NURS 4005 – Week 6 Discussion- Promoting Safety and Quality
In today’s competitive healthcare marketplace, quality of care, patient safety, and clinical care outcomes remains a top priority because the data is not only tied to the hospital’s community image and marketing but also to its reimbursement for services by private and government insurance services (CMS, n.d.). The costs, morbidity, and mortality related to healthcare-associated infections (HAIs) in the United States (U.S.) are continually surpassing record highs, despite the increased focus by the entire healthcare system, from top to bottom, on reducing these never events and their impact on quality and safety outcomes for patients.
In 2009, the Centers for Disease Control (CDC) estimated the cost associated with the more than 1.7 million hospital-acquired infections (HAIs) that occur annually in the U.S. fell somewhere between $35.7-$45 billion, while the top five HAIs were also associated with the highest levels of in-hospital deaths and an estimated cost of nearly $10 billion annually (Fratantoro, 2013; Ramanathan, Leavell, Wolfe, & Duane, 2014). Of those in the top five of most interest to me was postoperative sepsis, which accounted for 33.7% of that cost and responsible for nearly 39% of the HAIs which required increased intensive care needs for the patient (Fratantoro, 2013; Ramanathan et al., 2014). The use of quality care standards and data reporting from The Joint Commission (TJC) and the Centers for Medicare & Medicaid Services (CMS), allows institutions and healthcare providers to monitor outlying areas of concern and implement policies and changes in practice which address quality and safety concerns that directly impact patient outcomes. These standards also reduce overall healthcare costs and costs. Associated with HAIs, such as postoperative sepsis, by improving clinical practice and safety measures aimed at preventing HAIs (CDC, n.d.). However, despite concerted efforts by institutions to change processes and procedures which target postoperative sepsis and HAIs in general, many fail to recognize the importance of the nursing role in the quality of care and patient safety improvement efforts.
Quality improvement is a cyclical process which requires the continual reassessment/monitoring, planning, implementation, and evaluation of clinical practices and outcomes (Barker, 2017). However, nurses are not often a part of the quality improvement process during the assessment, planning, and implementation stages, which can create gaps in both knowledge and understanding of the seriousness of the issues and the desire or perceived benefit of adhering to needed changes in practice (Lacey et al., 2017). Another challenge is the lack of communication of the goals and objectives of quality improvement to the bedside nurse. It is hard to get staff buy-in and change clinical practices when the nurse fails to understand the significance of the changes or feels as though their knowledge and expertise are not valued.
NURS 4005 – Week 6 Discussion- Promoting Safety and Quality
Using the nursing process, nurses continually assess, plan, implement, and evaluate the care they provide their patients to ensure they are continually improving the care delivered to the patient, which improves the patient’s health status (Barker, 2017). There are striking similarities between our nursing practice process and quality improvement efforts, making the nurse the ideal leader in driving improvement in clinical outcomes and quality care in support of the organization’s goals (Barker, 2017; Lacey et al., 2017). In fact, studies show that institutions which involve nurses in the application of evidence-based practices and quality improvement initiatives have improved healthcare delivery efficiency and decreased organizational costs (Moore & Stichler, 2015). Therefore, nurses play a significant role in the clinical outcomes of the patients and the financial health of an organization due to the amount of direct care that takes place during the nurse-patient encounter and should therefore be an integral part of, if not lead, quality of care, patient safety, and clinical outcome initiatives, which aim to meet the organization’s strategic goals (Lacey et al., 2017).
References
Barker, B. (2017, July/August). Quality improvement and the nursing process: What’s the relationship? Ohio Nurses Review, 92(4), 12-12. Retrieved from https://www.ohnurses.org/resources/publications-2/
Centers for Medicare & Medicaid Services. (n.d.). Quality Initiatives. Retrieved October 2, 2017, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/QualityInitiativesGenInfo/index.html
Fratantoro, M. (2013, September). The annual cost of healthcare-associated infections. RT: The Journal for Respiratory Care Practitioners, 29(9), 6. Retrieved from http://www.rtjournalonline.com
Lacey, S. R., Goodyear-Bruch, C., Olney, A., Hanson, D., Altman, M. S., Varn-Davis, N. S., … Cox, K. S. (2017, August). Driving organizational change from the bedside: The AACN Clinical Scene Investigator Academy. Critical Care Nurse, 37(4), e12-e25. http://dx.doi.org/10.4037/ccn2017749
Moore, S., & Stichler, J. F. (2015, October). Engaging clinical nurses in quality improvement projects. Journal of Continuing Education in Nursing, 46(10), 470-476. Retrieved from https://www.healio.com/nursing/journals/jcen
Ramanathan, R., Leavell, P., Wolfe, L. G., & Duane, T. M. (2014, August). Agency for healthcare research and quality patient safety indicators and Mortality in surgical patients. The American Surgeon, 80(8), 801-804. Retrieved from http://www.ingentaconnect.com/content/sesc/tas
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NURS 4005 – Week 6 Discussion- Promoting Safety and Quality
How has the emphasis on quality of care, patient safety, and clinical care outcomes been impacted by specific standards emanating from TJC and/or CMS? Cite your selected core measure or Never Event in your
What is the impact of the nurse’s role on clinical outcomes for the organization?
Discuss nurse-specific challenges in influencing change in quality
How does this influence the ability of the organization to achieve its strategic agenda?