Exploring EBQ Quality Improvement

Part 1: Key Project Elements

Acute Care Hospital

The services provided in an acute care hospital include inpatient and outpatient services, nursing, pharmacy, food, and ancillary services. Other services, such as surgery, interventional, obstetrics, and nursing, benefit patients. In an acute care hospital, the hypothetical practice problem that will be addressed is medication error. An evidence-based quality improvement is to be implemented to solve the problem by promoting patient safety, improving the quality of their care, and positively impacting the healthcare industry.

Hypothetical Problem Identified

The hypothetical problem identified in this site is medication error. Medication errors are a significant challenge in healthcare administration. There is a direct relationship between medication error and patient’s hospitalization. Medication errors arise because of failure to adhere to the five “rights” of medication administration: patient rights, medication, time, dose, and route (Hanson & Haddad, 2022). The five rights were established to promote patient safety in medication. In addition to the rights, documentation, action, form, and response were included to contribute to the medication administration process. However, medication errors remain challenging in acute care hospitals because of inadequate training, system failure, complex processes, and distractors. The problem requires evidence-based quality improvement because the outcome of medication error has severe implications on a patient’s life, negatively impacting hospitals.

Stakeholders Involved

In implementing an evidence-based quality improvement project, some critical stakeholders must be part of the project to address the hypothetical issue effectively. The hospital administration for acute care is vital in promoting patient safety by addressing medication errors because they occur within their premises. The hospital administration can contribute to improving patient safety by allocating resources that can help to implement the evidence-based quality improvement plan. Acute care hospitals can also promote governance by ensuring the project is implemented successfully. Physicians have a role to play in medication management.

On the other hand, nurses help administer medication as physicians prescribe and actively care for patients (Gebremariam et al., 2023). Pharmacists should ensure the proper medication is given and safe for the patient’s consumption. They are also responsible for safe medication practices. The quality improvement team promotes quality improvement initiatives, such as evidence-based quality improvement plans, to address the hypothetical problem. Patients and their families are also stakeholders involved in tackling the challenge of medication error at acute care hospitals. They should ensure they follow medication instructions to prevent medication errors.

Interventions for Medication Error

Three intervention programs can be included to improve medication errors as part of an evidence-based quality improvement project. The interventions include electronic systems, patient-centered interventions, and inter-professional education. Electronic systems have been proven to be effective in addressing medication errors. Electronic systems are equipped with healthcare information systems and combined with clinical decision support, which makes it easier to diagnose and make medication decisions. Electronic systems tend to be error-resistant and are more accurate in making medication diagnoses and treatments because of the health information fed into their systems. Electronic systems provide intervention for overall medication error, making it practical for implementation. Humans are also responsible for medication errors. Equipping physicians and nurses with educational training on how to administer medication effectively provides a solution to medication errors. Inter-professional education allows students to work with healthcare professionals, thus equipping them with knowledge and skills in effective medication, reducing medication errors at hospitals (Marshall et al., 2020). Patient-centered interventions focus on patient outcomes. Therefore, medication administration is based on the patient’s preferences and needs.

Steps for Plan-Do-Study-Act (PDSA) Cycle

Plan

• Identify the problem
• Establish SMART objectives
• Determine evidence-based interventions to address the problem
• Implementation strategies ( resources, timeline, and stakeholder’s roles)

DO

• Implementation of intervention programs
• Training of staff for new procedures and skills
• Monitoring the implementation process

Study

• Data collection of medication errors before intervention programs
• Determine the effectiveness of intervention programs
• Determine unexpected outcomes of the interventions

Act

• Determine the effectiveness of the intervention programs
• Implement a more extensive organizational set-up
• Seek alternatives in case the interventions fail
• Monitor and evaluate the intervention implementation to determine its outcome in the long run, adjusting where possible.

Acute Rehab Hospital

Acute rehab hospitals are sites for patient’s recovery suffering from disabling injuries, illnesses, or diseases that take time to heal and need specialized care. Patients with brain injury, stroke, spinal cord injury amputation, fracture of the femur, and neurological disorders, among other acute conditions, are taken to acute rehab hospitals to aid them in recovery. Patients in acute rehab hospitals are vulnerable to medication error, which is a risk to their well-being, considering their acute conditions. Patients in rehabilitation wards require constant medication to assist in managing their conditions (Suzuki et al., 2022). Thus, it is critical to facilitate effective medication administration to help them recover.

Hypothetical Problem

The hypothetical problem experienced in acute rehabilitation hospitals is medication error. Medication management is done by patients and medical professionals, especially nurses. Patients in acute conditions find it challenging to manage their medication because of their conditions. When taking medication that involves narcotics, patients with acute conditions must be assisted by medical professionals such as nurses. Despite the assistance of nurses in helping acute patients take their medication, medication is still prevalent in acute rehabilitation hospitals, such as taking the wrong medication and missing medication. Outpatient self-management is also associated with medication errors because of the complexity of prescriptions and the number of days required for administration each day, posing a challenge to practice effective medication among patients tackling acute conditions (Meng, Chao, & San San, 2021). As a result of medication errors, the costs of medical care increase, leading to a health economic problem.

Stakeholders

The stakeholders in acute rehabilitation hospitals include the hospital administration, clinical staff, quality improvement team, and patients and their families. The hospital administration supports the implementation of evidence-based intervention programs to improve patients’ quality outcomes by providing resources and governance and creating appropriate policies that support the implementation of the interventions in the hospital. The clinical staff in acute rehabilitation hospitals include nurses, physicians, therapists, and other clinical practitioners in charge of care management in the hospital setting. The collaboration of the clinical team helps successfully implement the intervention plan. The quality improvement team contributes to managing and controlling quality improvement plans in the hospital to promote change. Patients and families contribute to promoting patient-centered care in the hospital setting, where their experiences and feedback provide crucial information required to promote medication error intervention solutions.

Interventions

Self-administration of medication is an intervention program aimed at shifting the responsibility of medication to patients with the ability to handle their medication. Self-administration of drugs helps promote patient-centered care by allowing patients to manage care. However, nurses need to determine the capability of chronic patients to manage their medication without struggles. SAM program effectively provides rehabilitation care that acute patients undergo to recover. SAM program helps to reduce medication errors and make patients comply with their medication, thus impacting their well-being and recovery. SAM program has been associated with patient and staff satisfaction in healthcare. Apart from the SAM program, other intervention programs applied at acute rehabilitation hospitals include electronic systems and inter-professional education to promote patient safety.

Steps for EBP Model of Implementation

1. Introduction of the EBP quality improvement plan
2. Assessing the current practice and its effectiveness
3. Identifying evidence-based practices and the best interventions
4. Setting goals and objectives for medication error solutions
5. Engagement with stakeholders
6. Implementation of the intervention programs and monitoring
7. Evaluation and continuous assessment of the intervention success

Patient Psychiatry Hospital

Patient psychiatry hospitals provide mental health services, rehabilitation, and counseling services aimed at promoting the well-being of patients. Patient fall is a common phenomenon experienced among inpatients in psychiatry hospitals. Falls in psychiatry hospitals can be between 13-25 in 1000 hospital days (Carpels et al., 2022). Hospital falls tend to increase patient mortality rates. Falls are a result of intrinsic and extrinsic factors. Falls may result in brain injury, bruising, and damaging soft tissue, leading to a negative health impact on the patient.

Hypothetical Problem

The hypothetical problem is that patients fall in psychiatric hospitals. Patients in psychiatric hospitals need care management to help improve their mental conditions. Preventing hospital falls reduces brain, spine, and tissue injury cases that increase patient mortality rates. Developing fall intervention programs that are proven to be based on evidence-based practice is essential in promoting the well-being of patients in psychiatry homes.

Stakeholders

The stakeholders in implementing the EBP quality improvement project as an intervention for fall incidents in psychiatry hospitals include the hospital administration, psychiatrists and mental health professionals, patients and their families, and the quality improvement team. Hospital administrators are essential in promoting patient safety. Hospital management has to provide the proper support, including resources, and develop policies that allow effective implementation programs. The patients and their families contribute to the improvement process through their experiences and feedback, which enables the hospital to create appropriate and best practices for the intervention programs. The hospital team, including psychiatrists and mental health professionals, helps foster patient safety and care. The healthcare professionals at the psychiatry hospitals provide valuable feedback on readmission factors, which helps in decision-making at their facility. The quality improvement team contributes to overseeing the quality improvement plan aimed at creating change in the organization. They evaluate and monitor its success to determine its effectiveness in tackling fall challenges at the psychiatry hospital.

Intervention

Preventing falls in psychiatry hospitals requires patient monitoring practices. Patient monitoring practices allow nurses to take an active role in monitoring patients, especially in environments prone to falls, such as bathrooms. Nurses can also conduct hourly rounds to check on patients, provide sitters for patients at risk of falls, and schedule toileting to prevent falls among mentally ill patients (Turner et al., 2022). Patient safety practices also prevent frequent falls among patients. Psychiatry patients can also be educated on fall prevention, including their families, to help promote self-management care among patients contributing to patient-centered care.

Steps for EBP Quality Improvement Implementation

The model used for the improvement implementation will be the Steps for Plan-Do-Study-Act (PDSA) Cycle.

Plan

1. Defining Goals and Objectives of the Fall Intervention Program
2. Developing an implementation plan

Do

1. Implementing the fall implementation programs
2. Establishing open communication among healthcare workers

Study

1. Collecting data for the fall intervention program
2. Evaluating the program’s effectiveness
3. Assessing feedback from stakeholders

Act

1. Monitoring and control of the program implementation
2. Adjusting where necessary
3. Scaling up to a large psychiatry unit for implementation after the program’s success

References

Carpels, A., de Smet, L., Desplenter, S., & De Hert, M. (2022). Falls among psychiatric inpatients: a systematic review of literature. Alpha psychiatry, 23(5), 217. doi: 10.5152/alphapsychiatry.2022.21735

Gebremariam, S. N., Sema, F. D., Jara, A. G., Mekonen, B. T., & Mekonnen, G. A. (2023). Medication error and associated factors among adults admitted to emergency ward at the university of Gondar comprehensive specialized hospital, North-West Ethiopia: a cross-sectional study, 2022. Journal of Pharmaceutical Policy and Practice, 16(1), 148. https://link.springer.com/article/10.1186/s40545-023-00616-2.

Hanson, A., & Haddad, L. M. (2022). Nursing rights of medication administration. In StatPearls [Internet]. StatPearls Publishing.

Marshall, C., Van Der Volgen, J., Lombardo, N., Hamasu, C., Cardell, E., & Blumenthal, D. K. (2020). A mixed methods approach to assess the impact of an interprofessional education medical error simulation. American Journal of Pharmaceutical Education, 84(2), 7133.

Meng, K. K., Chao, W. T., & San San, T. (2021). A novel program of self-administration of medications within an acute inpatient rehabilitation unit. Proceedings of Singapore Healthcare, 30(2), 131-137. https://journals.sagepub.com/doi/full/10.1177/2010105820960168

Suzuki, R., Uchiya, T., Nakamura, A., Okubo, N., Sakai, T., Takahashi, M., … & Ohtsu, F. (2022). Analysis of factors contributing to medication errors during self-management of medication in the rehabilitation ward: a case control study. BMC Health Services Research, 22(1), 292. https://link.springer.com/article/10.1186/s12913-022-07679-y

Turner, K., Staggs, V. S., Potter, C., Cramer, E., Shorr, R. I., & Mion, L. C. (2022). Fall prevention practices and implementation strategies: examining consistency across hospital units. Journal of patient safety, 18(1), e236-e242. doi: 10.1097/PTS.0000000000000758