Nursing Quality Indicator Improvement

GUIDELINES FOR THE QUALITY INDICATOR (QI) PROJECT PRESENTATION This assignment provides students opportunity to examine the

contributing processes and procedures in identifying a health care quality
indicator and come up with proposed strategies in improving specific related
patient outcomes. Selection of the quality indicator and its relationship to at
least one of the NPSG related to your area of practice from the link National
Patient Safety Goals/The Joint Commission and specify the NPSG identifier with
the related number

Nursing Quality Indicator Improvement

This is a 3-page paper (excluding cover page and references) the
student(s) will include everything mentioned in the rubric below to complete
this assignment. Rubric for each section:1.            The selected QI is
Safe use of medications in hospital (NPSG.03.06.01) (10%)2.            Mechanism for
gathering data to support the indicator both internal (clinical facility
data/reports) and external (research articles, best practices, and practice
guidelines). (25%) 3.            Implementation plan
of the QI project describing the teaching strategy and anticipated facilitators
and possible barriers. (40%) 4.            Method of evaluation
of the success of the QI project and recommendations for future QI related to
the selected quality indicator. (15%) 5.            Writing mechanics
(5%) 6.            APA 7 proper citation
(5%)

Nursing Quality Indicator Improvement

Quality Indicator: Safe Use of Medications in the Hospital

           Quality indicators (QIs) are vital measures in nursing and healthcare in general. The indicators are vital in measuring the quality of delivered care, indicating prevalent quality matters, selecting areas for further improvement, and following up on changes with time (Vieira et al., 2020). The main QIs currently recognized by the Agency of Healthcare Research and Quality (AHRQ) include Pediatric Quality Indicators (PQIs), Inpatient Quality Indicators (IQIs), Patient Safety Indicators (PSIs), and Prevention Quality Indicators (PQIs) (Bao et al., 2019). The QI of focus in this project is the Safe use of medications in the hospital, an element of Goal 3: Improving the safety of using medications of the National Patient Safety Goals (NPSG.03.06.01) (Rodziewicz & Hipskind, 2020). The QI focuses on the improvement of safe medication administration in hospitals.

            Nurses are crucial to healthcare providers in ensuring proper drug administration, enhancing the right medication at the appropriate dose and time for the patients, and following up on possible signs of interactions (Eukel et al., 2023). According to WHO (2019), medication discrepancies and errors can severely impact patient health outcomes, cause morbidities and mortalities, and impair quality of life. Addressing the discrepancies entail medics’ adequate comparison of patients’ prior and current drug prescriptions with the new ones to improve medication safety (WHO, 2019). The analysis often checks for drug interactions, omissions, duplications, and any necessity for continued medication intake.

Data Collection to Support the QI (Internal and External)

           Data to support the QI can be gathered both internally and externally. Internal data source entails the hospital patient records of medication and treatment prescribed. Within the clinical facility, existing data on medication use is obtained from the facility’s patients’ inpatient and outpatient medication records (WHO, 2019). All drug administration and medication errors and their causes will be vital in gathering data for the QI. Their files and doctors’ reports are a vital mechanism that will aid data collection to support the QI. Conversely, the data can be gathered externally through Evidence-Based Medication and existing practice guidelines on the safe use of medication and incidences of drug administration discrepancies.

Implementation Plan of the QI Project

Teaching Strategy

           After data collection, the implementation phase entails the approval of vital strategies which foster the safe use of medication. The teaching strategies can be directed to nurses, patients, and their families to avoid any possible dangers of unsafe medication use in the facilities. Nurses can be enlightened on the essence of:

  • Standardized administration periods of the drugs 
  • Undertaking medication reconciliation on admission, discharge, and before any prescription (WHO, 2019).
  • Implementing nurse-led medication training for the patients and their kin. Nurse-led and interprofessional education is crucial in fostering medical safety (Grimes & Guinan, 2022)
  • Utilization of technology advancements in preventing medication errors, for example, tech physician order entry electronically enabled medication reconciliation and bedside bar-coded drug administration (Kahn &Abramson, 2019).

Additionally, such education can be offered to patients and their families specifically:

  • The need to understand and enquire when unsure of the medication information, for example, the name, purpose, dosage, route, and frequency (Kini &Ho, 2018).
  • The essence of acquiring written information on all the drugs prescribed upon discharge.
  • The importance of managing past and present medication data and updating any new physicians on the same.

Anticipated Facilitators

           The successful implementation of the strategies for improving the safe use of medication will entail support from hospital management/ system configurations, the nursing unit, behaviors and facilitation of nurse-led education, the hospital’s record system, and patient/family interactions (Daliri et al.,2019).

Possible Barriers

           The anticipated hindrances to the success of the quality indicator improvement project are a lack of adequate data to identify the gaps, a constraint hospital system configuration, and nurses’ reluctance to support the improvement.

Method of Evaluation of the Success of the QI Project and Recommendations for Future Related QI

Evaluation

           The success of the QI project will be revealed by the success of the implemented interventions, as seen in the reduction in the prevalence of unsafe medication discrepancies. The effect will be revealed on the changes in standardization of medication times, the occasional patient/family education, and the implementation of medication reconciliation to reduce medication errors. Kini &Ho (2018) assert that improving safe medication in hospitals is linked to high-quality care and preventing adverse events following unsafe use incongruities. Successful utilization of technologically inclined approaches like bar-coded bedside administration, tech physician order entry, and electronically enabled medication reconciliation are good indicators of the success of the QI project on safe medication use in hospitals (Kahn &Abramson, 2019).

Recommendations

  • Utilization of technological physician order entry for most medication orders to avoid inherent medication errors.
  • Good maintenance of an active medication list for all patients for reference (Dixon-Woods, 2019).
  • Maintenance of specific patients’ drug allergies or contraindications for safe prescription in future hospital visits.
  • Nurses and other involved healthcare workers (HCWs) should always prioritize adherence to the approved standards for Safe medication, including prescribing the right drug and dose, at the right time, to the right patient, and while using the correct route (WHO, 2019).
  • Drug packaging, nomenclature, and labeling scrutiny are vital before any prescription, and pharmacists and nurses should keenly comply. 


References

Báo, A. C. P., Amestoy, S. C., Moura, G. M. S. S. D., & Trindade, L. D. L. (2019). Quality indicators: tools for the management of best practices in Health. Revista brasileira de enfermagem, 72, 360-366.

https://www.scielo.br/j/reben/a/T89wNCjgBwCKCYS9whxjSsm/abstract/?lang=en

Daliri, S., Bekker, C. L., Buurman, B. M., Scholte op Reimer, W. J., van den Bemt, B. J., & Karapinar–Çarkit, F. (2019). Barriers and facilitators with medication use during the transition from hospital to home: a qualitative study among patients. BMC health services research, 19, 1-10.

https://link.springer.com/article/10.1186/s12913-019-4028-y

Dixon-Woods, M. (2019). How to improve healthcare improvement—an essay by Mary Dixon-Woods. bmj, 367.

https://www.bmj.com/content/367/bmj.l5514.long

Eukel, H. N., Steig, J., Hodges, A., O’Gary, B., & Strand, M. A. (2023). Nurse delivered medication safety screening program for home care visits. Public Health Nursing.

https://onlinelibrary.wiley.com/doi/abs/10.1111/phn.13178

Grimes, T. C., & Guinan, E. M. (2022). Interprofessional education focused on medication safety: A systematic review. Journal of Interprofessional Care, 1-19. https://www.tandfonline.com/doi/abs/10.1080/13561820.2021.2015301

Kahn, S., & Abramson, E. L. (2019). What is new in paediatric medication safety?. Archives of Disease in Childhood104(6), 596-599.

https://adc.bmj.com/content/104/6/596.abstract

Kini, V., & Ho, P. M. (2018). Interventions to improve medication adherence: a review. Jama320(23), 2461-2473.

https://jamanetwork.com/journals/jama/article-abstract/2718800

Rodziewicz, T. L., & Hipskind, J. E. (2020). Medical error prevention. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. http://www.saludinfantil.org/Postgrado_Pediatria/Pediatria_Integral/papers/Medical%20Error%20Prevention%20-%20StatPearls%20-%20NCBI%20Bookshelf.pdf

Vieira, J., Santos, M. R., Pires, R., & Pereira, F. (2020). Quality indicators of professional practice of nurses: the caregiver role. Millenium-Journal of Education, Technologies, and Health, (16), 41-48.

https://revistas.rcaap.pt/millenium/article/view/24785

World Health Organization. (2019). Medication safety in polypharmacy: technical report (No. WHO/UHC/SDS/2019.11). World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/325454/WHO-UHC-SDS-2019.11-eng.pdf

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