple other perspectives are integrated effectively.