NURS 835 Topic 4 DQ 1 Describe how your direct practice improvement project achieves clinical improvement. How will you achieve widespread change?

NURS 835 Topic 4 DQ 1 Describe how your direct practice improvement project achieves clinical improvement. How will you achieve widespread change?

NURS 835 Topic 4 DQ 1 Describe how your direct practice improvement project achieves clinical improvement. How will you achieve widespread change?

Topic 4 DQ 1

Reflecting on the “IHI Module QI 202: Addressing Small Problems to Build Safer, More Reliable Systems,” describe how your direct practice improvement project achieves clinical improvement. How will you achieve widespread change? How would the widespread change of your DPI Project be affected if it were implemented in a country with universal health care. Describe how the health outcome would be impacted. Provide supporting evidence.

Thinking of quality improvement (QI) as a principle-based approach to change provides greater clarity about the contribution QI offers to staff and patients, how to differentiate it from other approaches, and the benefits of using QI together with other change approaches. According to Backhouse and Ogunlayi (2020), The benefits to front line clinicians of participating in quality improvement (QI) activity are promoted in many health systems. QI can represent a valuable opportunity for individuals to be involved in leading and delivering change, from improving individual patient care to transforming services across complex health and care systems. My direct Practice improvement project will achieve clinical improvement by opening up communication amongst the healthcare team to reduce patient safety mishaps. With the continuous rise of sentinel and adverse events due to ineffective communication, it is time for health care organizations to start implementing a focus on enhancing effective communication in which will, in turn, improve patient safety and experience, boosting the bottom line.

Communication breakdown is one of the main causes of adverse events in clinical routine, particularly in handover situations. The communication tool SBAR (situation, background, assessment and recommendation) was developed to increase handover quality and is widely assumed to increase patient safety. Wide spread change would be achieved using tools such as SBAR for reporting out all patient to each other and physicians. Muller et al, 2018 suggest that Patient safety is crucial for the delivery of effective, high-quality healthcare and is defined by the World Alliance for Patient Safety of WHO as ‘the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum’. To illustrate the impact of patient safety on healthcare quality, the incidence of adverse events is commonly cited.  Adverse events are injuries that are caused by medical conduct resulting in prolonged hospitalisation and/or disability at the time of discharge. The Joint Commission reported that poor communication is a contributing factor in more than 60% of all hospital adverse events they reviewed. Poor communication is found in many different healthcare settings and is especially prominent in patient hand-offs and settings where fast and effective management is indispensable. As a health care system world wide, patient safety event can be prevented with better communication amongst the teams.

Backhouse, A., & Ogunlayi, F. (2020). Quality improvement into practice. BMJ (Clinical research ed.), 368, m865. https://doi.org/10.1136/bmj.m865

Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ open, 8(8), e022202. https://doi.org/10.1136/bmjopen-2018-022202

Jan 30, 2023, 7:37 PM

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ffective communication is a critical component of not only meeting patient care needs but providing the highest quality of care. According to the Joint Commission, communication was the leading root cause of sentinel events in the United States (Burgener, 2020).  In creating a culture of safety, a healthcare organization must have effective communication at all levels. As a nurse leader, often I review patient safety events that could have been prevented if there was stronger communication between the disciplines involved. Recently, one that comes to mind, is a miscommunication between the telemetry monitor technicians and the staff nurse caring for the patient. The patient had converted to a lethal arrythmia however when the monitor tech notified the nurse, they did not communicate the rhythm or level of urgency to check the patient. Hence, there was a delay in care which led to the patient needing a higher level of care. In this situation if the monitor tech had stated the rhythm or communicated the urgency then the staff nurse would have likely responded right away and there would have been early intervention.

You are recommending a communication tool in which I believe will help prevent some adverse events. Standardized communication tools are effective in ensuring information shared between clinicians are concise and structured in a way that keeps patients safe.

Reference

Burgener, A. M. (2020). Enhancing communication to improve patient safety and to increase patient satisfaction. The Health Care Manager, 39(3), 128-132. https://doi.org/10.1097/hcm.0000000000000298

Jan 30, 2023, 7:57 PM(edited)

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Hello Yolanda, Your DPI project is very intriguing and valuable to the safety concerns of our current healthcare. We have been using SBAR for quite some time in nursing, or at least so we think. However, our healthcare industry and nursing, to be specific, continue to see severe injuries due to missed or ineffective communication. Your statements, “With the continuous rise of sentinel and adverse events due to ineffective communication, it is time for health care organizations to start implementing a focus on enhancing effective communication which will, in turn, improve patient safety and experience, boosting the bottom line. Communication breakdown is one of the main causes of adverse events in clinical routine, particularly in handover situations” are profoundly true.  The implications of missed or ineffective communication can be severe. A patient’s clinical condition can deteriorate very quickly, and the ability to impart nursing assessment data rapidly and in a way that will be received as intended can mean the difference between life and death.  According to Müller M. et al. (2018), the communication tool SBAR (status, background, assessment, and recommendation) was developed to increase handover quality and is widely assumed to improve patient safety, which is crucial for delivering effective, high-quality healthcare. The Joint Commission reported that poor communication contributes to more than 60% of all hospital adverse events they reviewed. Poor communication is found in many different healthcare settings and is especially prominent in patient hand-offs and settings where fast and effective management is indispensable. These settings include the perioperative period, the intensive care unit (ICU), and the emergency department. The components and processes of communication are complex and prone to misunderstanding (Institute of Medicine). To overcome these barriers, communication strategies are needed, which take little time and effort to complete, deliver comprehensive information efficiently, encourage interprofessional collaboration and limit the possibility of error. It is well known that components and processes of communication are complex and prone to misunderstanding.  According to the Institute for Healthcare Improvement, the SBAR (situation, background, assessment, recommendation) instrument and its derivatives ISBAR, SBAR-R, ISBARR, and ISOBAR fulfill this need and are widely used in different healthcare facilities as a communication and hand-off tool both intraprofessionally and interprofessional. With a clear structure, SBAR calls for all relevant information to be organized logically. Furthermore, it enables preparation before the communication process, and because the sender and receiver share the same mental model, understanding and awareness are expected to be higher. The Joint Commission reports that it reduces inhibitions, especially in hierarchical contexts, by encouraging the sender to provide a personal assessment and suggestion of the situation. Preventable medical errors continue to occur at alarming rates, and communication failures are at the root of many of these incidents. Adopting a Structured “best practice” communication tool for delivering information in critical situations can help nurses focus on communication to improve the effectiveness of information transfer. The technique can be implemented on any scale, from individual to institutional, and facilitates the interpretation of interdisciplinary dialects born from differing educational systems, hierarchies, and power gradients (Müller M. et al., 2018).

Institute for Healthcare Improvement. SBAR technique for communication: a situational briefing model. http://www.ihi.org/resources/Pages/Tools/SBARTechniqueforCommunicationASituationalBriefingModel.aspx (accessed January 30, 2023).

Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). A systematic review of the impact of the communication and patient hand-off tool SBAR on patient safety. BMJ open, 8(8), e022202. https://doi.org/10.1136/bmjopen-2018-022202

The Joint Commission. Sentinel event data: root causes by event type 2004–2014. 2014. http://www.tsigconsulting.com/tolcam/wp-content/uploads/2015/04/TJC-Sentinel-Event-Root_Causes_by_Event_Type_2004-2014.pdf (accessed January 30, 2023)

World Health Organisation. Conceptual Framework for the International Classification for Patient Safety. 2009. http://www.who.int/patientsafety/taxonomy/icps_full_report.pdf (accessed January 30, 2023).

Jan 30, 2023, 8:42 PM

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Yolanda, you raised an important topic as effective communication is a very vital tool for achieving an improved quality of patient care. Miscommunication is linked to delayed treatment, misdiagnosis, medication errors, patient injury, or death, therefore, improving effective communication in healthcare is a global priority (Foronda, et al., 2016). Regardless of the diverse training by different health professions, the focus must be based on patient outcomes. Foronda, et al. (2016) suggest that healthcare workers should recognize the challenges and barriers to effective communication such as lack of confidence, lack of experience, the complexity of healthcare, distraction, and lack of structure and standardization to effectively strategize on mitigating the problem. The authors further identified other forms of communication as may be used in the healthcare system in form of synchronous and asynchronous means where the synchronous type are the communications happening in real-time such as a meeting, ward round, handoff, or impromptu conversation, and asynchronous are in a documented format such as on whiteboards, through medication orders, or written progress notes. Consequently, communication is not only verbal and written however it includes body language, attitude, and tone applied (Foronda, et al., 2016). Communication happens interprofessional between the healthcare team and the healthcare professional and the patient. When communicating with the patient, it is crucial that the patient’s level of understanding and method of learning is of priority to achieve productive patient-nurse contact. Patient cultural behavior towards communication is important to eliminate bias. Whatever method is used clarity of communication is vital and feedback for understanding is essential.

Reference

Foronda, C., MacWilliams, B., & McArthur, E. (2016). Interprofessional communication in healthcare: An integrative review. Nurse education in practice, 19, 36-40.

Jan 31, 2023, 8:15 AM

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Greetings ladies,

All of you have added insightful thoughts into problems associated with poor communication. I found it interesting that the HIPAA journal conducted research to investigate the effects of defective communication (HIPAA Journal, 2022). The study reviewed medical malpractice cases and realized that of the 23000 cases 7000 were attributed to communication failures (HIPAA Journal, 2022). Unfortunately, these mishaps costs almost 2 billion dollars and another 200 preventable deaths (HIPAA Journal, 2022). The article used a case study where a patient died due to post operative hemorrhage; noting that the nurse failed to notify the doctor of lowered RBC and patient complaints of abdominal pain (HIPAA Journal, 2022). The article then reviewed patient clinician communication and explained that as providers we could do a better job with this process, this would decrease medication errors and better informed consent (HIPAA Journal, 2022).

Addressing this issue may involve the use of HIPAA compliant text messaging (HIPAA Journal, 2022). This process would require patient consent but, if approved interdisciplinary communication increases (HIPAA Journal, 2022). HIPAA compliant text message reduces misunderstandings, allows the patient to ask questions, and reduces insufficient informed consent (HIPAA Journal, 2022). In addition it provides a hard copy of patient handover, the process when used with a template proves extremely helpful as the HIPAA compliant system addresses issues with outdated communication systems (HIPAA Journal, 2022)

HIPAA Journal. (2022, August 5). Effects of poor communication in healthcare. https://www.hipaajournal.com/effects-of-poor-communication-in-healthcare.

Jan 29, 2023, 12:45 AM

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An estimated 25% to 50% of all antibiotics prescribed in primary care are unnecessary and inappropriate antibiotic use is known to course adverse drug effects, increased seeking of health care for self-limited illnesses, and increased costs (Schwartz et al., 2021). Without intervention to prevent unnecessary antibiotic use, it is estimated that drug-resistant infections will increase dramatically in the coming decades, and the overuse of antibiotics contributes to a public health crisis of antimicrobial resistance (Schwartz et al., 2021). My direct project improvement (DPI) is focused on the implementation of the updated Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America to aid in the reduction of unnecessary antibiotic therapy for asymptomatic bacteriuria among the residents in the nursing home facility. In the updated guidelines to the 2005 version, various updates were established to curb the overprescription of antibiotics among them is that treatment and screening are not recommended for healthy women, healthy nonmenopausal women, nonpregnant women, or healthy postmenopausal women, children and infants, functionally impaired older people, and older individuals in the long-term care facilities (Nicolle et al., 2019).

The implementation of the project will incorporate the maximum participation of the agency administration in making a smooth transition from what is already known and practiced at the facility as change is always difficult to adapt. An educational presentation with evident-based data will be presented. Reference materials and follow-up question and answer session for clarification. Resources made available both material and human to enhance and promote the implementation for the long time effect and make the guideline a standard in the facility where it will prompt the prescribers and the nurses in the electronic health record when treating and caring for the patient with asymptomatic bacteriuria.

It is crucial to establish what constitutes a urinary tract infection and what other assessments need to be completed before calling the clinician for treatment. Beeber et al. (2021) in their article examined the nurses’ decision-making for suspected urinary tract infections and noted that the knowledge gap contributed to the decision-making. Hence education to enhance knowledge for patient assessment for the appropriate information when communicating with clinicians is essential.

If the DPI were to be implemented in a country with universal health care, the adoption may be quicker to incorporate universally as the health system is comprehensive where access to care is guaranteed unlike a system that is more privatized where some entities are in total control of their decisions (National Academies of Sciences, Engineering, and Medicine, 2018).  Adopting a standard guideline involving a more comprehensive assessment of patients with suspected UTI will give a broader understanding of the patient’s overall health status that the nurse can use to educate the patient and the family, and communicate to the clinician the best treatment plan that may eliminate unnecessary antibiotic use.

Reference

Beeber, A. S., Kistler, C. E., Zimmerman, S., Dictus, C., Ward, K., Farel, C., Chrzan, K., Wretman, C. J., Boyton-Hansen, M., Pignone, M., & Sloane, P. D. (2021). Nurse Decision-making for Suspected Urinary Tract Infections in Nursing Homes: Potential Targets to Reduce Antibiotic Overuse. Journal of the American Medical Directors Association, 22(1), 156–163.

National Academies of Sciences, Engineering, and Medicine. (2018). Embedding Quality Within Universal Health Coverage. In Crossing the Global Quality Chasm: Improving Health Care Worldwide. National Academies Press (US).

Nicolle, L. E., Gupta, K., Bradley, S. F., Colgan, R., DeMuri, G. P., Drekonja, D., … & Siemieniuk, R. (2019). Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 68(10), e83-e110.

Schwartz, K. L., Ivers, N., Langford, B. J., Taljaard, M., Neish, D., Brown, K. A., … & Garber, G. (2021). Effect of antibiotic-prescribing feedback to high-volume primary care physicians on number of antibiotic prescriptions: a randomized clinical trial. JAMA Internal Medicine, 181(9), 1165-1173.

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