Quality Improvement Initiative Evaluation Essay.

Preparation

Deliver a 5–7-page analysis of an existing quality improvement initiative at your workplace. The QI initiative you choose to analyze should be related to specific disease, condition, or public health issue of personal or professional interest to you.Quality Improvement Initiative Evaluation Essay.

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Too often, discussions about quality health care, care costs, and outcome measures take place in isolation—each group talking among themselves about results and enhancements. Because nurses are critical to the delivery of high-quality, efficient health care, it is essential that they develop the proficiency to review, evaluate performance reports, and be able to effectively communicate outcome measures related to quality initiatives. The nursing staff\’s perspective and the need to collaborate on quality care initiatives are fundamental to patient safety and positive institutional health care outcomes.Quality Improvement Initiative Evaluation Essay.

You have been asked to prepare and deliver an analysis of an existing quality improvement initiative at your workplace. The QI initiative you choose to analyze should be related to a specific disease, condition, or public health issue of personal or professional interest to you. The purpose of the report is to assess whether specific quality indicators point to improved patient safety, quality of care, cost and efficiency goals, and other desired metrics.Quality Improvement Initiative Evaluation Essay.

Your target audience consists of nurses and other health professionals with specializations or interest in your selected condition, disease, or issue. In your report, you will define the disease, analyze how the condition is managed, identify the core performance measurements used to treat or manage the condition, and evaluate the impact of the quality indicators on the health care facility.Quality Improvement Initiative Evaluation Essay.

The numbered points below correspond to grading criteria in the scoring guide. The bullets below each grading criterion further delineate tasks to fulfill the assessment requirements. Be sure that your Quality Improvement Initiative Evaluation addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels that relate to each grading criterion.Quality Improvement Initiative Evaluation Essay.

Please address #1-4 in the paper. section 1 should address #1 and bullet points under it, section 2 should address #2 and bullet points under it, etc..

1. Analyze a current quality improvement initiative in a health care setting, and identify knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty.
   • Evaluate a QI initiative and explain what prompted the implementation. Detail problems that were not addressed and any issues that arose from the initiative.Quality Improvement Initiative Evaluation Essay.
2. Evaluate the success of a current quality improvement initiative through recognized benchmarks and outcome measures, and identifies assumptions on which the analysis is based.
   • Analyze the benchmarks that were used to evaluate success. Detail what was the most successful, as well as what outcome measures are missing or could be added.
3. Incorporate interprofessional perspectives related to initiative functionality and outcomes, and identifies areas of uncertainty, knowledge gaps, and additional information that would be needed in order to gain a more complete understanding.
   • Integrate the perspectives of interprofessional team members involved in the initiative. Detail who you talked to, their professions, and the impact of their perspectives on your analysis.Quality Improvement Initiative Evaluation Essay.
4. Recommend additional indicators and protocols to improve and expand quality outcomes of a quality initiative, and impartially explains the pros and cons of these recommendations.
   • Recommend specific process or protocol changes as well as added technologies that would improve quality outcomes.
5. Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
6. Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.Quality Improvement Initiative Evaluation Essay.

Submission Requirements

• Length of submission: A minimum of five but no more than seven double-spaced, typed pages.
• Number of references: Cite a minimum of four sources (no older than seven years, unless seminal work) of scholarly peer reviewed or professional evidence that support your interpretation and analysis.Quality Improvement Initiative Evaluation Essay.
• APA formatting: Resources and citations are formatted according to current APA style and formatting.

Attached is the paper directions, scoring guide, and suggested but not required resources.

Evaluation of a Quality Improvement Initiative in a Healthcare Organization: Meeting the Six Domains of Healthcare Quality by Curbing Nursing Errors

The concept of quality is a reality that first emerged in manufacturing industries that produced tangible products. The focus in these industries was to produce products that were identical in every respect including functionality. When one product differed with the rest in terms of how it functioned, that was considered a defect and a blemish on its quality. This concept of quality was later on adopted by service organizations and industries such as the healthcare industry. However, it is not as easy to determine the quality of services as it is with tangible products due to the intangibility of services.Quality Improvement Initiative Evaluation Essay. Another factor is that the recipient of a service participates in the delivery of the service and therefore their perception of the same also determines the quality of the service. Lately, quality has become a very important consideration in the delivery and consumption of healthcare services. The Institute of Medicine (IOM) mentions six important domains or characteristics of healthcare quality. These are that healthcare services should be safe, effective, patient-centered, timely, efficient, and equitable (Tzelepis et al., 2015; Beattie et al., 2014). This means that the healthcare services should not cause harm to the patient, should be based on established evidence of efficacy (evidence-based practices), should put the patient first (respect them and their preferences, culture, and wishes), should be delivered at the required time without wastage in labor and other resources, and should be non-discriminatory. Many healthcare institutions, as a result, have come up with quality improvement initiatives to better their healthcare services and meet these quality requirements. This paper evaluates one such quality improvement initiativeby a healthcare organization.Quality Improvement Initiative Evaluation Essay.

Analysis of the Quality Improvement Initiative in a Healthcare Setting

The quality improvement (QI) initiative was prompted by reports and verification of rampant nursing errors with regard to drug administration in the institution (dosing and wrong medication given to the wrong patient). There was a realisation that this seriously compromised the safety of the patients and lowered the quality of nursing care offered at the institution. It also dented the image of the institution and led to unfavorable patient ratings undertaken by Medicare in terms of quality of care delivered. Furthermore, it was obvious that these errors placed the institution at great risk of litigation and culpability on vicarious liability grounds. Action needed to be taken to right this situation. Quality Improvement Initiative Evaluation Essay.The best option was not to victimize the nurses and the nurse managers, but to undertake a quality improvement initiative aimed at bettering the structures and processes for better outcomes. For this, the QI model known as FADE was chosen for the task.FADE is an acronym for Focus (the process is defined and the processes that need to be improved as well), Analyze (data is collected and analyzed to identify the nature of the problem and propose possible solutions), Develop (action plans for quality improvement of the problem are formulated and measurement parameters arrived at), and Execute (the improvement plans are implemented and ongoing monitoring and evaluation started).Quality Improvement Initiative Evaluation Essay.

This quality improvement project was reactive and focused on intervention to better the nursing processes. This was also in appreciation of the fact that the Patient Protection and Affordable Care Act of 2010 or “Obamacare” required that the policy of ‘pay-for-performance’ (value-based payment) be implemented by all payers including Medicare (NEJM Catalyst, 2018). This means that providers must provide services whose quality is commensurate with the compensation/ reimbursement demanded. This expected value is measured periodically by patient outcomes and patient satisfaction surveys, often carried out by Medicare.Quality Improvement Initiative Evaluation Essay.

This QI initiative focused on the so-called nursing-sensitive indicators that are specific to nursing and that define quality by structure and processes. Structure and processes define or influence outcomes. According to the National Database of Nursing Quality Indicators (NDNQI), it reports the structure, process, and outcome indicators of nursing care quality. An example of the NDNQI process and outcome indicators that this initiative also examined is patient falls (Heslop & Lu, 2014; Lippincott Solutions, 2014). Some of the problems that could not immediately be addressed were the negative image that the nursing errors had brought to the institution and the fringe benefits required to motivate nurses to work with singular resolve.Quality Improvement Initiative Evaluation Essay. However, measures were put in place to address these in due course. One important issue that arose from this initiative during the ‘Analyze’ stage of FADE was that the nurse managers in the institution were harsh, authoritarian, and non-consulting. This made the work environment for the nurses be full of tension and lack psychological safety. They then became more prone to committing errors and also afraid to report any mistakes made for fear of victimization. The knowledge gaps and unknowns in this initiative were the overall impact of the nursing errors on the bottom line of the institution, the number of unreported cases of errors by the nurses due to fear of victimization, and the proportion of the nursing turnover that was a result of the lack of psychological safety at the institution’s workplace. Missing information and areas of uncertainty were represented by the patients who experienced these errorsbut chose not to report or complain and instead move on to other healthcare institutions. Lastly, the main unanswered question was why the nurses did not bypass the unit nurse managers and report the toxic work environment to a more senior person in the nursing hierarchy in the organization if they were afraid of them.Quality Improvement Initiative Evaluation Essay.

Evaluation of the Success of the Quality Improvement Initiative

The assumptions on which this analysis is based are that all nurses are motivated to care for patients and love their profession;nursing errors will only occur if there is a problem with the workplace environment; and nurse managers can motivate their workforce to achieve and even surpass organizational strategic objectives. During the QI initiative, it became clear that internal organizational factors tied to the nurses and the nurse leadership were the ones that were going to determine its success or failure (Abdallah, 2014). Some of the improvement plans that were proposed during the ‘Develop’stage of FADE and implemented during the ‘Execute’ stage were:Quality Improvement Initiative Evaluation Essay.

• New standard operating procedures and clinical guidelines to guide nursing care in the institution.
• Appointment of new tried and tested transformational nurse managers to replace the authoritarian ones.
• Enactment and adoption of new workplace policies that focus on bringing and maintaining psychological safety in all the healthcare institution’s units and departments.Quality Improvement Initiative Evaluation Essay.

Through the above interventions, the quality improvement initiative proved to be hugely successful. In the first three months since implementation,there was a significant reduction in the self-reported and patient-reported nursing errors in drug administration and overall nursing care. Apart from medication errors, patient falls due to non-vigilance of the nurses also decreased to almost none.Quality Improvement Initiative Evaluation Essay. The number of readmissions due to medication adverse effects as a result of nursing errors declined from 10% to just 4%, safety of care rose significantly, mortality recorded as a result of nursing errors dropped to zero, and patient experience improved by a large margin. These were the outcome measures and benchmarks that were used to evaluate for success of the quality improvement initiative. The outcome measures that were missing and that could be added were timeliness of care and effectiveness of care. The most successful of the benchmarks was the patient experience, which showed that patients had immediately noted a change in the way the institution’s nurses treated them and the overall improvement in nursing care.Quality Improvement Initiative Evaluation Essay.

Interprofessional Perspectives Related to Initiative Functionality and Outcomes

Nurses do not work alone in their delivery of healthcare services in the form of nursing care. They work in an interprofessional collaborative environment with physicians, nurse practitioners, therapists, pharmacists, radiologists,and dieticians among other healthcare professionals. During this quality improvement initiative, a physician, a radiologist, and a dietician were interviewed and they all gave their perspectives about the situation and the whole exercise. The physician praised the initiative and commented that it was long overdue since the rampant errors compromisedtheir work.Quality Improvement Initiative Evaluation Essay. He pointed out that many a times did he make a change to a medication thinking it was not working for a patient, only to realize later that the patient had been receiving the wrong dose of the drug and in a haphazard manner (sometimes the nursing care related to medication administration was not timely). On a personal level, he had lodged several complaints with nursing managers for them to look into the matter of medication errors by the nurses. The impact of the perspectives of the physician was far-reaching. As a matter of fact, part of the reason why this quality initiative was undertaken was the constant complaints that he lodged with the nursing leadership at the institution.Quality Improvement Initiative Evaluation Essay.

The radiologist also had nothing but praise for the quality improvement initiative which he also termed as long overdue. He had several anecdotes detailing how the nurses had failed to observe the instructions he gave for the nursing care of patients on whom contrast had been used during imaging. He was particularly disturbed by the case of a 45-year-old female patient who ended up developing acute kidney failureafter diagnostic imaging with contrast. An examination of the patient’s medical and nursing notes revealed that the nurses had neither monitored the patient as instructed nor reported that the patient was going into anuriaor renal shutdown on the night of the radiologic examination.Quality Improvement Initiative Evaluation Essay. He also lodged several complaints and his perspectives had a positive impact on this analysis by way of helping focus quality outcomes. Lastly, the dietician reported that many were the times that her random checks revealed that patients who had renal problems and on dialysis were being allowed by the nurses to take potassium-rich foods like bananas, patients with hypertension were allowed to take salty food, and obese patients allowed to take fatty junk foods brought from home. She wondered why the nurses allowed this when they knew very well the implications of these dietary actions on the recovery of the patients. She was also aware that the health education to these patients was supposed to come from the nurses who were caring for them. Her perspectives were very helpful in focusing on outcomes and evaluating the success of the QI.Quality Improvement Initiative Evaluation Essay.

The areas of uncertainty and knowledge gaps in all this centered on what impact the actions of the nurses (omission and/ or commission) had on the effectiveness of their roles as physician, radiologist, and dietician. Additional information to get a more complete understanding would be required with respect to why some of these omissions by nurses occurred. Was it that the instructions were ambiguous or unclear? Was it that they thought it was not their duty or work but that of the other interprofessional team members?Quality Improvement Initiative Evaluation Essay.

Recommendation of Additional Indicators and Protocols

To improve and expand quality outcomes of the quality improvement initiative, the additional quality indicators that can be recommended are patient satisfaction with medical information given, nurse job satisfaction, patient satisfaction with nursing care, and patient satisfaction with the overall care. The pros of these recommendations are that they broaden the impact of the QI on the organization and enable no stone to be left unturned in the quality improvement process. The cons, on the other hand, are that nurses may feel targeted, misunderstood, and unappreciated by virtue of their performance being examined so closely. Lastly, upskilling of the nursing workforce for them to be able to use the latest technological innovations in healthcare will go a long way in helping improve the quality of nursing care provided in my healthcare institution.Quality Improvement Initiative Evaluation Essay.