improvement and safety issue in healthcare focus on the care that patients
receive, and the outcomes that patients experience. We as nurses play a significant
advocacy role in ensuring safe and quality care to all patients. One of the
ongoing problems plaguing skilled nursing homes I discussed with the Director
of Nursing (DON) during the interview was the development of new pressure
ulcers in patients after initial admission. According to the Centers for
Medicare and Medicaid (CMS), patients should never develop pressure ulcers
while under the supervision of any medical facilities, because they can be
prevented (CMS, 2009).
Yearly more than 2.5 million
people in the United States develop pressure ulcers. These skin injuries bring
pain, related risk for acute infection, and increased healthcare consumption.
Prevention requires the facility attention and working practices that encourage
teamwork and proper communication, as well as individual knowledge (Agency of
Healthcare Research and Quality (AHRQ), 2014). During the interview, the DON mentioned: ” A
good QI plan incorporates the process put in place to ensure there is
consistency in the quality delivered.”
At the facility where I work
the management and nurses have outlined several proposals to attain the goals
of Quality strategy and safety through development in nursing care, effectiveness,
patient participation, and access to more information.
To improve quality and safety of a patient the facility have to have every
staff member’s engaged.
(QI) puts the patient at the center of the practices that links knowledge, process, and outcomes to improve quality and
safety of the patients throughout the facility. The intention is to develop the
level of performance of key process and outcomes within an organization. Quality
Improvement is a methodical, official approach to the evaluation of practice
and efforts to improve performance (American Academy of family physicians,
2017). According to AAFP (2017), understanding
and rightly implementing QI is crucial to a well implementation practice and is
nonnegotiable for any organization or facility interested in improving effectiveness,
patient safety, or clinical outcomes.
The purpose of the QI and patient safety plan is to identify the
health system’s approach and successful attain its performance through prioritization
design, implementation, monitoring and analysis of the performance improvement
initiative. According to AHRQ (2014) to prevent pressure
ulcers, it is essential to understand how the different components work and
following a clinical pathway.
recommendation I could make is the frequency of skin assessment. In the
facility, we do skin assessment during admission, when a patient is being
transferred to acute care, and during discharge. Skin assessment should not be a one-time event. As nurses
we should do skin assessment every shift in order to notice any new skin issues.
One suggestion I made was for the nursing assistant to be trained on how to
properly check the skin while cleaning the patient, bathing, or repositioning
and immediately report any changes to the charge nurse. This should be followed
by proper documentation. In order to be most useful, the result of the
comprehensive skin assessment must be documented in the patients’ medical
record and communicated among staff.
recommendation discussed was how frequently should comprehensive skin
assessment be done. In our facility, we
use a periodic scorecard to get feedbacks that provide information on how
performance, including QI, is progressing toward goals. After the interview and
discussion, the DON started considering training for the nurse assistants, and
patient safety rounds where the DON and the administrator would visit the patients
periodically, and even sit down and talk with staff one on one.
One of the
potential barriers to implementing the recommended QI is poor communication.
Communication among the staff is complex. Often the information is lost or not
correct which might result in multiple interruptions and gaps in care
coordination of the patient. Another
barrier, the nurse assistants might not be willing to do skin assessment or
report the right information due to lack of proper training.
Improvement and safety issue initiative will continue to be a feature of the
healthcare landscape. The exchange of information must take place if the
facility wishes to maximize patient safety and cost effectively reduce
liability. By forging a new path that is patient safety-focused, a QI and
safety management partnership can contribute to the overall improved quality
and safety of a patient. Finally, with a spirit of mutual respect and
appreciation and working as a team, we can improve our patient’s Safety.