Safety And Quality Improvement

Safety And Quality Improvement 

Please answer the question below:

1.  How do best practices contribute to quality and safety?

·      Follow the 3 x 3 rule: minimum three paragraphs per DQ, with a minimum of three sentences each paragraph.

·      All answers or discussions comments submitted must be in APA format according to Publication Manual American Psychological Association (APA) (6th ed.) 2009 ISBN: 978-1-4338-0561-5

·      Minimum of two references, not older than 2015.

Please provide plagiarism report



Patient Safety

Ensures that nursing practice is safe, effective, efficient, equitable, timely, and patient-centered (ANA)

Minimization of risk of harm to patients and providers through both system effectiveness and individual performance (QSEN & NOF)


To Err Is Human: Building a Safer Health System (IOM, 2000)

At least 44,000 and possibly up to 98,000 people die each year as the result of preventable harm.

Cause of the errors is defective system processes that either lead people to make mistakes or fail to stop them from making a mistake, not the recklessness of individual providers.


Error is the failure of a planned action to be completed as intended, or the use of a wrong plan to achieve an aim with the goal of preventing, recognizing, and mitigating harm.

Common errors include drug events and improper transfusions, surgical injuries and wrong-site surgeries, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken patient identities (IOM, 2000).

Event Analysis

Individual approach or system approach

Culture of blame

Culture of safety

Just culture

Root-cause analysis


Reason’s Adverse Event Trajectory

Example Fishbone Diagram

Figure 8-2 Typical fishbone diagram.

Classification of Error

Type of error


Patient management

Clinical performance

Where the error occurs

Latent failure and active failure

Organizational system failures and system process or technical failure

Human Factor Errors


Deviation in the pattern of a routine activity such as an interruption



Conscious decision by the nurse to “workaround” or take a shortcut, so the system defense mechanisms are bypassed, thereby increasing risk of harm to patient

To Err Is Human: Building A Safer Health System (IOM, 2000) (1 of 2)

User-centered designs with functions that make it hard or impossible to do the wrong thing

Avoidance of reliance on memory by standardizing and simplifying procedures

Attending to work safety by addressing work hours, workloads, and staffing ratios

Avoidance of reliance on vigilance by using alarms and checklists

To Err Is Human: Building A Safer Health System (IOM, 2000) (2 of 2)

Training programs for interprofessional teams

Involving patients in their care; anticipation of the unexpected during organizational changes

Design for recovery from errors

Improvement of access to accurate, timely information such as the use of decision-making tools at the point of care

Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2000)








10 rules for redesign

Rule #6: Safety is a system property.

Keeping Patients Safe: Transforming the Work Environment of Nurses (IOM, 2004)

Chief nursing executive should have leadership role in the organization.

Creation of satisfying work environments for nurses.

Evidence-based nurse staffing and scheduling to control fatigue.

Giving nurses a voice in patient care delivery.

Designing work environments and cultures that promote patient safety.

Preventing Medication Errors: Quality Chasm Series (IOM, 2006)

Paradigm shift in the patient–provider relationship

Using information technology to reduce medication errors

Improving medication labeling and packaging

Policy changes to encourage the adoption of practices that will reduce medication errors

Joint Commission National Patient Safety Goals

Reviewed and updated annually, focuses on system-wide solutions to problems

2015 goals: Identify patients correctly, use medications safely, improve staff communication, use alarms safely, prevent infection, identify patient safety risks, and prevent mistakes in surgery

National Quality Forum Goals

Improving quality health care by setting national goals for performance improvement

Endorsement of national consensus standards for measuring and public reporting on performance

Promoting the attainment of national goals

National Quality Forum Safe Practices

Endorsed safe practices defined to be universally applied in all clinical settings in order to reduce the risk of error and harm for patients.

34 practices have been shown to decrease the occurrence of adverse health events.

Also endorses list of 29 preventable, serious adverse events for public reporting.

Sentinel Events

An unexpected occurrence involving death or serious physical or psychological injury or the risk thereof.

Examples include wrong patient events, wrong site events, wrong procedures, delays in treatment, operative or postoperative complications, retention of foreign body, suicides, medication errors, perinatal death or injury, and criminal events.


Healthcare organizations have responded to incentive programs, accreditation standards, and public opinion.

Professional organizations have responded with revisions to standards that place more emphasis on healthcare quality and patient safety.

Educators have responded by infusing quality and safety concepts into student didactic and clinical experiences guided by initiatives such as the QSEN and Nurse of the Future.

Patient Narratives

A short video about The Betsy Lehman Center for Patient Safety and Medical Error Reduction is available at:

The Chasing Zero: Winning the War on Healthcare Harm video is available at:

The Transparent Health−Lewis Blackman Story video is available at:

Healthcare Quality (1 of 2)

Quality is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Healthcare Quality (2 of 2)

Quality improvement refers to the use of data to monitor the outcomes of care processes, and uses improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems.


Crossing the Quality Chasm (IOM, 2001)

Safe, timely, effective, efficient, equitable, and patient-centered (STEEEP)

10 rules for redesign to move the healthcare system toward the identified performance expectations

10 Rules for Redesign (1 of 3)

Care is based on continuous healing relationships with patients receiving care whenever and wherever it is needed.

Care can be customized according to the patient’s needs and preferences even though the system is designed to meet the most common types of needs.

The patient is the source of control and, as such, should be given enough information and opportunity to exercise the degree of control he or she chooses regarding decisions that affect him or her.

10 Rules for Redesign (2 of 3)

Knowledge is shared and information flows freely so that patients have access to their own medical information.

Decision making is evidence based; that is, it is based on the best available scientific knowledge and should not vary illogically between clinicians or locations.

Safety is a system property and patients should be safe from harm caused by the healthcare system.

10 Rules for Redesign (3 of 3)

Transparency is necessary where systems make information available to patients and families that enable them to make informed decisions when selecting a health plan, hospital, or clinic, or when choosing alternative treatments.

Patient needs are anticipated rather reacted to.

Waste of resources and patient time is continuously decreased.

Cooperation among clinicians is a priority to ensure appropriate exchange of information and coordination of care.

Measures of Quality


Core measures


Composite measures

Measures of Nursing Care

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey

National Voluntary Consensus Standards for Nursing-Sensitive Care

National Database of Nursing Quality Indicators (NDNQI)


Continuous Quality Improvement (CQI)

Structured organizational process that involves personnel in planning and implementing the continuous flow of improvements in the provision of quality health care that meets or exceeds expectations

Processes or Pathways for CQI

First process occurs as data that is regularly collected is monitored; if the data indicate that a problem exists, then an analysis is done to identify possible causes and a process is initiated to pilot a change.

Second process involves the identification of a problem outside of the routine data monitoring system.

Quality Improvement Methodologies

“Plan, Do, Study, Act”

Six Sigma

Define, Measure, Analyze, Improve, Control

Swiss Cheese Model

Figure 8-5 Plan, Do, Study, Act (PDSA) cycle.

American Nurses Association (ANA) Standard #14

ANA standard of professional performance: The registered nurse contributes to quality nursing practice with competencies that include the nurse’s role in various quality improvement activities such as collecting data to monitor quality and collaboration to implement quality improvement plans and interventions.


Adequacy of resources

Engaging nurses from management to the bedside in the process

Increasing number of QI activities

Administrative burden of QI initiatives

Lack of preparation of nurses in traditional nursing education programs for role in QI


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