HLT 362 Quality Improvement Proposal

Sample Answer

Nurses are professionally mandated to provide high-quality care regardless of situations and work environments. Attaining this goal requires nurses to be conversant with quality improvement essentials and adopt the appropriate approaches to achieve high outcomes consistently.

The evidence-based practice (EBP) approach is highly recommended for nurses engaging in quality improvement. The approach ensures that interventions are supported by scientific evidence, hence problem-centered and relevant to nursing.

As nurses continue to work in complex work environments, a commitment to achieve high patient outcomes should dominate their routine goals. The purpose of this paper is to describe a practice issue and propose a quality improvement initiative based on evidence-based practice.

Problem or Issue in Practice or Organization

Nursing environments encounter many issues that harm patient care in varying magnitudes. Medication errors are among such issues, defined as failure in the treatment leading to patient harm, including injury and health complications (Tansuwannarat et al., 2022).

Medication errors result in death and permanent damage if not effectively addressed. Salar et al. (2020) found that medication errors are common in today’s practice since between 16 and 27% of nurses commit a medication error. The high prevalence and the magnitude of impacts underline the need for practical interventions to avert the dangers of medication errors.

Awareness of the causes and setting where medication errors occur is fundamental for effective decision-making and solutions. According to Bell et al. (2023), medication errors are common in environments with a high workload due to the eventual fatigue that reduces attention and vigilance. Such settings include the emergency department, intensive care units, and surgical units, where nurses perform cognitively demanding tasks persistently.

However, other areas where medication administration is involved are prone to medical errors. The Agency for Healthcare Research and Quality (2023) highlights that medical errors can be experienced at any point in the healthcare system.

Such points include clinics, hospitals, pharmacy units, and nursing homes. Since the prevalence is high and the impacts on care quality severe, medical errors should be addressed by problem-centered, organization-wide interventions. Such interventions require leaders and nursing professionals to collaborate in the quality improvement process through problem identification, implementation of interventions, evaluation, and other tasks.

Significance of Quality Improvement in Practice or Organization

Quality improvement in nursing should be a key objective for all professionals involved in direct patient care. Broadly, quality represents the extent to which patient care services achieve the desired health outcomes. As a result, quality improvement is centered on implementing interventions to improve care systematically by standardizing processes and structures (CMS.gov, 2021).

An appropriate quality improvement initiative is mindfulness meditation training for nurses to overcome fatigue. A significant reduction in fatigue would lead to a proportional reduction in medical errors, hence better care quality. Improving care quality in areas where medical errors occur implies a commitment to achieving the goals of standardized processes and structures.

These include reduced variations and improved outcomes for patients and healthcare facilities (CMS.gov, 2021). Quality improvement also leads to predictable results and helps healthcare organizations to reduce operational costs.

A critical evaluation of the impacts of medical errors further signifies the importance of quality improvement to reduce variations. As Ahsani-Estahbanati et al. (2022) observed, medical errors significantly burden the healthcare system since they undermine patient outcomes and impact nursing professionals’ mental health.

Their occurrence also reduces people’s trust in the health system. Quality improvement through evidence-based interventions would prevent or mitigate these adverse impacts, hence improved patient outcomes.

Nursing professionals would also be protected from mental health dangers, empowering them to provide comprehensive care timely and satisfactorily. Achieving these goals would also make nurses enjoy their work, which is pivotal for nurse retention in high-stressful work environments.

Demonstration of Support from Previous Research

Nursing research has extensively assessed the effectiveness of mindfulness meditation in stressful work environments and supports its implementation. In general, studies reveal that skills to practice mindfulness can caution nurses against the damaging effects of fatigue and work productively. Owens et al. (2020) found a 3-minute mindfulness intervention practice over four weeks crucial in reducing compassion fatigue among nurses.

Burnout risk and secondary traumatic stress levels are reduced significantly among nurses practicing mindfulness. Sulosaari et al. (2022) also found that mindfulness interventions effectively improve nurses’ psychological well-being. Outcomes include reduced stress and depression and improved resilience and quality of life.

In another study, Yıldırım and Çiriş Yıldız (2022) evaluated the impact of mindfulness breathing and music therapy on nurses during the COVID-19 pandemic. The primary finding was that these interventions decreased work-related strain and improved nurses’ psychological well-being. These studies show that mindfulness techniques can reduce fatigue among nurses, which is crucial in reducing medical errors.

Steps Necessary to Implement Quality Improvement Initiative

Quality improvement implementation is procedural and starts with basic processes before advancing to complex procedures. The first step is to assess the problem in terms of complexity and the scope of intervention required. When these dimensions are identified, the project leader should move into the next step- preparation.

Here, nurses who should receive mindfulness meditation training should be prepared for the acquisition of skills and their implementation. De Kok et al. (2023) stressed the importance of preparing nurses for change since many resist change due to comfort in the status quo. Preparing them reduces potential resistance to change.

Preparation also includes the organization of resources for comprehensive training. The next phase should be training to ensure nurses acquire the required skills to cope with workplace fatigue and execute them independently.

This phase aligns with the most influential step of evidence-based practice, which involves integrating research findings into practice after evaluation and appraisal (Abu-Baker et al., 2021). Project leaders should also outline measures for quality improvement initiatives’ evaluation to assess whether they will achieve the desired outcomes.

Evaluation of Quality Improvement

Quality improvement initiatives should be evaluated to provide a holistic view of their impacts. The proposed intervention will be proposed qualitatively and quantitatively to ensure all dimensions are assessed. Qualitative evaluation will be done using surveys of feasibility and satisfaction with the training.

Here, participants in the training should describe their experiences with the training and its usefulness. Focus areas include benefits, readiness to implement the skills, and their perception of the training. Unlike qualitative evaluation, which focuses on collecting non-numerical data, quantitative analysis collects and evaluates numerical data to make predictions (Leavy, 2022).

Appropriate data that can be evaluated quantitatively include the reported cases of medical errors and workplace fatigue before and after the initiative. This data can be collected at baseline and 4-6 months post-implementation. A reduction in medical errors and related issues by over 24% would be a reliable indicator of a successful initiative.

Identification of Variables, Hypothesis Test, and Statistical Tests
Quality improvement should demonstrate a causal relationship between variables. In this initiative, mindfulness meditation training is the independent variable, while fatigue/workplace stress is the dependent variable.

After the training, nurses’ stress levels would reduce, further reducing medical errors in the workplace. Accordingly, the hypothesis is that implementing mindfulness meditation training would reduce medical errors by reducing fatigue. As previous studies (Sulosaari et al., 2022; Owens et al., 2020) demonstrate, positive outcomes are achieved by properly implementing mindfulness techniques in stressful work environments.

Similar outcomes should be achieved by implementing the proposed initiative. Statistical tests to prove the success of the initiative include the mean differences between incidents before and after the intervention and the frequency of occurrence.

The mean is calculated by dividing the number of medication error incidents within a particular period by the number of days. The frequency of occurrence could be daily, weekly, or monthly. Comparing pre-intervention and post-intervention data can reliably demonstrate whether the project was successful.

Conclusion

Issues that hamper care quality are widespread in nursing practice. Due to the need for high-quality care and optimal patient safety, nurses should evaluate issues hampering outcomes and address them accordingly. Regardless of the setting, medical errors are a common occurrence that poses a significant risk to patients, nursing professionals, and health systems.

In response, nurses should design and implement practical interventions for preventing medical errors to improve care quality. As proposed in this paper, mindfulness meditation training can be implemented among nurses working in stressful work environments. The objective is to reduce fatigue, which would reduce medical errors proportionately.

References

• Abu-Baker, N. N., AbuAlrub, S., Obeidat, R. F., & Assmairan, K. (2021). Evidence-based practice beliefs and implementations a cross-sectional study among undergraduate nursing students. BMC Nursing, 20(1), 1-8. https //doi.org/10.1186/s12912-020-00522-x
  
• Agency for Healthcare Research and Quality (2023). Topic Medical errors. https //www.ahrq.gov/topics/medical-errors.html# ~ text=Medical%20errors%20can%20occur%20anywhere,%2C%20equipment%2C%20or%20lab%20reports.
  Ahsani-Estahbanati, E., Sergeevich Gordeev, V., & Doshmangir, L. (2022). Interventions to reduce the incidence of medical error and its financial burden in health care systems a systematic review of systematic reviews. Frontiers in Medicine, 9, 875426. https //doi.org/10.3389/fmed.2022.875426
  
• Bell, T., Sprajcer, M., Flenady, T., & Sahay, A. (2023). Fatigue in nurses and medication administration errors a scoping review. Journal of Clinical Nursing, 32(17-18), 5445–5460. https //doi.org/10.1111/jocn.16620
  
• CMS.gov. (2021). Quality measurement and quality improvement. https //www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-# ~ text=Quality%20improvement%20is%20the%20framework,%2C%20healthcare%20systems%2C%20and%20organizations.
  De Kok, E., Schoonhoven, L., Lalleman, P., & Weggelaar, A. M. (2023). Understanding rebel nurse leadership‐as‐practice Challenging and changing the status quo in hospitals. Nursing Inquiry, e12577. https //doi.org/10.1111/nin.12577
  
• Leavy. (2022). Quantitative, qualitative, mixed methods, arts-based, and community-based participatory research approaches. Guilford Publications.
  Owens, R. A., Alfes, C., Evans, S., Wyka, K., & Fitzpatrick, J. J. (2020). An exploratory study of a 3-minute mindfulness intervention on compassion fatigue in nurses. Holistic Nursing Practice, 34(5), 274-281. https //doi.org/10.1097/hnp.0000000000000402
  
• Salar, A., Kiani, F., & Rezaee, N. (2020). Preventing the medication errors in hospitals a qualitative study. International Journal of Africa Nursing Sciences, 13, 100235. https //doi.org/10.1016/j.ijans.2020.100235
  
• Sulosaari, V., Unal, E., & Cinar, F. I. (2022). The effectiveness of mindfulness-based interventions on the psychological well-being of nurses a systematic review. Applied Nursing Research, 64, 151565. https //doi.org/10.1016/j.apnr.2022.151565
  
• Tansuwannarat, P., Vichiensanth, P., Sivarak, O., Tongpoo, A., Promrungsri, P., Sriapha, C., … & Trakulsrichai, S. (2022). Characteristics and consequences of medication errors in pediatric patients reported to ramathibodi poison center a 10-year retrospective study. Therapeutics and Clinical Risk Management, 669-681. https //doi.org/10.2147/TCRM.S363638
  
• Yıldırım, D., & Çiriş Yıldız, C. (2022). The effect of mindfulness-based breathing and music therapy practice on nurses’ stress, work-related strain, and psychological well-being during the COVID-19 pandemic a randomized controlled trial. Holistic Nursing Practice, 36(3), 156–165. https //doi.org/10.1097/HNP.0000000000000511