Implementing Evidence-Based Medication Safety Interventions on a Progressive Care Unit
Williams, Tyeasha DNP, APRN, FNP-C; King, Melissa W. PharmD, BS; Thompson, Julie A. PhD; Champagne, Mary T. PhD, RN, FAAN
AJN, American Journal of Nursing: November 2014 – Volume 114 – Issue 11 – p 53-62
doi: 10.1097/01.NAJ.0000456433.07343.7f
The Joint Commission and Centers for Medicare and Medicaid work in tandem to develop the core measures required for Joint Commission accredited agencies.
- TJC Core Measures
- https://www.jointcommission.org/measurement/measur…
- Joint Commission Sentinel Event Summary
- https://www.jointcommission.org/resources/patient-…
OUTCOME MEASURESAlthough outcome measures is the last point of this keynote discussion, trust me, deciding what one is going to measure to determine if the quality improvement effort makes a difference and how the data is to be collected occurs early in the process. Outcome measures are generally a re-evaluation of the baseline data that informed you there was a problem to begin with. So, before one implements change, determining how the change is going to be evaluated (outcome) has to be determined. Data is powerful! As noted in the QI overview video, determining the effectiveness of quality improvement efforts informs us as to how we should proceed. In other words, the project outcomes will help one decide if the implemented change was successful, or not. If not successful, one would critically analyze the change process. Was the planning poor? Implementation flawed? Was the organization ready? The analysis of change processes and outcomes will inform the change team whether the practice or process is ready to be spread outside the original testing site or whether the practice or implementation strategy should be revised or even aborted. Okay, now let’s talk a little more about the different types of quality measures (structure, process, and outcome).Structure, process, and outcome measures have significant value in determining effectiveness of QI labors. Donabedian (2005) proposed using structure, process, and outcomes measures to evaluate care. Structure measures refer to settings, administration, staffing, materials, etc. Process measures are the means to the end. Process measures are linked to the desired outcome, but in and of themselves do not measure the effectiveness of the intervention. An example of a process measure would be determining staff compliance in implementing a best practice protocol. Specifically, what percentage of time did the nurses elevate the HOB as indicated in the protocol. Outcome measures are the desired outcomes of a quality improvement project such as the rate of patient falls per patient days or the rate of ventilator associated pneumonia per patient days. As stated earlier, it is essential to consider measurement outcomes during the planning phase of QI. A comparison of baseline outcome measures (whether structure or process measures) determines whether interventions implemented through quality improvement plans are successful or not. I cannot emphasize enough the importance of your understanding of outcome measurement. Please take time to carefully review the Donabedian article and any other resources needed for you to conceptualize this important part of quality improvement.
The video really emphasized the following and that it should not go unaddressed was this included? If so, where?
QUALITY IMPROVEMENT PROJECT MUST MEASURE THE PROBLEM: On a LOCAL LEVEL meaning to reduce medication errors via less distractions MUST indicate number that happened the prior year; if unable to access the number to QUANITUFY the problem IT MUST BE NOTED. By noting “the number of medication errors as a result of nurse distraction during medication administration are often___ per __nationally.” Although data could not be shared the National data reveals/states_______.”
MEASURING the numbers are _____ nationally. although data could not be shared per facility national data states/suggests/reveals_____. although many attempts to gather proved unsuccessful. As a result the National data was used and reveals/states
Improvement tool section: should be used to not only speak with the nursing staff but the interprofessional team members managers like Nurse Assistants, Unit Secretaries, PT/OT/Physicians ,NP’s, to find out their perception of nursing, their awareness of medication administration, and the reason for interrupting nurses. And use the tool to interview nurses to also describe CAUSE/EFFECT OF ROOT CAUSE ANALYSIS like meet with nurses to find out the type/source of interruptions (cause), and distraction effects so that management can call a meeting with the head of each department to call a meeting regarding the distraction/ of nurses during critical medication administration times to find out why and/or is it that other team members are unaware of the critical nature of this intervention.
Under Model section: Also shouldn’t all staff be included in education as they are the ones doing it and shouldn’t nurses be educated on how to and not respond to such distractions/interruptions to maintain a conflict free and safe environment? As well as other staff education regarding their responses to patient’s and family members while the nurse is administering medications. Like finding out what they could do for the patient, alerting the patient that the nurse is administering medications=educated on appropriate responses instead of opting to get the nurse for things that they can take care of. Answering call lights during this time not going on break, leaving the unit durIng at this time etc……MUST HAVE EVIDENCE LIKE A CITED PEER RECIEWED ARTICLE TO VALIDATE ALL OF THIS .These are just some ideas
what does following mean and who/how does this involve nurses and staff?
“Eventually, no answer will be able to satisfy the why, and the root cause has been found. ”
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