Discussion: Supporting Quality and Safety Efforts in Clinical Settings
Discussion: Supporting Quality and Safety Efforts in Clinical Settings
NURS 6341: Week 2: Clinical Judgment and Ethics
“I was to give Synthroid IV to a woman who was hypothyroid… I thought it was a very large dose… [and] had this icky feeling that it wasn’t right… It was an error. I had given the woman three times the amount of the drug that was intended… She came through it…, but I will never give the wrong dose of Synthroid again. I will always check the original order and call the doctor if I have questions. I will never go against my instincts, overriding my icky feeling that this is not right.”
—Diane Pestolesi, from Educating Nurses, 2010, p. 100
Take a moment to recall this incident from last week’s readings. Although nurse educator Diane Pestolesi now uses it as an example when teaching connections between clinical practice and the 3Ps, her story of a medication error is applicable to this week as well. As Pestolesi explains, she called the pharmacy to question the order, but it was not until after she administered the full dose that she consulted the patient’s chart and found directions reading one vial, not three.
Though Pestolesi’s story depicted how to successfully respond in the face of an error, the stories you read this week are of clinical errors resulting in tragic consequences. These stories help to translate the concerns of overarching quality and safety issues in clinical settings, the focus for this week.
Note: This week you view a documentary that is 53 minutes in length. You may wish to watch this documentary throughout the span of a few days or all at once. Be sure, however, to allow yourself enough time to view this media in its entirety. This week’s media will take the place of the standard required reading time.
Learning Objectives – Discussion: Supporting Quality and Safety Efforts in Clinical Settings
Students will:
- Evaluate organizational structures that support quality and safety
- Evaluate the practicum experience as means to further develop QSEN competencies
- Evaluate a practicum experience in the context of quality indicators
- Evaluate evidence-base of quality indicators
- Construct a detailed practicum log
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Note: In this week’s Learning Resources, you are required to watch a 53-minute video. This will take the place of a textbook reading.
Required Readings
Quaid, D., Thao, J., & Denham, C. R. (2010). Story power: The secret weapon. Journal of Patient Safety, 6(1), 5–14.
The article describes specific stories of medical errors as catalysts for understanding causes and solutions to breakdowns in patient care. As you read, consider both the cases presented and the lessons to be learned in promoting greater patient safety in nursing practice.
American Association of Colleges of Nursing. (2012). Graduate-level QSEN competencies: Knowledge, skills, and attitudes. Retrieved from http://www.aacn.nche.edu/faculty/qsen.competencies.pdf
This document provides 17 pages of graduate-level QSEN competencies covering the following: Quality Improvement, Safety, Teamwork and Collaboration, Patient-Centered Care, Evidence-Based Practice, and Informatics. Each competency presents the specific knowledge, skills, and attitudes to be demonstrated, organized in chart form.
Institute for Healthcare Improvement. (2013). Knowledge center. Retrieved from http://www.ihi.org/resources/Pages/default.aspx
Browse the Knowledge Center for information of greatest value with regard to your specialty area of interest.
The Joint Commission. (2013). National patient safety goals. Retrieved from http://www.jointcommission.org/standards_information/npsgs.aspx
Access the patient safety goals for the setting that matches your practicum and browse for other resources of particular interest and value to you (e.g., look-alike/sound-alike drug list and official “do not use” abbreviation list).
QSEN Institute. (n.d.). Retrieved February 21, 2013, from http://www.qsen.org
This section of the QSEN (Quality and Safety Education for Nurses) website provides resources such as YouTube videos of instructive patient stories, including the Josie King story, which is featured in the required article, “Story Power: The Secret Weapon.” Also browse the Learning Modules on quality and safety education for nurses in the Faculty Resources.
Required Media
Listiak, M., & TMIT (Producer). (n.d.). Chasing zero: Winning the war on healthcare harm [Video file]. Retrieved March 22, 2013, from http://www.safetyleaders.org/pages/chasingZeroDocumentary.jsp
Note: The approximate length of this media piece is 53 minutes. It is also available as a podcast. Please use the following resource for the transcript:
Safety Leaders. (n.d.). Chasing zero: Winning the war on healthcare harm: TMIT patient safety documentation transcript. Retrieved from http://www.safetyleaders.org/downloads/ChasingZero_transcript.pdf
Discussion: Supporting Quality and Safety Efforts in Clinical Settings
Consider the following statements from this week’s Learning Resources. What implications might they have for advanced nurses and nurse educators?
“…[G]raduate nurses will be the future leaders in practice, administration, education, and research. Due to healthcare reform, multiple changes in the delivery of care, and the number of Americans with access to this care, the need for highly educated nurses will expand dramatically. It is essential that these nurses understand, provide leadership by example, and promote the importance of providing quality health care and outcome measurement.”
—(AACN, 2012, p. 2)
As an advanced nurse educator, you will be responsible for supporting the quality and safety standards of the organization. In preparation, consider how you can use your practicum experience to further develop your own competencies in ensuring quality and safety in health care.
In this Discussion, you share quality and safety measures from your practicum setting and goals for enhancing your own competencies.
To Prepare
- View this week’s media, Chasing Zero: Winning the War on Healthcare Harm. Consider the ineffective quality and safety measures highlighted throughout the documentary as well as the quality initiatives and reforms that resulted.
- With the media in mind, investigate the organizational structure in your clinical practicum setting. How are quality initiatives supported? In addition, how are the contributions of each nurse impacting these initiatives?
- Review Graduate-Level QSEN Competencies: Knowledge, Skills, and Attitudes from this week’s Learning Resources. As you consider the six areas of competency, reflect on any gaps in your own expertise.
- Select a minimum of two competencies you could continue to develop during your practicum experience, noting how the clinical setting might help to foster this growth.
By Day 3
Post an explanation of the organizational structure that supports quality and safety in your practicum setting. Identify at least two QSEN competencies you plan to further develop during your practicum experience and explain how this setting will help to foster this growth.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different days using one or more of the following approaches:
- Ask a probing question, substantiated with additional background information or research.
- Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
- Validate an idea with your own experience and additional resources. Discussion: Supporting Quality and Safety Efforts in Clinical Settings.
Supporting Quality and Safety Efforts in Clinical Settings
Introduction
Nurses play a crucial role in finding ways to improve patient outcomes. They work with interdisciplinary teams to implement quality, safety and patient care initiatives. Nurses can use technology such as computerized databases or electronic medical records (EMR) systems to track patient data and document clinical findings that can help researchers identify areas for improvement in clinical settings.
Describe the role of nurses in promoting and advancing quality, safety and patient care initiatives in clinical settings.
Nurses are key to quality and safety initiatives in clinical settings. They are the front line of care, providing direct patient contact, which means they have a deeper understanding of their patients’ needs than do physicians. Nurses also play an important role in informing administrators about what’s going on at their facility and how it can be improved. Additionally, nurses often serve as mediators between patients and staff members who may disagree on issues related to patient care or those involving reimbursement for services rendered (e.g., prescription drugs).
Nurses provide the most trusted source of information regarding treatments recommended by physicians; however, other healthcare professionals must also be involved if these recommendations are going to be implemented successfully within your organization’s systems or policies
Recognize how nurses work with interdisciplinary teams to implement quality, safety and patient care initiatives.
Nurses work with other disciplines to improve the quality of care and patient safety. Nurses are key members of interdisciplinary teams that include physicians, pharmacists and other health care providers. They are also involved in planning for changes in the organization or environment that will affect patient safety.
Identify how technology affects quality, safety and patient care initiatives.
It is important to recognize that technology can be used to improve patient care, patient safety and quality.
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Patient Care: For example, a patient may have received incorrect medication or an incorrect dose of medication. This could lead to drug interactions or side effects that are harmful or even life-threatening. In this case, using electronic medical records (EMRs) can help healthcare providers quickly identify problems so they can take appropriate action in response.
Safety: In other cases, technology can be used to prevent medical errors before they occur. For example, EMRs can allow healthcare providers to see a patient’s complete medical history by providing access to all of his or her past records and current medications. This helps doctors determine the best course of treatment for each individual patient.
Describe various types of healthcare delivery models that support safe patient care and quality improvement efforts.
In the hospitalist model, a physician or group of physicians provide care to patients in an outpatient setting. This model is used when it’s not possible to mix inpatient and outpatient services within a facility as they are often separated by distance and/or level of expertise.
The primary care medical home (PCMH) is another approach that encompasses elements of both hospitalist and team-based care models. The PCMH aims to improve access and coordination between primary care providers, specialists, community resources, health systems organizations and other stakeholders involved in patient care.
In addition to providing direct services through one or more clinicians who perform them directly on site at one location(s), this type of model also includes partnerships with other types of healthcare delivery models including:
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Patient-centered medical home (PCMH) – A patient-centered approach encourages patients’ participation in their own health decisions through individualized communication between patient advocates/care managers; physicians; nurses; social workers/case managers; pharmacists & others who play critical roles supporting safe patient care & quality improvement efforts – thus promoting better outcomes for everyone involved!
Nurses play a crucial role in finding ways to improve patient outcomes.
Nurses are the frontline of care and are responsible for providing quality patient care. They have a deep knowledge of how to make their patients feel better, often using their nursing skills to help increase patient satisfaction.
Nurses can also play a crucial role in finding ways to improve patient outcomes by implementing evidence-based practice and developing policies that will enhance quality improvement within your organization.
Nurses are an invaluable resource for improving patient care. They have an intimate understanding of how the human body works and can use this knowledge to make patients feel better. Nurses can also play a crucial role in finding ways to improve patient outcomes by implementing evidence-based practice and developing policies that will enhance quality improvement within your organization.
Conclusion
The role of nurses in promoting and advancing quality, safety and patient care initiatives in clinical settings is one that is not often highlighted. Nurses play a crucial role in finding ways to improve patient outcomes, especially when faced with complex challenges as they are often the ones who know best how each individual patient can be helped improve their health by using technology or adjusting existing delivery models.
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