Safety and quality

PROMOTING SAFETY AND QUALITY

In the article “Managing to Improve Quality: The Relationship Between Accreditation Standards, Safety Practices, and Patient Outcomes,” the authors discuss the growing trend by medical insurance companies to eliminate reimbursement for 
Never Events. As these types of mistakes should be easily preventable, hospitals have developed protocols to lessen or extinguish the occurrence of these events. In addition, The Joint Commission (TJC) and the Centers for Medicare & Medicaid Services (CMS) have developed core measures to guide health care providers’ efforts in improving patient safety and the quality of care delivered.

Health care organizations have developed strategic agendas to help meet these standards and reduce the incidence of 
Never Events. Nurses significantly influence the overall quality of health care provided and play a pivotal role in improving patient outcomes.

For this Discussion, you will consider the standards that are in place for nurses and how they can be used to improve quality of care.

Resources:

Required Readings

· Amin, A.N., Hofmann, H., Owen, M.M. Tran, H., Tucker, S., & Kaplan, S.H. (2014). 

Reduce readmissions with service-based care managementLinks to an external site.
. 
Professional Case Management, 19(6), 255-262. http://doi.org/10.1097/NCM.0000000000000051

 

· Forster, A.J., Dervin, G., Martin, C. & Papp, S. (2012). 

Improving patient safety through the systematic evaluation of patient outcomesLinks to an external site.
. 
Canadian Journal of Surgery, 55(6), 419-425.  http://doi.org/10.1503/cjs.007811 

 

· Johansen, M.L. (2014). Conflicting priorities: 

Emergency nurses perceived disconnect between patient satisfaction and the delivery of quality patient careLinks to an external site.
. 
Journal of Emergency Nursing, 40(1), 13-19.  http://doi.org/10.1016/j.jen.2012.04.013 

 

· McDowell, D. S. & McComb, S.A. (2014). 

Safety checklist briefings: A systematic review of the literatureLinks to an external site.
. Association of PerOperative 
Registered Nurses Journal, 99(1), 125-137. http://doi.org/10.1016/j.orn.2013.11.015

 

· Payne, D. (2014). 

Elderly care: Reflecting on the ultimate ‘never event’Links to an external site.
. 
British Journal of Nursing, 23(13). 702. http://doi.org/10.12968/bjon.2014.23.13.702

 

· Thornlow, D.K. & Merwin, E. (2009). 

Managing to improve quality: The relationship between accreditation standards, safety practices, and patient outcomesLinks to an external site.
. 
Health Care Management Review, 34(3), 261-272. http://doi.org/10.1097/HMR.0b013e3181a16bce

 

·

American Hospital AssociationLinks to an external site.
. (2016). http://www.aha.org/
Explore the American Hospital Association’s website. Focus on the information on improving patient safety and quality of care.

 

·

American Organization of Nurse ExecutivesLinks to an external site.
. (2016). http://www.aone.org

“Since 1967, the American Organization of Nurse Executives (AONE) has provided leadership, professional development, advocacy and research to advance nursing practice and patient care, promote nursing leadership excellence and shape public policy for health care nationwide. AONE is a subsidiary of the American Hospital Association” (AONE, 2016).

 

· Centers for Medicare & Medicaid Services. (n.d.). 


Quality of care centerLinks to an external site.


. http://www.cms.gov/Center/Special-Topic/Quality-of-Care-Center.html?redirect=/center/quality.asp

Most health care organizations receive some amount of reimbursement from the Centers for Medicare & Medicaid Services (CMS). Reimbursement continues to be jeopardized and reduced by pay for performance standards. Health care organizations are being held to higher standards by CMS. Explore the standards set to improve patient safety and the quality of care. Consider how they affect acute care providers and nursing practice.

 

· The National Academies of Sciences, Engineering, and Medicine. (2016). 


Health and Medicine Division

Links to an external site.
. http://www.nationalacademies.org/hmd/

 

· The Health and Medicine Division (HMD) promotes policies and best practices in an effort to improve patient safety and delivery of quality care. Review a few of the publications available at this site.

 

· The Joint Commission. (2016). 


National Quality Forum (NQF) endorsed nursing-sensitive care performance measures

Links to an external site.
. http://www.jointcommission.org/national_quality_forum_nqf_endorsed_nursing-sensitive_care_performance_measures/

The Joint Commission (TJC) also accredits health care organizations. Through funding provided by the Robert Wood Johnson Foundation, the Joint Commission developed the 
Implementation Guide for the National Quality Forum (NQF) Endorsed Nursing-Sensitive Care Performance Measures. Review this guide as you consider how core measures and national guidelines improve nursing practice.

· Walden University, LLC. (2009). Topics in clinical nursing: Accountability for clinical outcomes and promoting safety and quality [Video]. Walden University Canvas. https://waldenu.instructure.com/

· Note: The approximate length of this media piece is 15 minutes.

To prepare for this Discussion:

· Review the information at the Joint Commission and Centers for Medicare & Medicaid Services websites on the core measures and standards presented in this week’s Resources.

· Consider the nurse’s role in supporting the organization’s strategic agenda as it relates to improving clinical outcomes.

· Conduct an Internet search for either a 
Never Event or a core measure and select one to address in your post.

Respond to the following:

· How has the emphasis on quality of care, patient safety, and clinical care outcomes been impacted by specific standards emanating from TJC and/or CMS? Cite your selected core measure or 
Never Event in your response.

· What is the impact of the nurse’s role in clinical outcomes for the organization?

· Discuss nurse-specific challenges in influencing change in quality improvement.

· How does this influence the ability of the organization to achieve its strategic agenda?

Support your response with references from the professional nursing literature.

Note: Post a 3-paragraph (at least 350 words) response. Be sure to use 
evidence
Links to an external site.,
 

in-text citations
Links to an external site.
, and 


essay-levelLinks to an external site.

 writing skills, including the use of 


transitional materialLinks to an external site.

 and 


organizational framesLinks to an external site.

. Use the writing resources and the Discussion Rubric to develop your post.

Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).

Respond with a comment that asks for clarification, provides support for, or contributes additional information to 
two or more of your colleagues’ postings.

Kelly Ransom

The Joint Commission and the centers for Medicaid and Medicare services have placed clinical standards and specific guidelines related to patient safety, quality care and patient care. Being able to provide care safely and effectively to prevent costly medical errors is the main focus. The clinical standards give nurses and medical professionals with a lay out to go by to prevent “never events”. Never events are identified as serious and costly errors in health care services that should never happen. According to CMS, never events are clearly identifiable, preventable and serious errors that harm the patient and reduce credibility of the health care facility. Of the care management events, giving wrong medications to the wrong patient and all medication errors. 

As a nurse in a long-term care facility, our main role is to pass their medications at scheduled intervals. The impact that it makes on our patients is to give medications related to medical conditions and how they affect the resident. We monitor our residents 24 hours a day with three different shifts. When passing medications, the five rights are followed. Right person, right route, right dose, right medication and right time. We had an event in our facility that five rights were not followed and two residents with the same last name were given the opposites medication. One resident had increased HR and blood pressure was lowered significantly and the nurse had to send resident to hospital for interventions. The resident survived and the nurse was terminated. Nurses should make decisions without rushing and without distractions. Using the five rights would prevent most medication errors.

Nurse specific challenges that are present in our facility is lack of communication and following up with orders placed. Also time, stress and fatigue are a few more challenges that are present. Nurses have the ability to speak up for their residents and communicate effectively with the providers. Being able to have adequate staff and staff following the same guidelines is also a challenge. This comes back to lack of communication and the barrier between agencies sending in nursing staff and not following facility policies. The organization faulters in the structure as more events can occur. When full time staff is in place, the facility can track such things as med errors, acquired pressure ulcers, falls, etc. and have care plans in place. The staff being able to follow the care plans has been difficult when there is not consistency.

References

Forster, A.J., Dervin, G., Martin, C. & Papp, S. (2012). 

Improving patient safety through the systematic evaluation of patient outcomesLinks to an external site.
. 
Canadian Journal of Surgery, 55(6), 419-425.  http://doi.org/10.1503/cjs.007811

· Payne, D. (2014). 

Elderly care: Reflecting on the ultimate ‘never event’Links to an external site.
. 
British Journal of Nursing, 23(13). 702. 

http://doi.org/10.12968/bjon.2014.23.13.702Links to an external site.

· www.cms.gov

Csilla Orban Bonacci

 I choose surgery errors such as wrong site surgery.

According to the NQF they first coined the term “never events” in 2001 an organization in the USA that wants to ensure patient safety and quality care through public reporting. The NQF believes that “never events” are events that are preventable and can affect the credibility of a hospital. Over the years the NQF has identified numerous never events and these never events are broken down into categories: surgical, criminal, patient protection, and management radiologic just to name a few. 

Of the surgical never events we can find errors such as the wrong surgical procedure performed on the patient, surgery on the wrong body part, leaving objects inside the patient that were supposed to come out, and others. 

The nurse has a tremendous role in this case. This is why nurses working in the OR have to call a “time out” where everyone stops and identifies the patient and verifies why he or she is there and what procedure he or she needs to have done. Also, they count how many gauzes, sponges, and instruments they used and how many are left at the end of the procedure. All these are done to follow standards of care and guarantee patient safety. 

What contributes to surgical errors? A study in the past showed that Iran was the country with the highest number of surgical errors. In underdeveloped countries reporting errors is not common. Lack of properly trained surgeons, staff, surgeon-to-patient ratio, lack of instruments needed for surgery, etc. all contribute to surgical errors. 

As nurses, we can try our best to follow standards of care and even then we can make errors. Errors can be in the form of communication, system failure, due to fatigue, etc. It is up to us to speak up when we need help when we are tired when we need a break, when we cannot pick up a shift, when a machine is broken, or when we were not given a report. Being proactive helps nurses reduce medical errors and reduce patient safety events. 

We can avoid these kinds of surgical or medical errors by following the guidelines of mandatory reporting, working as a team, asking for help when we do not know something instead of just winging it, etc. 

Also, it is important to identify the patient by name and date of birth is possible. These are all simple guidelines we learned in nursing school that sometimes we can forget to do. We must not forget the most basic guidelines that ensure standard care.