NURS FPX 4020 Assessment 1 Enhancing Quality and Safety

NURS FPX 4020 Assessment 01 Enhancing Quality and Safety

Enhancing Quality and Safety

Medication errors threaten patient safety and are increasing problems in the provision of care in the United States (US). The errors related to medication lead to longer patient stays at the hospital. These longer stays and emergency care provided to patients who have suffered medication errors increase the overall cost of healthcare (Mieiro et al., 2019). According to statistics, over 400,000 patients visit healthcare institutions each year due to medication errors (Single Care, 2021). Eliminating medication administration errors by promoting safety, quality, and practice standards can enhance the quality of care, patient safety, and care coordination (Khan & Tidman, 2022). Individual performance and systematic effectiveness are two primary reasons to achieve a culture of safety in healthcare institutions, according to Quality and Safety Education for Nurses (QSEN) (WTCS, 2023). The assessment assumes that identifying teaching and training methods for nursing can help reduce medication errors. According to research, medication administration errors can be reduced significantly by educating nurses on their impacts (Phillips et al., 2019). The assessment aims to analyze medication administration-related safety issues to propose evidence-based quality practices. 

Scenario

I experienced an error related to medication administration recently at Mass General Brigham (MGH). A colleague nurse named Betty overdosed on a complex chronic patient with severe pain from Chronic Kidney Disease (CKD). Morphine was prescribed by the doctors in the hospital in case of moderate to severe pain for the patient. Due to the sudden high pain, the nurse got tensed and provided more doses than prescribed. The patient skin immediately got pale, and he was barely breathing. Since the overdosage was not severe, the patient recovered by continued medical procedures. 

Reason for Specific Patient Safety Risk

The overdosage of morphine resulted from different situations in the workspace on the day. A patient had died earlier that day in MGH with the same CKD problem as the current patient. Therefore, Betty was having a very hard time coping with the earlier event. Before the medication error, Betty observed the patient and tried to communicate with him about his pain levels. Subsequently, she remembered that morphine was prescribed to the patient. She did not check the prescription on the paper and provided a dosage of 10mg to the patient, which caused an immediate reaction. The prescribed dosage for the patient was only 2mg, which Betty did not review, and the medication error happened (Nosek et al., 2022). Medication errors are preventable at institutions like MGH where resources are abundant. Therefore, the need to plan for safe conduct is necessary to mitigate the errors related to medication administration. 

Data and Evidence

According to Food and Drug Authority (FDA), the institution receives over 100,000 reports of medication errors every year. It has also been stated that the institution encounters medication error-related injuries, which are over 400,000 patients per year. The cost of care increases according to the institution (Single Care, 2021). According to Khan and Tidman (2022), the primary reason for medication-related errors is the lack of training of nurses, negligence, low standards of practice, and ignorance towards risk management practices. The unavailability of health literacy is one primary reason for this capacity which causes medication-related errors (Mieiro et al., 2019). For example, in the present case of Betty, she was already disturbed and forgot to review administrative records for the patient before providing the dosage to the patient. 

Evidence-Based Practices to Improve Patient Safety

There are different evidence-based methods to reduce medication errors in a given healthcare setting. According to Mieiro et al. (2019), implementation of the decision-support system or Electronic Health Records (EHR) at the healthcare institution was an evidence-based practice for mitigating the medication error and ultimately improving patient safety. Best practices for improving patient safety was also possible through the mitigation of the medication-related errors (Jordan et al., 2019). The research also presented that using a standard protocol and practice through workflow changes and processing was the best practice for mitigating medication errors (Mieiro et al., 2019). 

Along with these best practices, educational strategies like explanatory manuals, training sessions, and campaigns were proposed as evidence-based practices by the research to reduce medication-related errors (Craig et al., 2020). Eliminating adverse drug events related to medication administration significantly reduces healthcare costs by removing the costs related to readmissions, hospital stays, and legal penalties (Jordan et al., 2019). Therefore, MGH should adopt provided evidence-based practices to address the issue of medication errors while treating patients with CKD or any other chronic illness.

Role of Nurses in Improving Patient Safety

Nurses are the primary stakeholders of care in any healthcare institution. Therefore, the role of nurses is very important when providing patients with coordinated care. Implementing best and evidenced practices can only be beneficial if the nurses are trained to adopt these practices (Mathieson et al., 2019). For example, implementing decision support or EHR at MGH can only be successful if Betty or other nurse colleagues can use this system. The role of nurses is significantly important in eliminating medication errors and improving the corresponding patient safety, according to Jordan et al. (2019). 

It has also been evaluated that the role of nurses is significantly important while providing coordinated care (Mathieson et al., 2019). For example, nurses must read the prescriptions from physical or online systems at the institution. The lack of training, medical literacy, or knowledge can lead to the wrong interpretation of medication prescribed to a patient resulting in medication errors (Khan & Tidman, 2022). Therefore, the educational strategies provided as best practices need to be implemented at MGH to avoid overdosage or relative medication administration issues. Nurses hence, play an important role in patient safety as they are responsible for providing coordinated care. 

Trained and well-experienced nurses are less likely to make errors during drug administration to patients, which reduces healthcare costs (Mieiro et al., 2019). The reduction in medication errors causes a decrease in patient safety compromises at the institution. For example, in case of a medication error, the hospital will either admit the patient for a longer time without any charges or pay legal fines if reported (Phillips et al., 2019). Similarly, the increased medication errors cause an increase in the overall cost of care per patient, causing losses and performance gaps in healthcare organizations like MGH. 

Stakeholders to Collaborate

There are different stakeholders that nurses collaborate with to ensure the quality of care, coordination of care, and reduction in medication errors. The first is prescribers, physicians, psychologists, or orthopedics (Dionisi et al., 2021). The familiar handwritings are easy to read. The prescription written by any of the mentioned stakeholders can only be interpreted accurately by nurses if they have effectively coordinated with them (Mieiro et al., 2019). Similarly, medication administration is reduced by the clear handwriting of prescribers or EHR. Therefore, nurses need to collaborate with the prescribers regularly to take an update on the medication schedule and other information related to patient medication (Hutchinson et al., 2020). The nurses collaborate with patients by communicating with them or knowing about their medical condition to provide better care for them in correspondence with the other interprofessional team members. The other stakeholders with which nurses collaborate include pharmacists, members of interprofessional or interdisciplinary teams, and patient families. Collaboration with these stakeholders is important as it allows nurses to provide coordinated care to patients with minimum medication administration errors (Dilles et al., 2021). 

Importance of Stakeholders

Patient families are the most important stakeholders as they provide information about patients’ undocumented behavior, allergies, or other medical conditions that can improve medication prescription and overall care provision (Hutchinson et al., 2020). Pharmacists are also important as they provide authorized medication dosages to the nurses, and the collaboration provides reluctance towards medication errors in dosage. The interdisciplinary team includes the prescribers, who are also very important to collaborate with (Mieiro et al., 2019). Nurse collaboration with all of these stakeholders can only be efficient in providing high-quality care if professional and ethical ways of coordination and conversation have been used (Dilles et al., 2021).

Conclusion NURS FPX 4020 Assessment 01 Enhancing Quality and Safety

It has been reviewed that medical administration is an important process to be managed by nurses and other medical staff at MGH. The recent medication errors have shown that evidence-based best practices must be adopted in healthcare settings. The role of nurses has been found most prevalent in providing coordinated care and increasing patient safety. Training nurses through educational campaigns or using technologies for medication administration like EHR are evidence-based practices that can reduce the risk of medication administration errors. Nurses must collaborate with stakeholders like prescribers, interprofessional teams, patients, patient families, and pharmacists to provide coordinated care and improve patient safety. 

References

Craig, S. J., Kastello, J. C., Cieslowski, B. J., & Rovnyak, V. (2020). Simulation strategies to increase nursing student clinical competence in safe medication administration practices: A quasi-experimental study. Nurse Education Today96, 1–11. https://doi.org/10.1016/j.nedt.2020.104605

Dilles, T., Heczkova, J., Tziaferi, S., Helgesen, A. K., Grøndahl, V. A., Van Rompaey, B., Sino, C. G., & Jordan, S. (2021). Nurses and pharmaceutical care: Interprofessional, evidence-based working to improve patient care and outcomes. International Journal of Environmental Research and Public Health18(11)https://doi.org/10.3390/ijerph18115973

Dionisi, S., Di Simone, E., Liquori, G., De Leo, A., Di Muzio, M., & Giannetta, N. (2021). Medication errors’ causes analysis in home care setting: A systematic review. Public Health Nursing39(4), 876–897. https://doi.org/10.1111/phn.13037

Hutchinson, A. M., Brotto, V., Chapman, A., Sales, A. E., Mohebbi, M., & Bucknall, T. K. (2020). Use of an audit with feedback implementation strategy to promote medication error reporting by nurses. Journal of Clinical Nursing29(21-22), 4180–4193. https://doi.org/10.1111/jocn.15447

Jordan, S., Banner, T., Gabe-Walters, M., Mikhail, J. M., Panes, G., Round, J., Snelgrove, S., Storey, M., & Hughes, D. (2019). Nurse-led medicines’ monitoring in care homes, implementing the Adverse Drug Reaction (ADRe) profile improvement initiative for mental health medicines: An observational and interview study. PLOS ONE14(9)https://doi.org/10.1371/journal.pone.0220885

Khan, A., & Tidman, M. (2022). Causes of medication error in nursing. JMRHS5(1), 1753–1764. http://jmrhs.info/index.php/jmrhs/article/download/511/610

Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: A systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development20(20)https://doi.org/10.1017/s1463423618000488

Mieiro, D. B., Oliveira, É. B. C. de, Fonseca, R. E. P. da, Mininel, V. A., Mascarenhas, S. H. Z., & Machado, R. C. (2019). Strategies to minimize medication errors in emergency units: An integrative review. Revista Brasileira de Enfermagem72(1), 307–314. https://doi.org/10.1590/0034-7167-2017-0658

Nosek, K., Leppert, W., Puchała, Ł., & Łoń, K. (2022). Efficacy and safety of topical morphine: A narrative review. Pharmaceutics14(7)https://doi.org/10.3390/pharmaceutics14071499

Phillips, J. M., Stalter, A. M., Goldschmidt, K. A., Ruggiero, J. S., Brodhead, J., Bonnett, P. L., Provencio, R. A., Mckay, M., Jowell, V., Merriam, D. H., Wiggs, C. M., & Scardaville, D. L. (2019). Using systems thinking to implement the QSEN informatics competency. The Journal of Continuing Education in Nursing50(9), 392–397. https://doi.org/10.3928/00220124-20190814-04

Single Care. (2021, May 2). Medication errors statistics. The Checkup. https://www.singlecare.com/blog/news/medication-errors-statistics/#:~:text=How%20many%20medication%20errors%20occur

WTCS. (2023). QSEN: Advocating for patient safety and quality care in nursing education. Wtcs.pressbooks.pub. https://wtcs.pressbooks.pub/nursingmpc/chapter/10-7-qsen-advocating-for-patient-safety-and-quality-care-in-nursing-education/#:~:text=The%20Safety%20QSEN%20competency%20focuses

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