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Enhancing Quality and Safety

The role of the baccalaureate nurse includes identifying and explaining specific patient risk factors, incorporating evidence-based solutions to improving patient safety and coordinating care. A solid foundation of knowledge and understanding of safety organizations such as Quality and Safety Education for Nurses (QSEN), the Institute of Medicine (IOM), and The Joint Commission and its National Patient Safety Goals (NPSGs) program is vital to practicing nurses with regard to providing and promoting safe and effective patient care.
You are encouraged to complete the Identifying Safety Risks and Solutions activity. This activity offers an opportunity to review a case study and practice identifying safety risks and possible solutions. We have found that learners who complete course activities and review resources are more successful with first submissions. Completing course activities is also a way to demonstrate course engagement.

As a baccalaureate-prepared nurse, you will be responsible for implementing quality improvement (QI) and patient safety measures in healthcare settings. Effective quality improvement measures result in systemic and organizational change, ultimately leading to the development of a patient safety culture.
Consider the hospital-acquired conditions that are not reimbursed under Medicare/Medicaid, some of which are specific safety issues such as infections, falls, medication errors, and other concerns that could have been prevented or alleviated with the use of evidence-based guidelines.
The purpose of this assessment is to better understand the role of the baccalaureate-prepared nurse in enhancing quality improvement (QI) measures to address patient safety risk at a healthcare setting of your choice. You will do this by exploring the professional guidelines and best practices for improving and maintaining patient safety in healthcare settings from organizations such as QSEN (Quality and Safety Education for Nurses) and the IOM (Institute of Medicine). Looking through the lens of these professional best practices to examine the current policies and procedures in place at your chosen organization and the impact on safety measures for patients, you will consider the role of the nurse in driving quality and safety improvements. You will identify stakeholders in QI improvement and safety measures as well as consider evidence-based strategies to enhance quality of care and promote safety in your chosen healthcare setting.
See Nursing Competencies for more information.
Instructions
Select one of the safety quality issues presented in the Assessment 01 Supplement: Enhancing Quality and Safety [PDF] Download Assessment 01 Supplement: Enhancing Quality and Safety [PDF]resource and incorporate evidence-based strategies to support communication and ensure safe and effective care.
For this assessment, be sure to focus on an organizational setting. This could be a primary care office, urgent care, mobile clinic, hospital ED, rural clinic, etc. Then use the literature to support the problem and solution in the organization. Reflect on costs to that organization/setting and what nurses can do to coordinate the care within the setting. Reflect on stakeholders who may be involved.
Be sure that your plan addresses the following, which corresponds to the grading criteria in the rubric. Please study the rubric carefully so you understand what is needed for a distinguished score.
• Explain factors leading to a specific patient safety risk.
• Explain evidence-based and best-practice solutions to improve patient safety related to a specific patient-safety risk and reduce costs.
• Explain how nurses can help coordinate care to increase patient safety and reduce costs.
• Identify stakeholders with whom nurses would need to coordinate to drive safety enhancements.
• Communicate using writing that is clear, logical, and professional, with correct grammar and spelling, using current APA style.

• Competency 1: Analyze the elements of a successful quality improvement initiative.
o Explain evidence-based and best-practice solutions to improve patient safety related to a specific patient safety risk and reduce costs.
• Competency 2: Analyze factors that lead to patient safety risks.
o Explain factors leading to a specific patient-safety risk in a healthcare setting.
• Competency 4: Explain the nurse's role in coordinating care to enhance quality and reduce costs.
o Explain how nurses can help coordinate care to increase patient safety and reduce costs.
o Identify stakeholders with whom nurses would coordinate to drive safety enhancements with a specific safety quality issue.
• Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.
o Organize content so ideas flow logically with smooth transitions; contains few errors in grammar or punctuation, word choice, and spelling.

Full Answer Section

Factors contributing to medication errors in acute care settings are often multifaceted and extend beyond individual practitioner lapses. A primary cause is the high-acuity environment and the associated heavy workload, which can lead to interruptions and distractions during medication administration (Institute of Medicine [IOM], 2000). Compounding this is a lack of standardization in medication order entry and documentation, which can result in illegible or incomplete prescriptions. Furthermore, human factors such as fatigue, inexperience, and the pressure to quickly turnover patients can compromise the meticulous checks required for safe medication practice (QSEN Institute, n.d.). Each error has a direct financial consequence for the organization in the form of extended hospital stays, increased resource consumption, and potential legal fees, making the need for preventative measures a fiscal and ethical imperative. Implementing evidence-based and best-practice solutions is essential for improving medication safety and simultaneously reducing organizational costs. The use of Barcode Medication Administration (BCMA) systems, a strategy endorsed by both the IOM and QSEN, directly addresses human error by providing a digital verification process at the patient's bedside. A study by Agrawal et al. (2018) found that BCMA significantly reduced the rate of medication errors, leading to a decrease in adverse drug events and their associated costs. Beyond technology, the baccalaureate nurse can champion the adoption of standardized protocols such as the "three checks" of medication administration and the "five rights" of medication safety. Creating a culture of safety, as advocated by the IOM, also involves promoting non-punitive error reporting, which allows organizations to learn from mistakes and implement systemic change rather than placing blame on individuals. These solutions not only protect patients but also contribute to cost savings by preventing adverse events and the subsequent need for additional medical interventions. Nurses play a pivotal role in care coordination, serving as the central hub of communication among various healthcare disciplines. In the context of medication safety, the nurse's role in coordination is a proactive and continuous process. By collaborating with pharmacists to clarify medication orders, communicating with physicians regarding potential drug interactions, and providing comprehensive medication education to patients and their families, the nurse ensures that a holistic and consistent approach to care is maintained. This role is crucial for preventing medication errors at multiple points along the care continuum. By ensuring accurate and timely communication, the nurse reduces the potential for costly delays or adverse events stemming from miscommunication. For example, a nurse who clarifies an ambiguous medication order with a physician before administration prevents a potential error that could have led to patient harm and subsequent financial burden on the organization. Driving safety enhancements requires coordination with a diverse group of stakeholders, all of whom play a role in the QI process. The most immediate stakeholders are the nurses themselves, as they are the direct implementers of safety measures and advocates for change. They must coordinate with hospital leadership and administrators to secure the necessary resources for implementing new technologies or protocols. Physicians and pharmacists are also key stakeholders, as their collaboration is essential for accurate order writing, medication verification, and interdisciplinary communication. The Information Technology (IT) department is a critical partner, responsible for the successful deployment and maintenance of safety-enhancing systems like BCMA. Lastly, the Quality Improvement Committee and patient safety officers provide oversight and analyze data to track the effectiveness of interventions and identify new areas for improvement. By engaging with these diverse stakeholders, the baccalaureate nurse can build a collaborative coalition to champion lasting organizational change. In conclusion, the baccalaureate-prepared nurse is a crucial catalyst for enhancing patient safety and quality improvement in healthcare. By explaining the factors leading to a specific safety risk like medication errors, proposing and implementing evidence-based solutions, and skillfully coordinating care with a wide range of stakeholders, these nurses contribute directly to a safer healthcare environment. This proactive and systems-oriented approach not only protects patients from preventable harm but also promotes a culture of safety that benefits the entire organization through reduced costs and improved outcomes. References Agrawal, A., Wu, W., & Singh, R. (2018). The impact of barcode medication administration on patient safety. Journal of Patient Safety, 14(3), 162-167. Institute of Medicine. (2000). To err is human: Building a safer health system. National Academies Press. QSEN Institute. (n.d.). Patient safety competencies. Retrieved from http://qsen.org/competencies/pre-licensure-

Sample Answer

The Role of the Baccalaureate Nurse in Enhancing Patient Safety and Quality Improvement The baccalaureate-prepared nurse is uniquely positioned to lead and implement quality improvement (QI) initiatives that address patient safety risks within healthcare organizations. Through a synthesis of clinical knowledge, critical thinking, and a comprehensive understanding of systems, these nurses can identify systemic flaws, propose evidence-based solutions, and coordinate care to enhance safety and reduce costs. The pervasive and costly issue of medication errors, particularly within a hospital's medical-surgical unit, serves as a prime example of a patient safety risk that can be mitigated through the deliberate actions of the baccalaureate nurse.

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