Assignment: Enhancing Quality and Safety

Unsafe medication practices occur mostly during drug administration and are the common causes of avoidable patient harm in healthcare organizations globally. Medication errors can occur during drug prescribing, transcribing, dispensing, or administration (Wondmieneh et al.,2020). Nursing professionals play a major role in the incidence and prevention of MAEs. The purpose of this assignment is to discuss factors causing patient-safety risks in regard to medication administration, identify evidence-based solutions, and how nurses can coordinate care to promote patient safety.

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Factors Leading to a Specific Patient-Safety Risk

Medication administration errors (MAEs) are the prevalent types of medication errors and are associated with adverse consequences for patients, healthcare providers, and health facilities. Wondmieneh et al. (2020) explain that commonly perpetrated MAEs are wrong patient, wrong drug, wrong dose, wrong route, wrong time, dose omission, failure to document, and technical errors. MAEs significantly affect patients by increasing morbidity, adverse drug events, mortality, prolonged hospital stay, and increased medical costs (Härkänen et al., 2019). The WHO explains that patients from developing countries experience twice as many disabilities caused by MAEs-related harm than those from developed nations.

Factors that cause MAEs can be grouped as nurse-related, physician-related, nurse-physician, and organizational factors. The nurse-related factors include old age, limited work experience, poor medication knowledge, poor dose calculation skills, failure to double-check drugs, inattention during drug administration, new hires, similar medication package, and insufficient training (Wondmieneh et al., 2020). Physician-related factors include physicians changing medication orders and failing to communicate clearly through documentation. In addition, ineffective communication between nurses and physicians is a major cause of MAEs. The most common organizational factor related to MAEs is a high workload for nurses characterized by high nurse-to-patient ratios that lead to fatigue and burnout (Härkänen et al., 2019). Busy shifts and units with a high patient flow have been found to have more MAEs. Furthermore, interruptions during drug administration and pharmacy procedures contribute to MAEs.

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

MAEs can be prevented by cutting short any medication errors before they get to the patient by sticking to the five rights of drug administration and reporting MAEs, which improves patient safety. Salami et al. (2019) assert that increasing nurses’ drug knowledge effectively reduces MAEs. Another essential preventive measure to reduce MAEs is encouraging nurses to behave professionally. Adib & Eshraghi (2018) explain that elements of professional nursing behavior include reading medication labels, following MAEs, nurses being aware of medication errors, attending regular training on medication protocols, and precision. Furthermore, MAEs can be prevented by motivating the nurses to report them so that they can reflect on how to reduce the errors. Thus, organizations can offer a motivating mechanism for reported MAEs and build a conducive environment for error reporting (Salami et al., 2019). Nursing and hospital managers should also lower the nursing workload and ensure safe nurse-to-patient ratios, which can minimize errors caused by fatigue and distractions.

How Nurses Can Help Coordinate Care to Increase Patient Safety and Cost

Poor coordination of patient care poses a risk of preventable events like uncontrolled polypharmacy, medication errors, and ineffective follow-up care. Coordinating patients’ care among multiple providers and care settings is a big challenge. Nurses can participate in care coordination by ensuring patients’ multidimensional needs are met at the bedside, during the transition from one facility to another, and as they live in the community (Karam et al., 2021). Moreover, nurses can coordinate patient care through medication reconciliation. Nurses can adopt a methodical and comprehensive medication reconciliation process and perform it every time a patient transitions to a new level of care along the continuum of care. In addition, nurses can adopt practices that promote care coordination, like handoffs, huddles briefings, and multidisciplinary rounding, that simplify and standardize communication and improve patient safety by minimizing communication breakdowns (Karam et al., 2021). Furthermore, nurses can involve patients and their families in discharge planning and education and conduct follow-up visits with the patient post-discharge to address any concerns and foster compliance with the discharge plan.

Stakeholders Needed for Quality and Safety Enhancements

Nurses need to collaborate with various stakeholders in the above care coordination approaches, including pharmacists, physicians, case managers, and social workers. Pharmacists and physicians can participate in medication reconciliation and provide education during discharge planning. The pharmacist can educate patients about their medications, including indications, potential side effects, and the adverse effects to look out for (Hanifin & Zielenski, 2020). Case managers are important in helping patients and caregivers navigate the discharge process, including understanding how to take their discharge medications to prevent errors caused by wrong doses (Hanifin & Zielenski, 2020). Besides, social workers can help follow up on patients and help patients to access community resources in medication management.

Conclusion

MAEs are related to poor medication knowledge and calculation skills, insufficient nurse training, high nursing workload, ineffective physician-nurse communication, and interruptions. Updating nurses’ knowledge, particularly about new drugs, reducing nurses’ workload, encouraging nurses to behave professionally, and reporting errors can significantly reduce MAEs. Nurses can coordinate care by meeting patients’ multidimensional needs, medication reconciliation, multidisciplinary rounding, and involving patients in discharge education.

References

Adib, H. M., & Eshraghi, A. N. (2018). Assessing Nurses’ Clinical Competence from Their Own Viewpoint and the Viewpoint of Head Nurses: A Descriptive Study.

Hanifin, R., & Zielenski, C. (2020). Reducing medication error through a collaborative committee structure: An effort to implement change in a community-based health system. Quality Management in Healthcare, 29(1), 40-45. doi: 10.1097/QMH.0000000000000240

Härkänen, M., Paananen, J., Murrells, T., Rafferty, A. M., & Franklin, B. D. (2019). Identifying risks areas related to medication administrations-text mining analysis using free-text descriptions of incident reports. BMC Health Services Research, 19(1), 1-9. https://doi.org/10.1186/s12913-019-4597-9

Karam, M., Chouinard, M. C., Poitras, M. E., Couturier, Y., Vedel, I., Grgurevic, N., & Hudon, C. (2021). Nursing Care Coordination for Patients with Complex Needs in Primary Healthcare: A Scoping Review. International Journal of Integrated care, 21(1), 16. https://doi.org/10.5334/ijic.5518

Salami, I., Subih, M., Darwish, R., Al-Jbarat, M., Saleh, Z., Maharmeh, M., … & Al-Amer, R. (2019). Medication administration errors: Perceptions of Jordanian nurses. Journal of Nursing Care Quality, 34(2), E7-E12.

Wondmieneh, 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), 1-9.

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Assessment 1 Instructions: 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.

SCORING GUIDE

Use the scoring guide to understand how your assessment will be evaluated.

VIEW SCORING GUIDE