Reflective Journal Week 16: Accreditation Standards

1) I expected to learn about accreditation standards established by Joint Commission on Accreditation of Hospitals (JCAHO).

2) What I actually learned:

            Accreditation is a formal declaration of designated authority that an organization has met a predetermined set of standards (Sollecito & Johnson, 2013). Health organization accreditation standards were initiated by the American College of Surgeons in 1917 and called the “Minimum Standards for Hospitals”. Later, after collaboration with colleges and associations from the United States and Canada they created the Joint Commission on Accreditation of Hospitals (JCAHO) in 1951.  It is now referred to as The Joint Commission (TJC) in the U.S. and happens to accredit more then 4,000 organizations, or 82% of hospitals in the country (Sollecito & Johnson, 2013, p. 516).  From this beginning, accreditation has spread around the world and continues to be practiced (Sollecito & Johnson, 2013).  

            The common accreditation model is when an organization develops, implements, and continually reviews their quality improvement plan and self-assesses progress against the standards of the accreditation program (Sollecito & Johnson, 2013, p. 519). They then submit a written self-assessment report to the accrediting agency.  The agency will send a team to observe the facility, interview the staff, review documentation, and then at the end will give verbal feedback. The feedback is submitted afterwards in written form, and the facility will make the necessary corrections based off the recommendations. The accrediting organization will then assess the report of corrections and decide whether to grant accreditation status or not. The accreditation is usually for about 3 to 5 years.

            Chapter 18 of our text goes on to explain that despite global expansion of accreditation organizations, evidence on accreditation remains under-developed. Growth in accreditation requires more research, and systematic literature reviews are one important evidence source to be considered to better understand the relationship between quality measures and accreditation.

3) From the discussion, we were to determine two goals for our new hospital in order to obtain accreditation status by The Joint Commission. By referring to their website of National Patient Safety Goals (Joint Commission, 2016), we determined that the basics of hand hygiene and preventing all types of infections would be best to implement in our facility. These goals provide a foundation for quality and safe care to be given to all patients.

4) I plan to use this information in my nursing profession by showing the HCAPS survey questions to staff members at our next InstaCare staff meeting. This way we can all be informed of what patients are looking for and can plan ways to best meet their desires. Basically, we will be developing quality improvement plans from the survey questions.

5)  I enjoyed the material covered. I am actually disappointed the class is over, as I was able to learn new things about quality improvement in nursing each week and apply it to my own practice. I have learned much from this class and feel all nurses should take this course.

This course has helped me realize the reasons why hospitals continually implement change and strive to do better—even though change can be difficult for many. I learned the importance of being a nurse full of integrity and always adhering to check-lists, policies, and procedures, since they are standards of care based off of evidence-based practice meant to increase patient safety. My example can help motivate other nurses to do their best as well. I feel more empowered to create and implement change in my own work environment, and I plan to refer back to this course for ideas/processes/models of change in the future.

References

Sollecito, W. A. & Johnson, J. K. (2013). McLaughlin and Kaluzny’s continuous quality   improvement in health care. (4^th ed.). Burlington, MA: Jones & Bartlett Learning, LLC.

The Joint Commission (2016). 2016 jospital national patient safety goals. Retrieved from             http://www.jointcommission.org/assets/1/6/2016_NPSG_HAP_ER.pdf

Reflective Journal Week 15: Patient Safety Application

1) I expected to learn about different methods of patient safety that can be applied in a healthcare setting.

2) I learned about patient safety and became better informed about Joint Commission standards. Patient safety is essential in healthcare so patients can trust the care they receive and accidents or patient deaths can be prevented. The Joint Commission (2015) has been an advocate of patient safety for more than sixty years. They help health care organizations to improve the quality and safety of the care they provide by providing patient safety-focused initiatives and education for hospitals. This is aimed at encouraging and supporting organizations in their efforts to make patient safety a continuous priority. The Hippocratic Oath to “do no harm” requires physicians to abide by professional ethical standards and treat patients safely (North, 2002). Nurses have a code of ethics set forth by the American Nurses Association to have wholeness of character and preserve their integrity. This is entirely applicable to the patient situation when rendering care. Honesty, safety, and high ethical standards are needed for the provision of safe patient-centered care by practitioners.

           

The Joint Commission has set forth standards that hospitals must abide by for accreditation. If practitioners do not adhere to these standards, the hospitals can lose their accreditation, resulting in a loss of business for the company. Therefore, hospitals consider patient safety a top priority and much effort is aimed at quality improvement measures to create a safer environment for patients.

3) The team discussion involved a situation of witnessing another nurse place an unlabeled syringe filled with clear medication and an empty heparin vial on a patient’s bedside table. We were to discuss as a team if this was a violation of standards of care and what to do about it. We discussed that the nurse was breaching Joint Commission standards of handling medications safely. The best way to fix the problem was to confront the nurse and assess their knowledge of safe medication handling. Likely the nurse was poorly trained and needs more education involving standards of care. After speaking with the nurse, discussing the situation with the charge nurse, and then documenting an incident would be the next course of action. This way Risk Management teams can be informed and develop new process and education aimed at ensuring all staff are aware of safe medication handling policies and procedures.

4) I plan to document incident reports about unsafe patient experiences I witness or am involved in (hopefully I am not involved in any though!). This can lead to better process improvement system designs. I also plan to implement Just Culture in my own process and not shame or cast blame at practitioners who do make mistakes. They need to be supported and given more education to prevent future mistakes. The system needs to be fixed as well to prevent future patient fatalities or errors.

5) I enjoyed the material covered—as always, it was very insightful for me. I feel I have gained better ways to confront individuals about patient safety concerns, instead of assuming things and casting blame. I have also been better educated about Joint Commission standards and feel more informed about online resources available to me that promote and outline patient safety standards.

References

North, M. (2002). Greek medicine: The Hippocratic Oath. National Library of Medicine.   Retrieved from https://www.nlm.nih.gov/hmd/greek/greek_oath.html

The Joint Commission (2015).  Patient safety and quality. Retrieved online from             http://www.jointcommission.org/topics/patient_safety.aspx

Reflective Journal Week 13: Maintaining a Culture of Safety Overview

1) I expected to learn ways to maintain a culture of safe practicing nurses for patients.

2) I learned that the best doctor or nurse can make a tiny error that leads to really big consequences for patients. Thus, it is imperative for nurses (and all healthcare professionals) to learn to practice safely, lead by example, and help unify others in maintaining a culture of safety. This can lead to the best and safest results for patients. From the case studies we read, I think I most learned to always question a patient’s situation and think deeper into WHY they are experiencing the symptoms they are. I also learned to educate my patients thoroughly about doctor’s orders, interventions I am performing, and why they are needed. If the patient or family members feel they don’t agree with the care plan, they have every right to disagree. We must remember they are partners in the care plan and a consensus can be reached that is most safe for the patient.

Lastly, I learned from a Quality and Safety in Nursing youtube clip(Vital Smarts India, 2012) that policy is only effective if nurses are willing to follow it. This statement is so true. Rules, policies, and guidelines are in place for patient safety. They were likely created and implemented because of a patient harm that occurred (or by risk management teams foreseeing risks and designing processes to prevent them from occurring). If nurses don’t abide by the rules, then what is the point of having them? No safe care will be rendered to patients. The same mistakes, medication errors, patient harms, and accidental deaths will keep occurring. This unit lesson really taught me the importance of having integrity as a nurse. What I am taught and trained to do, which is best practice for the patient, is what I will always do

3) The team discussion was interesting to me. I felt stopping the IV, continually monitoring the patient for a change in status, and then calling a Rapid Response may have been the most efficient and safe solution to the patient’s situation. Others in my group felt discussing the issue with the charge nurse would be a good idea. Another felt like the hospitalist should come assess the patient. I think calling the Rapid Response team would bring more sets of eyes and hands to come in and assess the patient. They are trained professionals that can have an open dialogue about the patient and their situation—while getting the doctor back on the phone with more specific orders for the patient (i.e. changing antibiotic, dose of IV Benadryl or subcutaneous epinephrine, or a steroid). I feel like just talking to the charge nurse doesn’t really solve any problems. Things actually need to be communicated and implemented as a team to ensure the patient’s safety.

4) This unit lesson really taught me the importance of having integrity as a nurse. I plan to look up evidence-based practice guidelines on online sites such as Up-to-Date and National Guidelines Clearinghouse (www.guideline.gov) whenever I am in doubt about a patient and their situation. This information can guide me to make safe decisions for the patient and open up dialogue with the practitioner to discuss safer options for the patient. This way I will be advocating for the patient. I will also show through my example I support and am implementing a culture of patient safety.  

5) The Case Study about a four-year-old, Noah Lord, who died from post-surgical hemorrhage, possible infection, and dehydration really scared me. It showed me that poor communication among healthcare professionals and the patient/family members can result in patient death. This experience has instilled a desire in me to make all of my actions meaningful as an emergency room nurse. Patients should not be discharged until they feel safe to go home. The right physicians and specialists should be attending to patients. Admitting a patient for observation is always a possibility to ensure their safety.  

Reference

Vital Smarts India (2012). The silent treatment: Patient safety. Retrieved online from https://www.youtube.com/watch?v=ly0wW95Or7I&list=PLUuOgSK-0gzFg1N0A4o_ZbKvzcCXEFyR-&index=3

Reflective Journal Week 12: Errors and Near Misses

1) I expected to learn about errors and near misses with patients in the healthcare setting.

2) I learned just this and more about specific case studies that were so devastating, I don’t think I will ever forget about them! (This is a good thing because it will always remind me to slow down while giving care to patients.) I first watched a playlist movie on the Nursing 4550 Quality and Safety page (Stop MICRA, 2014). It was about Dennis Quaid, his wife, and twins they had long awaited for and were finally born. Both twins developed a staph infection soon after birth and were admitted to the NICU. A nurse accidentally gave a dose of heparin ten times the ordered dose to clear the twins’ lines. The twins were basically bleeding out and unable to clot their blood. Miraculously, they survived, but their stay was extended much longer and their parents had to deal with this traumatic experience. After the event, Dennis Quaid decided to let this information out to the public in hopes of preventing human medical errors in the future. The interviewer on 60 Minutes had even asked the pharmaceutical company why the adult Heparin vial and pediatric vials were so similar—and how come they were not recalled after wards. The representative of the pharmaceutical company basically said it wasn’t their fault and nurses need to carefully read labels before administering medications.

I agree with this statement, but I also can see how these types of errors occur. Human Factors Theory refers to “the relationship between human behavior, system design and safety this is becoming increasingly influential in helping us understand the causation of errors, accidents and failures in health care systems” (Royal College of Nursing, 2015).  There are three main factors that can attribute to human errors, namely job, individual, and environment. Individual nurses may be fatigued, feel rushed, or lack certain training when caring for patients. The system at the hospital may not have many safety rules or procedures to follow. The environment may be dimly lit, chaotic, or lack necessary machines to do one’s job effectively (or the technological equipment is in need of repair). These all contribute to how safely a nurse will render care to her patient. To help solve these problems, risks need to be identified in each of these areas to help prevent potential errors before they occur—because in healthcare, errors that do occur can result in accidental death.

3) I was saddened and surprised after reading the case study (Johnson, Haskell & Barach, 2016) that we discussed as a group. A nurse spiked an enteral feeding bag with IV tubing and administered it to a pregnant patient through her PICC line. The patient was supposed to receive TPN which is compatible with a PICC line and yellow in color. (Vastly different from brownish-gray feeding tube solutions). The patient’s baby died from excessive fat clogging its vasculature, and the patient also coded and died soon after. The error of administering an enteral formula via the patient’s intravenous line was not noticed for 6 entire hours. During this time, the formula continued to infuse and cause the patient to experience more pain and difficulty breathing. The patient’s family was not notified that the error had occurred until the very last minute. In addition, the deceased patient left her husband a widow to raise his 3-year old son alone.

The case study was written by the patient Robin’s mother, Glenda Rodgers. She was a Registered Nurse herself with many years in obstetrics. From Glenda’s perspective she wishes to this day she would have questioned more what was going on with her daughter so they could have intervened earlier and potentially saved Robin’s life. Glenda wonders if she was too trusting. Glenda ended her account by stating that if patients and families are asking questions, they are not questioning your ability and authority as a nurse. They are genuinely concerned, and as their nurse, you should be as well. Diligently seeking out and finding a resolution to questions can help save patient lives.

I also learned about Just Culture. Traditionally, healthcare’s culture has held individuals accountable for errors and mishaps that befall patients under their care.  In contrast, a Just Culture recognizes that individual practitioners should not be held accountable for system failings over which they have no control (American Nurses Association, 2010, p. 2). A culture that focuses on “no blame” helps clinicians feel more safe and open about reporting errors and near misses that occurred. This way, risk management teams can learn of the errors/patient harms, and intervene quickly by new process implementation, in hopes of preventing the reoccurrence of the event. This leads to better patient safety outcomes and improved processes in a healthcare system.

4) I plan to admit near misses by filing out incident reports. I also plan to slow down when caring for patients, more diligently seek out answers to patient/family concerns, and always follow policies and procedures I’ve been trained on. (If I have not been trained on something, I will openly communicate that with my charge nurse and find ways to safely care for the patient within my scope and with other nurses’ help if needed). I will continue to ask questions when in doubt as well—this is a practice I have always strived to do anyway.

5) I enjoyed this unit immensely. Yes, it was very disheartening to learn about, but reading the cases helped instill important lessons in my mind of listening to and valuing patient concerns. If something doesn’t feel right with a patient, I will further assess the problem to find the safest solutions for the patient.

References

American Nurses Association (2010). Position statement: Just culture. Retrieved online from             http://nursingworld.org/psjustculture

Johnson, J. K., Haskell, H. W., & Barach, P. R. (2016). Case studies in patient safety:        Foundations for core competencies. Case 18, p. 231-245. Burlington, MA: Jones & Bartlett Learning

Royal College of Nursing (2015). Human factors in patient safety. Retrieved online from             https://www.rcn.org.uk/development/practice/cpd_online_learning/making_sense_of_pati            ent_safety/human_factors_in_patient_safety

  

Stop MICRA (2014). Dennis Quaid talks about his twins and medical negligence. Retrieved from https://www.youtube.com/watch?v=GEDMYsm3Nxs&index=7&list=PLUuOgSK-            0gzFyneo6CVElbN1wWLO1YGth

Reflective Journal Week 11: Building a Culture of Safety

1) I expected to learn about building a culture of safety in the healthcare environment.

2) I actually learned about ensuring risk management teams are available in health care settings to build cultures of safety. In healthcare, there are multiple potential possibilities for death and disability. The vision of risk management is to build resilient systems with a goal of zero avoidable harm. Risk can be measure in terms of likelihood and consequences. Human error, performance limitation and accidents are all potential risks. Safeguards and systems need to be put in place to foresee and plan for risk, implement processes to decrease risk, and recover from adverse events.

Organizing a culture of safety involves leadership commitment, trust in communication, shared importance on safety, teamwork and support/encouragement, and reporting/analysis systems (Pronovost, et al., 2003). Most methods suggest focusing on the clinical microsystem where physicians and patients meet, and then focusing on a meaningful change. Methods also suggest viewing the whole causal system and not just a single root cause.

Risk management aims to ensure healthcare providers are acting in the best interests of the patient. If errors do occur, patients and their family members should be informed about it and the cause of it. Disclosure is very important following errors in hospital settings. This way, improvements can be made and others can learn from the experience to prevent it from happening again.

3) The article “It’s Hard to Kill a Healthy 15-Year-Old” (Johnson, Haskell & Barach, 2012) made me sick inside to read. I was honestly amazed at how poor of communication and care processes this single patient received. The patient was hemorrhaging internally with peritonitis, tachycardia, poor pulses, paleness and abdominal pain. There were so many signs pointing out that something was extremely wrong with the patient.  I mean, when a nurse gives a pain medication, and the pain continues to persist or worsen, other forms of medication should be considered while discontinuing the one causing increased discomfort or symptoms.  A nurse or pharmacist could have double checked to ensure the dosing was proper for the patient, or even determine whether the medication was appropriate for his age category. I was shocked that they were ambulating the patient to relieve him of his “gas pains” while he was hemodynamically unstable. It just makes me sick to think about, and I feel so bad for the mother, father and sister that had to deal with his tragic death.

This depressing and devastating case study proves to me how important wearing a badge is that indicates one’s title and abilities. It proves to me how important communicating with physicians and other experienced professionals is when patients display initial signs of worsening. I appreciated that the parents tracked down the patient’s information and remained diligent in finding his cause of death. What if she hadn’t? No Hospital Patient Safety Acts would have been created to help protect other patients. I hope all health care facilities have risk management teams to ensure safe implementation of processes where risks can be foreseen and prevented.

4) I plan to disclose the cause of errors with patients/family members and filling out an Incident Report form so risk management teams will be aware of problems in the microsystem and can help plan ways to fix them so other patients can be protected. (My goal, of course, is to not let errors occur—as is all well-meaning care providers.)

5) I will restate my personal feelings about the case study. It is entirely devastating that a family lost their son to a chain of errors from incompetent providers. Yes, hindsight makes things easier. A novice nurse being told by a resident physician her patient has gas pains, will likely not doubt and continue to believe this fact (while simultaneously causing more harm to the patient by ambulating him). A more experienced nurse will question what the resident says and look deeper into the problem at hand with the patient. The nurse will also take action to make things better for the patient!

References

Johnson, J., Haskell, H., & Barach, P. (2012). The Lewis Blackman Hospital Patient Safety Act:   It’s hard to kill a healthy 15-year-old. In C.P. McLaughlin, J. K. Johnson, & W. A. Sollecito (Eds.), Implementing continuous quality improvement in health care: A global casebook (pp. 5-14). USA: Jones and Bartlett Learning, LLC

Provonost, P., Weast, B., Holzmueller, C. G., et al., (2003). Evaluation of the culture of safety:    Survey of clinicians and managers in an academic medical center. Quality Safety in Health Care, 12: 405-410.

Reflective Journal Week 10- Informatics

1) Honestly, I wasn’t quite sure what informatics even meant. I assumed it dealt with genes or something.

2) From an online Google search, I learned that informatics is the science of processing data for storage and retrieval (https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=informatics%20definition). Informatics is also the study and application of information technology to the arts, science and professions. In healthcare, according to David Blumenthal, “information is the lifeblood of modern medicine. Health information technology (HIT) is destined to be its circulatory system” (Sollecito & Johnson, 2013, p. 335). Goals for the future of healthcare include designing HIT standards that include precise data definitions for diagnoses/treatments, an architecture for aggregating data for each patient over time and across providers, and protocols for seamless communication among systems (Sollecito & Johnson, 2013, p. 336). Data access, comparability, transparency, and interoperability are needed data system characteristics to ensure the successful future for HIT.  Acts for meaningful use of electronic health records (EHRs) have been passed in order to improve patient quality and safety outcomes. Ensuring that EHRs in both hospital and office practice settings are interoperable would be an example of “meaningful use”.

3) From our discussion, I learned the importance of ensuring processes are firmly outlined when it comes to implementing and transitioning to new electronic charting systems. Most all persons are resistant to change. This makes it especially hard to implement new ideas/processes/goals in a healthcare environment—because healthcare is constantly changing. Our discussion focused on the fact that physicians/mid-levels in a healthcare setting were noncompliant with the new CPOE charting system. As a team, we discussed why this was so and how a QI team could analyze the process, redesign it, and implement it. It seemed the answer would be found by interviewing the physicians as to WHY they weren’t using the new system. We discussed the possibility that the computer system was freezing, contained errors, was slow, or was malfunctioning. Maybe the new system wasn’t meeting the needs of this specific healthcare setting. This would lead to a mistrust in the system by staff and create an immediate need for computer support personnel to fix the problems. We decided that to prevent physician non-compliance with the new CPOE system, a more detailed plan should have been implemented initially. A date of transition would need to be set early on. This way staff could mentally prepare for the change. Trainings on the new system and familiarizing oneself with it would need to take place. Computer support personnel would need to be on-site to answer questions and help users become comfortable with it. This way, they too could see if the system was malfunctioning. A positive attitude and team approach was the best way to ensure the change went as best it could. Lastly, the QI team could analyze their process and determine better ways to go about computer charting changes in the future.

4) I plan to be more positive about a change that will be coming to Intermountain Healthcare here soon. They are changing over form HELP2 to a new iCentra computer charting system in April 2016. I am already excited to learn about it and am trying to help my co-workers be more excited about it too. When people are negative about it, I try to encourage them by stating that “super users” will be on-site to help us get comfortable with the new system, and hopefully it will be more efficient.

5) I enjoyed the material covered. I like how health information is recorded and stored in computers these days—it makes finding and storing information so much quicker and easier. I also like how the ARRA-HITECH act was passed to contribute to health care improvement (Sollecito & Johnson, 2013, p. 353). Increased interoperability and transparency among office providers and hospitals will be difficult to do via one single computer system, but remains the goal for now so information can be communicated to all disciplines about patients. This will increase patient safety and improve continuity of care (for example, an Emergency Department could look up information about a patient that was transferred from a nursing home and vice versa).

Reference

Sollecito, W. A., & Johnson, J. K. (2013). Mclaughlin and Kaluzny's continuous quality improvement in health care. Burlington, MA: Jones & Bartlett Learning.

Case Study Week 10

A newly hired registered Nurse (RN) is assigned to work at the telehealth work center.  The RN is monitoring the in coming data from home-bound (based) patients from arount the county, checking to see if there are any situations which require nursing interventions and taking the appropriate actions. One (1) patient is a type II diabetic. He reports his fasting blood sugar level of 54. Another patient who has congestive heart failure (CHF) and regularly reports in on daily basis does not send in any information (data).

·         What is the best course of action for the RN to take regarding the diabetic patient?

·         How should the RN proceed regarding the lack of information from the CHF patient?

1) The best course of action regarding the patient with a blood sugar of 54mg/dL is to have the patient immediately ingest 15 grams of carbohydrates. (This is fine because the patient is alert and communicating with you, showing they are capable of tolerating oral forms of glucose). I would stay online (via telehealth) with the patient and have the patient recheck his blood sugars in 15 minutes to see if there is improvement. If his blood sugars remain low, I would have the patient repeat the steps again, even until a third time if necessary. I would then ask the patient what doses of insulin he takes and how often, and what his blood sugar trends were this past month. After I would inform the physician (via telephone or electrical transmission) about the patient’s status and blood glucose trends to determine if insulin doses needed to be adjusted or lowered for the patient.

2) The RN should call the CHF patient on the phone to determine how he is doing. If the patient does not answer, the nurse can call an emergency contact to see if they can get a hold of the patient. If there is still no response, the RN can have emergency services go to the patient’s home to ensure they are safe or if they are needing immediate transport to the nearest Emergency Department.  The fact that the patient did not send any information, when he usually does on a regular basis, is of concern and requires these actions by the nurse. 

Critical Thinking- Week 10

The registered nurse (RN) is reviewing orders and completing the medication reconciliation (Med Rec) in the electronic Medical Record (EMR). Med Rec is a process for double checking medications, where the RN verifies that the details of the medications written on the provider's orders match those recorded in the medication administration record (MAR) used by the nurse. During the Med Rec process, several alarms/alerts go off.

·         Does the use of EMR guarantee error-free patient care? If yes, why? If no, why?

The use of EMR most definitely does NOT guarantee error-free patient care. I actually worry these standardized systems of EMR charting means care won’t be individually tailored to the patient (i.e. specific health issues of patients won’t be factored in; certain medications they are taking won’t show up and prompt the physician to be careful on what they are ordering; maybe the patient has a blood clotting issue like Factor 5 and the physician won’t notice this since it was entered in a big long list for the medical history and doesn’t stand out amongst the others; doses may not be weight-based since the physician can just use the CPOE drop-down menu and accidentally order/prescribe it for the patient without thinking about their weight or age (i.e. adult vs pediatric doses)). I feel like it is so easy to just click through things on computers without actually reading the prompts or what it is saying. This can be hazardous for patient care. This is why I am glad alerts are generated at times to help staff members think through what they are doing and ask themselves if what they are doing/charting is really safe or not.

EMR is definitely a more efficient way to enter, store, collect, and share information, but it does not mean it is error-free. It requires just as much diligence from nurses as does the old-fashioned hand-written charting.   

·         What types of nursing behavior regarding the use of EMRs might contribute to jeopardizing patient safety?

Nurses getting sloppy and not thoroughly reading computer prompts, such as just clicking through them to get to more familiar screens or cancelling/silencing alarms, are types of behavior that can contribute to jeopardizing patient safety.  

Nurses can be reluctant to change from paper to computer charting because they are set in their ways. They may avoid becoming educated or familiar with the computer charting system and this can lead to error-prone charting on patients.

Due to the ease of computer charting, some nurses may purposefully procrastinate and leave their charting to the end of the shift. This sets them up for making more mistakes because they may forget very important details about the patient’s status and critical information will be missed for continuity of care because of the nurse’s accidental omission.  

·         What are the dangers of excessive system alerts in computer charting systems?

Too many system alerts in computer charting systems can lead nurses to quit reading them and do anything to just silence the alarms such as skipping through alerts quickl. Ignoring these alarms results in increased mistakes that affect patients and communication among healthcare personnel.

·         How can the nurse guard against the potential effect? 

Nurses need to be more diligent in their charting and reading of the electronic health record. They must slow down and read each prompt and be familiar with and educated in the computer charting system. If not, they are more prone to charting on the wrong patient by simply clicking too close to another patient’s name by accident, they may neglect to chart important patient information, or they may just browse through information too quickly without thinking about the alarms/alerts relevance or importance. 

Reflective Journal Week 9: Quality Improvement Strategies IV

1) I expected to learn more about quality improvement strategies and how they pertain to my role as a nurse. 

2) From this unit and chapter 7 of our textbook (Sollecito & Johnson, 2013), I learned about the role of the patient in quality improvement (QI), how to involve patients in QI and different models of patient involvement. Since health systems have changed and become more developed, patients have been expected to be involved in healthcare. A greater knowledge of health has increased knowledge of errors in the media and public domains. Health systems have been forced to acknowledge the patient or caregiver perspectives. CQI is part of the shift to patient-centered health care because patients are ultimately customers. Factors affecting patient involvement are their willingness to participate due to health literacy or self-efficacy, minority social positions, severity of conditions, the health setting and issues around power relations. Clinician attitudes and beliefs also affect patient involvement.  

Measuring patient involvement via customer satisfaction surveys has become widespread in healthcare. HCAHPS are posted online for patients to review results and compare different hospital levels and quality of care. Different models to facilitate patient involvement have been designed, including the MAPR model. National Patient Safety goals have been implemented to involve patients in their own safe care. The Joint Commission published a “Patients as Partners” toolkit to support patients and caregivers in identifying safety issues. These efforts, in addition to many others, are supportive of involving patients in their care and hopes to identify how patient involvement can have a positive impact on the medical errors/rates that continue to exist in health care.  

3) I enjoyed the Root Cause Analysis (RCA) critical thinking assignment where we asked the question “Why?” five times to a certain problem I have been struggling with as of late. I decided to try this method on another problem I have been facing and interestingly, both answers to my fifth WHY question were the same for both problems. I am excited to learn more about RCA because this is what our team will be presenting on for the final project.

The discussion was more difficult to come to a consensus on since everyone seemed a bit confused about creating indicators for preventing Surgical-Site Infections. I enjoyed learning that clipping hair, as opposed to shaving hair, is the standard of care. It makes sense that clipping would be performed instead of shaving, so hair follicles aren’t entirely exposed leading to bacteria becoming embedded in the follicle and not scrubbed off during the surgical scrub procedure.

4) I plan to continue involving patients more in their own health care by educating them more thoroughly during their discharge about instructions, who to follow up with, and their medications/side effects. I also plan to encourage patients to keep a list of their current medications and bring them with them to all doctor’s appointments, urgent care visits, or hospital stays.

5) I enjoyed this unit on quality improvement. The patient is the customer. Involving them in their healthcare, I feel, can help us find ways to reduce medical errors, HAIs, etc.

Reference

Sollecito, W. A., & Johnson, J. K. (2013). Mclaughlin and Kaluzny's continuous quality improvement in health care. Burlington, MA: Jones & Bartlett Learning.

Reflective Journal Week 8: Quality Improvement Strategies III

1)         I expected to learn about more quality improvement strategies that I can implement into my work environment.

2)         I actually learned about measures of consumer satisfaction and its effect on healthcare. Sollecito and Johnson (2013) stated that consumer satisfaction data is now recognized as the best source on communication, education, and pain management. It is a requirement of patients and payers in health systems. Who is the consumer? In healthcare it is the patient or any party that will be potentially using the product or service on offer (Sollecito & Johnson, 2013). So, hospitals purchasing from vendors, managed care organizations contracting doctors for clients, and Medicare contracting with insurers can all be considered consumers.

            Measuring patient satisfaction in healthcare is of utmost importance since hospitals desire to maintain public images of quality and service. Government and other authorities regulate and continue to require patient satisfaction data. Ratings about different hospitals are displayed online so patients can look up information and then make an informed decision about their choice of providers or hospitals (CMS, 2015).  A Balanced Scorecard influences patient’s choices of hospitals as well.

            HCAHPS surveys to patients include communication with doctors, nurses and the responsiveness of staff. Questions also include if pain was managed, education was given on medication, discharge information was given, and how quiet and clean the hospital environment was. Patient feedback and ratings help guide Continuous Quality Improvement (CQI) measures in healthcare.

3) I enjoyed our discussion on how nurses can implement evidence-based practice (EBP) in their work environment. Our group members thought of ideas for incorporating EBP by questioning the nursing practice and then actively researching scholarly articles that show EBP. This can be presented in staff meetings or to the chain of command in healthcare. Teams can then be created to design quality improvement processes to implement the EBP standards of care. We discussed an important point that nurses likely are not engaged in EBP implementation because they feel they are of only modest education and lack the ability to understand research and statistical terminology (Majid, et al., 2011).  Nurses may not feel there is enough incentive too. I wondered if nurses who engage in EBP could be monetarily compensated for their efforts. Another idea we considered is if nursing schools could require EBP courses where they simulate implementing research into different possible healthcare environments. These courses could be so beneficial for new graduate RNs since they would feel more competent in research and implementing EBP in their practice when they land their first jobs.

4) My goal is to look up EBP whenever I have a question in my nursing environment and speak up about it to my provider I am working with. I work in an InstaCare and even though it is a part of a large corporation, practices and processes still differ from the other Medical Group settings and the larger hospital. This variance is largely due to traditions and healthcare team members’ levels of experience.

5) My personal feelings are that EBP is the gold standard of care.  Healthcare team members should continually strive to be knowledgeable about and implement EBP in their own personal environments. Their examples of engagement will help others want to be committed as well. Patient care would begin to improve on a larger scale and this would be reflective in consumer satisfaction data.   

References

Centers for Medicare and Medicaid Services (2015). Medicare.gov: Hospital compare. Retrieved from https://www.medicare.gov/hospitalcompare/search.html

Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y., Chang, Y., & Mokhtar, I. (2011). Adopting evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229-236

Sollecito, W. A. & Johnson, J. K. (2013). Mclaughlin and Kaluzny’s continous quality improvement in health care. Burlington, MA: Jones and Bartlett Learning, LLC. 

Reflective Journal Week 7: Quality Improvement Strategies II

1) I had expected to learn more quality improvement strategies during this unit.

2) I actually learned a great deal how not to confuse Common Causes with Special Causes.  According to our lecture video provided from the Mayo Clinic (2012) which presents Edward Deming’s theories of profound knowledge, reacting to common causes is like scraping burnt toast. One might ask what a common cause is? A Common Cause is an occurrence that is constantly active within a system (Mayo Clinic, 2012). It is predictable. A Special Cause, on the other hand, is the new, unanticipated, emergent or previously neglected occurrence within a system (Mayo Clinic, 2012). Special Causes are unpredictable. Deming stated not to react to common causes, because they are already going to be present in a system, and it will only make things worse. For example, a Common Cause is the burnt toast produced by a poorly designed toaster. Continually scraping the burnt toast to make it look better only makes things worse and doesn’t fix the problem. In contrast, a Special Cause is the toaster.  If the heat is turned down on the toaster, burnt toast will no longer be produced.

            Quality Improvement teams need to remember not to react to Common Causes, because they will always be present in a system—there is no point in scraping burnt toast. The focus should be fixing the Special Causes in a system. Ways to recognize the Special Causes is through collection of data and creation of a control chart with upper and lower controls. A sequence of seven or more points continuously moving upward or downward is considered a “trend.” A clump of eight points above or below the upper/lower control limits is called a “run.” These runs are the Special Causes that must be paid attention to in a system. They are unpredictable and need fixing to produce better outcomes.

3) I enjoyed the team discussion on our burn victim patient that had second and third degree burns on 75% of his body. Our burn victim had a poor nutritional status with a decreased appetite.  One member of my team brought up research about the caloric needs for victims with a burn covering 25% of total body surface area (TBSA). Caloric needs can exceed 5,000 calories per day. Our group discussion focused on possible reasons why this patient had a decreased appetite and ways to increase his nutritional status.

            We concluded that pain was likely a large contributing factor to this patient’s decreased appetite. Dehydration secondary to his burns likely increased his feelings of nausea and compounded his poor appetite too. We also assumed the patient may be depressed from trying to cope with this disfigured body, and those feelings of depression were possibly reasons why he may not feel like eating as well.

            We decided the healthcare team needed to focus their efforts on increasing his appetite via pain control, ensuring adequate hydration via intravenous fluids and oral intake, beginning tube feedings with a high-calorie/high-protein formula, make snacks readily available for the patient, and administer anti-nausea medications and appetite stimulant medications such as marinol to help meet this patient’s nutritional needs and stimulate his appetite. The nurse would include the patient’s family in encouraging him to eat high calorie/high-protein snacks throught the day as well. We concluded that these efforts implemented by the healthcare team would increase his nutritional status allowing for better wound healing to take place and for his immune system to be improved.

4) I plan to utilize the information I have learned in my nursing practice by trying to recognize common causes in our process improvement systems, and not react to them. They are predictable and will always be present in a system. I will, however, recognize the special causes and try to fix them, so process improvement plans can carry on, and lead to better patient outcomes.   

5) I enjoyed the material covered. I want to become more familiar with statistical analysis, variation, data collection and research in my nursing practice. This way I can use statistical tools such as flow charts, diagrams, or control charts (Sollecito & Johnson, 2013, p. 77-116) to help analyze and improve processes.

References

Mayo Clinic (April 2012). Common cause and burnt toast. Retrieved online from     https://www.youtube.com/watch?v=ctn1JFsNiCE&list=PLUuOgSK-0gzHmArwz4iwLy0zz_EeP0JSN

Sollecito, W. A., & Johnson, J. K. (2013). Mclaughlin and Kaluzny's continuous quality improvement in health care. Burlington, MA: Jones & Bartlett Learning.

Week 6 Reflective Journal- Quality Applications

1) I expected to learn about applying quality measures to healthcare.

2) I actually learned from this unit what benchmarking and balanced scorecards are, in addition to best practices for urinary catheters and venous thromboembolism prevention guidelines.  Benchmarking is “the use of external comparisons to understand how one is doing compared to one’s peers and/or one’s competitors” (Sollecito & Johnson, 2013, p. 173). It requires a type of decision regarding the standards that should be used when comparing outcomes across facilities or within a facility over time including Normative, Empirical, and Institutional. The Normative approach are standards that reflect best possible outcomes that can be achieved under optimal circumstances, so results are determined by evidence-based medicine. In the Empirical approach, results are assessed relative to other institutions treating similar patients (Sollecito & Johnson, 2013, p. 174). The Institutional approach is where results are based on a self-comparison over time.

I was able to look up different hospital balanced scorecards, via a google image search, indicating how well institutions have performed over time. They would post targeted goals in an organized framework and then post their actual percentages to determine if they met their goals. These scorecards made performance information easily accessible and showed where improvement was needed in different categories such as patients (customers), employees, enablers, and financers. By viewing their companies’ scorecard, quality improvement teams could easily compare their benchmarks with other organizations to determine their level of standing.

I also looked up the guidelines for preventing catheter-associated urinary tract infections from the Center for Disease Control and Prevention. The Case Study activity I completed reminded me of the trainings I went through while working at Utah Valley Specialty Hospital. We completed ERASE CAUTI programs and implemented them on our patients. We followed specific protocols by assessing our patients for the actual need of a catheter, inserted them aseptically with the specialized/updated kits, ensured we removed them as soon as possible with documentation, and then did bladder retraining for the patients to help with urinary continence afterwards. This program helped decrease UTIs in our patients, and helped us ensure our patients only received catheters if indicated.

3) I enjoyed the team discussion on best practice guidelines for preventing venous thromboembolism (VTE). It was a great refresher to remind me of standards of care and how pharmacists, physicians, and nurses are all needed to help prevent VTEs in patients. The team approach is what will provide the most thorough and safe care to patients, leading to better benchmark outcomes.

4) I plan to look at my own hospital’s benchmarks, determine where improvement is needed, and help implement that with my manager. This way, patient outcomes will be better  because they are based on standards of care, and our benchmark scores will improve.  

5) I enjoyed this unit on Quality Applications. I didn’t realize how much is involved when it comes to measuring the strengths and weaknesses of one’s company. It is an intricate process involving a lot of analyzing, planning, implementation, and additional research on ways to improve--a definite difficult task requiring teamwork.  

Reference

Sollecito, W. A., & Johnson, J. K. (2013). Mclaughlin and Kaluzny's continuous quality improvement in health care. Burlington, MA: Jones & Bartlett Learning.

Week 5: Roles of Health Professionals

1) I expected to learn about the different roles of health care professionals.

2) I actually learned about working together as an interdisciplinary team to provide quality care. Chapter 4 in our text discusses different approaches to improve outcomes produced by teams by examining how the team functions together or the issues preventing its functioning (Sollecito & Johnson, 2013). First, quality problems are not always visible to senior management leaders, but can be seen frequently by staff nurses or others and the problems end up impacting everyone at all levels. Persons at the lowest level of health care often acquire considerable expertise and have great ideas for fixing problems—so they are a valuable member of a team and need to be listened to. For example, receptionists in an Emergency Department can more easily see why wait times are increased, versus the manager in his office. Sollecito and Johnson (2013) stated that “a substantial proportion of health care quality problems reside in communication structure problems in the organization” (p. 148). By focusing efforts on cohesiveness in communication, problems can be solved quicker and more efficiently. Using a centralized structure where information passes from the team leader down to team members is effective. In a very complex environment, using an all-channel open communication approach is better. This way teams can network and communicate with other units/teams (p. 149). Team characteristics such as size, relationships, status, psychological safety (team members perceive it is okay to take risks among the team for process improvement), and team norms all impact how a team functions.

            Teams are people who work together towards specific goals. They use multiple interconnected processes and produce performance outcomes. Chapter 4 also states that teams need to be able to adapt to changing circumstances and continue with quality improvement. Health care is a dynamic environment and needs the building blocks of teams to ensure its proper function. 

3) I enjoyed the discussion activity about the 11-year old patient with Juvenile Diabetes that continued to be readmitted to the hospital for non-compliance. After assessing the patient’s situation in more detail, our team was able to come to a consensus that the grandmother needed greater education on diabetes, blood sugar control, cooking meals that conform to a consistent carbohydrate diet, and ensuring the patient had proper insulin administration in relation to his blood sugars. Ensuring this is all properly communicated to her via a translator was the most appropriate plan of action. The interdisciplinary team would work most effectively together if the patient, parents, and grandparents were all educated together, and then if the school nurse was also aware of the patients’ diabetic care plan. This way, at home, at school, and then with his check-ups, all care team members would be aware of his diagnosis, dietary plan, and insulin needs.  

This experience taught me to make sure I am looking at all possibilities for situations and then finding solutions for them. I also realized the importance of an interdisciplinary care team. If everyone is properly communicating to one another, greater outcomes will be established for the patient and no gaps of knowledge will exist.

4) I plan to utilize this information in my nursing practice by working as a team and ensure I properly communicate information regarding patients to those involved in their care (i.e. nurse to nurse report, shift report to charge nurse, at patient discharge to a facility, if other team members such as physical therapy come to work with the patient I will inform them of their situation for patient safety).

5) I have always loved healthcare because greater things are accomplished for patients when working together as a team. There are definite team dynamics where some persons seem easier to work with. Others you may feel like you automatically understand their unspoken intentions and will just start to work side-by-side to best help the patient. Overall, communication amongst all disciplines will help everyone be on the same page. Each professional does have their specific role, but when working together, care is optimized for the patient. 

Reference

Sollecito, W. A., & Johnson, J. K. (2013). Mclaughlin and Kaluzny's continuous quality improvement in health care. Burlington, MA: Jones & Bartlett Learning.

Week 4- Legal and Ethical Issues in Quality Improvement

            Before beginning this unit, I expected to learn about legal and ethical issues affecting quality improvement in healthcare. I actually learned a great deal about legal and ethical issues. Our group discussed a case study about a young girl, named Elsa, who was diagnosed with fibromyalgia shortly after obtaining her dream job as an elementary education teacher. We concluded her life would be negatively impacted with this new diagnosis, leading to depression and suicidal ideation. Sadly, suicide would be a viable option for Elsa. Although, as her nurse, we would focus all our efforts on preventing Elsa from doing this by helping her find value in her life and coping with this disease. I researched different support services that would be available to Elsa. I was surprised to find social media support groups, in-home physical therapy assistance, and countless online resources educating a person all about fibromyalgia and how to live with it. There are many ways to live a fulfilling and successful life, even with the disease. Pain management and emotional/mental support via counseling are two areas of focus for the nurse to keep Elsa’s spirits uplifted.

            The discussion asked if assisted-suicide was a viable option for Elsa. I did some research and found that it was not. Only certain states in the U.S. allow assisted-suicide, including Oregon, Washington, and Vermont (Oregon Public Health Division, 2015). Certain criterion must be met in order to be considered, including age over 18 years, being of a sound mind, and being diagnosed with a terminal illness with six months left to live. This, of course, is determined by the physician. A lethal dose of medication would then be prescribed to be ingested by the patient at home.

            I also researched an article on legal and ethical issues in quality improvement. The article discussed legal issues from the implementation of Electronic Health Records (EHRs) in countries around the world and in Emergency Departments specifically (Ben-Assuli, 2015). EHR systems require more time being dedicated to charting and less to the patient experience. Initially when learning the system, clinicians often will make personal mistakes in how they enter information leading to adverse medical events and errors. When charting in EHRs clinicians may copy and paste data obtained from other clinicians, give inadequate discharge summaries, accidentally send information to unintended places, easily get authorship misnomers, and the efficiency of EHRs can lead to carelessness in charting and harmful shortcuts (i.e. lacking patient specific information and giving over-generalized information to save time via pasting information). This results in poorer care for the patient, since all of their needs/issues may not be getting addressed with these charting shortcuts. This is something, I personally, have witnessed in the Emergency Department. Charting electronically seemed redundant at times and became less patient-specific due to time constraints and the ease of copying and pasting information. Even though EHRs have contributed to easy sharing of patient information and storage, it is still important to remember care is always patient-centered and requires clinicians to pay special attention to details to prevent errors and continue improving the quality of care delivered, whether electronically or in person.

            I also learned about an 85 year old female patient with walking pneumonia who got up to use the restroom and then “eased herself to the ground” due to feeling light-headed. The World Health Organization (WHO) defines a fall as “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level” (2015). According to this criteria, this patient experienced a fall. Many different factors contribute to falls including, but not limited to, age, patient impulsivity/confusion/disorientation, certain medical diagnoses, vital signs outside of normal parameters, morbidly obese or frail patients, and moderate to maximum assist patients. It is essential that nurses document event forms when falls occur so process improvement measures can be implemented to lead to better outcomes. Some of these measures can include ensuring beds are in the lowest position, at least two side rails are up, a bed alarm is on and hooked to the patient, the patient is educated to ask for help, the call light is within reach and signs are on the door.

            My personal feelings about the material covered are that with all process improvement endeavors, there will be legal and ethical issues associated with them. These issues can be addressed by understanding the complex nature of processes and implementing quality improvement models such as Plan-Do-Check-Act, by W. Edward Deming, to fix and evaluate processes to improve them even more. Healthcare will always consist of continuous quality improvement.             

References

Ben-Assuli, O. (2015). Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments. Health Policy, 119(3), 289- 297. doi: 10.1016/j.healthpol.2014.11.014

Oregon Public Health Division (2015). FAQs about the Death with Dignity Act. Retrieved from https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/Deathwit            hDignityAct/Pages/faqs.aspx

World Health Organization (2015). Falls, fact sheet. Retrieved from             http://www.who.int/mediacentre/factsheets/fs344/en/

Quality Improvement Strategies I- Overview

            The Funnel Experiment, developed by W. Edwards Deming, demonstrates interesting aspects of quality care in healthcare settings (Mayo Clinic, 2012). A basic overview of the experiment consists of dropping a marble down a funnel in hopes of it landing on a marked “x.” Even when one drops the marble multiple different times, it may or may not hit the target. Sometimes this can be frustrating and so the person dropping the marble will try to change things in the system by moving the funnel’s position, changing the size of the marble, dropping the marble differently, and even changing the temperature of the environment. As time goes by with the marble dropping, even greater variation ends up taking place than what would have originally taken place had they stuck with the original method. In this example, Deming is trying to show that when well-meaning persons tamper with any type of system or process, outcomes only became worse over time and complexity greatly increases.  

            In quality improvement, it is best not to react to variations in a stable system. No matter what, all processes will vary and this needs to be remembered. Focusing on outcomes will generate better results than focusing on the processes leading to outcomes. The Funnel Experiment is a great analogy for healthcare quality improvement showing that strong leadership who remain focused on outcomes will generate better results and decreased costs.

            From the PowerPoint on chapter two (Sollecito & Johnson, 2013), I learned about the Checklist Continuous Quality Improvement methodology. It originated in aviation and has spread to healthcare. Implementing checklists has significantly decreased central-line infections and allowed for better outcomes in the surgical centers. To be most effective, the checklists depend upon effective leadership, interdisciplinary teamwork, use of a Plan-Do-Study-Act cycle, and engagement of experts on a global scale to improve safety.

            Research shows check-lists (and other QI processes) have been effective in improving care overall, but the question remains as to why healthcare continues to have errors and adverse events occur. Why has not much improvement occurred especially when so many QI processes are in place and available? Two key issues have been shown to not only impede the implementation and adherence of check-lists, but virtually all QI processes in healthcare. These are complexity and cost.  Experts have tried to simplify the matter showing that incentives for improvements, maximizing value and minimizing costs, with effective leadership is what will be most effective in improving quality in healthcare. Because healthcare is so complex, it requires diligence to spread the improvement process (Sollecito & Johnson, 2013).  
           I plan to be a strong leader by adhering to quality improvement processes and standards in my nursing practice. I plan to focus on outcomes and not tamper with systems even if I am well-meaning. My goal is to rally others together in the workplace to work as a team in improving processes. My efforts and their efforts can start improving healthcare at a small scale, but hopefully this diligence can spread.  

Reference

Mayo Clinic. (2012 May). The funnel experiment. Retrieved online from Youtube https://www.youtube.com/watch?v=2VogtYRc9dA&list=PLMB9evqeBMEjBxqB8dNS9CFhcsI0uHJIh&index=7

Sollecito, W. A., & Johnson, J. K. (2013). Mclaughlin and Kaluzny's continuous quality improvement in health care. Burlington, MA: Jones & Bartlett Learning

Reflective Journal- Week 2

            The United States has the most costly healthcare system but major quality and safety issues persist (Davis, 2010). An article from Agency for Healthcare Research and Quality (AHRQ) compares the years 2002 and 2012 to determine the most costly health conditions in the U.S. In both years, the same five medical conditions (heart disease, trauma related disorders, cancer, chronic obstructive pulmonary disease and asthma, and mental disorders) were ranked highest for medical spending (Soni, 2015). The data presented in this article shows that expenditures have risen in some areas (mental health) and have stayed nearly the same in other areas (heart disease and cancer)—proving that the same costly medical conditions have continued to exist over the past decade. These problems aren’t being fixed, proving the need for quality improvement in our healthcare system.

             Quality is constituted by the degree of excellence something possesses, as compared to other things of a similar kind (Google Chrome online definition). In class, we also learned quality to be defined as the science of process management. Florence Nightingale was a prime example of contributing to quality improvement with her genuine caring, data collection, and use of statistics for data visualization. Her research helped show others in her day about the need for improved care through better sanitation measures for patients. Now different national organizations have been implemented to support nurses in giving quality care with research, data collection, and evidenced-based practice. The Institute of Medicine, Robert Wood Johnson Foundation, American Nurses Association, and National League for Nurses are a few of these organizations helping set standards of quality care. They conduct research on our behalf to find ways to prevent errors, improve outcomes, and improve processes. One of their most important goals is to encourage nurses to attain higher levels of education in nursing so they can render safe care and be able to implement change as leaders themselves. (I am currently in the Bachelors of Nursing program because of this.)

            During this unit we also learned about Deming’s 14 Points of Profound Knowledge for quality improvement. His system stated that usually quality improvement ideas sound great, but in reality, they forget the complexity of life. So many x-variables affect the y-dependent outcomes and a thorough examination of systems, variation, theories, and human behavior is only what will lead one to find the profound lens of knowledge (QI idea) suitable for solving the problem or enacting positive change (Lloyd, 2009). The quality improvement team must take into account the different common causes and special causes while looking for different trends, in order to help identify more thorough quality improvements.  It begins with working as an interdisciplinary team, establishing leadership, removing slogans and fear, and maintaining a continuous quality improvement philosophy.

            In our Quality Improvement Lecture, we also learned that quality care is meeting customer expectations. In healthcare, the patient is the customer. I want my patients to feel safe and confident that they are receiving the best possible care. If every practicing nurse can adapt the philosophy of continuous quality improvement and abide by it, I believe medication errors, hospital acquired infections, falls, central-line infections, bed sores, (etc!) can be decreased substantially. This would be the epitome of quality healthcare.

References

Davis, K., Schoen, C., & Stremikis, K. (2010). Mirror, mirror on the wall: How the performance of the U.S. health care system compares internationally, 2010 update. Retrieved from http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2010/Jun/1400_Davis_Mirror_Mirror_on_the_wall_2010.pdf

Lloyd, R. (2009 January). Deming’s System of Profound Knowledge 2. Retrieved from the IHI’s

online course https://www.youtube.com/watch?v=STTwZGNvLmM&list=PLMB9evqeBMEjBxqB8dNS9CFhcsI0uHJIh&index=4

Soni, A. (2015 April). Statistical brief #470: Trends in the five most costly conditions among the U.S. civilian noninstitutionalized population, 2002 and 2012. Agency for Healthcare Research and Quality. Retrieved from http://meps.ahrq.gov/mepswe/data_files/publications/st470/stat470.shtml

Critical Thinking #2- Week 2

1. What I consider elements of quality care when receiving healthcare services are:

-they make eye-contact with me and smile

-the professional considers and values me as a person with feelings

-adherence to standard hand hygiene

-explains why they do what they are doing

-medications are labeled always

-the professional teaches me more than what I already know; they can always answer my questions, and if not, they will research an answer for me.

-they show empathy and compassion

-when they go the extra mile to fix problems

-they update the white-boards to keep me informed

-they keep me updated and check on me frequently

-they are prompt and come when they say they will

2. As a professional nurse, I believe the elements of quality care are what I have just stated above. I would also like to add improved patient outcomes and being knowledgeable about diverse cultures so care is tailored more specifically to the patient (i.e. patient-centered care). I have always believed in the “Golden Rule” and to treat my patients how I want to be treated. Adhering to hospital policy and standards of nursing care are the key elements of quality care, while showing empathy, respect and compassion to meet the patient’s emotional needs.

3. Whether on the receiving or giving ends of patient care, the quality of care should be no different. I will always treat patients my very best, and in return, I hope I am treated the best as well. 

Nursing 4550-X02: Quality and Safety Nursing

Hi there! I am taking another course aimed toward completing my Bachelor's in Nursing degree. This course is Quality and Safety in Nursing. I will be writing in this Reflective Blog to keep a record of my thoughts, feelings, and reflections in regards to my learning during this course. I am not quite sure what this class will entail. I am hoping it provides me with a broader understanding of rendering safe patient care, and the reasons behind why I do what I do as a nurse. Here's to another semester!

Risk Management & Legal Responsibilities of the Nurse Leader

1) I wasn’t really sure what Risk Management meant. I know I’ve heard of it before though.

2) After this unit’s learning, I realized how important Risk Management is. There is a saying that says, “To be human is to error.” To apply this to the patient-care setting, most all nurses render care with their best intentions in mind, but even with these good intents, errors still occur.  Risk Management realizes that nurses cannot predict the future and what will happen with a patient. It is never the intention of the nurse to cause injury, neglect or harm the patient. This being said, Risk Management is in operation to ensure better safety measures are implemented in order to keep patients safe and protect staff members.

Risk Managers look at domains and areas of risk. These include: finance, operational/clinical, human capital, legal/regulatory, technology, and natural disasters/hazards. For example, for financial risks, liability insurance is bought to cover the company’s risks. For human capital risks, research can be done to gather data on what part of the shift nurses tend to make the most mistakes.  This way appropriate interventions can be made to limit or prevent the risks from occurring (i.e. Risk Mitigation).

An important role hospital staff can play is filling out “Incident Reports” to help track and view trends of various events, complaints, grievances, serious safety issues, or sentinel events.  It is important to document only the facts of the event, remembering the Who, What, When, and Where information. Because Incidents Reports are protected pieces of information, a nurse must never refer to it in her nursing notes. If the nurse does, it can be “discovered” by the court during depositions and cases.

When an event occurs, it is necessary to ask the initial question, “What is the standard of care?” Then, risk management will research to see if what actually happened was a breach in the standard of care, and if that breach caused the patient injury or damage.

Risk management is so important because it aims at getting serious safety events down to zero. Across the U.S. medication errors, falls, and patient care/treatment are high volume nursing event types. If we all can decrease injuries and errors by 40%, 60,000 patient lives can be saved.

3) I enjoyed the discussion about the 27-year old intoxicated and aggressive patient getting serious burns on his body, and how the nurse leader would go about resolving the event. It was interesting to see my team member’s ideas on how to fix the problem in the future. I had forgotten that a 1:1 psych sitter could have immediately helped prevent the burns from occurring, due to rapidly putting out the fire and noticing the patient movement. As an ER nurse myself, this type of patient is quite common, and it was eye-opening to see the results of what could happen if I were not diligent.

The scholarly article I looked up on the topic ‘Risk Management in Nursing Leadership’ was interesting. Failure Mode Effects Analysis (FMEA) is a systematic method, developed by the U.S. military, for evaluating parts of processes in need of change (Reams, 2011). Nurse leaders can use this method to make the delivery of healthcare safer for patients. It is an 8-step process which allows for thoroughness and questioning what may not be right. The first step involves identifying a system and a process within it that’s likely to cause harm to a patient.  A multi-disciplinary team will break the process a part and analyze each part of it using a flow chart. Problems that need fixing will be identified and assigned a severity score (how mild-catastrophic the patient outcome will be) and probability score (likelihood of error occurring). These scores will be multiplied together and then ranked in order. A score of 16 would be considered a severe threat to patients, whereas a score of 6 would not be as big a concern. Items with a higher score would be given higher priority to address and fix the process. FMEA is a straightforward process that can decrease and stop harmful incidents from occurring if conducted appropriately by the nurse manager and multidisciplinary team (Reams, 2011).

4) I plan to always be honest and forthright with my patients. I will continue to document Incident Reports if they occur. I realize involving Risk Management is helpful in preventing errors to patients in the future. We are all human—unintended mistakes happen.

5) I enjoyed this unit. It really struck me how important the role of Risk Management is in limiting risks. I realize how important all the skills certifications are (i.e. applying restraints, etc) now. It ensures competency while also limits potential risks to patients.  

Reference

Reams, J. (2011 May). Making FMEA work for you. Nursing Management, 18-20. doi: 10.1097/01.NUMA.0000396500.05462.6e