Essay Sample on Improving Patient Quality and Safety: Guidelines & Evidence-Based Practices

Introduction

Patient Quality (PQ) and safety are essential in any health care setting. Enhancing patient quality and safety requires knowledge in factors that can hinder the provision of quality and safe services. Professional organizations such as Quality and Safety Education for Nurses (QSEN), the Institute of Medicine (IOM), as well as the Joint Commission and its National Patient Safety Goals (NPSGs) have guidelines and evidence-based practices to improve and maintain patient quality and safety. There are specific safety issues and hospital-acquired conditions that are not compensated by Medicare or Medicaid. One of the hospital conditions which is not reimbursed under Medicaid or Medicare is medication errors. In many hospitals globally, many patients die because of medication errors. The baccalaureate nurse is responsible for ensuring quality improvement measures are in place to address safety risks. Medication reconciliation can be alleviated by the use of evidence-based guidelines. One of the ways to prevent medication errors through evidence-based practice is medication reconciliation. Medication reconciliation ensures that the baccalaureate nurse guarantees reduced costs as well as increases patient safety by avoiding medication errors such as medication interactions, repetitions, omissions, and prescription errors. The most important nursing role is the coordination of care to avoid medication errors. Nurses should coordinate with stakeholders such as nurse leaders, independent practitioners, nursing staff, and other clinicians to fuel safety within the hospital. The purpose of this paper is to explore the safety issue of medication reconciliation in the Joint Commission and its National Patient Safety Goals (NPSGs). Nurses should collaborate with stakeholders to improve the quality and safety of their patients.

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There are several factors which, lead to medication errors. Alemu, Balachew, and Yiman (2017) stated in many hospitals, factors such as distractions and looking-like drugs are contributors to medication errors. As the authors added, medication errors happen because of other reasons such as the lack of knowledge about medicines, illegible handwriting, high patient to nurse ratio, unclear verbal communication, insufficient training, inadequate training on medications, nursing incompetence, and work overload (Alemu et al., 2017). In the healthcare facility, the factors, which were responsible for 50% of the medication errors were the failure of physicians to complete and sign the patient medication form. Alemu et al. (2017) affirmed that scientists and health professionals have created many principles to ensure that the administration of medication is safe. One of the widely used principles is the "six rights" of medication administration (Alemu et al., 2017). The "six rights" include (1) identifying the right patient, (2) selecting the right medication, (3) measuring the appropriate dose, (4) establishing the right route, (5) administering medication at the right time, and (6) using the right documentation (Alemu et al., 2017). The authors indicated that is health care practitioners followed the "six rights" carefully, then medication administration errors would be minimal (Alemu et al., 2017). Medication errors can cause devastation on patient's families, health professionals, and health institutions (Alemu et al., 2017). In an event of a medication error, nurses and physicians have to report the case as soon as possible to ensure the safety and quality of the patient. Collaboration between healthcare staff at any healthcare facility is significant to ensure that patients receive the right type and dosage of medication.

The evidence-based and best-practice solutions to improve patient safety related to a medication errors and reduce costs is medication reconciliation. The Joint Commission (2019) defined medication reconciliation as the process of comparing medication orders to all the new medications taken by a patient. medication reconciliation is intended to resolve inconsistencies (The Joint Commission, 2019). The comparison in the medication reconciliation process addresses issues regarding duplications, omissions, interactions, and the need to continue with the current medications (The Joint Commission, 2019). Clinicians should use information such as medication name, dose, frequency, route, and purpose in the reconciliation process (The Joint Commission, 2019). The medication reconciliation process involves four steps. The steps include (1) verification where physicians collect a current medication list, (2) clarification where physicians ensure that the medication doses are appropriate, (3) reconciliation where physicians compare new medications with the list and document changes in the orders, and (4) transition where physicians communicate with other caregivers about the updated and verified patient medication (The Joint Commission, 2019). Medication reconciliation is the best practice because the development of a reconciliation form can be used by physicians as a template for recording current medications that can help to prevent medication errors (The Joint Commission, 2019). When reviewing charts at the hospital facility, it was determined that most physicians fail to complete or sign the medication reconciliation forms. Following the medication reconciliation form would help to achieve a performance goal of 90% on completed and signed documents.

Nurses can help to coordinate care to increase patient safety and reduce costs in various ways. The Joint Commission (2019) indicated that coordinating medication information during the transition of care both within and outside of the organization is significant to reduce medication discrepancies. Also, coordination of care would involve patient education about the use of medication and communication with other healthcare providers (The Joint Commission, 2019). Furthermore, on the topic of patient safety and quality, there is the issue of clinical alarm systems. The Joint Commission (2019) indicated that nurses can develop a coordinated approach to the clinical alarm system to detect any errors. In the essentials of baccalaureate nursing, The American Association of Colleges of Nursing (2018) indicated that the nurse has to ensure patient-centered care by coordinating care across the continuum. The coordination of care would involve practicing from an evidence base and educating patients on care provided within the facility (American Association of Colleges of Nursing, 2018). Health care team coordination involves the accountability of care delivery within the healthcare setting (American Association of Colleges of Nursing, 2018). Quality improvement measures employed by the baccalaureate nurse would ensure cost-effectiveness to help in quality and safety. In the case of medication errors as a safety risk, nurses could coordinate with other health care professionals such as physicians to improve the quality of medication delivery.

Nurses should work with stakeholders in the quality improvement program of medication reconciliation to improve the safety of patients. Some of the stakeholders with whom nurses would coordinate to drive safety enhancements within the hospital setting include nurse leaders, independent practitioners, nursing staff, and other clinicians. The Joint Commission (2019) indicated provided one of the elements of performance for the NSPG as providing multi-drug resistant organism and outcome data to stakeholders as an evidence-based and best-practice. Another element of performance for the NSPG is to educate stakeholders on medication error prevention strategies (The Joint Commission, 2019). Furthermore, another element of performance for the NSPG is to provide data and outcome measures to stakeholders (The Joint Commission, 2019). Furthermore, Silver, Harel, McQuillaan, Weizman, Thomas, Chertow, Nesrallah, Bell, and Chan (2016) emphasized that the quality improvement process requires collaboration with stakeholders to ensure that key issues affecting the health care system are addressed. The authors discuss stakeholder mapping and analysis is significant to identify the supporters and resistors of change (Silver et al., 2016). Categorizing stakeholders into groups such as all physicians within the hospital, and outlining the relationship between the various groups would help to identify the quality problem (Silver et al., 2016). In the quality improvement program, nurses need to consult with stakeholders on activities such as the evaluation's purpose, questions and methods, assumptions, data collection, and the interpretation of results (Leviton & Melichar, 2016). In the case of medication errors, when nurses work with physicians, then the overall performance of the organization would be improved because the medication reconciliation forms would be up-to-date.

Conclusion

Overall, improving patient safety involves redesigning health care processes. This paper has outlined a significant evidence-based and best-practice, medication reconciliation, for resolving the safety risk of medication errors. Considering the charts of medication errors at the hospital facility, it is clear that physicians have to be vigilant to ensure that they complete and sign the medication reconciliation forms to improve patient safety and quality as well as enhance the performance of the entire organization. The coordination of care is imperative in a hospital setting to ensure that nurses drive patient quality and safety. Medication errors, an issue in many hospitals needs to be addressed through medication reconciliation. The Joint Commission and its National Patient Safety Goals (NPSGs) has guidelines and evidence-based practices that would help healthcare practitioners to improve and maintain the quality and safety of patients. Evidence-based research has established that medication reconciliation would help to save millions of lives of patients. Patient safety incidents are preventable. When nurses match their services to the type of treatment, then the quality and safety of patients within a hospital would be improved. All physicians and nurses should ensure that they follow the four steps of the medication reconciliation process to improve the quality and safety of patients within the healthcare facility.

References

Alemu, W., Belachew, T., & Yimam, I. (2017). Medication administration errors and contributing factors: A cross sectional study in two public hospitals in Southern Ethiopia. International Journal of Africa Nursing Sciences, vol. 7, pp.68-74. https://doi.org/10.1016/j.ijans.2017.09.001

American Association of Colleges of Nursing. (2018). The essentials of baccalaureate education for professional nursing practice. Retrieved from http://www.aacnnursing.org/portals/42/publications/baccessentials08.pdf

Leviton, L. C., & Melichar, L. (2016). Balancing stakeholder needs in the evaluation of healthcare quality improvement. British Medical Journal Quality & Safety, 25(10), 803-807. doi:10.1136/bmjqs-2015-004814

Silver, S. A., Harel, Z., McQuillan, R., Weizman, A. V., Thomas, A., Chertow, G. M., ... Chan, C. T. (2016). How to begin a quality improvement project. Clinical Journal of the American Society of Nephrology, 11(5), 893-900. doi:10.2215/CJN.11491015

The Joint Commission. National patient safety goals effective January 2019. Retrieved from https://www.jointcommission.org/assets/1/6/NPSG_Chapter_HAP_Jan2019.pdf