Quality Health Care Research Paper
Quality Health Care Research Paper
Quality health care is a critically significant yet underachieved goal in the United States. The prevalence and scope of medical errors are one of the most important threats to the achievement of quality healthcare care. after heart disease and cancers, medical errors are the third principal cause of death in the US, with 400,000 deaths occurring each year due to medical errors (Marquis & Huston, 2020). Pressure ulcers/ pressure injuries are a significant health issue. It is approximated that around one and a half million hospitalizations in the US are a result of pressure ulcers. Pressure ulcers are associated with pain, infection risk, prolonged hospital stay, additional treatment, and increased health care costs(Borojeny et al., 2020)Quality Health Care Research Paper. The purpose of this quality improvement paper is to analyze the incorporation of wearable sensors in pressure injury prevention intervention to meet the Institute of Medicine (IOM) six aims of improving the quality of care
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The Problem
Pressure ulcers are a main concern for healthcare facilities because their frequent occurrence is in both pediatric and adult inpatients, diminishing patients’ quality of life of patients. Nutritional status, continence, age, mobility, and activity are factors that increase the risk of an individual developing a pressure ulcer. Also, pressure ulcers increase the costs of health care (Triantafyllou et al., 2021)Quality Health Care Research Paper. Padula and Delarmente (2019) posit that pressure ulcers occur in around two and a half million Americans receiving care from acute care facilities each year. The majority of people who develop pressure injuries include the malnourished, the elderly, and those who have been hospitalized for a long time. Pressure injuries cause severe harm to patients, including the development of chronic wounds. Pressure injuries result in up to 60, 000 deaths each year. Compared to around 63,000 overdose deaths in 2016, 44,000 deaths due to suicide in 2015, and almost 56,000 deaths resulting from influenza from 2015 to 2016. Despite pressure injury-related deaths being the same and even greater, pressure injuries have not received much attention as a public health crisis.
Hospital-acquired pressure ulcers (HAPIs) increase mortality and morbidity for millions of individuals annually. Internationally, the prevalence of HAPIs is 12.8 percent, and the incidence of HAPIs is 5.4 per 10,000 days spent in the hospital. HAPIs adversely affect both patient and organizational outcomes. Patients who suffer from HAPIs spend more days in the hospitals (6.7 days) compared to patients without HAPIs who hospital stay in the hospital for 4.5 days on average. Also, HAPIs are connected with pain, increased infection, and high rates of mortality. Pressure injuries increase the cost of care as a result of lengthy hospital stays, treatment costs, and decreased reimbursement from third parties (Crotty et al., 2023)Quality Health Care Research Paper.
IOM Aims for quality
The IOM classified aspects of care delivery with its six aims of improvement to meet the healthcare needs of the patient and preserve the safety of the patient. the six aims are safety, effectiveness, efficiency, patient-centered care, timing, and equity (IOM, 2001). In addition to the IOM, other organizations focus on improving health care quality and patient safety including the Joint Commission, CMS, and American Nurses Association (ANA). According to Marquis and Huston (2020), the Joint Commission provides accreditation to over 21, 000 healthcare programs and organizations in the United States and has had a significant effect on planning for quality control in hospitals that provide acute care. Also, the Joint Commission maintains databases of serious adverse events/ sentinel events by healthcare providers along with their underlying causes. The Joint Commission defines sentinel as a patient safety event (a condition, incident, or event that could have led or did lead to patient harm) that reaches the patient and leads to severe temporary harm, permanent harm, or death, and intervention needed to sustain life. Such events are termed as sentinel since they are an indicator of the necessity to be immediately investigated and responded to. All organizations that have obtained accreditation are encouraged, but not mandated to report sentinel events to the accrediting body (Marquis & Huston, 2020).
The CMS actively participates in setting standards for and gauging quality in health care. In 2001, the CMs introduced the Medicare Quality Initiative (presently known as the Hospital Quality Initiative (HQI) which targets health outcomes as a source of data. HQI encourages physicians and consumers to discuss and make informed decisions on the way to get optimal care, support public accountability, and incentivize hospitals to improve care. Also, through Medicare, the CMS developed pay-for-performance programs to align quality and payment incentives and to decrease costs via improved efficiency and quality (Marquis & Huston, 2020)Quality Health Care Research Paper.
The National Committee for Quality Assurance (NCQA) assesses quality control in healthcare institutions. The NCQA provides accreditation to managed care organizations and has formulated the health plan employer data and information set (HEDIS) for comparing care quality in managed care organizations. Over 90 percent of the nation use HEDIS for measuring performance on significant dimensions of service and care (Marquis & Houston, 2020)Quality Health Care Research Paper.
The ANA founded the National Database of Nursing Quality Indicators (NDNQI) whose purpose is to investigate the relationship between nursing and patient outcomes. Over 2,000 hospitals in the United States and 98 percent of facilities that have received Magnet recognized to take part in the NDNQI program via surveys to improve nurse satisfaction, measure nursing quality, evaluate staffing levels, strengthen the work environment for nurses, and improve how organizations are reimbursed under pay for performance policies. NDNQI provides hospitals with unit-level performance data, enabling them to develop more effective improvements as well as assisting them in understanding the link between staffing data, nursing-sensitive quality indicators, and resisted nurse survey data (Marquis & Houston, 2020).
Safety
IOM (2001) defines safety as preventing patients from being harmed from care that is aimed at helping them and neither should injury originate from healthcare workers. Pressure injuries are a significant, frequently underrecognized patient safety problem and have a substantial effect on patients’ quality of life. They expose patients to the risk of developing infections and sepsis, are associated with pain, and might result in lengthy hospital stays and mortality. Also, pressure injuries expose patients to the risk of psychological trauma and worsened quality of life including absenteeism from work (Gupta et al, 2020)Quality Health Care Research Paper.
Effectiveness
The IOM (2001) defines effective as offering services based on scientific knowledge and desisting from offering services that are unlikely to benefit patients. Evidence-based pressure ulcer prevention interventions greatly influence the occurrence of pressure ulcers, pressure ulcer prevalence, and pressure ulcer severity per patient. for instance, frequent repositioning of the patient decreases the risk of development of pressure injury, and supporting surfaces are regarded to decrease pressure ulcer incidence more than standard hospital surfaces. Nevertheless, single interventions, like repositioning alone or risk assessment, have not been demonstrated to be as effective as multiple intervention programs. Also, it is not always easy to implement evidence-based interventions into practice and there is considerable variation in health care professionals’ competence and attitudes towards evidence-based practice and pressure ulcer prevention. Moreover, the self-efficacy of nursing staff in preventing and treating pressure ulcers might also significantly contribute to pressure ulcer prevention interventions (Haavisto et al., 2022)Quality Health Care Research Paper.
Efficiency
The IOM (2001) defines efficiency as avoiding waste. An efficient healthcare system is one in which the utilization of resources is to get the best value for money spent. Pressure ulcers lead to a waste of resources and increase the costs of health care. In the US, the cost of pressure ulcer treatment and care is between 9.1 billion dollars and 11.6 billion dollars. Therefore, prevention of pressure ulcers is vital for improving outcomes for patients and lessening the economic burden on both patients and healthcare facilities (Scafide et al., 2020)Quality Health Care Research Paper.
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Patient-centered care
The IOM (2001) defined patient-centered care as care that is responsive to and respectful to the values, needs, and preferences of the patient and basing all clinical decisions on patient values. Porkarna et al. (2019) posit that patient-centered care primarily aims at achieving a partnership between patients and families concerning healthcare services delivery. Health literacy is a crucial component of patient-centered care because it supports patients to become partners in their own health, and it improves the quality of interactions between healthcare systems and patients. There is a positive association between health literacy and improved self-care practices, better patient experience, and better health outcomes. For the management of pressure ulcers, health literacy is the extent to which patients can obtain, process, and understand pressure injury-related health information including symptomatology, prevention, and needed services to appropriately make informed decisions about health care. As such, the involvement of patients is vital (Pokorna et al., 2019)Quality Health Care Research Paper.
Timeliness
Timely is defined by IOM (2001) as reducing waits and harmful delays to both providers and receivers of care. Timeliness is a vital characteristic of a service and is a valued and legitimate focus improvement in the health care industry. (IOM, 2001). Timely repositioning is essential to pressure ulcer prevention. According to Cortes et al. (2021), repositioning is a practice used for pressure ulcer prevention, and its major goal is to lessen mechanical pressure on the skin. Pressure ulcers occur when repositioning of an immobile patient is done at very low frequencies in 24 hours Clinical practice guidelines recommend that those who are in an altered state of consciousness need to be mobilized every two hours.
Equity
Equity is the provision of care that has no variation in quality as a result of personal characteristics like ethnicity, gender, socioeconomic status, and geographic location (IOM, 2001). The overall prevalence of pressure ulcers among residents admitted in United States nursing homes varies from 5 percent to 20 percent, but for racial/ethnic minorities, the prevalence of pressure is almost two-fold that of Whites. The higher proportion of minority nursing home admissions with a pressure injury might heighten the risk of a disparity in the treatment and help of pressure ulcers (Bliss et al., 2017)Quality Health Care Research Paper.
Interdisciplinary teams
A unified – team-based approach towards prevention of pressure ulcers is endorsed as best practice while interprofessional teamwork is believed to promote interdependency among members of the team, improving staff satisfaction and optimizing patient care. individual interprofessional groups involved in pressure ulcer prevention and treatment include physicians, nurses, nursing assistants, physiotherapists, occupational therapists, podiatrists, and rehabilitation assistants. To achieve an interprofessional team approach, there is a need for professional groups to be knowledgeable of the causative factors for pressure ulcers and positive attitudes towards pressure ulcer prevention. Assessing the knowledge and attitudes of the interprofessional teams in pressure ulcer prevention and providing pressure ulcer-related training for staff is of great significance in pressure injury prevention (Clarkson et al., 2019). Gedamu et al. (2021) posit that frequently providing health education and training staff on pressure ulcer prevention is regarded as an element of methods for preventing pressure ulcers.
Nurses input
As the largest group of healthcare providers, nurses are responsible for the delivery of pressure injury prevention care for patients. According to Gedamu et al. (2021), nurses have the responsibility of providing a good process of nursing to hospitalized patients. Care quality in a specific patient is maintained by applying a good nursing process and it averts pressure ulcer incidence. Attitudes and knowledge of nurses significantly impact the form of the nursing process along with interventions for patient outcomes. Pressure ulcer prevention can be regarded as intensive nursing which involves regularly assessing and effectively preventing pressure ulcers from developing. Properly applying tools for assessing the risk of pressure ulcers as the Braden scale can prevent pressure ulcers from developing. Also, repositioning the patient every two hours and using pressure-relieving mattresses decreases the pressure ulcer development. If the development of pressure ulcers is occurring, nurses can offer a process of wound healing by changing dressing, continually assessing the wound, and providing appropriate nutrition for the maintenance of quality of care. prevention of pressure ulcers is an important challenge for nursing and its occurrence is regarded as a poor care quality indicator. Quality Health Care Research Paper
Technology
Patient repositioning every two hours lessens the duration of periods of exposure of body tissues to pressure, thus reducing the probability of the occurrence of a pressure injury. The majority of guidelines suggest that patients at risk of developing a pressure ulcer should be turned to optimally offload bony prominences and maximize redistribution of pressure. Conventionally, turn protocols necessitate adherence to a two-hour repositioning interval, yet this standard is hardly met (Nherera et al., 2021). Incorporating wearable sensors in pressure prevention programs sensors is one way of preventing pressure ulcers. Pressure injury prevention usually involves implementing bundles for pressure prevention. There is the inclusion of turn protocols, which involve repositioning patients at set intervals to relieve pressure are included in the pressure prevention. wearable monitoring devices track patient turns and can increase compliance with pressure injury prevention interventions by using wearable monitoring devices that track tuns. The sensors are applied on the patient’s chest and utilized in tracking the time between turns as well as the quality of repositioning to augment repositioning protocol compliance (Crotty et al., 2023).
A wireless sensor and a computer/tablet are technologies. A wearable wireless sensor gathers data on body pressure over time and wirelessly transfers it to a computer at a control center. After the sensor is connected to the patient, the tablet tracks the whereabouts of the patient. The nurses need to select a cutoff from a preset array of degrees to differentiate a turn from other forms of body movements. The default settings of the patient are modified to account for their motion level. Through a color-coded system, the computer display notifies and automatically assists the health care provider through the repositioning task. Green indicates that there is no scheduling of the patient for repositioning while amber signifies that a patient is about to make a turn. Red indicates there is an urgent need for patient turn and the position needs to be changed (Deshpande et al., 2023)Quality Health Care Research Paper.
Quality improvement
Over the last numerous decades, the United States healthcare system has shifted from a quality assurance model to a model that focuses on quality improvement. Quality improvement models target ongoing and continuously improving quality. Total quality management/ continuous quality improvement, (CQI) is a model that emphasizes the continuing nature of quality improvement. Dr. W. Edward Deming developed the CQI philosophy. CQI assumes that service and production focus on an individual and that quality can always be improved. Therefore, recognizing and doing the correct things, the first time, the right way planning and preventing but not inspecting, and reactively solving a problem can result in quality outcomes. Since CQI is a non-stop process all things and people in an organization should be engaged in continuous efforts to improve quality (Marquis & Huston, 2020)
Pressure injury is a disease that can be prevented with more room for improvement. However, despite medical advancements, the has been a slight increase in pressure injury incidence over recent years In 2020, the National Pressure Ulcer Advisory Panel reached a consensus that although all pressure ulcers cannot be prevented, the majority are preventable (Siotos et al., 2022). A 2007 CMS ruling categorized pressure ulcers acquired in the hospitals as never events and in 2008, halted making reimbursements to healthcare facilities for the costs of offering treatments to patients with pressure injuries. According to the CMS a HAPI, as a secondary diagnosis makes an additional 1,180 dollars to each stay at the hospital (Scafide et al., 2020)Quality Health Care Research Paper.
Evidence-based research
Several research studies have demonstrated the effectiveness of wearable sensors in preventing pressure ulcers. The study by Crotty et al. (2023) which aimed at examining the impact of wearable sensors on healthcare organizations, nurses, and patients demonstrated that wearable sensors heightened patient repositioning compliance and decreased the rates of HAPIs and associated costs. Wearable sensors can improve the turning of patients as the sensors enable providers to swiftly recognize patients in need of repositioning. Another study by Nherera (2021) demonstrated that patient wearable sensors are effective in preventing HAPIs and improving compliance with patient repositioning. This implies that wearable sensors should be considered for their clinical effectiveness and potential to save resources since they are less expensive.
The study by Turmell et al. (2022) demonstrated that cueing technology such as wearables sensors has the potential to improve patient safety by enabling healthcare providers to comply with routine repositioning schedules. The wearable sensors offer staff visual indications about the positions and repositions needs of patients (Turmell et al., 2022)Quality Health Care Research Paper. The study also demonstrates that a visual cue can prompt members of the staff to assemble resources and supplies including additional members to safely turn the patient. Also, the study revealed that members of the nursing staff had the perception that the visual cues enhanced a feeling of improved teamwork. Members perceived that there was improvement in teamwork when information about the repositioning needs of patients was displayed in the unit. Also, cueing was believed to influence communication and teamwork by facilitating the capacity of staff members to more easily share repositioning activities (Turmell et al., 2022).
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Conclusion
Pressure injuries are an important patient safety issue and their prevention fits with the IOM’s six aims of improving quality. Pressure injuries are associated with morbidity and mortality for hundreds of individuals in the United States and millions of individuals globally each year. HAPIs are connected with pain, prolonged hospital stays increased infection, and high rates of mortality. In addition to adversely impacting the quality of care, HAPIs increase the cost of care as a result of lengthy hospital stays, treatment costs, and decreased reimbursement from third parties. Patient repositioning is a major strategy of pressure injury prevention, but health care providers do not frequently reposition patients as required. Wearable sensors are a technology that prevents the development of pressure ulcers by enabling providers to comply with repositioning protocols. Studies have demonstrated that wearable sensors heightened patient repositioning compliance and decreased the rates of occurrence of pressure injuries and associated cost of care. Quality Health Care Research Paper
References
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Borojeny, L. A., Albatineh, A. N., Dehkordi, A. H., & Gheshlagh, R. G. (2020). The Incidence of Pressure Ulcers and its Associations in Different Wards of the Hospital: A Systematic Review and Meta-Analysis. International Journal of Preventive Medicine, 11,171. doi: 10.4103/ijpvm.IJPVM_182_19
Clarkson, P., Worsley, P. R., Schoonhoven, L., & Bader, D. L. (2019). An interprofessional approach to pressure ulcer prevention: a knowledge and attitudes evaluation. Journal of Multidisciplinary Healthcare. 12, 377-386. doi: 10.2147/JMDH.S195366 Quality Health Care Research Paper.
Cortes, O. L., Herrera-Galindo, M., Villar, J. C., Rojas, Y. A., Paipa, M. P., & Salazar, L. (2021). Frequency of repositioning for preventing pressure ulcers in patients hospitalized in ICU: protocol of a cluster randomized controlled trial. BMC Nursing, 20, 121. doi: 10.1186/s12912-021-00616-0.
Crotty, A., Killian, J. M., Miller, A., Chilson, S., & Wright, R. (2023). Using wearable technology to prevent pressure injuries: An integrative review. Worldviews on Evidence-Based Nursing, 20(4), 351-360. https://doi.org/10.1111/wvn.12638
Deshpande, B., Hanumanthayya, M., & Niwas, R. (2023). Development of a Wearable Technology for the Early Detection of Pressure Ulcers in Nursing Homes. Salud, Ciencia y Tecnología, 3(S1):458doi: 10.56294/saludcyt2023458
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Quality Improvement:
Decreasing Medication Errors using Barcode Scanning
University of South Alabama
Quality Improvement:
Decreasing Medication Errors using Barcode Scanning
Medication errors cause injury, disability, birth defects, and death to a large number of patients every year. They account for over 100,000 reports sent to the U.S. Food and Drug Administration (FDA) each year (FDA 2019). Quality improvement can assist with decreasing these errors by putting a focus on continually improving processes for medication handling (Marquis & Huston 2017). Barcode scanning medication administration (BCMA) is one way of decreasing medication error. This system uses barcodes on medications and patient armbands with scanning equipment and an electronic medication administration record (eMAR) to correctly identify the right patient, right drug, right dose, right time, and right route (FDA 2019). Human elements can occur, and more support systems are needed to assist in the verification of the five rights (Grissinger 2010). The IOM (2000) To Err is Human report recognizes many medical errors that occur due to human elements causing a need for safer health system improvements. Quality improvements to healthcare systems and processes assist healthcare professionals and patients to work together to facilitate safer care (IOM 2000)Quality Health Care Research Paper. This quality improvement paper will further discuss the use of barcode scanning in medication administration to benefit the Institute of Medicine’s (IOM) six aims and goal of preventing medication errors, considerations when using barcode scanning, and patient-centered care to improve the process.
The Problem
Medication errors can happen in all stages of the medication operation, from prescribing to administration and are characterized as a patient taking a medication other than what the provider prescribed. One of the most significant amounts of errors occurs in the administration phase, with thirty-four percent of all errors occurring in this phase (Voshall, Piscotty, Lawrence, & Targosz, 2013). The five rights of medication administration have always been standard practice and are an excellent tool for nurses to use to prevent medication error but lack troubleshooting suggestions when problems arise (Grissinger 2010). The IOM (2004) recommends medication administration be an initial work redesign in nursing practice to prevent medication error. The redesign will allow for more opportunities to prevent errors before occurring. Currently, only two percent of medication administration errors are intercepted prior to reaching the patient (Voshall et al. 2013). Problems with similar packaging, similar drug names, and similarities in drug labeling designs have been noted to cause medication error, causing the FDA to come up with guidelines to help manufacturers prevent these issues (FDA, 2019). The CDC has recognized the problem with medication errors creating a program for monitoring adverse drug events (ADEs) that occur due to medication error (CDC, 2017). These events count for $3.5 billion in spending on medical costs and approximately 350,000 hospitalizations each year (CDC, 2017)Quality Health Care Research Paper. The IOM (2006) committee found that the total number of preventable ADEs are at least 1.5 million per year in the United States alone. These ADEs are the cause of hospital-acquired injury and are the most common of injuries (Leung et al. 2015). The good news about this issue is that medication errors are preventable with continuous quality improvement helping to shape practice utilizing such technologies as BCMA. Good work here!
IOM Aims for Quality
Safety
Safety in practice continues to be a focus in healthcare as an aim for quality improvement and defined by the IOM (2001) as preventing harm to patients from practices designed to help them. The Joint Commission, known for high-quality standards, oversees the accreditation and certification of health care facilities in the United States. Every year the Joint Commission creates a report of patient safety goals for health care organizations to focus on, and using medications safely has consistently been on the list of goals (Joint Commission 2019). The IOM (2004) recommends one way to improve safety is to create and sustain a culture of safety amongst workers. To create a culture of safety, they suggest to clearly define safety goals, acknowledge successes, encourage error reporting, educate on error detection, and provide feedback to increase safety (IOM 2004)Quality Health Care Research Paper. Great job on this paragraph!
Medication safety is a complex process affected by many different outside elements. Barcode administration technology can improve the medication process by improving medication administration safety. Marcias, Bernaneu-Andreu, Arribas, Navarro, and Baldominos (2018) found that barcode administration system decreased the number of errors and the severity of their impact using a pre/post-intervention study. To provide safe quality care, this technology needs to be recognized and introduced as a tool, not in place of nursing assessment, skills and judgments when administering medications (Bowers, et al. 2015).
Effectiveness
The IOM defines effectiveness as an aim to providing care based on scientific knowledge and avoiding redundant or unnecessary services (IOM 2001). Medication barcode scanning has helped streamline, simplify, and standardize the medication administration process, making it more effective (Leung et al. 2015). When using barcode scanning, documentation becomes more effective by ensuring real-time charting of medications on the electronic medication administration record (eMAR) (Leung et al. 2015)Quality Health Care Research Paper. Based on a systemic review comparing medication error prevention, barcode scanning has shown to decrease errors (Berdot, Roudot, Schramm, Katsahian, Durieux, & Sabatier 2015). In contrast, self-guided education and a designated medication nurse showed no change in errors found (Berdot et al. 2015). Good!
Efficiency
The best way to improve efficiency, as recommended by the IOM (2001), is by decreasing quality waste and minimizing administrative and production costs. Waste is considered using additional resources without patient gain (IOM 2001). In a letter to state Medicaid Directors, Kuhn (2008), Deputy Administrator for Center for Medicaid and State Operations, explains in detail the recommendations for Medicaid and Medicare Services (CMS) to no longer pay for events that are considered Never Events, following with a list of all events considered Never Events. Medication error causing death or disability is on this list (Kuhn 2008). Lack of reimbursements to injuries caused by medication error causes loss of revenue and creates an initiative to decrease errors. Organizations may assume the upfront cost of BCMA is too much, and they are unable to rationalize the usage of BCMA, but a cost-benefit analysis shows the breakeven point occurs in the first year (Voshall et al. 2013). This is due to the substantial cost of medication errors and the amount of savings on decreasing these errors once BCMA is implemented (Voshall et al. 2013)Quality Health Care Research Paper. Well done here!
Equity
Equity in healthcare is defined by the IOM (2001) as equal services to benefit all people in the United States. Unfortunately, throughout the U.S., there are still inequities in care due to lack of health insurance and prejudice. This can be seen amongst hospital systems with a lack of technology and processes to increase patient safety. Even though the recommendation for barcode scanning by the American Society of Health-System Pharmacists (ASHSP) occurred, only 35% of American hospitals have implemented this system (Berdot et al. 2015). This causes inequity in the care given to those in hospitals without BCMA. The Leapfrog Group (2017) operates as a not-for-profit watchdog organization whose goal is to foster change in U.S. healthcare by requesting hospital transparency to influence value-based care. They have implemented a standard for all hospitals to implement a BCMA in all med-surg and critical care units with compliance reporting and best practice processes (The Leapfrog Group 2017)Quality Health Care Research Paper. This will help improve equity by actively encouraging all hospitals to implement the BCMA system to decrease medication errors, lowering adverse outcomes for patients. Change is hard to enforce and may cause push back by nurses when implementing BCMA, but a descriptive study showed a substantial level of nurse satisfaction when using the system (Voshall et al. 2013). More research is required to verify the reduction of medication errors using BCMA to help hospitals reach readiness for change to increase the implementation of BCMA. Great job here!
Timeliness
Timeliness is significant in every aspect of life, and healthcare must take responsibility to cut time off every process to improve workflow, decrease patient complications from a delay of care, reduce emotional stress from waiting, and increase respect for patient’s time (IOM 2001). Timeliness in medication administration is essential to improve nurse workflow and administer medications properly within a timeframe of 30 minutes before and 30 minutes after the medication is due, a standard that varies with individual hospital policy. Some nurses may be skeptical of BCMA due to a worry of an increase in time used to administer medications. A before-and-after study was done using direct observation concluding that the time taken when using bar-coding was unchanged (Voshall et al. 2013). When administering medications, the timing of those medications need to be considered and collaborated with the prescriber, nurse, and pharmacist. This is important when implementing BCMA as it is essential to have a user-friendly system and allow for easy modification of administration time due to unforeseen events. This is only to increase compliance as the influence of BCMA on wrong time errors, which aren’t as clinically significant, is unclear (Shah, Lo, Babich, Tsao, & Bansback 2016)Quality Health Care Research Paper. Good!
Patient-centered
The aim patient-centeredness concentrates quality efforts on increasing patient overall experience of healthcare and systems that create success or spotlight those that fail to focus on patients (IOM 2001). The IOM (2006) states the first step to improving outcomes, quality, and preventing medication error is to encourage the patient to participate, be connected, and pay attention to the care given by providers. The relationship between patient and provider should be more of a partnership. The healthcare team should use communication with the patient as a two-way street (IOM 2006). Listening to the patient needs to become a top priority as it helps the provider give more personalized care. Education is another tool that can be used to include the patient. Medication uses, side effects, contraindications, proper administration time, and tips to improve effectiveness need to be standard education topics to improve the overall health of the patient (IOM 2006). In turn, the patient and their family should take responsibility for keeping medication records and being involved in the administration process during hospitalization.
Planning and Collaboration
Interdisciplinary Teams
The team needed to implement BCMA is a collaboration between pharmacy, nursing, and Information Technology (IT). The technology required for BCMA will require an efficient wireless network needing IT to implement, maintain, and troubleshoot problems with all technology and wireless network (Ross 2008). Pharmacy is necessary to stock and verify medications, adjust medication orders to align with exact medication type (capsule vs. liquid, for example), adjust medication schedule when complications interfere and answer administration, interaction, and medication questions as they arise (Ross 2008)Quality Health Care Research Paper. Nurses carry out the task of medication administration using BCMA with the support of Pharmacy and IT. As previously stated, it is crucial to include patients as part of the team by educating them in the process of BCMA to increase autonomy and give them a sense of responsibility to help achieve safe care (IOM 2006). Ross (2008) found this collaboration and efficient communication between Nursing, Pharmacy, and IT was critical for the execution of BCMA. Good job here!
Information and technology
The BCMA system relies on several different technology systems to work together, creating one fluid system, including an automated medication dispensing cabinet, electronic medical record with an eMAR, medication labeling and packaging system in pharmacy, and a correct patient armband with readable barcode. Workstation computers will be needed at every patient bedside, or workstations on wheels (WOWs) will be required to bring the technology to the bedside. Nurses may have difficulty using WOWs due to the system in need of adequate battery charge or lack of access to WOWs when needed. As previously stated, medication records need to allow documentation of the exact reason for medications being late and allow time adjustments from a set schedule to ensure nurse compliance of BCMA use (Strudwick et al. 2018). This can be used when the patient is unable to take medications because of vomiting, off the unit for a procedure, or the wrong schedule began with the original order. Nurse and patient education on technology are essential for proper usage of BCMA to increase compliance, decrease workarounds, and decrease medication errors (Strudwick et al. 2018)Quality Health Care Research Paper. Great work
Quality Improvement
Medication errors can be tracked by nurse reporting, reviewing patient medical records, or through direct observation. Nurse reporting can be biased due to a lack of knowledge of error or fear of termination (Berdot et al. 2015). Reviewing charts is an ineffective way to detect medication errors due to the lengthy time it takes to go through every chart (Berdot et al. 2015). This leaves direct observation as the best measure of error during the study (Berdot et al. 2015). Nurses may change practice when observed, but when observed before and after the intervention, outcomes will show equal improvement during both measures (Berdot et al. 2015). When BCMA is implemented, barcode scanning rates need to be monitored for noncompliance and workarounds to point out the clinical areas in need of further education and reinforcement of the importance of use (Strudwick et al. 2018). The Healthcare Information Management Systems Society (HIMSS) recommends the usage of BCMA to decrease medication errors with a scanning rate of 95% and above on patient armbands and medications (Strudwick et al. 2018)Quality Health Care Research Paper.
Evidence-based
Nurses have a direct link to how effective and successful BCMA is to decreasing medication errors. Workarounds are ways nurses use shortcuts and bypass proper steps to using BCMA technology. These can include silencing alerts without addressing them, using a medication label or patient armband other than the original, and manually entering information if the technology isn’t working without using proper troubleshooting mechanisms (ASHP 2018). This is when monitoring user compliance is vital to decreasing medication errors using BCMA (ASHP 2018). More research is required to formulate standards for educating nurses to use BCMA and to reduce workarounds (Strudwick et al. 2018). A systematic review done by Voshall, Lawrence, Piscotty, and Targosz (2013) showed that BCMA has been successful in preventing medication errors, and improving the quality of patient care as well as decreasing healthcare costs. Another systematic review by Shah, Lo, Babich, Tsao, and Bansback (2016) concluded that BCMA helps improve checking of patient identification and decreases significant medication errors.
Conclusion
The IOM aims have helped to shape quality improvement in the U.S. healthcare system and decrease medication errors. Medication errors have substantial consequences for patient outcomes and are costly for healthcare. Studies show BCMA technology reduces medication errors and improves patient quality of care. This can decrease cost long term if compliance is monitored, and standards are followed. More research is needed to create BCMA’s best practices and find processes that improve nurses’ use of workarounds. Continued support for BCMA is required to increase hospitals’ desire to invest in technology in their organization to increase equity of care. Using a collaborative team, including the patient at the center, will help the efficiency of BCMA to reduce medication errors. Continuous quality improvement is necessary to increase compliance of BCMA use, create a culture of safety, and reduce medication errors. Quality Health Care Research Paper
References
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