The delivery of health services to patients occurs within a complex environment defined by interactions between a variety of different elements, including policies, procedures, technology, doctors, resources, and the illness process itself. When these complicated components combine, unexpected and negative results such as drug mistakes might occur. Faults in a healthcare setting result from human error, defined as the failure of a series of physical and mental processes to be accomplished efficiently and adequately. As a result, it’s worth mentioning that everything related to healthcare is intricate. Consider the complexity of organizations, patient requirements, the complexity of healthcare technology, and the complexity of patient reactions to therapeutic treatments. Notably, there are several problems and possibilities to enhance the safety and quality of healthcare.
There is enough evidence that implementing a medical safety standard in any business is difficult (Ulrich and Kear, 2014). The health organization and institution must enhance or replace current systems. Modification and adjustment of the systems will need the cooperation of the folks who will be receiving the services (Karra et al., 2017). Medical staff modifications in health care organizations will permit a decrease in medical mistakes. Changes and modifications must be made to deliver exceptional healthcare services and achieve good outcomes. The initiative proposes to enhance communication between the different health agencies and people responsible for providing health services. The initiative proposes to provide competent service for prescribing, distributing, and administering medications. This is all to help eliminate medical mistakes and improve health care services (Raban and Westbrook, 2014).
The significance of this suggestion is to go into depth into the reasons for medical mistakes made by medical practitioners, particularly nurses, and to analyze methods for preventing pharmaceutical errors (Kim and Bates, 2013, p.590). The initiative will assist in identifying risk factors for medical mistakes over time. The data for this report will be derived from the general jurisdiction’s examination of fatalities and mental illnesses and territorial medical mistakes mortality evaluations (Roughead et al., 2016).
Aim of this proposal
This quality improvement project’s objective is to enhance the department of medicine and healthcare. This initiative is more established in its objective of defining and recommending strategies for reducing medical mistakes in society (Raban and Westbrook, 2014, p.414). Additionally, this will help minimize the effects of medical blunders—medications aid in the relief of symptoms, enhancing life quality, and treating illnesses. However, drugs are associated with pharmacological and human error incidents that have a detrimental influence on human life (Roughead et al., 2016). The project will be guided by input from various stakeholders in a variety of health care facilities. This will contribute to the enhancement of the medical system and the quality of service provided to patients (Ulrich and Kear, 2014).
The project’s strategies are projected to reduce the rate of mortality and complications caused by pharmaceutical errors. Appropriate training of the health care workforce will facilitate the delivery of advice to patients. Patient records will be maintained, which will facilitate the medical group’s rapid response in the case of a crisis. With meticulous record-keeping, there is little likelihood of making pharmaceutical errors. The proposal includes a process for increasing the medical staff in clinics (Graban and Toussaint, 2018). This will guarantee that patients get enough follow-up. This implies that medicine administered onwards is not combined since there are sufficient people to cope with prescription allotment and management. Instruction to the community helps them to gain knowledge about the drugs prescribed.
What research evidence exists to support your proposed change?
Like any other nation, Australia has its share of medical blunders and unfavorable outcomes (Roughead et al., 2013). The majority of medication mistakes are caused by professional practice, health goods, processes, and systems (Jee and Kim, 2013, p.123). Health organizations must devise a method to ensure safe prescription, dispensing, proper administration, and medication management. Successful drug prescriptions, administration, and dispensing include a variety of professionals from several departments (Tariq, 2018). The patient is the focal point of drug management. Medication management provides a framework for identifying possible problems and providing remedies (Tariq, 2018). It has been shown that nearly 70% of drip medicine administrations include clinical mistakes (Burroughs et al., 2007).
Medical blunders are becoming a growing problem in Australia (Roughead et al., 2013). There have been around 469 documented medical occurrences, most of which are caused by medical mistakes. This outcome is linked to a failure to read or a misunderstanding of patient documents, prescriptions, or the presence of imprecise or incomplete directions (Keers et al., 2013, p.1050). Error rates in administration vary between 15% and 20%. This rate is determined by the ward stock system (Keers et al., 2013, p.1050). This is the location of the ward’s massive supply for several patients. Between 5% and 8% of mistakes occur during administration when hospital pharmacists accurately measure and distribute the appropriate amounts for individual patients (Ulrich and Kear, 2014).
Prescription-related medical mistakes occur as a consequence of incorrect data being transferred from one medication record to the next (Keers et al., 2013, p.1063). 0.6 percent of mistakes occur due to missed doses, 1% as a result of incorrect prescriptions, and 0.5 percent as a result of confusing guidelines for medication administration (Jee and Kim, 2013, p.124). Around 70%–75% of medical mistakes occur as a result of allergies in Australia (Keers et al., 2013, p.1062). A medical mistake is a problem that primarily affects hospitalized patients. Changes must be made to the healthcare system. Numerous attempts have been made to reduce the case-to-population ratio (Jee and Kim, 2013, p.127). The system’s gains have not been maintained, and attempts to create further changes to preserve the change have not been evaluated (Ulrich and Kear, 2014, p447). Due to a lack of review and maintenance, the ideal condition of healthcare, particularly in the administrative sector, has remained unachieved.
According to research, numerous deaths have been reported in Australia’s homes and hospitals. The number of deaths caused by medical mistakes continues to rise (Roughead et al., 2016). With the execution of the project’s initiatives, it is anticipated that the incidence of medication-related fatalities and complications will decrease. Education of health staff enables the delivery of teaching to patients to be more easily accomplished. Patient records will be maintained, enabling the medical team to respond more quickly in the event of an emergency. There is no possibility of drug mistakes with proper record keeping. The project’s objective is to boost hospital staffing levels (Graban and Toussaint, 2018). This will guarantee that patients are appropriately followed up. This will ensure that medication is not jumbled in the wards since there will be sufficient staff to manage drug distribution and administration. Education provides the population with the information necessary to ask pertinent questions regarding the medications prescribed.
Identification and involvement of stakeholders
The government’s and non-governmental organizations’ involvement will be increased. This is critical to the project’s success since it strengthens the project’s objectives. They will be contacted individually to help in the project’s execution. Additionally, they will aid with finance and recruiting efforts (Burwell, 2015, p.897). The project’s adoption would be facilitated by including both public and commercial sector players. All stakeholders will convene meetings and seminars to reinforce and implement any improvements, remove impediments, and stay current on any new methods for a more effective and improved health care system with few to no medical mistakes (Grol et al., 2013). There will be the launch of a standard project emphasizing the need for more precise ways of recording and storing patient health information history (Roughead et al., 2016). Having thorough and precise information on a patient enables the pharmaceutical prescription process to be improved (Ulrich and Kear, 2014, p.448).
What specific QI methods or tools will you utilize?
Always place a premium on patient outcomes in healthcare. The outcomes should demonstrate a dedication to the patient’s quality and safety. This should take precedence over all other considerations. Patient quality may be maintained while avoiding staff distress and stress. Utilizing SIEPs and flowcharts, the quality improvement plan was developed (Wong, 2013). By using these methods, quality improvement has developed a strategy for reporting all drug mistakes, automating the transmission of information through the computer and electronic systems, and changing the hospital’s culture around emergency wait times.
This healthcare institution can rectify this situation regarding lab test findings. This is accomplished by providing stronger criterion designations, such as a deadline for reporting the findings and notifying the ordering physician when the results are available utilizing the process mapping tool. This simplifies the procedure and ensures the hospital’s safety. In terms of wait times, this should imply a shift in the culture of the emergency room. In the institution, waiting times must be prioritized. This indicates that the hospital’s policy must be adjusted to address the factors contributing to longer wait times.
Additionally, the hospital must be ready to spend time and money on solutions that would expedite care delivery, such as an automated scheduling system similar to the lab difficulties. Automated medicine administration is a standard practice in most hospitals and should be introduced at Thunder Hospital. The quality assurance team intends to use checklists to monitor care. Checklists and lists may assist in rapidly resolving any minor difficulties that may occur. (Johnson and Sollecito, 2018). One of the quality improvement team’s objectives is to save the hospital money and seek funding from organizations that will assist in implementing and funding quality improvement.
What measures will determine if the change(s) made during your proposal would make an improvement?
It is evident that the health industry is under pressure to modernize, enhance, and automate its procedures for monitoring medication-related difficulties to reduce medical mistakes (Roughead et al., 2016). This enables the evaluation of each individual’s medical history. The range and efficacy of indicators used to determine the causes of medical mistakes should be expanded (Keers et al., 2013, p.1066). The most effective method of improving the medical system and avoiding medical mistakes is for all practitioners at a health center to work together (Kim and Bates, 2013, p.592). This improves their ability to communicate. Additionally, this will keep all members engaged in the sector and informed of new developments.
Medical mistakes may be reduced by improving the service given by medical practitioners (Kim and Bates, 2013, p.592). The project’s objective is to provide pharmacists with the necessary expertise to administer medications properly. This enables workers to deliver the medications without accidentally mixing up the amounts (Ulrich and Kear, 2014, p.452). Order supplies should be cross-checked to verify they are being followed and that proper documentation of orders placed is kept.
Explain the process to generate an improvement.
Additionally, this study on quality improvement will provide recommendations on how to decrease medical mistakes in Australia. It will provide a comprehensive report on the procedures involved in changing or improving the health sector (Raban and Westbrook, 2014, p.418). It will educate and teach the public and medical community about the value of effective communication and the significance of knowing the patient’s medical history. It will also advocate for more funding for improved order tracking, employing appropriate personnel, and conducting seminars and educational tests to allow practitioners to brush up on their expertise and refresh their recollections (Kim and Bates, 2013, p.597).
Representatives of the initiative will be located in a variety of healthcare settings. This will allow the systems to get baseline information (Grol et al., 2013). This initiative aims to improve stock management by enabling accurate record keeping. A mechanism will be established to guarantee that the records are correctly maintained. A budget will be established to allow for the recruitment of more health professionals. There will be an increased need for health care practitioners and pharmacists (Kim and Bates, 2013, p.598). This would guarantee that healthcare providers are adequately staffed and deliver high-quality treatment. The trainers will guarantee that the community receives proper knowledge on prescriptions and the need of providing accurate information on medical records. Facilitation of seminars and tests offered by non-health sectors (Burwell, 2015, p.897). This will guarantee improved and enhanced education (Burwell, 2015, p.897). A funding allocation will be made to allow the addition of nurses and personnel and promote community educational forums (Kim and Bates, 2013, p.598).
Several things will need to be altered or amended to implement this approach to reduce medical mistakes. Ascertain that the health sector’s administration is transparent and trustworthy to operate the center. The project’s objective is to guarantee that the health care industry receives sufficient funding to operate (Jee and Kim, 2013, p.125). The initiative will familiarize itself with non-health organizations and sectors that contribute to the smooth operation of health centers. They will be summoned for a conference to establish a common understanding of how to enhance their service delivery (Burwell, 2015, p.899). It will be necessary to ensure that non-health sectors get enough funding and are managed effectively.
Effective management ensures that work is completed to a high standard. The monies will increase staffing levels and improve the quality, safety, and accessibility of records (Ulrich and Kear, 2014, p.454). With increased education from medical professionals, managers and patients would understand their responsibility in minimizing medical mistake incidents.
Resuming this project after a few months will assure the efficacy of the work accomplished and brought to light throughout the course of the project. There will be roadblocks and impediments throughout the investigation (Grol et al., 2013). The majority of health care facilities lack sufficient workers to care for patients adequately. The successful completion of his project will demonstrate that the healthcare industry has altered and improved its system, focusing more specifically on reducing medical mistakes (Jee and Kim, 2013, p.126). Training is provided to medical personnel and the general public to facilitate information transmission. The input provided will allow for the collection of more data on the project’s impact. A health organization’s medicine system must be assessed regularly. This enables the identification of necessary system adjustments to guarantee its continued relevance (Ulrich and Kear, 2014, p.456).
What implementation strategies could you consider to sustain your change(s) in the longer term?
To carry out this plan’s goal of reducing medical errors, several changes and balances must be made. Ascertain that the administration of health areas is legible and trustworthy in carrying out their activities and operations. The project’s objective is to guarantee that the health division receives sufficient assets to operate its programs. The research will get a better understanding of non-health organizations and sectors that support the operation of health centers. They will be gathered together for a session in which they will attempt to obtain one pattern concession about how they may better their administration’s delivery (Burwell, 2015, p.899). There will be an emphasis on ensuring that non-health divisions get enough funding and have an effective and persuasive administration.
A functional administration will assure the completion of high-quality tasks. The assets will consider increased staffing and enhanced record-keeping methods that are of high quality, secure, and easily accessible (Weller et al., 2014, p.150). With increased medical staff education, executives and patients will understand their role in reducing medical error incidents.
Plans for sharing learning from your project (Dissemination)
To summarize, the project’s goal is to create health centers and clinicians that are effective, efficient, patient-centred, competent, and successful. The most often utilized means of therapy, medications, should not be causing more damage. Inadequate drug management may result in serious health consequences, including death. A healthcare organization’s inefficient medical system will result in many drug mistakes. Adapting this high-quality initiative is a necessary first step toward transforming the health system. The neighborhood will benefit from more educational opportunities and increased access to health professionals. Health organizations should have a medical management system that advocates for safe prescription writing, distribution, advanced management, and any other aspect of pharmaceutical handling. The medical management system will guarantee that patients get medication that is safe. Successful execution of this project across sectors will result in a decrease in the number of health problems caused by medical mistakes.
Medication management is a complicated procedure that involves a variety of tasks. Nurses are critical to the successful administration of drugs. Notably, patient safety should be prioritized since it is the foundation for providing high-quality treatment. Therefore, nurses in nursing homes should adhere to medication regulations and adopt any technical and process-related measures that decrease or avoid medication mistakes. This may effectively reduce undesirable incidents in nursing homes.
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Graban, M. and Toussaint, J., 2018. Lean hospitals: improving quality, patient safety, and employee engagement. Productivity Press.
Grol, R., Wensing, M., Eccles, M. and Davis, D. eds., 2013. Improving patient care: the implementation of change in health care. John Wiley & Sons.
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Keers, R.N., Williams, S.D., Cooke, J. and Ashcroft, D.M., 2013. Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug safety, 36(11), pp.1045-1067.
Kim, J. and Bates, D.W., 2013. Medication administration errors by nurses: adherence to guidelines. Journal of clinical nursing, 22(3-4), pp.590-598.
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Roughead, L., Semple, S. and Rosenfeld, E., 2013. Literature review: medication safety in Australia. Sydney: Australian Commission on Safety and Quality in Health Care.
Ulrich, B. and Kear, T., 2014. Patient safety and patient safety culture: Foundations of excellent health care delivery. Nephrology Nursing Journal, 41(5), pp.447-456.
Weller, J., Boyd, M. and Cumin, D., 2014. Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgraduate medical journal, 90(1061), pp.149-154.
Wong, M. (2013). 5 Benefits of Adopting Patient Safety Checklists | Physician-Patient Alliance for Health & Safety. Retrieved May 23, 2020, from http://ppahs.org/2013/03/5- benefits-of-adopting-patient-safety-checklists/
Johnson, J.K. and Sollecito, W.A., 2018. McLaughlin & Kaluzny’s continuous quality improvement in health care. Jones & Bartlett Learning.
Tariq, R.A., Vashisht, R., Sinha, A. and Scherbak, Y., 2018. Medication dispensing errors and prevention.
Karra, M., Fink, G. and Canning, D., 2017. Facility distance and child mortality: a multi-country study of health facility access, service utilization, and child health outcomes. International journal of epidemiology, 46(3), pp.817-826.