For this assessment, you will develop a 3-5 page paper that examines a safety quality issue pertaining to medication administration in a health care setting. You will analyze the issue and examine potential evidence-based and best-practice solutions from the literature as well as the role of nurses and other stakeholders in addressing the issue

4020 Assignment 1

Improving Quality of Care and Patient Safety

For this assessment, you will develop a 3-5 page paper that examines a safety quality issue pertaining to medication administration in a health care setting. You will analyze the issue and examine potential evidence-based and best-practice solutions from the literature as well as the role of nurses and other stakeholders in addressing the issue.

Health care organizations and professionals strive to create safe environments for patients; however, due to the complexity of the health care system, maintaining safety can be a challenge. Since nurses comprise the largest group of health care professionals, a great deal of responsibility falls in the hands of practicing nurses. Quality improvement (QI) measures and safety improvement plans are effective interventions to reduce medical errors and sentinel events such as medication errors, falls, infections, and deaths. A 2000 Institute of Medicine (IOM) report indicated that almost one million people are harmed annually in the United States, (Kohn et al., 2000) and 210,000–440,000 die as a result of medical errors (Allen, 2013).

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The role of the baccalaureate nurse includes identifying and explaining specific patient risk factors, incorporating evidence-based solutions to improving patient safety and coordinating care. A solid foundation of knowledge and understanding of safety organizations such as Quality and Safety Education for Nurses (QSEN), the Institute of Medicine (IOM), and The Joint Commission and its National Patient Safety Goals (NPSGs) program is vital to practicing nurses with regard to providing and promoting safe and effective patient care.

You are encouraged to complete the Identifying Safety Risks and Solutions activity. This activity offers an opportunity to review a case study and practice identifying safety risks and possible solutions. We have found that learners who complete course activities and review resources are more successful with first submissions. Completing course activities is also a way to demonstrate course engagement.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 1: Analyze the elements of a successful quality improvement initiative.
- Explain evidence-based and best-practice solutions to improve patient safety focusing on medication administration and reducing costs.
Competency 2: Analyze factors that lead to patient safety risks.
- Explain factors leading to a specific patient-safety risk focusing on medication administration.
Competency 4: Explain the nurse’s role in coordinating care to enhance quality and reduce costs.
- Explain how nurses can help coordinate care to increase patient safety with medication administration and reduce costs.
- Identify stakeholders with whom nurses would need to coordinate to drive quality and safety enhancements with medication administration.
Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.
- Organize content so ideas flow logically with smooth transitions; contains few errors in grammar or punctuation, word choice, and spelling.
- Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.

References

Allen, M. (2013). How many die from medical mistakes in U.S. hospitals? Retrieved from https://www.npr.org/sections/health-shots/2013/09/20/224507654/how-many-die-from-medical-mistakes-in-u-s-hospitals.

Kohn, L. T., Corrigan, J., & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for implementing quality improvement (QI) and patient safety measures in health care settings. Effective quality improvement measures result in systemic and organizational changes, ultimately leading to the development of a patient safety culture.

Scenario

Consider a previous experience or hypothetical situation pertaining to medication errors, and consider how the error could have been prevented or alleviated with the use of evidence-based guidelines.

Choose a specific condition of interest surrounding a medication administration safety risk and incorporate evidence-based strategies to support communication and ensure safe and effective care.

For this assessment:

Analyze a current issue or experience in clinical practice surrounding a medication administration safety risk and identify a quality improvement (QI) initiative in the health care setting.

Instructions

The purpose of this assessment is to better understand the role of the baccalaureate-prepared nurse in enhancing quality improvement (QI) measures that address a medication administration safety risk. This will be within the specific context of patient safety risks at a health care setting of your choice. You will do this by exploring the professional guidelines and best practices for improving and maintaining patient safety in health care settings from organizations such as QSEN and the IOM. Looking through the lens of these professional best practices to examine the current policies and procedures currently in place at your chosen organization and the impact on safety measures for patients surrounding medication administration, you will consider the role of the nurse in driving quality and safety improvements. You will identify stakeholders in QI improvement and safety measures as well as consider evidence-based strategies to enhance quality of care and promote medication administration safety in the context of your chosen health care setting.

Be sure that your plan addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so that you know what is needed for a distinguished score.

Explain factors leading to a specific patient-safety risk focusing on medication administration.
Explain evidence-based and best-practice solutions to improve patient safety focusing on medication administration and reducing costs.
Explain how nurses can help coordinate care to increase patient safety with medication administration and reduce costs.
Identify stakeholders with whom nurses would coordinate to drive safety enhancements with medication administration.
Communicate using writing that is clear, logical, and professional, with correct grammar and spelling, using current APA style.

Additional Requirements

Length of submission: 3–5 pages, plus title and reference pages.
Number of references: Cite a minimum of 4 sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.
APA formatting: References and citations are formatted according to current APA style

Enhancing Quality and Safety Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Explain factors leading to a specific patient-safety risk focusing on medication administration.	Does not identify factors leading to a specific patient-safety risk focusing on medication administration.	Identifies factors leading to a specific patient-safety risk focusing on medication administration.	Explains factors leading to a specific patient-safety risk focusing on medication administration.	Explains factors leading to a specific patient-safety risk focusing on medication administration. Makes reference to specific data, evidence, or standards to illustrate the safety risk.
Explain evidence-based and best-practice solutions to improve patient safety focusing on medication administration and reducing costs.	Does not identify evidence-based and best-practice solutions to improve patient safety focusing on medication administration and reducing costs.	Identifies evidence-based and best-practice solutions to improve patient safety focusing on medication administration and/or discusses reducing costs but not both.	Explains evidence-based and best-practice solutions to improve patient safety focusing on medication administration and reducing costs.	Explains evidence-based and best practice solutions to improve patient safety focusing on medication administration and reducing costs. Makes explicit reference to scholarly or professional resources to support explanation.
Explain how nurses can help coordinate care to increase patient safety with medication administration and reduce costs.	Does not identify how nurses can help coordinate care to increase patient safety with medication administration and reduce costs.	Identifies how nurses can help coordinate care to increase patient safety with medication administration and/or how to reduce costs but not both.	Explains how nurses can help coordinate care to increase patient safety with medication administration and reduce costs.	Explains how nurses can help coordinate care to increase patient safety with medication administration and reduce costs, providing specific examples related to a patient safety risk.
Identify stakeholders with whom nurses would need to coordinate to drive quality and safety enhancements with medication administration.	Does not identify stakeholders with whom nurses would need to coordinate to drive quality and safety enhancements with medication administration.	Identifies stakeholders, but their relevance to collaboration with nurses or their ability to drive quality and safety enhancements with medication administration is unclear.	Identifies stakeholders with whom nurses would need to coordinate to drive quality and safety enhancements with medication administration.	Identifies stakeholders with whom nurses would need to coordinate to drive quality and safety enhancements with medication administration, noting the relevance and potential importance of the stakeholders.
Organize content so ideas flow logically with smooth transitions; contains few errors in grammar or punctuation, word choice, and spelling.	Does not organize content for ideas. Lacks logical flow and smooth transitions.	Organizes content with some logical flow and smooth transitions. Contains errors in grammar or punctuation, word choice, and spelling.	Organizes content so ideas flow logically with smooth transitions; contains few errors in grammar or punctuation, word choice, and spelling.	Organizes content with a clear purpose. Content flows logically with smooth transitions using coherent paragraphs, correct grammar or punctuation, word choice, and free of spelling errors.
Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.	Does not apply APA formatting to headings, in-text citations, and references. Does not use quotes or paraphrase correctly.	Applies APA formatting to in-text citations, headings and references incorrectly or inconsistently, detracting noticeably from the content. Inconsistently uses headings, quotes or paraphrasing.	Applies APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.	Exhibits strict and flawless adherence to APA formatting of headings, in-text citations, and references. Quotes and paraphrases correctly.

Resources: Collaboration and Leadership

· Collaboration and Leadership

Cho, S. M., & Choi, J. (2018). Patient safety culture associated with patient safety competencies among registered nurses.Journal of Nursing Scholarship, 50(5), 549–557. https://doi-org.library.capella.edu/10.1111/jnu.12413
- This article discusses the importance of creating a unit-specific patient safety culture that is tailored to the competencies of the unit’s RNs in patient safety practice.
SonÄŸur, C., Özer, O., Gün, C., & Top, M. (2018). Patient safety culture, evidence-based practice and performance in nursing.Systemic Practice and Action Research, 31(4), 359–374.
- Evidence-based practice is a problem-solving approach in which the best available and useful evidence is used by integrating research evidence, clinical expertise, and patient values and preferences to improve health outcomes, service quality, patient safety and clinical effectiveness, and employee performance.
Stalter, A. M., & Mota, A. (2017). Recommendations for promoting quality and safety in health care systems.The Journal of Continuing Education in Nursing, 48(7), 295–297.
- This article provides recommendation to promote quality and safety education with a focus on systems thinking awareness among direct care nurses. A key point is error prevention, which requires a shared effort among all nurses.
Manno, M. S. (2016). The role transition characteristics of new registered nurses: A study of work environment influences and individual traits. (Publication No. 10037467) [Doctoral dissertation, Capella University].http://library.capella.edu/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fdissertations-theses%2Frole-transition-characteristics-new-registered%2Fdocview%2F1775393522%2Fse-2%3Faccountid%3D27965
- This research study may be helpful in identifying traits and qualities of new registered nurses that are helpful in coordinating and leading quality and safety measures related to this assessment.
Boomah, S. A. (2018). Emergence of informal clinical leadership as a catalyst for improving patient care quality and job satisfaction.Journal of Advanced Nursing. 75(5), 1000–1009. https://doi-org.library.capella.edu/10.1111/jan.13895
- This research analyzes attributes and best practices of leadership and nursing staff that help aid in patient care quality and job satisfaction.
Greenstein, T. (2020). Leading innovation is completely different from leading change.com.
- This article examines competencies that may help nurses collaborate more effectively to improve patient outcomes.
Poder, T. G., & Mattais, S. (2018). Systemic analysis of medication administration omission errors in a tertiary-care hospital in Quebec.Health Information Management Journal, 49(2-3), 99–107.
- This examination of underlying systemic causes of medication errors may be useful as you consider QI vest practices and ways to coordinate care to increase safety and quality.
Antevy, P. (2017). How care collaboration is improving patient outcomes.EMS World, 46(4), 26–33.
- This article examines competencies that may help health care professionals collaborate more effectively to improve patient outcomes.
Keers, R. N., Plácido, M., Bennet, K., Clayton, K., Brown, P., & Ashcroft, D. M. (2018, October 26). What causes medication administration errors in a mental health hospital? A qualitative study with nursing staff.PLOS One. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206233
- This examination of underlying systemic causes of medication errors may be useful as you consider QI best practices and ways to coordinate care to increase safety and quality.

A Sample Of This Assignment Written By One Of Our Top-rated Writers

Assessment 1: Enhancing Quality and Safety

Medication errors are a major cause of avoidable patient harm in healthcare systems globally. Medication administration errors (MAEs) are the most prevalent types of medication errors and are associated with adverse consequences for healthcare consumers, providers, and organizations. The purpose of this paper is to discuss factors that lead to patient-safety risks in medication administration, explore evidence-based solutions, and explain the coordination of care in patient safety.

Factors Leading to a Specific Patient-Safety Risk Focusing on Medication Administration

When working in the Emergency Department (ED) unit, the attending physician prescribed IV Amoxicillin-clavulanate to a male adult patient who was diagnosed with Acute bacterial rhinosinusitis. The patient developed rash and itching and upon asking him if he had any allergies, he reported being allergic to penicillin. Various factors contribute to patient-safety risks related to medication administration. One of the factors is poor documentation of patients’ medication histories and drug allergies. Kiechle et al. (2018) explain that documentation of medication histories, drug allergies, and adverse drug reactions (ADRs) is often weighed down by error and discrepancy. Missing documentation contributes to severe allergic reactions. On the other hand, over-reporting of drug allergies and ADRs or mislabeling the severity or nature of the drug reaction contributes to suboptimal treatment and poor outcomes. Medication histories are often incomplete, with omission of drugs strengths and doses and missing information on over-the-counter and complementary medicines.

Evidence-Based and Best-Practice Solutions to Improve Patient Safety

Patient safety related to medication administration can be improved through medication reconciliation. Reconciling medicines at care transition points has been shown to decrease medication errors by a statistically high percentage. Sproul et al. (2018) explain that medication reconciliation increases patient safety by decreasing medication errors at transitions of care. It also reduces potential and actual adverse drug events (ADEs). Another solution is obtaining the best possible medication history (BPMH). BPMMH is a crucial step in the medication reconciliation process and entails interviewing the patient or the caregiver to collect information on the patient’s prescribed and home medications (Sproul et al., 2018). The provider then verifies the information against another reliable source, like the patient’s medical record, medication vials, or the community pharmacy record. A BPMH is important for: Promoting continuity of medication management; Recognizing drug-related problems; Recognizing potential drug-related discrepancies; Guiding the decision-making process; and improving medication use.

Engaging the pharmacy team in the medication reconciliation process helps minimize discrepancies and in the documentation of drug allergies and ADRs. Kiechle et al. (2018) assert that involving the pharmacy team in medication reconciliation is effective in decreasing discrepancies in the medical record. This can be more effective even than clinician- or nurse-led initiatives. Furthermore, improved allergic reaction and ADR documentation platforms in the electronic medical record can decrease discrepancy rates, especially if outpatient and pharmacy records are faultlessly integrated (Braund et al., 2019). Moreover, the administration of medications to patients with an established drug allergy or previous ADR can be mitigated by having mechanisms for alerting providers who prescribe, dispense and administer drugs.

How Nurses Can Help Coordinate Care to Increase Patient Safety with Medication Administration and Reduce Costs

Care coordination entails managing a patient’s care between two or more healthcare professionals and the patients themselves. Russ-Jara et al. (2021) assert that medication errors are linked with challenges in care coordination among primary care providers, pharmacists, and specialists. Nurses can help coordinate care, especially in the medication reconciliation process by collecting information on a patient’s known drug allergies and ADRs upon presentation to the healthcare facility and recording it in the BPMH. The nurse can also document any new drug allergies or ADRs in the BPMH. Furthermore, nurses during medication reconciliation can coordinate care by creating a definitive list of patients’ medications from different care settings and informing the prescribers of any discrepancies (Ceschi et al., 2021). This will not only reduce medication errors and related patient-safety risks, but it will also reduce costs to both the patients and hospitals.

Stakeholders with Whom Nurses Would Coordinate To Drive Safety Enhancements

Care coordination to improve medication administration safety will require the nurse to coordinate with clinicians, pharmacists, and patients/caregivers. Clinicians are responsible for prescribing medications. Thus, the nurse will need to communicate any discrepancies in a patient’s medications to avoid ADEs. Pharmacists have a vast knowledge of pharmaceuticals and can offer professional advice on the best medications for a patient (Russ-Jara et al., 2021). Therefore, the nurse will engage the pharmacy team in the medication reconciliation process. Furthermore, nurses will need to create a partnership with patients or their caregivers when collecting information on a patient’s prescribed and home medications.

Conclusion

Poor documentation of medication histories and drug allergies often leads to discrepancies that lead to MAEs. Failing to document a patient’s drug allergies can lead to prescribers administering a drug the patient is allergic to resulting in allergic reactions and ADRs. Strategies to reduce medication safety risks include medication reconciliation, obtaining the best possible medication history, engaging the pharmacy team, and establishing improved allergic reaction and ADR documentation platforms.

References

Braund, R., Lawrence, C. K., Baum, L., Kessler, B., Vassart, M., & Coulter, C. (2019). Quality of electronic records documenting adverse drug reactions within a hospital setting: identification of discrepancies and information completeness. The New Zealand Medical Journal (Online), 132(1488), 28-37.

Ceschi, A., Noseda, R., Pironi, M., Lazzeri, N., Eberhardt-Gianella, O., Imelli, S., … & Ferrari, P. (2021). Effect of medication reconciliation at hospital admission on 30-day returns to hospital: a randomized clinical trial. JAMA network open, 4(9), e2124672-e2124672. https://doi.org/10.1001/jamanetworkopen.2021.24672

Kiechle, E. S., McKenna, C. M., Carter, H., Zeymo, A., Gelfand, B. W., DeGeorge, L. M., Sauter, D. A., & Mazer-Amirshahi, M. (2018). Medication Allergy and Adverse Drug Reaction Documentation Discrepancies in an Urban, Academic Emergency Department. Journal of medical toxicology: official journal of the American College of Medical Toxicology, 14(4), 272–277. https://doi.org/10.1007/s13181-018-0671-7

Russ-Jara, A. L., Luckhurst, C. L., Dismore, R. A., Arthur, K. J., Ifeachor, A. P., Militello, L. G., Glassman, P. A., Zillich, A. J., & Weiner, M. (2021). Care Coordination Strategies and Barriers during Medication Safety Incidents: a Qualitative, Cognitive Task Analysis. Journal of general internal medicine, 36(8), 2212–2220. https://doi.org/10.1007/s11606-020-06386-w

Sproul, A., Goodine, C., Moore, D., McLeod, A., Gordon, J., Digby, J., & Stoica, G. (2018). Quality of Best Possible Medication History upon Admission to Hospit=-al: Comparison of Nurses and Pharmacy Students and Consideration of National Quality Indicators. The Canadian journal of hospital pharmacy, 71(2), 128–134.