NRSG 314 How does continuous quality improvement (CQI) play a role in patient safety and patient outcomes?

NRSG 314 How does continuous quality improvement (CQI) play a role in patient safety and patient outcomes?

NRSG 314 How does continuous quality improvement (CQI) play a role in patient safety and patient outcomes?

Quality Improvement Program for Reduction of Medication Errors

The perennial issue of medication errors continues to impact every health organization despite changes and strategies to eliminate the problem. Medication errors remain common in the clinical environment at the rate of up to 25% for errors related to medication dispensing. While there are various healthcare-related errors, errors due to medication administration are the most prevalent. These errors originate from multiple issues and circumstances, varying from one hospital to another. Given the multiple causes, developing and multiprogram strategy is the most effective way to deal with the problem of medication errors (Loper et al., 2022). The purpose of this education plan is to outline the problem of a medication error, including causes and consequences, and apply continuous quality improvement strategies to address the issue.

Safety Issue

Medication error related to medication administration is a significant problem in healthcare, impacting the quality and safety of patients. Receiving the wrong medication harms the patient because of the possibility of injury or death. For example, the wrong medication can lead to drug interactions causing harm. According to statistics, approximately 1.5 million Americans experience injuries related to medicine administration errors. Medication errors also increase the length of hospital stay for the affected person by 1.7-4.6 days (Salar et al., 2020). Additionally, medication errors result in an economic burden to the healthcare system and extra costs for the patient because of increased length of hospital stay. Finally, a high rate of medication errors indicates poor quality, resulting in poor patient care, lack of patient satisfaction, and poor quality of life for the patient.

Cause of the Issue

Medication errors related to medicine administration are caused by a number of factors. One of the causes is the failure of the personnel to confirm all the five Rights of medicine administration during dispensing and administration. The Medicine administration procedure starts from the point of prescribing to dispensing to the time the drug is administered to the patient. During this process, multiple practitioners are involved, and any of them can make the mistake of failing to confirm important details, leading to an error (Salar et al., 2020). These errors occur in the wrong dosage, drug, or patient. Other common causes of medication errors include similar drug names, inefficient pharmacological knowledge by the nursing staff, high workload, workarounds, interruptions, writing abbreviations instead of full names, and illegible handwriting. Another cause of medication errors during administration and dispensing is the failure of the electronic dispensing system to work properly; for example, the system can fail to produce alarms in cases of drug interactions; hence the personnel misses such critical alerts leading to mistakes (Salar et al., 2020). Moreover, practitioners can create a workaround in the electronic dispensing workflow because of challenges with the system, resulting in opportunities for errors. Errors can also occur when patients fail to take medication correctly due to a lack of adequate education on how to take their medication.

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Applying CQI to Solve Medication Errors

Most medication administration errors result from multiple human mistakes. The proposed CQI approach to medication errors is multifaceted, involving automated dispensing cabinets, barcode medication administration (BCMA), staff training, and pharmacist-led interdisciplinary medication reconciliation. Automatic dispensing cabinets are technology-controlled systems that allow the decentralization of medicine dispensing distribution. The system involves computerized storage, inventory, dispensing, barcode administration, order entry, and documentation (Douglas et al., 2018). The system is proposed for high-risk medications to minimize the risk of errors encountered during the dispensing process for these medications. BCMA is a technology-controlled inventory system that allows providers to confirm all the 5Rights of medicine administration to prevent human error related to prescription, dispensing, and administering drugs (Yousef & Yousef, 2018). Staff training is necessary to promote awareness of medication errors, including causes, and skills and knowledge in pharmacology and IT systems used for electronic medication administration such as BCMA. Finally, pharmacist-led interdisciplinary medication administration is an evidence-based solution to human errors causing medication errors (Fernandes et al., 2020). In the pharmacist-led CQI program, the pharmacist conducts medication reconciliation for every patient, particularly at discharge, to identify errors involving wrong medication, patient, or dosage. The program also encourages interdisciplinary involvement in the medication prescribing, dispensing, reconciliation, and administration process. Studies support this approach to reduce medication errors related to human mistakes (George & Supramaniam, 2019).

Outcomes

The first outcome of the CQI program is the identification of unintended discrepancies leading to corrective

NRSG 314 How does continuous quality improvement (CQI) play a role in patient safety and patient outcomes
NRSG 314 How does continuous quality improvement (CQI) play a role in patient safety and patient outcomes

measures. The beneficial outcome would be a reduction in the rate of medication errors associated with the medication administration process. Another expected outcome from the CQI program is patient safety because of improvement in care delivery leading to quality outcomes, patient satisfaction and other positive patient outcomes such as reduced length of hospital stay and cost-effectiveness (Karaoui et al., 2019). Similarly, the success and effectiveness of the CQI process is likely to have an outcome of staff satisfaction because of reduced workload due to the electronic dispensing system and patient safety.

Evaluation Plan

The proposed evaluation plan uses the Plan-Do-Check-Act cycle, a tool for measuring how effectively a program is meeting the assigned objectives and desired goals. PDCA monitors the performance of a CQI program to identify challenges and areas where the objectives are not being met. Monitoring results necessitate developing mitigation solutions to improve the system (Loper et al., & Metz, 2022). The monitoring tool ensures continuous improvement of the program to attain excellence in patient safety and quality. Evaluation of the proposed program will occur after three months following implementation and subsequently every six months.

 

References

Douglas, C., Desai, N., Aroh, D., Quadri, M., Williams, R., Aroh, F., & Nyirenda, T. (2018). Automated dispensing cabinets and nurse satisfaction. Nurs Manage, 48(11):21-24. https://www.doi.10.1097/01.NUMA.0000526064.53973.54.

Fernandes, B., Almeida, P., Foppa, A., Sousa, C., Ayres, L., & Chemello, C. (2020). Pharmacist-led medication reconciliation at patient discharge: A scoping review. Res Social Adm Pharm, 16(5), 605-613. https://www.doi.10.1016/j.sapharm.2019.08.001.

George, D., & Supramaniam, N. (2019). Effectiveness of a pharmacist-led quality improvement program to reduce medication errors during hospital discharge. Pharmacy Pract, https://www.dx.doi.org/10.18549/pharmpract.2019.3.1501.

Karaoui, L., Chamoun, N., & Fakhir, J. (2019). Impact of pharmacy-led medication reconciliation on admission to internal medicine service: experience in two tertiary care teaching hospitals. BMC Health Serv Res, 19, 493. https://www.doi.org/10.1186/s12913-019-4323-7.

Loper, A., Jensen, T., Farley, A., Morgan, J., & Metz, A. (2022). A Systematic Review of Approaches for Continuous Quality Improvement Capacity-Building. J Public Health Manag Pract., 28(2), E354-E361. https://www.doi.10.1097/PHH.0000000000001412.

Salar, A., Kiani , F., & Rezaee, N. (2020). Preventing the medication errors in hospitals: A qualitative study. International Journal of Africa Nursing Sciences, 13. https://www.doi.org/10.1016/j.ijans.2020.100235.

Yousef, N., & Yousef, F. (2018). Using total quality management approach to improve patient safety by preventing medication error incidences. BMC Health Serv Res, 17, 621. https://www.doi.org/10.1186/s12913-017-2531-6.