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Applying Quality Improvement to Nursing Practice

NR544 Quality and Safety Core Elective

Week 1 Discussion

Applying Quality Improvement to Nursing Practice

Describe one patient care scenario where a safety or quality issue is apparent. This can be something you have experienced in your current practice or one you develop for this discussion. Explain the details surrounding the scenario and the impact of the problem.

 

Select either the DMAIC or PDSA model, and describe how the model could be applied to address the specific issue in your case scenario. Explain how this process would improve patient-related and organizational outcomes.

 

 

 

NR544 Quality and Safety Core Elective

 

Week 2 Discussion

 

Data Collection and Risk Management

 

Saleema had total hip replacement in March 2015. One week later, the stitches started to bleed. She was concerned and went to the doctor’s office and was told it was a superficial hematoma. The bleeding continued on for three weeks and involved two doctor’s appointments and one trip to the emergency room. She was sent home each time with a diagnosis of a superficial hematoma.

 

Finally, Saleema’s visiting nurse saw her on a home care visit and called an ambulance, concerned about the amount of blood loss. Upon further investigation at the ER, a terrible infection was discovered that had spread into the bone. Saleema went in for emergency surgery and a PICC line was placed in order to administer the medication vancomycin. On this medication, she developed Steven’s Johnson’s syndrome, which was not diagnosed right away as the skin peeled off her hands. She ultimately went into acute renal failure and had to go back to the hospital. Two days post-admission, she developed C-diff and several vancomycin-resistant infections. She died in the hospital, two months after the original surgery. The cause of death was determined to be septicemia. Saleema lost her life over what was supposed to be a routine hip replacement.

 

As a future risk management nurse, please discuss the following points and questions.

 

Discuss your interview plan with Saleema’s family to collect data around her incident.

 

Which method of interview do you prefer to use, and why?

 

The goal of the interview is to provide accurate answers to questions of interest. Please provide two relevant questions and discuss which measurement levels you would use with your question. Explain your choices.

 

 

 

NR544 Quality and Safety Core Elective

 

Week 3 Discussion

 

Medical Errors and Patient Safety

 

Welcome to the Collaboration Café. In specific weeks of the course, you will have the opportunity to collaborate with your classmates in the Collaboration Café for a graded assignment (50 points). The Collaboration Café is an interactive process between the students. Faculty involvement in the Café will be minimal, however, faculty will monitor this section for compliance and clarification. There are no scholarly references required in this discussion format. The idea is for you to share and learn from your classmates about real-life experiences. Pleaser refer to the guidelines and grading rubric below for more information on the Collboration Café.

 

Please watch the following video, Transparency, Compassion, and Truth in Medical Errors: Leilani Schweitzer at TEDxUniversityofNevada, (Links to an external site.) and address the following prompt:

 

As you look back over your career as a nurse or even as a nursing student, can you think of a time when you were either involved in or aware of an adverse medical error with a patient that compromised patient safety? What did you learn from this experience? What did the organization learn from this experience?

 

IMPORTANT NOTE: Your instructor will be monitoring the Collaboration Café but not participating as this is your opportunity to give and receive feedback from your peers. The Collaboration Café is graded this week (50 points). There are no scholarly references required in this discussion format. Please see the guidelines and grading rubric below.

 

 

 

NR544 Quality and Safety Core Elective

 

Week 4 Discussion

 

Risk Management and Patient Safety

 

Please review the case scenario and answer the questions below.

 

Diane was an 80-year-old resident who was returning to the nursing home from the hospital following a left hip fracture on Friday evening. She has a history of congestive heart failure with frequent exacerbations. Her hospital discharge medication list was different than the prior medication list at the nursing home, specifically relating to her Lasix prescription. Diane was already taking Lasix at the nursing home before her hip fracture. All of her medication orders were transcribed by hand onto a new medication administration record (MAR). The old MAR, prior to the hospital stay, was not removed. The nurse checked Diane’s new orders and wrote “repeat” next to the new Lasix order and yellowed out the line. She was interrupted and was not able to finish reviewing the orders so she asked another nurse to review it for her. The second nurse reviewed the order and saw that the old MAR was still there. She removed the old MAR and finished reviewing the new MAR.

 

On Sunday, the medication nurse passed meds for Diane, as she had done for the past three days. She saw the yellowed line through the Lasix order and thought that the medication had been discontinued. She sent the medication back to pharmacy. Pharmacy picked up the medication on Monday. On Monday, it was noted that Diane weighed three pounds more since being discharged from the hospital. The nurse recorded the weight and placed a call to the physician, who failed to respond. At 2:00 a.m. Tuesday morning, Diane began to have difficulty breathing. Assessment findings included +4 pitting edema, a BP of 190/110, a HR of 120, and respirations at 28. Crackles were heard through her lungs. The on-call physician was consulted and an order was placed to transfer Diane back to the hospital. She went into cardiac arrest while waiting for the ambulance and was not able to be resuscitated.

 

Provide your risk analysis for this event. Develop an action plan for the prevention of events like this one in the future. Which theory or model would you apply in developing your action plan?

 

 

 

 

 

 

 

 

 

NR544 Quality and Safety Core Elective

 

Week 5 Discussion

 

QSEN and Patient Safety

 

In reviewing the QSEN competencies, which competency do you feel is most important? (There is no right or wrong answer here.) Give specific examples of how you have applied this competency to your current nursing practice with respect to patient safety. How will you apply this competency to your nursing practice as a graduate nurse?

 

IMPORTANT NOTE: Your instructor will be monitoring the Collaboration Café but not participating as this is your opportunity to give and receive feedback from your peers. The Collaboration Café is graded this week (50 points). There are no scholarly references required in this discussion format. Please see the guidelines and grading rubric.

 

 

 

NR544 Quality and Safety Core Elective

 

Week 6 Discussion

 

Accrediting Agencies and Hospital Quality

 

Sunny Valley Medical Center is accredited by The Joint Commission (TJC). The last survey was in 2016. Consistent with TJC tracer methodology approach to surveying, the survey was unannounced. The hospital worked diligently and continuously to prepare for this survey. Sunny Valley Medical Center and The Joint Commission are interested in customers’ concerns, problems, and any feedback at all times. If you have any problems, The Joint Commission encourages you to call the hospital. Sunny Valley Medical Center is committed to working out any concerns or problems that any customer may have.

 

During an official survey visit, Sunny Valley Medical Center demonstrated compliance with The Joint Commission’s national dimming status for the CMS standard for quality and safety. “The official survey visit was an intense three days, with extensive data review for most of their clinical processes, but the staff was ready,” the quality manger said.

 

Please use the case above to reflect on the following questions.

 

Briefly describe and differentiate between the TJC accreditation and CMS guidelines. Evaluate how these guidelines might influence the survey preparation.

 

Medicare.gov’s Hospital Compare has information about the quality of care at over 4,000 Medicare-certified hospitals: https://www.medicare.gov/hospitalcompare/search.html (Links to an external site.). Please reflect on the performance of one of your community hospitals using Hospital Compare’s quality matrix.

 

 

 

NR544 Quality and Safety Core Elective

 

Week 7 Discussion

 

Patient Safety and Cost

 

Lisa Anderson is a 74-year-old female with a history of osteoporosis. She is a widow and lives alone in a two-story home. Mrs. Anderson is retired and depends on her Social Security income. She takes pride in making all her own food from scratch. While she is walking at the hospital today, Mrs. Anderson falls and fractures her left hip. She is transported to the OR for immediate surgery.

 

Patient falls are a serious problem in hospitals, resulting in substantial morbidity, mortality, increased length of stay, and higher costs. It is estimated that high hospitalization rates in healthcare organizations result from patient falls. Fall rates in acute-care hospitals have been measured between 2.2 and 7 falls per 1,000 admissions. Injuries occur in approximately 30% of falls, and severe injuries occur in 4% to 6% of falls. Patient falls increase the cost of patient care. It was found that patients who fell and were injured as a result of a fall had $4,233 higher charges and a length of stay (LOS) of 12.3 days.

 

Provide an example of something in your current facility that is increasing the cost of care in your organization. How is it being controlled, or how could it be controlled? Make sure to provide some ideas of what could be done better to improve care and outcomes.

 

IMPORTANT NOTE: Your instructor will be monitoring the Collaboration Café but not participating as this is your opportunity to give and receive feedback from your peers. The Collaboration Café is graded this week (50 points). There are no scholarly references required in this discussion format. Please see the guidelines and grading rubric.

 

 

 

NR544 Quality and Safety Core Elective

 

Week 8 Discussion

 

Ethical Position Versus Standards Violation

 

Two nurses, Vicki, RN, and Cindy, RN, say they were just trying to protect patients when they anonymously reported their concerns last November to the Department of Health and to the Joint commission. The RNs believed that the 140-bed hospital that they work for was not living up to ethical practice standards. The report given by the RN’s indicated Ms. Anderson, one of three quality review coordinators working for the quality department in the hospital, improperly encouraged clinical mangers to change patient safety data at the Sunny Valley Medical Center.

 

By encouraging the data changes to misrepresent what was truly happening, Ms. Anderson actions affected an important decision regarding a patient safety issue. Moreover, the county attorney’s office indicted Ms. Anderson on “misuse of official information,” a third-degree felony that carries potential penalties of 2-10 years’ in prison and a maximum fine of $10,000.

 

Vicki and Cindy, both long-time nurses at the facility, were fired from their positions and were subsequently arrested last December, just five days past the 60-day window that could have been part of the defense to prove retaliation. The two nurses are free on bond of $5,000 each.

 

The Department of Health attorney sent a letter to the hospital attorneys stating that it is improper to criminally prosecute people for raising complaints with the board; that the complaints were confidential and not subject to subpoena; that the Department of Health is exempt from federal HIPAA law; and that, on the contrary, the board depends on reporting from healthcare professionals to carry out its duty of protecting the public from improper practitioners.

 

Please discuss ethical considerations in Vicki’s and Cindy’s behavior. Justify your answer.

 

Describe the various ethical, legal, and interpersonal conflicts that exist in this case.

 

IMPORTANT NOTE: Your instructor will be monitoring the Collaboration Café but not participating as this is your opportunity to give and receive feedback from your peers. The Collaboration Café is graded this week (50 points). There are no scholarly references required in this discussion format. Please see the guidelines and grading rubric.

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