NURS-FPX 4020 Assessment 1 Enhancing Quality and Safety

Enhancing Quality and Safety

The pursuit of patient safety within healthcare is continuous and paramount. As guardians of patient well-being, nurses are tasked with implementing quality improvement measures that enhance patient safety during medication administration while striving to reduce the associated costs. Medication errors can have severe consequences for patients and healthcare organizations (Mulac et al., 2020). In this assessment, we delve into a critical scenario involving John, a 63-year-old diabetic patient, who experienced a medication error due to high workload and distractions. Our exploration will revolve around identifying factors contributing to the patient safety risk, presenting evidence-based and best-practice solutions, and examining how nurses can coordinate care with various stakeholders to bolster patient safety and economize healthcare resources. By dissecting this scenario, we will unveil the pivotal role of baccalaureate-prepared nurses in shaping a culture of safety within healthcare settings. NURS-FPX 4020 Assessment 1 Enhancing Quality and Safety

Patient Safety Risk and Administration of Medication

John’s safety risk focusing on medication administration can be attributed to several factors, supported by data, evidence, and standards:

High Workload and Distractions

The primary factor contributing to John’s safety risk was the high workload and distractions in the healthcare setting during medication administration. This is a common issue in healthcare. According to data from the Agency for Healthcare Research and Quality (AHRQ), high nurse workload and distractions are significant contributors to medication errors, with research indicating that increased patient-to-nurse ratios are associated with higher error rates (Ratanto et al., 2021).

Lack of Double-Check Protocol 

The absence of a robust double-check protocol for high-risk medications like insulin played a role in the medication error. The Institute for Safe Medication Practices (ISMP) recommends a double-check process for high-alert medications to prevent errors (ISMP, 2019). The lack of adherence to this standard contributed to John’s safety risk. NURS-FPX 4020 Assessment 1 Enhancing Quality and Safetyc

Complexity of Medication Regimen 

John had a complex medication regimen due to his diabetes and comorbidities. The complexity of the regimen increases the risk of errors. The American Diabetes Association (ADA) emphasizes simplifying medication regimens whenever possible to enhance patient safety (Luzuriaga et al., 2021).

Lack of Technology Support 

The absence of technology support, such as Barcode Medication Administration (BCMA) or Electronic Health Records (EHR) with medication alerts, also contributed to the safety risk. Research published in the Journal of Nursing Scholarship has shown that BCMA systems can significantly reduce medication errors (Mulac et al., 2021). NURS-FPX 4020 Assessment 1 Enhancing Quality and Safety

Evidence-Based and Best Practice Solutions

To enhance John’s safety during medication administration while simultaneously reducing costs, healthcare organizations should adopt evidence-based and best-practice solutions. Implementing Barcode Medication Administration (BCMA) technology, as supported by a study in the Journal of Nursing Scholarship, can significantly reduce medication errors by ensuring the “Five Rights” of medication administration. These are the right patient, right medication, right dose, right route, and right time (Poon et al., 2020). Additionally, conducting comprehensive medication reconciliation, a recommended practice by the World Health Organization, helps identify discrepancies and improve medication safety. Standardized protocols and guidelines for high-risk medications, such as insulin, should be developed, following evidence-based recommendations from organizations like the American Diabetes Association (ADA) (Killin et al., 2021). Furthermore, ongoing nurse training and education, as emphasized by the Quality and Safety Education for Nurses (QSEN) initiative, ensure that healthcare professionals are well-equipped to practice medication safety (Acorn & Adynski, 2022). 

NURS-FPX 4020 Assessment 1 Enhancing Quality and Safety

Optimizing nurse-to-patient ratios, as indicated by a study in the Journal of Nursing Administration, can reduce distractions and workload, leading to improved patient safety. The integration of Clinical Decision Support Systems (CDSS) within electronic health records, as demonstrated in research published in the Journal of General Internal Medicine, offers real-time alerts and reminders to prevent medication errors (Panduwal & Bilaut, 2020). Lastly, according to The Joint Commission’s recommendations, interprofessional collaboration enhances medication safety by facilitating a team-based approach to medication review and optimization. Establishing a Continuous Quality Improvement (CQI) culture with resources from the Institute for Healthcare Improvement (IHI) ensures that healthcare organizations regularly assess and enhance medication administration processes, contributing to long-term safety improvements and cost reduction (Abdurrouf & Pandin, 2021).

Nurses’ Role in Coordinate Care

Nurses are pivotal in coordinating care to increase John’s safety during medication administration and reduce associated costs. The following are specific examples of John’s safety risk and how nurses can help improve patient safety.

Medication Reconciliation 

Nurses can lead in conducting thorough medication reconciliation to ensure that John’s home medications are accurately documented upon admission. Studies have shown that medication reconciliation by nurses can reduce medication discrepancies by up to 80%. By preventing discrepancies, nurses contribute to safer medication administration and avoid costly medication errors resulting from discrepancies between the home medication list and hospital orders (Francis et al., 2021).

NURS-FPX 4020 Assessment 1 Enhancing Quality and Safety

Patient Education 

Nurses should provide comprehensive medication education to patients, ensuring they understand their medication regimen, including insulin administration techniques. Research indicates that patients who receive adequate medication education are less likely to experience errors. By empowering patients with this knowledge, nurses enhance their active involvement in their care, ultimately reducing the risk of errors and related costs (Leeson, 2022).

Adherence Monitoring

Nurses can closely monitor a patient’s medication adherence during their hospital stay. Non-adherence to medication regimens is associated with increased healthcare costs due to complications and readmissions. A study found that non-adherent patients had 21% higher healthcare costs than adherent patients. Nurses can identify signs of non-adherence and intervene promptly, preventing complications and costlier interventions (Naser, 2021).

Communication

Nurses should communicate effectively with pharmacists and physicians to review and optimize patient’s medication regimens. Poor communication has been linked to medication errors, which can result in significant healthcare costs. According to the Institute for Safe Medication Practices (ISMP), communication breakdowns contribute to 30% of medication errors (ISMP, 2019). By fostering clear communication, nurses facilitate collaborative decision-making, reducing the risk of errors and related costs.

Stakeholders with Whom Nurses Will Need to Coordinate

Nurses play a crucial role in coordinating care and driving quality and safety enhancements in medication administration, and they must collaborate with various stakeholders to achieve these goals effectively. Identifying and working closely with these stakeholders is essential for promoting a medication safety culture.

NURS-FPX 4020 Assessment 1 Enhancing Quality and Safety

Pharmacists and Physicians

Pharmacists are key partners in medication safety. Their expertise in medication management, drug interactions, and dosage calculations complements nursing knowledge. Collaborating with pharmacists ensures accurate medication orders and timely reviews, reducing medication errors. Communication and collaboration with physicians are vital to clarify medication orders, discuss treatment plans, and address medication-related concerns. Physicians provide essential input into medication decisions (Young et al., 2021).

Patients, Families, and Clinical Informatics Specialists

Engaging patients and their families as active participants in medication safety is critical. Educating them about medications, involving them in medication reconciliation, and encouraging them to ask questions enhances adherence and reduces errors. In the Electronic Health Records (EHRs) era, coordination with clinical informatics specialists is crucial. They can customize EHR systems to include safety alerts, reminders, and decision-support tools to prevent medication errors (Shrivastava & Shrivastava, 2020).

Hospital Administration and Quality Improvement Teams

Hospital administrators allocate resources, set policies, and establish a safety culture. Nurses must collaborate with administrators to secure resources for safety initiatives, implement policies, and foster a culture prioritizing patient safety. Collaborating with quality improvement teams allows nurses to participate in root cause analyses, develop action plans, and continually implement evidence-based strategies to enhance medication safety (Francis et al., 2021).

NURS-FPX 4020 Assessment 1 Enhancing Quality and Safety

Regulatory Agencies and Interdisciplinary Teams 

Nurses must comply with regulations and standards set by organizations like The Joint Commission and state boards of nursing. Compliance helps maintain accreditation and ensures adherence to best practices. Multidisciplinary rounds involving nurses, pharmacists, physicians, and other healthcare professionals facilitate comprehensive medication reviews, identify issues, and make informed decisions (Leeson, 2022). Effective coordination with these stakeholders fosters a safety culture, reduces medication errors, improves patient outcomes, and reduces healthcare costs, ultimately enhancing the quality of care.

Conclusion

In conclusion, ensuring medication safety and reducing associated costs are paramount in healthcare, and baccalaureate-prepared nurses play a central role in achieving these goals. By identifying safety risks, implementing evidence-based practices, coordinating care with various stakeholders, and fostering a culture of safety, nurses contribute significantly to enhancing patient well-being. This assessment has underscored the critical importance of evidence-based strategies, interdisciplinary collaboration, and ongoing quality improvement efforts in safeguarding patients like John during medication administration, ultimately leading to better outcomes and efficient resource utilization within healthcare organizations.

References

Abdurrouf, M., & Pandin, M. G. R. (2021). Interprofessional collaboration improves patient safety: A review. Www.preprints.org, 5(4). https://doi.org/10.20944/preprints202104.0230.v1 

Acorn, M., & Adynski, G. (2022). Nurses need quality education and supportive work environments to enhance medication safety. Evidence Based Nursing, 5(4), ebnurs-2022-103573. https://doi.org/10.1136/ebnurs-2022-103573 

Francis, M., Wai, A., & Patanwala, A. E. (2021). Association between admission medication reconciliation by pharmacists on the accuracy of hospital discharge medication lists. Jaccp: journal of the American college of clinical pharmacy, 4(6), 674–679. https://doi.org/10.1002/jac5.1420 

Han, Y., Kim, J.-S., & Seo, Y. (2019). Cross-sectional study on patient safety culture, patient safety competency, and adverse events. Western Journal of Nursing Research, 42(1), 019394591983899. https://doi.org/10.1177/0193945919838990 

Institute for Safe Medication Practices ISMP. (2019, June 6). Independent Double Checks: Worth the Effort if Used Judiciously and Properly. Institute for Safe Medication Practices. https://www.ismp.org/resources/independent-double-checks-worth-effort-if-used-judiciously-and-properly 

Killin, L., Hezam, A., Anderson, K. K., & Welk, B. (2021). Advanced medication reconciliation: A systematic review of the impact on medication errors and adverse drug events associated with care transitions. The Joint Commission Journal on Quality and Patient Safety, 47(7). https://doi.org/10.1016/j.jcjq.2021.03.011 

Leeson, D. (2022). Creating sustained and positive changes to patient safety: Reducing insulin administration errors in a district nursing service. British Journal of Community Nursing, 27(3), 122–126. https://doi.org/10.12968/bjcn.2022.27.3.122 

Luzuriaga, M., Leite, R., Ahmed, H., Saab, P. G., & Garg, R. (2021). Complexity of antidiabetic medication regimen is associated with increased diabetes-related distress in persons with type 2 diabetes mellitus. BMJ Open Diabetes Research & Care, 9(1), e002348. https://doi.org/10.1136/bmjdrc-2021-002348 

Mulac, A., Mathiesen, L., Taxis, K., & Granås, A. (2021). Barcode medication administration technology use in hospital practice: A mixed-methods observational study of policy deviations. BMJ Quality & Safety, 30(12), 1021–1030. https://doi.org/10.1136/bmjqs-2021-013223 

Mulac, A., Taxis, K., Hagesaether, E., & Granas, A. G. (2020). Severe and fatal medication errors in hospitals: Findings from the Norwegian incident reporting system. European Journal of Hospital Pharmacy, 28(1). https://doi.org/10.1136/ejhpharm-2020-002298 

Naser, A. Y. (2021). Cost-related nonadherence for prescription medications: A cross-sectional study in Jordan. Expert Review of Pharmacoeconomics & Outcomes Research, 5(4), 1–7. https://doi.org/10.1080/14737167.2021.1899814 

Panduwal, C. A., & Bilaut, E. C. (2020). The effectiveness of interventions to reduce the nurses’ distractions during medication administration: A Systematic Review. Jurnal Ners, 14(3), 132. https://doi.org/10.20473/jn.v14i3.17048 

Poon, E. G., Keohane, C. A., Yoon, C. S., Ditmore, M., Bane, A., Levtzion-Korach, O., Moniz, T., Rothschild, J. M., Kachalia, A. B., Hayes, J., Churchill, W. W., Lipsitz, S., Whittemore, A. D., Bates, D. W., & Gandhi, T. K. (2020). Effect of bar-code technology on the safety of medication Administration. New England Journal of Medicine, 362(18), 1698–1707. https://doi.org/10.1056/nejmsa0907115 

Ratanto, Hariyati, Rr. T. S., Mediawati, A. S., & Eryando, T. (2021). Workload as the most important influencing factor of medication errors by nurses. The Open Nursing Journal, 15(1), 204–210. https://doi.org/10.2174/1874434602115010204 

Shrivastava, S., & Shrivastava, P. (2020). Ensuring patient safety through reducing medication errors: World Health Organization. International Journal of Health & Allied Sciences, 9(1), 86. https://doi.org/10.4103/ijhas.ijhas_74_19 

Young, J., Zolio, L., Brock, T., Harrison, J., Hodgkinson, M., Kumar, A., Morphet, J., & Kent, F. (2021). Interprofessional learning about medication safety. The Clinical Teacher, 18(6), 656–661. https://doi.org/10.1111/tct.13430 

Explore our other nursing samples for further assistance and resources.