EBP Quality Improvement Proposal
Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice. Apply “The Road to Evidence-Based Practice” process, illustrated in Chapter 4 of your textbook, to create your proposal.
Include the following:
● Provide an overview of the problem and the setting in which the problem or issue occurs.
● Explain why a quality improvement initiative is needed in this area and the expected outcome.
● Discuss how the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes. Include a minimum of three peer-reviewed sources published within the last 5 years, not included in the course materials or textbook, that establish evidence in support of the quality improvement proposed.
● Discuss steps necessary to implement the quality improvement initiative. Provide evidence and rationale to support your answer.
● Explain how the quality improvement initiative will be evaluated to determine whether there was improvement.
● Support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
HLT-362V EBP Quality Improvement Proposal Example
Quality Improvement Proposal
Nurses and other healthcare providers’ roles also include continuously evaluating healthcare services and interventions against their objectives. They identify gaps in care provision and utilize their knowledge and skills to develop effective interventions to ensure patient safety and to provide patients with a safe environment. Problems vary with the settings, and interventions should target the root causes of these problems. Nurses have the most contact with patients and can use this opportunity to identify gaps and implement interventions for their management. This essay analyzes a current healthcare problem and a quality improvement proposal to help solve it.
Problem Overview and Setting
Medication administration errors are a common problem in inpatient care settings. The errors vary with the department, and critical care areas (especially the emergency department) report the highest number of medication administration errors. Medication errors occur between prescription and administration and can be committed by any healthcare professional. Nurses are professionals who are close to patients and administer most medications in healthcare institutions.
The problem causes consequences ranging from near misses and mild overdosages to severe injuries such as organ system failure and death. Medication errors occur more frequently in healthcare settings where many patients require attention and most have many medications with a narrow therapeutic index. Thus, medication administration error is a significant problem in inpatient settings at the care facility.
Need For the Quality Improvement Initiative and The Expected Outcome
Medication administration errors are the most common type of medical error in healthcare settings, making them significant. Medication errors cause between 7000000 and 1000000 deaths yearly, making them a leading cause of unintentional injury and death (Tariq et al., 2020). In addition, medication error injuries and related costs are above $40 billion annually in the US. A recent study shows that intravenous medication errors have the highest prevalence, and the IV route is the most common in inpatient settings (Härkänen et al., 2019).
In addition, medication administration errors are linked with costly lawsuits against the institution and professionals. Tariq et al. (2022) also note that some professionals have lost their jobs and ended up behind bars, and that institutions have suffered hefty fines and indefinite closures. These technologies prevent errors during the writing and translation of orders and help ensure that care providers prescribe the proper medications, doses, and frequencies for the right patient. More confirmation is also necessary when administering these medications, as it is the final and most crucial stage of the medication administration process. The technology will help increase efficiency and thus promote better patient outcomes.
Literature Support for the QI and the Expected Outcomes
Barcode medication administration is a technology that allows nurses and other care providers to scan medication before administering it. The technologies are vital because they are implemented at the point of care. The nurses use a scanner to read the patient’s wristbands and the medication barcode to ensure it is on the medication list. Scanning wristbands displays all patient medications on the monitor (in improved device formats), allowing nurses to reconfirm patient and medication information, such as duration, route, and dose. The technology also helps detect errors and alert the nurses.
The quality improvement project uses barcode medication administration to promote safety and prevent medication errors. The technology will allow nurses to confirm all patient medication rights before administration, thus preventing medication errors (Mulac et al., 2021). According to Mulac et al. (2021), barcode medication administration reduces medication errors and eliminates their severe consequences. Darawad et al. (2019) show that nursing professionals widely accept the technology because it eliminates errors and enables nurses to detect and prevent medication errors at earlier stages of the medication administration process.
The technology improves care by identifying errors made by other professionals, such as pharmacists, during dispatch and packing. Thompson et al. (2018) note that barcode medication interventions help professionals ensure flawless care provision, reducing medication administration errors by more than 50%. These errors are no longer the most common in medication administration. Owen et al. (2019) show that barcode medication administration in the emergency department reduces errors and enhances nurses’ job satisfaction.
Current technologies have been effective in preventing errors, such as prescription and transcription errors, through Computerized Provider Order Entry (CPOE) and clinical decision support systems (CDSS), which help clinicians diagnose and safely prescribe medications to patients (Khalil et al., 2018). Khalil et al. (2018) note that healthcare technologies help improve medication error prevention efforts and the reporting of medication errors to enable better action. Accurate records of these medication errors can help institutions implement survey interventions to help manage them.
Steps Necessary to Implement the Quality Improvement Initiative
Various steps will be involved in implementing the initiative. The steps will be based on the DMAIC Lean Six Sigma quality improvement theory. The theory asserts that quality improvement is a complex and continuous process that entails evaluating and reevaluating healthcare services for their involvement (Ahmed, 2019). The first step will define the problem and the proposed quality improvement process.
The information helps create urgency and promote the uptake and acceptance of the quality improvement initiative. The second step will be to quantify the problem’s existence. It will entail collecting data from research and the healthcare dashboard embedded in the healthcare information system. The third step will be analyzing the results to determine the major causes of the problem.
These causes include the hasty nature of the hospital environment and knowledge gaps. The fourth step is improvement; it entails preparing resources and other necessary processes to ensure the intervention’s implementation and success (Ahmed, 2019). The project executives will prepare the process map and budget, contact stakeholders and include their feedback, and obtain all necessary authorizations before implementing the interventions mentioned.
The Quality Improvement Initiative’s Evaluation
The evaluation of the intervention will be based on the effectiveness of preventing medication administration errors and sentinel events related to medication errors. According to Mulac et al. (2019), barcode medication administration helps reduce administration errors and their negative consequences, such as death and morbidity. These specific consequences, such as high healthcare costs, injuries, and deaths, will be the basis for the QI evaluation.
The QI will utilize data from the healthcare dashboard and electronic health records. Standardized terminology for recording medication errors and near-misses will be used to collect data on medication errors and their significance to nursing and healthcare. The data will then be analyzed and evaluated against data from a similar period. The project will be implemented for three months before its post-implementation evaluation. However, the results will be analyzed over three months to assess progress and clinical significance.
The hypothesis is that barcode medication administration technology will reduce medication administration errors and medication error costs, injuries, and deaths. The test is a quasi-experimental study involving a controlled trial investigating the effects of introducing barcode medication administration in a unit. The results will be evaluated against those from a similar previous period (six months). ANOVA, t-tests, and linear regression analysis will help evaluate relationships among these variables. These tests will help determine the relationship between the dependent variable and any similarities or differences between them. These tests will help determine any changes in these variables.
Conclusion
Medication administration errors are significant problems in healthcare and the nursing profession. These are expensive, costing over $40 million and about a million lives annually. Currently implemented technologies in the facility reduce other types of errors, but none help improve the administration process. Barcode medication administration increases the efficiency of the administration process and minimizes medication errors.
Existing literature supports the use of technology and other current technologies for better outcomes. Barcode medication administration can benefit from the DMAIC model for its implementation. The process will ensure that it is the best intervention to manage medication errors and will help gather support and resources while containing any resistance to the intervention. The intervention will improve care outcomes and reduce medication administration errors and their associated consequences.
References
Ahmed, S. (2019). Integrating the DMAIC approach of Lean Six Sigma and the theory of constraints toward quality improvement in healthcare. Reviews On Environmental Health, 34(4), 427–434. https://doi.org/10.1515/reveh-2019-0003
Darawad, M. W., Othman, E. H., & Alosta, M. R. (2019). Nurses’ satisfaction with barcode medication‐administration technology: Results of a cross‐sectional study. Nursing & Health Sciences, 21(4), 461–469. https://doi.org/10.1111/nhs.12620
Mulac, A., Mathiesen, L., Taxis, K., & Granås, A. G. (2021). Barcode medication administration technology use in hospital practice: a mixed-methods observational study of policy deviations. BMJ Quality & Safety, 30(12), 1021–1030. http://dx.doi.org/10.1136/bmjqs-2021-013223
Owens, K., Palmore, M., Penoyer, D., & Viers, P. (2020). The effect of implementing barcode administration in an emergency department on medication administration errors and nursing satisfaction. Journal of Emergency Nursing, 46(6), 884–891. https://doi.org/10.1016/j.jen.2020.07.004
Tariq, R. A., Vashisht, R., Sinha, A., & Scherbak, Y. (2021). Medication Dispensing Errors And Prevention. In StatPearls [Internet]. StatPearls Publishing.
Thompson, K. M., Swanson, K. M., Cox, D. L., Kirchner, R. B., Russell, J. J., Wermers, R. A., Storlie, C. B., Johnson, M. B., & Naessens, J. M. (2018). Implementation of barcode medication administration to reduce patient harm. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 2(4), 342–351. https://doi.org/10.1016/j.mayocpiqo.2018.09.001
Khalil, H., Kynoch, K., & Hines, S. (2020). Interventions to ensure medication safety in acute care: an umbrella review. JBI Evidence Implementation, 18(2), 188–211. https://doi.org/10.1097/XEB.0000000000000232
Härkänen, M., Vehviläinen-Julkunen, K., Murrells, T., Rafferty, A. M., & Franklin, B. D. (2019). Medication administration errors and mortality: incidents reported in England and Wales between 2007 ̶ 2016. Research in Social and Administrative Pharmacy, 15(7), 858-863. https://doi.org/10.1016/j.sapharm.2018.11.010
HLT 362 Week 5 Article Analysis and Evaluation of Research Ethics
Search the GCU Library and find one new health care article that uses quantitative research. Do not use an article from a previous assignment, or that appears in the topic Resources or textbook.
Complete an article analysis and ethics evaluation of the research using the “Article Analysis and Evaluation of Research Ethics” template. See Chapter 5 of your textbook as needed, for assistance.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
