MILESTONE 3 JOURNAL WRITINGBASED ON PREVIOUS WEEKS (ATTACHED)TEXT BOOK READINGChapter 6: pages 185–196, 199–204 Course OutcomesThe journals enable the student to meet the following Course Outcome

MILESTONE 3 JOURNAL WRITINGBASED ON PREVIOUS WEEKS (ATTACHED)TEXT BOOK READINGChapter 6: pages 185–196, 199–204 Course OutcomesThe journals enable the student to meet the following Course Outcome
Chamberlain College of Nursing NR392 Quality Improvement in Nursing Course Project Milestone 1 Template Directions: Prior to completing this template, carefully review Course Project Milestone 1 Guidelines paying particular attention to how to name the document and all rubric requirements. After saving the document to your computer, type your answers directly on this required template and save again. This assignment is due by Sunday end of Week 1 by 11:59 p.m. Mountain Time. Your Name: Amarjeet Kaur Assignment Criteria Your Answers: (NOTE: See Milestone 1 Grading Rubric for details required in each area.) Nursing Care Issue and Desired Outcome 50 points Nursing Care Issue: Deaths resulting from medication errors Desired Outcome: Reduce the number of outpatient and inpatient deaths to zero in the next six months. Details of the Issue 50 points A medication error is a preventable event in the treatment process of a patient due to inappropriate medication which can have a potential or leads to harm in the patient’s health condition. Medication errors can occur during the prescription of dosage to a patient, the determination of which dosage regimen or medicine to use as well as the wrong administering of the medicine. The manufacturing formulation and the dispensing of the formulation also lead to medication errors. Medication errors result in adverse drug reactions. Adverse events are the harmful and unpleasant reaction which results from the administration of a medicinal product not appropriate for the patient. Although medication errors cause serious effects on the patient and at times death, there are very few reported cases of medication errors. Most nurses are afraid of reporting cases where wrong medication has been done to a patient due to the fear of the blame game rather than correcting the error made. Also, errors going unnoticed may affect the reported cases of the errors unless there is a serious reaction to a dosage. Therefore nurses should be encouraged to report the cases of medication errors especially the prescription error which is common to most nurses in the field. To encourage this, they should be provided with blame free, non-punitive environment. Also, they should be keen when prescribing medicine to offer balanced prescribing to patients. Balanced prescribing involves the use of the appropriate medicine upon a patient according to the patient’s condition and within the limits that may be created by uncertainties to balance the optimum benefit of harm. Good record keeping of patients’ records may ease retrieval which results in right medication to patients as well as an assessment of a patient health condition and the decision of the drug that should be administered. Reason Issue Selected 50 points I selected the issue of medication errors because there has been an increase in the reported cases of medication errors especially when there are handoffs among nurses. During the transition, nurses who take over may administer wrong drugs to a patient due to the lack of the patient’s previous information. Poor record keeping of the patient records may lead to the prescription of a wrong drug according to a patient’s health condition which may result to harm or in extreme cases death of the patient. In the current facility, most of the reported cases of medication errors result from the nurse’s handoffs. When there is the transition of the nurses, those who take over at times do not get the exact records of a patient’s dosage administration and hence ends up giving or prescribing the wrong medicine to a patient. Another reason that led to the choice of the topic is that most new nurses in the profession have a fear of reporting the cases of errors made due to the fear of criticism or in some cases they are not able to detect errors. Therefore there is a need to encourage nurses to speak up, as well as getting keen with the prescription of drugs by keeping close track of patient’s health record. References Aronson, J. (2009). Medication errors: what they are, how they happen, and how to avoid them. QJM, 102(8), 513-521. doi: 10.1093/qjmed/hcp052. Finkelman, A. (2018). Quality Improvement: A Guide for Integration in Nursing. Jones & Bartlett Learning, LLC, an Ascend Learning Company. NR392 Course Project Milestone 1 Template.docx 9/27/2018 CJM
MILESTONE 3 JOURNAL WRITINGBASED ON PREVIOUS WEEKS (ATTACHED)TEXT BOOK READINGChapter 6: pages 185–196, 199–204 Course OutcomesThe journals enable the student to meet the following Course Outcome
Chamberlain College of Nursing NR392 Quality Improvement in Nursing Week 1 Journal Template Directions: Prior to completing this template, carefully review Week 1 Journal Guidelines paying particular attention to how to name the document and all rubric requirements. After saving the document to your computer, type your answers directly on this required template and save again. This journal is due by Wednesday of Week 1 by 11:59 p.m. MT. Instructions for Week 1 Journal Select a nursing care issue for the Course Project (not workforce issues such as staffing) that could be impacted by improved quality. Identify the issue and state the desired outcome. Ask at least one question of your instructor that could help you do your best on Milestone 1. Return to the Grades area to read the instructor’s response Saturday or Sunday of Week 1 prior to submitting your Milestone 1. Due Wednesday of Week 1 by 11:59 p.m. MT. Your Name: Amarjeet Kaur Assignment Criteria Your Answers Identify the nursing care issue and state the desired outcome Nursing Care Issue: One of the issues in the current state of medication is the medication error which is defined by NIH as failure that might lead to harm on the patient (NIH.gov). In the current sector of healthcare this issue has become a great challenge. Mistakes involving medication are among the most common healthcare issues. Web have different kind of medication errors which include failure to perform any of 6 rights in medical administration, cross sensitivity, wrong diagnosis etc. Medication error can result from those involved in the chain such as prescriber, manufacturer, blood level monitoring, administering and lack of education to patients. The nurses should do safety check before administering medication as they are the last in the chain. We have areas where nurses are not in position of identifying errors where the doctors and pharmacists can pin point out the error. An example is where a pharmacist forgets to identify problem of cross sensitivity and misdiagnosing medication to patient. For the nurses they have got direct contact with patients and in acute setting they are ones who spend time with patient hence this result to medication error in most instances which make it a big issue. Desired Outcome: From NIH they have estimated that medication error results to 1 of 131 patient deaths and 1 of 854 inpatient death according to report by institute of medicine (Nih.gov).In case of medical error most people are held accountable especially nurses who are supposed to do last check before administration. The medication errors range from nothing happening to as far as death of patients. Even though there are steps which have been taken to avoid the medication error we still have serious errors being made by members of the care team. For the acute care facilities they have taken steps to prevent errors from arising where they have adapted the electronic medical record connected with pharmacy, wrist scanning bands before administering medication, having nurses to do verification and pharmacy reviewing PT. The nurses are trained to review the lab results, diagnostic results and patient’s diagnosis and understanding why certain medication are prescribed to patients before administering. At times the nurses might fail to do this which could result to an error. There was a situation where the patient INR was at 3.1 and patient was on 5mg of Coumadin where the goal was 2-3.Pharmacists made a mistake and ordered 3mg of Coumadin but it fails discontinuing 5mg making total of 8mg.Nurse failed to question order and administered 8mg and next INR which was 4.8.Though there was an error from pharmacy the nurse who administered was held accountable. This example indicates that though we have measures in place the 6 steps have to be followed where lab results have to be reviewed before medication. From the facility we have got several measures taken to avoid medical errors. We have got access to medical records for community pharmacy. This enables us to view the medication records of the patient. Compare it with home list the patient came with and ask question where we had any doubts. This eliminates problem of missed dosses and wrong prescription by the provider. Hospitals discourage use of home medication. The relatives have to take back medication bottles after comparing. In case the patient is taking medication which is not in pharmacy formulary then it has to verify the medication, label with barcode and nurses should lock it up in medication drawer and administer it to patients as directed until they are discharged. For insulin two nurses have to verify it prior to administration as well as heparin drip. Medications which are not scanned are reported to the manager at the end of the month where each nurse should have 98% of scanning rate. All medications entered should be verified by the pharmacists before administering them. Reporting error as early as possible leads to a better outcome to the patient. An example is where you mistakenly administer 60 units of short acting insulin instead of long acting insulin has to be reported immediately otherwise it could be detrimental to patient life. I encourage colleagues to talk with patients about home medication regimen on admission and question orders they have doubts with. In case of any error they should report in timely manner. Create a non-punitive environment for the staff which can encourage staff to report the issue without fear of being punished. Ask at least one question of your instructor that could help you do your best on Milestone 1 Question: Why do you think medical error should be taken with a lot of seriousness? Reference https://learn.ana-nursingknowledge.org/products/Preventing-High-Alert-Medication-Errors-in-Hospital-Patients, Retrieved, October 2016. https://www.ncbi.nlm.nih.gov/pubmed/24981217, Retrieved, October 2016. NR392 Week 1 Journal Template.docx November 2018 CJM
MILESTONE 3 JOURNAL WRITINGBASED ON PREVIOUS WEEKS (ATTACHED)TEXT BOOK READINGChapter 6: pages 185–196, 199–204 Course OutcomesThe journals enable the student to meet the following Course Outcome
Chamberlain College of Nursing NR392 Quality Improvement in Nursing Course Project Milestone 2 Template Directions: Prior to completing this template, carefully review Course Project Milestone 2 Guidelines paying particular attention to how to name the document and all rubric requirements. After saving the document to your computer, type your answers directly on this required template and save again. This assignment is due by Sunday end of Week 3 by 11:59 p.m. Mountain Time. Your Name: Amarjeet Kaur Assignment Criteria Answers: (NOTE: See Milestone 2 Rubric for details required in each area.) Define: Briefly States Approved Nursing Care Issue from Milestone 1 25 points The approved nursing care issue from milestone one is deaths resulting from medication errors. Medication errors have significantly increased in the healthcare industry and this has led to many deaths which otherwise could have been avoided. According to research conducted by WebMed, approximately 64.55% of nurses have made some sort of medical errors. The most common type of medication error is the infusion rate and the wrong dosage. Measure: Identify Measures (Indicators; Data) to Support the Issue in Your Setting 75 points Despite the substantial efforts applied to ensure that medication errors are avoided, the issue has still not been addressed effectively. According to the Institute for Safe Medication Practices for analysis, medication errors have resulted in not less than 20% of patients’ deaths in healthcare facilities. According to the Food and Drug Administration, there have been approximately 30,000 medication errors reports since 1995. According to a report by the Institute of Medicine (IOM), 44,000-98,000 deaths are likely to be experienced each year due to medical errors in hospitals only. Moreover, the IOM report also establishes that more than 7,000 deaths are linked to medications every year. In my local area where I have operated as a caregiver, I have witnessed many medical errors which have resulted in fatal health conditions of a patient or even deaths. Many nurses don’t follow the clear prescription and they end up giving the wrong dosage to the patients. There also a number of times when I have witnessed the nurses giving the wrong medication to the patients due to lack of clear instructions. The doctors also at times fail to follow the doctrine of informed consent which has resulted in medication errors. There has been various government legislation enacted to protect the patients from any sort of medical error and to promote their safety. The patients are however not well informed of their rights and this calls for more training. The loss of lives which otherwise could have been avoided poses a great challenge to the entire world as potential people who could have changed the world end up losing their lives. Measure: List Titles of Stakeholders (important persons) and Their Roles in Improving this Nursing Care Issue 75 points The main stakeholders who have the potential of improving the nursing care issue are the government and its agencies, the management of various hospitals, the doctors and nursing associations, and the patients and their families. It is the role of the government and its agencies to ensure that patients are trained on their medical rights and how they can ensure prevent medical errors. The government and its agencies also have to ensure that the doctors and the nurses are educated on quality care. The set rules and regulations ought to be adhered to promote efficiency and effectiveness in healthcare. The caregivers who include the nurses and the doctors ought to implement the principles of quality care to ensure that medical errors are avoided at all costs. The doctors and nursing associations have the role of educating the healthcare staff on the ways that medication errors have to be avoided. There ought to be effective communication in every healthcare organization if the medication errors have to be avoided at all costs. The management of every healthcare facility should establish rules and regulations that need to be followed to facilitate effective communication and interaction between the patients and the caregivers. The patients also need to know their rights and ensure that there is quality in the care offered to them. Patients should always ask questions on the medical prescriptions and instructions given to them to ensure that they receive quality and individualized care. Analyze: Analyze the Possible Causes of the Nursing Care Issue 50 points There are various causes of medication errors in healthcare. First, the issue is caused by poor communication between the patients and the caregivers. Lack of clear communication leads to wrong prescription and treatment which is a fatal medical error. Secondly, medication errors arise from the existence of medical abbreviations which end up being abbreviated, hence wrong dosage and treatment. Thirdly, medical errors arise from an inadequate flow of information due to stems within the organization. Fourth, medical errors arise from human problems especially when procedures, policies, care standards, and processes are not adhered to. Another major cause of medication errors are issues related to the patients and they include failure of acquiring the patient’s consent, inadequate education to the patients, inadequate patient assessment, and unsuitable identification of the patients. References Aronson, J. (2009). Medication errors: what they are, how they happen, and how to avoid them. QJM, 102(8), 513-521. doi: 10.1093/qjmed/hcp052. Finkelman, A. (2018). Quality Improvement: A Guide for Integration in Nursing. Jones & Bartlett Learning, LLC, an Ascend Learning Company. Nicogossian, A., Stabile, B., Kloiber, O., & Zimmerman, T. (2018). Medical Errors: Next Steps. World Medical & Health Policy, 8(3), 220-222. doi: 10.1002/wmh3.199. Youngberg, B. (2011). Principles of risk management and patient safety. Sudbury, MA: Jones and Bartlett Publishers. NR392 Course Project Milestone 2 Template.docx 9/27/2018 CJM
MILESTONE 3 JOURNAL WRITINGBASED ON PREVIOUS WEEKS (ATTACHED)TEXT BOOK READINGChapter 6: pages 185–196, 199–204 Course OutcomesThe journals enable the student to meet the following Course Outcome
Chamberlain College of Nursing NR392 Quality Improvement in Nursing Week 3 Journal Template Directions: Prior to completing this template, carefully review Week 3 Journal Guidelines paying particular attention to how to name the document and all rubric requirements. After saving the document to your computer, type your answers directly on this required template and save again. This journal is due by Wednesday of Week 3 by 11:59 p.m. MT. Instructions for Week 3 Journal Explain your progress on Milestone 2. Ask at least one question of your instructor that could help you do your best on Milestone 2. Return to read Instructor’s response Saturday or Sunday of Week 3. Due Wednesday of Week 3 by 11:59 p.m. MT Your Name: Amarjeet Kaur Assignment Criteria Your Answers Explain your progress on completing your Milestone 2 assignment Progress: My progress with completing the Milestone 2 assignment has quite been challenging and encouraging at the same time. I believe that medical errors are quite an issue in healthcare and they need to be mitigated for efficiency in operations. Research shows that medical errors are among the leading cause of deaths in healthcare apart from chronic illnesses. The major solution to the issue of medical errors in healthcare is increased quality improvement. There should be the promotion of quality in all the areas of healthcare. Quality improvement applies to all the organizational operations starting from the admission of the patients, their treatment and their discharging from the hospital. Quality improved has to be a continuous process if the much-anticipated outcomes have to be witnessed. The milestone has enabled me to understand the major issues in healthcare through extensive research. My attempts in meeting the milestone requirements have played a paramount role in promoting my knowledge and understanding of how medical errors impact healthcare. The milestone has enabled me to increase my knowledge and skills in the field of healthcare. Currently, I am interviewing various officials and directors in different healthcare organizations. I have gathered enough evidence on what quality improvement means in healthcare. I have acquired the vital skills on the strategies that need to be implemented to ensure that continuous quality improvement in healthcare is not only a phrase but a functional operation. Ask at least one question of your instructor that could help you do your best on Milestone 2 Question: What are the strategies that should be implemented to ensure that continued quality improved is enhanced within the healthcare industry? What other additional strategies should healthcare organizations adapt to ensure that the issue of medical errors is resolved effectively? References Aronson, J. (2009). Medication errors: what they are, how they happen, and how to avoid them. QJM, 102(8), 513-521. doi: 10.1093/qjmed/hcp052. Finkelman, A. (2018). Quality Improvement: A Guide for Integration in Nursing. Jones & Bartlett Learning, LLC, an Ascend Learning Company. NR392 Week 3 Journal Template.docx November 2018 CJM
MILESTONE 3 JOURNAL WRITINGBASED ON PREVIOUS WEEKS (ATTACHED)TEXT BOOK READINGChapter 6: pages 185–196, 199–204 Course OutcomesThe journals enable the student to meet the following Course Outcome
Chamberlain College of Nursing NR392 Quality Improvement in Nursing Week 6 Journal Template Directions: Prior to completing this template, carefully review Week 6 Journal Guidelines paying particular attention to how to name the document and all rubric requirements. After saving the document to your computer, type your answers directly on this required template and save again. This journal is due by Wednesday of Week 6 by 11:59 p.m. MT. Instructions for Week 6 Journal Explain your progress on Milestone 3. Ask at least one question of your instructor that could help you do your best on Milestone 3. Return to read Instructor’s response Saturday or Sunday of Week 6. Due Wednesday of Week 6 by 11:59 p.m. MT Your Name: __________________________ Assignment Criteria Your Answers Explain your progress on completing your Milestone 3 assignment. Progress: Ask at least one question of your instructor that could help you do your best on Milestone 3. Question: NR392 Week 6 Journal Template.docx November 2018 CJM