Respond to 3 STUDENT quality improvement discussion post |

make a meaningful response to a minimum of 3 of your colleagues in the discussion. A meaningful response means you maintain professionalism, you respect the ideas and opinions of all other in the discussion group, and that you reflect on the ideas presented and provide substantial input or ideas in the response, not just saying “Wow, that’s interesting” and leave it at that. Illustrate that you did the assigned readings by applying information from the readings.
1. MK post
Patient safety has become a major focus of healthcare since 1999 when To Err is Human was published (Bates & Singh, 2018). Prevention of harm related to errors has improved but requires that everyone engage in a culture of change to decrease the risks to the patient and reduce liability in the organization (Bates & Singh, 2018). While improvements in safety have been realized with advancements in technology, techniques, and protocols their use is often not standardized, are underutilized, and are not universally used to optimize the benefits. Many models exist to improve patient safety, each with their own benefits and drawbacks. One thing that is apparent is that it will take the engagement at all levels of care to bring safety and improved patient outcomes to a new, sustainable level.
            One area noted to be of great concern is my previous work environment of long-term care. Falls are a taxing problem for patient safety, organizational liability, and poor outcomes of care in long-term care facilities. There is an estimated 600,00 falls early worldwide that result in death (Schoberer et al., 2022), with about one half of long term care residents suffering at least one fall yearly.  Reduction in fall rates is a focus of nursing facility administration and is often used as a measure of the quality of nursing care provided (Seo et al., 2021).  In my role as ADON, I performed QI routinely to assist in the reduction of falls and to implement a fall safety program.  All residents were screened on admission using a fall risk assessment tool, assessing their individual risk factors for falls.  If identified to be at high risk for falls, patients were placed on the fall program.  This included nursing interventions of increased observation, nutrition and medication review, environmental adjustments, placement into a restorative nursing program, and adaptive equipment utilized to reduce the risk of falls.  If a fall were to occur, a root cause analysis was performed to individualize further interventions to reduce the risk of falls.  These interventions are best practice per Scholberer et al. (2022).  The combination of multifactorial interventions such as those mentioned above are paramount to reducing falls in long-term care facilities (Seo et al., 2021).

2. AM post

Patient safety has always been of paramount importance in nursing. But no nurse, system, or hospital is perfect, and humans will make mistakes. Nurses play a crucial role in quality improvement (QI) by identifying safety issues, conducting research, and developing ways to improve them. In reading literature to prepare for this discussion board, I was surprised to learn that there are many different QI tools that can be utilized, and that even these tools have their advantages and disadvantages. Incident reports and root cause analyses are the tools that many of us are already familiar with and, while they provide valuable information on safety risks, it is not feasible to complete a root cause analysis on every incident report (Hagley et al., 2019). Since root cause analyses require so much time and resources, they are typically used for errors that cause the greatest harm, which allows no-harm and low-harm safety problems to slip through the cracks (Hagley et al., 2019).
One of the issues that my unit is currently struggling with is patient falls. Although fall prevention is a heavily researched topic with numerous recommended prevention strategies, it continues to be a problem in many clinical settings. Being that 70% of QI initiatives fail, often within the first year (O’Donoghue et al., 2021), I think I would give any QI process time to take hold within the unit’s culture. I like the strategies presented by O’Donoghue et al. (2021): focus on staff engagement (make sure staff feel like they are performing personally meaningful work by preventing falls), empower staff by giving them the necessary resources and reduce barriers to implementing a solution, and committing to sustainability by giving new fall prevention strategies time to take hold and become ingrained in current infrastructure and procedures. Advice from Thackeray et al. (2019) suggests investing early and robustly in data collection, which could be used to see why and how my unit is experiencing so many falls. It is also mentioned to anticipate staff obstacles (like turnover, unavailability, etc) and develop a backup plan (Thackeray et al., 2019). Ultimately, planning for problems in QI initiatives early and during the planning process can be one of the best ways to ensure that a QI initiative actually works as intended.

3. MB post

As Cepero (2011) points out, nurses tend to rely on their personal experience and that of their colleagues as opposed to official research and knowledge. I believe this can be attributed to what several other researchers found to be true: Carter et al. (2017) discuss the discrepancies between what nurses are taught in school and what happens in clinical practice. What we’re taught in school is a very basic foundation, especially those of us who took the associate’s degree route, and we do most of our learning on the job. As nurses, we are the frontline in patient care and it is vital that we take action to keep ourselves educated in the most current evidence-based practices. As Adolfo et al. (2021) note, “nurses play a significant role in improving overall hospital quality” (p. 206). However, there are several barriers in place that prevent us from making this happen. Adolfo et al. (2021) found nurses have very positive attitudes about being contributors to quality improvement (QI), but working conditions such as “increased patients’ workloads, longer working hours, lack of staff, limited health equipment, and budgetary constraints” (p. 207) are strong barriers to nurses’ participation in QI. Hospitals also need to establish a cultural foundation of QI implementation and adherence to those evidence-based practices.
At my current travel assignment, I am at a small level III trauma center that is a part of a large for-profit hospital system. And it shows. They are severely short-staffed, much of the equipment doesn’t work, and management is very hands-off. When I was at a large level I academic hospital, there were constant e-mails and unit huddles addressing QI and best practices to improve patient care. I knew the names of everyone at all levels of nursing management. At my current assignment, it feels very much like a factory: get the patients in, get them out. They are not doing a lot of the evidence-based practices that the large academic hospital implemented. Simple things like bundle-checks, turning schedules and teams, and alcohol caps. This hospital could greatly benefit from something as simple as huddles with unit management and the QI tool Tschannen et al. (2020) developed to assess nurses “demographics and engagement, QI competence (KSAs), and barriers/facilitators” (p. 373) to improve QI with nurses. Because “engaging nurses in quality improvement (QI) is essential for improving patient care” (Tschannen et al., 2020, p. 373). The tool is an assessment they’re termed “N-QuIP.” One of the things they found with the tool was that “a third of nurses reported being unsure whether the unit/department was conducting QI” (Tschannen et al., 2020, p. 376). With this tool, “health systems looking to improve staff engagement in QI can administer the N-QuIP to frontline staff and use these data to drive changes…identifying current gaps in knowledge and/or skill can assist with determining the type of training needed to equip nurses with the necessary competencies to engage in QI” (Tschannen et al., 2020, p. 378). The first step in improving nurses participation and implementation of QI and evidence-based practice is assessing the knowledge gaps and understanding of QI. Once these are addressed, there are several online resources for us to begin the practice, as discussed by Kazana & Dolansky (2021). But management must be active in implementing and encouraging nurses practice of QI.

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