Healthcare professionals are being challenged to find new ways to organize care and develop systems that hold providers accountable for the quality, cost, and patient experience of care (Ricketts & Fraher 2013). Nurses play an important role in providing quality and safe care because they are the frontline connection with the patient and are present in most settings where health care is delivered (Hickey and Giardino 2019).
For many years patient safety and safety culture was mainly studied in the hospital care setting. In recent years, there has also been an increasing interest in patient safety in primary care, as most patients receive their healthcare in primary care settings, particularly in countries with a strong primary care system (Smit et al., 2018). Nurses come to work every day with two goals, The first is to render the best care possible for the patients and families they serve, and second, to improve current care practices to achieve better outcomes for patients.
The purpose of this paper is to explain how safety and quality improvement (QI) initiatives achieve high-quality outcomes for patients and how an understanding of the relationships among research, evidence-based practice, and QI and the role of the professional nurse in QI helps nursing meet its commitment to achieving the best possible care and outcomes for patients
The role of nurse in quality improvement and patient safety
At OSF Healthcare our Mission Partners work to continually improve their skills, achieve the best practice standards, and ensure their patients receive exceptional care. To improve nurse quality and patient safety, Saint Francis Medical Center (OSF HealthCare) employs nearly 21,000 Mission Partners in 124 locations, including 13 hospitals with 1,874 licensed acute care beds, 18 urgent care locations, 11 centers for health, and two colleges of nursing throughout Illinois and Michigan (OSF HealthCare, n.d.).
New Leapfrog Hospital Safety Grades have been announced by The Leapfrog Group, a national watchdog organization for patient safety. OSF HealthCare Saint Francis Medical Center achieved an ‘A’ rating, placing it among the safest hospitals in the country (OSF HealthCare, n.d.-a). The American College of Surgeons National Surgical Quality Improvement Program has recognized OSF HealthCare Saint Elizabeth Medical Center as one of 88 ACS NSQIP participating hospitals that have achieved meritorious outcomes for surgical patient care in 2018 (OSF HealthCare, n.d.-b).
Informational
Patient safety practices have been defined as those that reduce the risk of adverse events related to exposure to medical care across a range of diagnoses or conditions (Smit et al., 2018). This definition is concrete but quite incomplete because so many practices have not been well studied with respect to their effectiveness in preventing or ameliorating harm. Practices considered to have sufficient evidence to include in the category of patient safety practices are as follows: System medication error, Use of perioperative beta-blockers in appropriate patients to prevent perioperative morbidity and mortality, and Use of maximum sterile barriers while placing central intravenous catheters to prevent infection (Smit et al., 2018). looking at my organization, medication error on the unit is less than 3.5 percent (Muyideen S. A. BSN. (personal communication on 12/92019). And Nanji et al., (2016), reported that the rate of medication errors reported is “193 out of 3,671 cases of medication administrations.
Consistent delivery of quality care is essential in all segments of nursing, from the highly complex to the more fundamental areas of practice, such as management of the peripheral intravenous (PIV) route for solution and medication administration (Nickel 2019). Personal communication with Ashley Leet RN., at Theorek Memorial Hospital on 12/07/2019 she told me they have less than a 5 percent failure rate of PIV. Although the use of peripheral intravenous access is common, its presence is far from benign, with a reported 35% to 50% failure rate, even in facilities with a dedicated infusion team (Nickel 2019).
Strategies
Many patient safety practices, such as the use of simulators, bar coding, computerized physician order entry (COPE), and crew resource management, have been considered as possible strategies to avoid patient safety errors and improve healthcare processes (Ricketts & Fraher 2013). CPOE enhances patient safety by reducing or eliminating medication errors. By enabling healthcare providers to quickly transmit orders electronically, CPOE can improve efficiency when submitting medication, lab, and radiology orders to their respective departments or facilities. Patient safety is highly linked to the attitudes of health care providers, where those with more positive attitudes achieve higher degrees of patient safety. Pharmacists across both hospitals said they were unable to fine-tune prescriptions within the CPOE system in the same way as they would have done on paper (Pontefract et al., 2018). This can lead to frustration since without prescribing rights it is an independent prescriber which could have a serious negative impact on the patient.
Conclusion
The acceptance of the contributions that professional nurses make to safety and quality outcomes is developing with the nurse as an equal partner with physicians in improving patient outcomes. Patient safety is the foundation of high-quality health care. Much of the work defining patient safety and practices that prevent harm has focused on negative outcomes of care, such as mortality and morbidity. Nurses are critical to the surveillance and coordination that reduce such adverse outcomes. Much work remains to be done in evaluating the impact of nursing care on positive quality indicators, such as appropriate self-care and other measures of improved health status.
Reference
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Nickel, B. (2019). Peripheral Intravenous Access: Applying Infusion Therapy Standards of Practice to Improve Patient Safety. Critical Care Nurse, 39(1), 61–71. https://doi-org.ezp.waldenulibrary.org/10.4037/ccn2019790
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Smits, M., Keizer, E., Giesen, P., Deilkås, E. C. T., Hofoss, D., & Bondevik, G. T. (2018). Patient safety culture in out-of-hours primary care services in the Netherlands: a cross-sectional survey. Scandinavian Journal of Primary Health Care, 36(1), 28–35. https://doi-org.ezp.waldenulibrary.org/10.1080/02813432.2018.1426150
Pontefract S. K, Coleman J. J, Vallance H. K, Hirsch C. A., Shah S, Marriott J. F, et al. (2018) The impact of computerized physician order entry and clinical decision support on pharmacist-physician communication in the hospital setting: A qualitative study. PLoS ONE 13(11): e0207450. https://doi.org/10.1371/journal.pone.020745
Saint Francis Medical Center (OSF HealthCare) n.d.-a mission and vision. Retrieved fromhttps://www.osfhealthcare.org/news/osfhealthcare/2019/may/patient-safety-g rades-released/
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