Application of Quality and Safety Concepts: Preventing Medical Errors


The problem of medical errors has been persistent in the nursing and healthcare setting for a while, causing numerous negative outcomes and endangering the lives of many patients. Medical errors occur at several levels and lead to injuries, traumas, nosocomial infections, and other consequences that affect patients negatively. However, from the perspective of a Doctor of Nursing Practice (DNP), the specified concern is manageable, even though addressing it will require a substantial amount of time and a significant number of resources. By introducing a nurse educational strategy and a framework aimed at improving the existing protocol for administering medication to patients, one will be able to implement a positive change and prevent medical errors from occurring in a nursing setting.

Literature Review

The issue of medical errors and particularly the problem of administering medication at the wrong time or in the wrong way is a common problem in the critical care setting. The 1999 report by the Agency for Healthcare Research and Quality (AHRQ) published by the Institute of Medicine (US) Committee on Quality of Healthcare in America (1999) shows the identified propensity toward medical errors in nursing explicitly.

Among other important issues, the report points to the problem of silencing the specified issue. Indeed, the lack of disclosure of medical errors and the propensity toward covering the specified issue leads to a drastic drop in the efficacy of provided nursing services (Farzi, Irajpour, Saghaei, & Ravaghi, 2017). Therefore, the lack of instructions, as well as the values needed for the management of medical errors, such as responsibility, professionalism, and the willingness to learn, can be seen as the primary cause of the specified problem.

Similarly, the report issued by the Institute of Medicine shows that the tendency to silence the problem of medical errors coupled with the lack of coherent and effective instructions for nurses to adhere to causes a drastic drop in the quality of nursing and the number of recovery rates (Institute of Medicine (US) Committee on Quality of Healthcare in America, 2001). Moreover, medical errors often lead to the development of nosocomial diseases and the development of additional health concerns (Simone et al., ‎2016). Therefore, changes to the current situation have to be made on the administrative level and the level of policymaking.

Particularly, nurses will have to be provided with rigid and improved guidelines for managing their responsibilities, while an education program aimed at building nurses’ knowledge systems will need to be launched (Heidari, ‎2017). The specified measures are expected to produce a shift in the target audience’s understanding of managing workplace processes to ensure complete patient safety and prevent instances of errors from occurring.

Theoretical Perspective

When exploring the issues that lie at the core of the problem, one has to mention the lack of willingness among nurses to accept changes in quality management and promotion of patient safety as the primary principles in their work. From a theoretical perspective, the identified phenomenon can be seen as the problem of decision-making. Specifically, the tenets of the Social Cognitive Theory will need to be applied to the specified issue to determine the nature of the problem and resolve it (Tougas, Hayden, McGrath, Huguet, & Rozario, ‎2015). At this point, it should be noted that the problem of decision-making intersects with the dilemma regarding motivation since nurses are not driven to deliver the expected performance, which requires the application of the theory of motivation as well.

Particularly, Maslow’s Hierarchy of Needs will have to be deployed. In the course of the program, one should focus on the self-actualization aspect of nurses’ work since the target demographic suffers significantly from conflicts in interdisciplinary settings (Jackson et al., ‎2014). At the same time, basic needs such as the need for rest and sleep will have to be considered due to high rates of workplace burnouts among ICU nurses (Chuang et al., 2016).

Indeed, studies show that the levels of motivation among nurses are comparatively low in the present-day nursing environment (Farzi et al., 2017). The specified phenomenon owes its existence to the rise in workplace burnout rates among nursing staff, the lack of opportunities for professional growth, and the inherent problems within the hospital hierarchy (Jackson et al., ‎2014). Moreover, researches prove that the problem of nurse-physician conflicts does not exist in a vacuum and leads to a significant drop in the quality of services provided to patients (Heidari, ‎2017).

Particularly, a significant percentage of medical errors emerge owing to confrontations between nurses and physicians in the designated setting, as well as conflicts during cross-disciplinary communication, in general (Foster, Gary, & Sooryanarayana, 2018).

The specified problem is linked directly to the issue of patient safety since it reduces the chances for patients to recover. Therefore, immediate actions need to be taken on an administrative level, as well as on the level of nurse education, to manage the specified issue and introduce the target population to the strategies for managing the workplace pressure. The human factor needs to be recognized as the key concept that defines the presence of medical errors, in general. The identified phenomenon is typically defined as the fact that, despite the existing standards of practice, some nurses still fail to meet the expected quality due to poor decisions that they make unintentionally when providing care to patients (Farzi et al., 2017). Unfortunately, medical errors are intrinsic to any workplace setting, including the nursing one.

Intervention: Description, Implementation, and Evaluation

Because of the complex nature of the problem at hand, one should consider using a twofold approach toward managing the specified concern. Particularly it is important to address both the current system of quality management, including the guidelines provided o nurses, and the tools for monitoring the quality of the provided services. At the same time, nurse education and a change in the target audience’s perspective should be seen as the priorities that have to be pursued in order to address the needs of patients in the Intensive Care Unit (ICU).

The application of the proposed solution will require introducing a program that will explore the methods of improving instructional guidelines for nurses, monitoring the process, and encouraging a shift in nurses’ attitudes. The latter is particularly important since the observed problem regarding the existence of medical errors in the IC context can be explained by the lack of enthusiasm in nurses to improve their skills and use innovative tools for decision-making.

Thus, the intervention will imply a rearrangement of the current standards for managing the needs of ICU patients. Specifically, nurses will be provided with rigid quality standards concerning administering medication to the specified population. The specified step is critical since the existing guidelines are rather loose and, thus, are in need of significant improvements. Specifically, patient safety will have to be integrated into the very foundation for the guidelines.

Without the specified notion incorporated into the ICU nursing context, the problem remains unmanageable: “In the ICUs, on average, patients exposed to 1.7 errors per day and medication errors account for 78% of serious medical errors” (Farzi et al., 2017, p. 158). Therefore, one will have to shape the existing nursing guidelines for catering to the needs of ICU patients to help nurses deploy a patient-centered approach. Specifically, the guidelines will need to incorporate.

Moreover, a two-week program aimed at improving nurses’ skills will be created. During the program, the participants will receive not only the relevant information and knowledge but also the impetus for engaging in self-directed learning. By building independence and professionalism in nurses, one will contribute to the increase in the cases involving positive patient outcomes and help reduce the instances of medical errors in the ICU context. As a result, nosocomial issues and the development of comorbid problems will be avoided successfully, and the length of the hospital stay in patients will be shortened significantly.

Furthermore, the program will need to focus on building the nurses’ ability to work in an interdisciplinary setting and cooperate effectively to respond to changes in a patient’s health status immediately. The specified change will demand alterations in the existing dynamic between nurses and other interdisciplinary team members, particularly, physicians since conflicts are very common in the specified environment. Due to the hierarchal issues and the lack of concern for nurses’ voice in the interdisciplinary setting, arguments will occur, hampering the process of care delivery, distracting the team, and leading to medical errors.

The efficacy of the proposed change will be assessed based on the change in the number of medical errors made in the ICU setting. For this purpose, a case study will have to be conducted. In the course of the study, one will have to compare pre-and post-interventional results to determine the effects of the program and locate the further steps to be taken. Specifically, the rates of recovery before and after the introduction of the program will be compared.

Moreover, interviews will be conducted with nurses to identify alterations in the way in which they perceive the issue of medical errors (Davis, Baral, Strayer, & Serrano, 2018). The principles based on which they will make decisions in the ICU setting, as well as the changes in their value system and the motivation levels, will be recorded closely based on the outcomes of the interview.

Instrument Evaluation

The use of pre-and post-interventional analysis as the method of determining the efficacy of the proposed intervention can be seen as reasonable since there is the need to determine the immediate effect of the designed strategy. The use of the selected instrument, in turn, will help identify the emergent trends in nurses’ behaviors in the ICU setting and their propensity toward making medical errors. Particularly, the application of a pre-and post-interventional instrument will help to gather the data related immediately to the problem at hand.

In regard to the interview, one should mention that the specified tool has its benefits and disadvantages. An interview will help obtain very detailed information about the implementation of the program and gain an insight into nurses’ perception of the program and the relevant values. However, the specified tool also implies gaining data that can be characterized as very subjective. Thus, it will be necessary to take a very critical stance toward the interpretation of the interview results. Furthermore, there is a very high chance of nurses providing the information that they think the interviewer expects to hear. Therefore, it will be crucial to create a safe setting in which the participants of the program will be very comfortable in detailing their experiences without the fear of being judged.

Summary and Conclusion

The current nursing setting and especially the environment of the ICU suffer extensively from the presence of medical errors made by nurses. The specified issue causes a rapid drop in the quality of healthcare and nursing services, the development of comorbid and nosocomial issues in patients, and the overall deterioration of healthcare. Therefore, a program aimed at reducing the threat of medical error in the ICU setting will be needed.

For this purpose, one will have to consider the factors that hamper the provision of care and lead to nurses making mistakes in the workplace. Particularly, the pressure of the workplace environment, the lack of relevant skills, poor instructions, and the absence of motivation among nurses are believed to be the key reasons for the problem to exist. Therefore, one will need to introduce a combination of instructional changes and an educational program to manage the specified concern.

By combining a nurse education framework aimed at improving nurses’ understanding of care with the use of medical protocols for administering medications, one will be able to reduce the number of medical errors made in the modern nursing setting. It is critical to link the instructional change, particularly the use of protocol records, with an educational program in order to produce a shift in people’s interpretation of nursing care. Specifically, the change in nurses’ values and philosophy of care is expected to occur once an appropriate teaching framework and a suitable leadership strategy are integrated into the process. As a result, nurses will receive the impetus for altering their current concept of care and paying closer attention to the factors that typically cause them to make medical errors.

References

Chuang, C. H., Tseng, P. C., Lin, C. Y., Lin, K. H., & Chen, Y. Y. (2016). Burnout in the intensive care unit professionals: A systematic review. Medicine, 95(50), 1-12. Web.

Davis, G. C., Baral, R., Strayer, T., & Serrano, E. L. (2018). Using pre-and post-survey instruments in interventions: Determining the random response benchmark and its implications for measuring effectiveness. Public Health Nutrition, 21(6), 1043-1047. Web.

Farzi, S., Irajpour, A., Saghaei, M., & Ravaghi, H. (2017). Causes of medication errors in Intensive Care Units from the perspective of healthcare professionals. Journal of Research in Pharmacy Practice, 6(3), 158-165. Web.

Foster, M. J., Gary, J. C., & Sooryanarayana, S. M. (2018). Direct observation of medication errors in the critical care setting. Critical Care Nursing Quarterly, 41(1), 76-92. Web.

Heidari, M., Yadollahi, S., Rafiee, Z., Karimifard, M., & Lalehgani, H. (2017). A survey of nursing staff’s perspective regarding reasons for medication errors. Journal of Critical Care Nursing, 10(2), 1-7. Web.

Institute of Medicine (US) Committee on Quality of Healthcare in America. (1999). To err is human: Building a safer health system. Washington, DC: National Academies Press.

Institute of Medicine (US) Committee on Quality of Healthcare in America. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press.

Jackson, J. C., Santoro, M. J., Ely, T. M., Boehm, L., Kiehl, A. L., Anderson, L. S., & Ely, E. W. (2014). Improving patient care through the prism of psychology: Application of Maslow’s hierarchy to sedation, delirium, and early mobility in the intensive care unit. Journal of Critical Care, 29(3), 438-444. Web.

Simone, E., Tartaglini, D., Fiorini, S., Petriglieri, S., Plocco, C., & Di Muzio, M. (2016). Medication errors in intensive care units: Nurses’ training needs. Emergency Nurse, 24(4), 24-29. Web.

Tougas, M. E., Hayden, J. A., McGrath, P. J., Huguet, A., & Rozario, S. (2015). A systematic review was exploring the social cognitive theory of self-regulation as a framework for chronic health condition interventions. PloS One, 10(8), 1-19. Web.