Discussion Question 2
Discussion Question 2
In many hospitals and health systems, nurses have taken the initiative to apply the principles of quality improvement to improve clinical practice and hence performance and patient outcomes. The process of identifying a problem, analyzing it, and planning, implementing, and evaluating interventions to address the issue and translate research evidence in the process, as well as documenting and disseminating results have led to the identification of best practices in these various areas of QI (Stevens, 2013). For instance, staff engagement or participation, employing models such as the Plan-Do-Study-Act (PDSA) cycle, and sustaining continuous improvements in performance through dashboard measurement and monitoring are frequently cited as elements that contribute to successful and long-lasting change (Collet et al., 2014; Melnyk & Fineout-Overholt, 2011; Salazar, Tyroch & Smead, 2011).
In the Veterans Affairs health system, a QI project implemented in collaboration with IT professionals permitted patients electronic access to their health records and, of late, their progress notes to facilitate engagement such as through active discussions with providers and continuity of care as patients move from one level of care to another (Weston & Roberts, 2013). The strategy is aimed at improving patient satisfaction with care. Another nurse-led initiative was to create electronic documentation systems to drive the prevention and management of pressure ulcers. Nurses in the VA have also piloted and implemented the bar-code medication administration as a strategy to prevent medication errors, specifically wrong drug, wrong time, and wrong patient events (Weston & Roberts, 2013). On the other hand, Kaiser Permanente implemented SmartCARE using the lean QI approach with the objectives of simplifying nursing tasks, reducing tasks that do not add value, and providing knowledge support to nurses (Weston & Roberts, 2013). The project is aimed at enhancing efficiency in the nursing workflow. The technology was developed based on input from nurses and other stakeholders as well as video ethnographic studies of nurses as they went about their daily tasks.
References
Collet, J., Skippen, P.W., Mosavianpour, M.K., Pitfield, A., Chakraborty, B., Hunte, G., McKellin, W.H. (2014). Engaging pediatric intensive care unit (PICU) clinical staff to lead practice improvement: The PICU Participatory Action Research Project (PICU-PAR). Implementation Science, 9(6), 1-10. doi:10.1186/1748-5908-9-6.
Melnyk, B.M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia, PA: Lippincott Williams & Wilkins.
Salazar, A., Tyroch, A.H., & Smead, D.G. (2014). Electronic trauma patient outcomes assessment tool. Journal of Trauma Nursing, 18(4), 197-203. doi: 10.1097/JTN.Ob013e31823a49ff.
Stevens, K.R. (2013). The impact of evidence-based practice in nursing and the next big ideas. Online Journal of Issues in Nursing, 18(2). Retrieved from http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJI N/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based- Practice.html
Weston, M., & Roberts, D.W. (2013). The influence of quality improvement efforts on patient outcomes and nursing work: A perspective from chief nursing officers at three large health systems. Online Journal of Issues in Nursing, 18(3). Retrieved from http://www.nursingworld.org/Quality-Improvement-on-Patient-Outcomes.html
