NURS FPX 4020 Assessment 3
Phillip September 15, 2023 No Comments

NURS FPX 4020 Assessment 3 – Improvement Plan In Service Presentation

NURS FPX 4020 Assessment 3 – Improvement Plan In-Service Presentation

Student Name

University Name

NURS FPX 4020 Improving Quality of Care and Patient Safety

Instructor Name

Date

Improvement Plan In-service Presentation

Hello, I am ______, and today I will be presenting an improvement plan that can be employed to improve patient safety by reducing the errors at the medication administration stage of patient care. First, let us discuss the goals and objectives of the presentation. 

Purposes and Goals of In-Service Session

The goals and objectives for today’s presentation are:

  • To discuss medication administration errors, their prevalence, and their poor consequences.
  • Identify the need to improve medication administration safety outcomes.
  • Recommend the processes to improve safety outcomes related to medication administration.
  • Discuss the role of the audience in the safety improvement plan 
  • Create resources and activities employed to encourage skill development and process understanding

Medication Administration Errors

Medication administration errors are defined as the administration of the wrong drug or incorrect drug dose, or using the improper route, at the inappropriate time, or to an incorrect patient. According to one research, about 40% of nurses’ floor time is spent on medicine administration to patients. This high volume of drug administration by nurses can lead to mistakes (Obua, 2019). Next, in our session, we will discuss why there is a need for a safety improvement plan related to medication administration errors. 

Needs to Improve Medication Administration Safety Outcomes

In hospitals, the reported rate of medication error-related adverse events is around 6.5 per 100 admissions (Carver & Hipskind, 2019). More than half of hospital medication errors are found to occur during the administration stage, which is why this stage is critical as it is the final step in implementing an ultimate interception barrier. According to a systematic review, the prevalence of error rates related to administration was found to be 25.2% in hospitalized patients. In addition, according to a medication incident report in the UK, most of the incidents resulting in severe harm or patient deaths were found to have been linked to the administration stage of the medication (Azar et al., 2023).

Improvement Plan In-service Presentation

Medication errors in hospitals are costly and have a detrimental impact on patients, their families, healthcare personnel, the healthcare institution, and the community. These errors can endanger patients’ lives or cause them permanent losses thus compromising their lives. The cases of mortality and morbidity due to MAEs deteriorate patients’ as well as the community’s trust in healthcare facilities. We have seen in our practice that MAEs often lead to a longer stay of patients in the hospital and require additional treatment regimens to be incorporated so as to avoid any adverse event from happening. Both of these factors incur an additional treatment cost on the part of the hospital as well as the patient. They’ve been labeled a public health issue and a serious threat to patients.  This high prevalence and poor consequences advocate the need for a safety improvement plan.

Processes to Improve Safety Outcomes Related to Medication Administration

The safety improvement plan to reduce medication administration errors that we are going to discuss here is based on the three most important strategies:

Incident Reporting and Blame-Free Culture

Error reporting is the fundamental principle in the prevention of adverse events. Several factors such as lack of SOP for error reporting, lack of support from colleagues, job risk, and cost-cutting measures have been found to be responsible for under-reporting of the medication errors (Chegini et al., 2020). Therefore, we can conclude errors can be avoided by modifying the healthcare system and culture such that reporting errors result in system development rather than individual punishment. 

Collaboration Among Healthcare Professionals

The next strategy included in our plan is effective collaboration among healthcare professionals. A respectful and professional workplace in which the multidisciplinary teams work together provides a safe work environment for all members of the healthcare team, families, and patients. Collaboration between nurses and other healthcare professionals results in reduced patient safety issues and increases the quality of care provided to the patients (Labrague et al., 2021). Risk management committees and interdisciplinary task teams should work together to identify and reduce risks. Joint education programs assist healthcare providers and support personnel in learning duties and developing connections to improve safety.

Health Information Technology

Computerized order input assists prescribers, chemists, and nurses in reducing adverse drug occurrences. According to studies, about 50% of medical mistakes can be minimized by the use of computerized provider order input systems (Manias et al., 2020).  Equipping the nurses with skills and knowledge to use technological tools such as BCMA, and CDSS can be employed to provide a seamless medication administration resulting in a decreased error rate (Kuitunen, 2022).  In addition to these, we can use the practice of double-checking to minimize medication administration errors. Adhering to the above improvement plan and properly following the strategies can result in achieving positive patient safety outcomes.

Role of Audience

 At this level, all of us can agree that the success of any strategy and plan, designed and employed depends upon the understanding and adherence of the audiences to the plan. The improvement plans at these healthcare organizations involve the active participation of all audiences present here including the healthcare staff, healthcare leaders, IT personnel, the finance team, and the quality improvement committee. Each one of this audience can collaborate with other stakeholders involved, to make a strategic plan focusing on safe medication administration. By providing a safe environment, the healthcare leaders can promote the reporting of medication error incidents by the healthcare staff. The healthcare staff being at the frontline can identify the obstacles and provide valuable insight into the interventions needed.

The participation of the healthcare staff in, and adhering to the improvement plan has a direct effect on the success of the plan. The training of the healthcare staff about technological tools and the education about latest practices is dependent upon the information technology team of the hospitals It provides them with skills and knowledge that can be leveraged in ensuring patient safety outcomes. In addition, their awareness of best practices, procedures, and standards is critical for implementation success. NURS FPX 4020 Assessment 3 – Improvement Plan In-service Presentation. The quality improvement committee being a multidisciplinary team is in charge of devising the improvement plan, assessing the conformity of other healthcare personnel with it resulting in a direct influence on patient care, and can provide valuable feedback about the strategies devised as a part of the improvement plan. 

Even the best-designed improvement strategy may fall short of its objectives if they are not actively engaged (Waweru et al., 2019). The finance team can help generate the financial resources that can be used for the incorporation of health information technology in hospitals, organizing the training and discussion sessions for healthcare staff.

Resources and Activities Employed

It is crucial to establish resources and activities to engage the healthcare professionals and give practical knowledge to stimulate skill development and process understanding related to a safety improvement program. In this session, we are going to generate a visually engaging checklist that outlines medication safety practices and the five rights of medication administration. This will help us understand the importance of accuracy in every step of medication administration. We will also go through a simulation exercise based on the actual drug administration error where a diabetic patient, Mr. Wallace, was injected with the wrong insulin. In this exercise, our purpose will be the improvement of decision-making, critical thinking, and communication skills during medicine administration. NURS FPX 4020 Assessment 3 – Improvement Plan In-service Presentation. Moreover, in the future more interactive workshops on safe drug administration practices can be organized that may provide nurses with training and the opportunity to practice their abilities in a controlled setting. These initiatives may empower the healthcare staff to be proactive in patient safety and contribute to a safer healthcare environment by providing different learning opportunities.

Conclusion

Medication administration errors pose detrimental effects on the patients, their families, healthcare organizations, and the practitioners involved. Patient safety can be assured by developing strategic improvement plans that include the use of evidence-based best practice solutions. In-service, sessions enhance the skills and knowledge of the nurses and other hospital staff. Various exercises including interactive Workshops, infographics, and quality improvement programs, can be used to stimulate skill development and process understanding related to a safety improvement program.

References

Azar, C., Raffoul, P., Rizk, R., Boutros, C., Saleh, N., & Maison, P. (2023). Prevalence of medication administration errors in hospitalized adults: A systematic review and meta‐analysis up to 2017 to explore sources of heterogeneity. Fundamental & Clinical Pharmacology. https://doi.org/10.1111/fcp.12873

Carver, N., & Hipskind, J. E. (2019). Medical error.. StatPearls. Treasure Island (FL): StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK430763 

Chegini, Z., Kakemam, E., Asghari Jafarabadi, M., & Janati, A. (2020). The impact of patient safety culture and the leader coaching behaviour of nurses on the intention to report errors: A cross-sectional survey. BMC Nursing, 19(1). https://doi.org/10.1186/s12912-020-00472-4 

NURS FPX 4020 Assessment 3 – Improvement Plan In-service Presentation

Kuitunen, S. (2022). Medication safety in intravenous drug administration: Error causes and systemic defenses in hospital setting. Helda.helsinki.fi. https://helda.helsinki.fi/items/5441c513-bff7-4d79-b448-98954e2064a7 

Labrague, L. J., Al Sabei, S., Al Rawajfah, O., AbuAlRub, R., & Burney, I. (2021). Interprofessional collaboration as a mediator in the relationship between nurse work environment, patient safety outcomes and job satisfaction among nurses. Journal of Nursing Management, 30(1). https://doi.org/10.1111/jonm.13491 

NURS FPX 4020 Assessment 3 – Improvement Plan In-service Presentation

Manias, E., Kusljic, S., & Wu, A. (2020). Interventions to reduce medication errors in adult medical and surgical settings: A systematic review. Therapeutic Advances in Drug Safety, 11(1), 1–29. https://doi.org/10.1177/2042098620968309 

Obua, U. (2019). Strategies for Reducing Medication Errors in an Outpatient Internal Medicine Clinic – ProQuest. https://www.proquest.com/openview/1933b2fc7c5bf1d708e99a9e150fe328/1?pq-origsite=gscholar&cbl=18750&diss=y 

Waweru, E., Sarkar, N. D. P., Ssengooba, F., Gruénais, M. – E., Broerse, J., & Criel, B. (2019). Stakeholder perceptions on patient-centered care at primary health care level in rural eastern Uganda: A qualitative inquiry. PLOS ONE, 14(8), e0221649. https://doi.org/10.1371/journal.pone.0221649