Applying Measurement Tools to a Practice Problem
Conduct a collaboration interview with two or three key leaders in your practice setting to determine the measures for your practice problem and associated challenges impacting measurement for your practice problem (include confidentiality, anonymity, access issues, etc.). Perform an existing evidence review on your practice problem and search for evidence that demonstrates how your practice problem is measured across the country.
Post a description of the measures identified from the interviews, the challenges to obtaining the data that were discussed, and a summary of how this quality indicator is measured in the literature. Discuss any gaps in the data that were identified and additional sources that might be needed to obtain this data. Be sure to support your practice problem with the literature that indicates the relevance of this problem for nursing practice. Provide evidence from practice and data that is available.
- THE ASSIGNMENT IS BELOW
Read and respond to two or more of your colleagues’ postings from the Discussion question. Provide feedback on the quality of data that was obtained and recommendations on where additional sources of data might be found. As a member of a community of practice, help each other refine and clarify the patient-centered Practice Experience Project.
ATTACHED IN THE FILE IS THE 3 POST THAT NEED TO BE RESPONDED TO
Applying Measurement Tools to a Practice Problem Conduct a collaboration interview with two or three key leaders in your practice setting to determine the measures for your practice problem and associ
POST A After interviewing my Clinical Supervisor KJ Troy, RN, and my Clinical Director, Michelle Appenzeller, RN, we collectively decided that the best practice problem to address is patient falls. Patient falls of older adults continue to be a concern industry-wide. However, now, these numbers may be even more challenging to manage with the rising population of aging adults. With this in mind, it is even more crucial that the healthcare industry figures out the best possible ways to prevent injurious falls from further increasing. Mercy Regional Medical Center uses the Power Business Intelligence application for recording patient safety data. After assessing the years 2018 to 2021, our 84-bed hospital had 217 falls, with 160 showing no injury. Of the 217 falls, injuries with varying degrees of severity occurred with 52 patients. Next, after performing research using the Leapfrog Group, results suggested that the best performance score is 0.000 indicating no falls have occurred. This measurement represents the number of falls per 1000 patients discharged (The Leapfrog Group, 2021). Mercy Regional Medical Center scored 0.432, and the worst-performing hospital score was 1.727. While the score is low compared to the worst-performing hospital, the desired goal continues to be closer towards the 0.000 scores. As the aging population continues to rise, this may be a more difficult task to achieve. The Administration for Community Living (2021) reports that 21.6 percent of the American population will be 65 and older by 2040 and almost 95 million by 2060. In addition, based on information from Towne et al. (2019), falls at an older age are exacerbated due to chronic medical conditions, visual impairment, dementia, and medication usage. Patient falls are considered preventable injuries for hospitalized patients and can increase the number of days for a hospital stay to anywhere from 6-12 days (Dykes et al., 2020). With the increased risk of falls come increased costs and burdens on the healthcare system nationwide. These costs can be related to an extended hospital stay, increased physician costs, and possible increased medication costs related to fall injuries (Towne et al., 2019). Again, with these numbers and statistics at the forefront of healthcare concerns, it is essential to determine how to make a difference with this practice problem. For recording falls, one needs to count the number of falls and the number of occupied bed days on a unit over a specific period. In addition to recording the number of falls, recording and interpreting the type of fall is critical information in the data collection process. It is crucial for staff alignment in what constitutes a fall, regardless of whether an injury occurs or not. Finding alignment may not prove to be as easy as it sounds, and there can be challenges in collecting fall data. Associated challenges with collecting data for falls include staff concerns, collaborating the definition of a fall, repeat falls with the same patient skewing data, and staff-patient ratios possibly impacting safety. Regarding staff concerns, staff may not want to report a fall for fear that the numbers will impact their hospital scores and or comparison to other units. While most facilities create a positive learning environment from safety incidents, staff may fear getting in trouble with their supervisors. Ensuring that all staff is clear about what constitutes the definition of a fall is essential in accurately reporting fall occurrences. In addition, if the same patient has repeat falls, this can skew the data, making it seem as though the fall rate is higher (Agency for Healthcare Research and Quality, 2021). Lastly, when patient numbers are high, and staff ratios are low, as these days with high numbers of Covid-19 patients, this can impact staff availability to get to patients promptly when bed or chair alarms go off. In conclusion, it is essential to be accountable and responsible for increasing patient safety concerning falls as a participant in the healthcare industry. Through the practice of sharing evidence-based research on fall prevention strategies and being committed to being a facilitator of change, one can make a positive impact on decreasing fall rates. POST B After speaking with leaders in my practice, it was determined that medication errors are a problem in the facility. As I spoke to Kristin RN and Mary RN, it was noted that any medication error could have devasting consequences, so it is important to keep the rates as close to zero as possible. The rate for medication errors is 25% in this facility (The Leapfrog Group, 2021). This is a large number of medication errors and needs to be reduced as soon as possible. The main objective is to have physicians put their computerized orders into the computer, so there is less room for error. There are many challenges associated with measuring medication errors. The facility uses a barcoded medication EMAR, but it doesn’t catch all the possible errors. Six Sigma is a new management philosophy that seeks a nonexistent error rate. Management can piggyback Six Sigma onto current total quality management (TQM) efforts to ensure minimal disruption in the organization. Six Sigma is an extension of the Failure Mode and Effects Analysis required by JCAHO. It can easily be integrated into existing quality management efforts (Revere 2003). This is just one of the tools available to use for measuring medication errors in the hospital setting. It is crucial to take medication errors as close to zero as possible. Error prevention can be planned by means of retroactive and proactive tools, such as audit and Failure Mode, Effect, and Criticality Analysis (FMECA). An audit is also an educational activity, which promotes high-quality care; it should be carried out regularly. In an audit cycle, we can compare what is done against reference standards and put corrective actions to improve the performances of individuals and systems (Montesi & Lechi 2009). This is another example of how to measure medication errors in the hospital setting. It is essential to keep track of all errors to prevent them from reoccurring. Medication errors remain one of the most common causes of unintended harm to patients. They contribute to adverse events that compromise patient safety and result in a large financial burden to the health service. The prevention of medication errors, which can happen at every stage of the medication preparation and distribution process, is essential to maintaining a safe healthcare system. One-third of the errors that harm patients occur during the nurse administration phase: administering medication to patients is, therefore, a high-risk activity (Cloete 2015). Medication errors are a common problem that needs to be reduced in this facility. All medication needs to be recorded so that the quality of care can be improved. POST C For this week’s assignment, I worked with my preceptor/ nurse manager Sarah, the quality improvement nurse Carl and infection disease nurse practitioner Monica. I interviewed each person and discussed the occurrence of CAUTI and the current measures that are in place for performance improvement. The facility began to convene a system-wide, multidisciplinary team to review the evidence for infections to help develop and create best care bundles, or care processes, to help attain the goal of zero infections, at the facility. We also discussed the measures such as educating and supporting staff on high-reliability activities and performance improvement competencies. We discussed protocols on the appropriate indication to use, guidelines for insertion procedure and technique, maintenance of closed system, hygiene, and protocols for nurse-driven removal. The facility has a nursing council that discusses quality improvement projects such as CAUTI. They assess, evaluate, and implement evidence-based research to address issues within the facility. Furthermore, research has shown that an interprofessional collaborative approach to reduce CAUTI is beneficial by reviewing data, performing a gap analysis, and implementing corrective and preventative action plans (Stancovici & Galvan-Anderson, 2019). Associated challenges which impact the measurement of CAUTI are widespread. Often times when a patient is admitted to the hospital, a foley catheter is inserted into the patient under the direction of a physician. This information may not be communicated to our facility by the time the patient is admitted. The admitting nurse may not be aware that a catheter is inserted in the patient therefore, it is left for prolonged periods of time. At my facility, Monica, Carl and Sarah discussed how this was an issue they encountered in the past. To obtain data for my topic, I utilized Hospital Compare, which is an online resource that provides information on how well hospitals and other health care facilities are performing when it comes to providing the recommended care to their patients. The data gathered by Hospital Compare is provided by the AHRQ, which uses a system of quality indicators to determine the standards of quality health care and publishes its results in an annual survey (Medicare.gov, 2020). When reviewing the evidence for CAUTI occurrences at my facility, the standardized infection ratio (SIR), is compared to the actual number of CAUTI reported at the facility. That number is then compared to the number of CAUTI that was predicted to occur at the facility (CDC. NHSN. 2020). When reviewing my facility, in particular, the SIR was 0.538, which fell below the national benchmark of 1.0. The AHRQ is the leading federal agency charged with improving the quality and safety of patients by collecting and reporting data through surveys. The incidence of CAUTI is also followed by the CDC, National Healthcare Safety Network (NHSN), which is the most widely used hospital-acquired infection tracking system. By providing facilities, states, regions, and the nation with data needed to identify problem areas, measure the progress of prevention efforts, and ultimately eliminate hospital-acquired infections (CDC, NHSN, 2020).