Current Issues in Quality and Safety

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The safety of medication administration has become a universal issue and crucial for one’s wellbeing. The majority of hospitalized patients are treated with medications (Agyemang & While, 2010). The medical treatment of patients has a direct effect on the patient’s quality of life. Srinivasan declared “patients have a right to know they are receiving safe care” (as cited by Zhani, 2012, p. 1).

The purpose of this paper is to identify current quality and safety issues in healthcare, share the impact the issues have on health care delivery, identify quality improvement strategies, and to reveal a plan to implement quality improvement strategies. The Safety and Quality Issue of Medication Errors The Department of Health identifies the medication method as ordering, distributing, and administering medications. Bates expands the process to include medication transcription and discharge instructions.

Fogarty and McKeon stated the main cause of unintentional injury to patients is medication errors (as cited by Agyemang & While, 2010). The National Coordinating Council for Medication Error Reporting and Prevention define medication errors as “preventable events that may cause or lead to inappropriate medication use or patient harm” (as cited by Thompson-Moore & Liebl, 2012, p. 431). Medication Errors Impact on Health Care Delivery The Institute of Medicine (IOM) reported an increase in medical errors within the healthcare industry.

The report revealed a yearly range of 44, 000 to 98,000 patient deaths occurs due to medical errors (Geiter, 2012). The IOM acknowledged the harm of these deaths as unnecessary and preventable. There is no evidence to prove that the healthcare industry is doing anything to reduce these numbers. Data required to be reported by State laws are insufficient in establishing progress in decreasing these numbers. The IOM addresses medication errors as a great dilemma. Medical errors in the U. S. is costly and average approximately $17- $29 billion a year.

The IOM stresses the importance of patient safety improvement and hope that the costly penalties may provoke safety improvement in health care industry. Some medication errors are less severe but still has negative impacts (Safe Patient Project, 2009). Geiter (2012) gave examples of a missed dose of an anticoagulant or a dose that should have been held as less severe medical errors. Each given example is costly, can prolong the patient’s hospitalization, and can be emotionally stressful for patients and families. Quality Improvement Strategies Medication errors are viewed as a human and systems problem.

Medications that are sound and look alike, the packaging and design increases the risk or medication errors. Illegible physician orders increases the risk of medication errors. The Joint Commission (2012) has instituted required standards for hospitals to improve the quality of care and medications administration safety. Verbal and telephone orders require verification, recording the order then reading back the order for confirmation. A list of standardize abbreviations, acronyms, symbols, and dose designation that are forbidden within the medical institutions.

Computerized Physician Order Entry (CPOE) systems and Bar-Code Medication Administration (BCMA) are recent strategies initiated to improve the quality and safety of medication administration (Safe Patient Project, 2009). CPOE helps to eliminate the legibility issues with physician orders. Geiter (2012) noted that telephone orders from physicians can contribute to medication errors, especially late night orders. Geiter shared an incident in which a physician had another patient in mind when he gave an incorrect medication dose for a patient.

The suggestion for improvement in the area of telephone orders is to allow another nurse to listen to telephone orders whenever possible. The five rights of medication administration method was instituted to help decrease medication errors. Nurses were required to confirm the right patient, medication, dosage, time, and route. The five rights aided in the process but errors were still made. Nurses working long hours, mandatory overtime, budget cuts, increased patient nurse ratio, and high patient acuities are also noted to contribute to the increase of errors.

For many of these issues there is not a quick remedy. Geiger shared the elimination of retribution for medications errors would help decrease the effects associated with medication administration. Quality Improvement Strategies Plan Nurses on the Progressive Care Unit (PCU) experience many interruptions during patient care, including medication administration. These interruptions can affect proper and safe medication passage. The time taken to manage interruptions can be diverted back to the patients to assist in safe medication administration.

Plan – goal is to improve safe medication passage by eliminating telephone interruptions during medication rounds and other non-emergent interruptions, perform Plan-Do-Study-Act (PDSA) cycle for 5 days, Monday through Friday, during 0900 medication rounds * Targeted audience – dayshift registered nurses, unit secretaries and the management team on the 21 bed Progressive Care Unit (PCU), patients, nurse technicians * Relevant Stakeholders – patients, providers, employer, and payers * Needed Resources – PDSA Worksheet to evaluate the, additional part-time registered nurse to assist between the hours of 0700 to 1100 * Processes for implementation – called unit meeting to present plan to the staff, communicate plans for implementation via emails, target all morning secretaries to take messages or transfer calls to charge nurse or management team, target dayshift nurses to inform of needed recorded data for evaluation of the process

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