NR392 Quality Improvement in Nursing Project Milestone 1 Completed

NR392 Quality Improvement in Nursing Project Milestone 1 Completed

NR392 Quality Improvement in Nursing Project Milestone 1 Completed
Project Milestone 1
 Directions: Prior to completing this template, carefully review Course Project Milestone 1 Guidelines paying particular attention to how to name the document and all rubric requirements. After saving the document to your computer, type your answers directly on this template and save again. This assignment is due by Sunday end of Week 1 by 11:59 p.m. Mountain Time.
Your Name: _____ _____________________

Assignment Criteria
Your Answers:
NOTE: See Milestone 1 Rubric for details required in each area.
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Nursing Issue
 
30 points
Medication error is defined by the NIH as “a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient’ (NIH.gov) Medication error has been a serious problem in the healthcare industry. Mistakes involving medications are among the most common health care errors. There different types of medication errors; failing to perform any of the 6 rights of medication administration can lead to medication error, cross sensitivity, wrong diagnosis etc. Medication error could sometimes generate from the prescriber, the dispenser, the manufacturer, monitoring of blood levels, educating patient correctly and administration. The nurses are usually the ones administering these medication directly to the patient, therefore is our responsibility to do last safety check before medication administration. Now there are certain instances where the nurse has no control over the error that is being made because they are not trained to identify the mistakes of the doctor or pharmacist. For example misdiagnosing a patient and giving the medications inappropriately and sometime pharmacy failing to recognize problems like cross sensitivity of certain medications given to the patient. NR392 Quality Improvement in Nursing Project Milestone 1 Completed. Nurses have direct contact with patients daily and in the acute care setting, they are usually the ones administering these medications directly to the patients, and so that makes medication errors a big issue in nursing.

Details of the Issue
 
45 points
According to NIH, It has been estimated by the Institute of Medicine that medication errors cause 1 of 131 outpatients and 1 of 854 inpatient deaths (Nih.gov). When medication error occurs a lot of people are held responsible for the mistake, especially the nurses who are suppose to be performing the last check prior to administration. Medication errors can and has had a wide range of effects on patients. NR392 Quality Improvement in Nursing Project Milestone 1 Completed. The effects of medication error ranges from nothing happening to the something as serious as death of the patient. Even though they have been significant improvement with prevention of medication errors, there are still serious errors being made by members of the care team. Is no denying fact that acute care facilities have taken great steps to prevent medication errors from occurring, such as the electronic medication record which is linked to the pharmacy, scanning patients wrist band before giving medications, having two nurses verify certain medications, pharmacy reviewing PT/INR and ordering Coumadin on a daily basis etc. As nurses we are trained to review lab results, diagnostic results, and patient’s diagnosis and also understand why certain medications are prescribed for patients before administering the medication. Sometimes the nurses fail to do so and encounter the possibility of a medication error. We had a situation where a patient INR was 3.1 and patient was on 5mg of Coumadin, the INR goal for the patient was 2-3. The pharmacist made a mistake and orders 3mg of Coumadin but fails to discontinue the 5mg making it a total of 8mg. The nurse failed to question the order, administer the 8mg and the next INR was 4.8. Although the pharmacy made an error, the nurse administering the mediation was held accountable as well for not reviewing the labs and questioning the order. This example goes to emphasize the fact that, although we have certain measures put in place, it is very essential for nurses to follow the 6 rights of medication administration and review labs results before giving any medications. NR392 Quality Improvement in Nursing Project Milestone 1 Completed.
 
My facility has put forward a series of measures to try and decrease the amount mediation error that occurs. We have access to the patient’s  medication record for their community pharmacy. This enables us view the medication the patient is on, compare it with the home list the patient brought in and ask question if we have any doubts. It eliminates the problem of missed doses and wrong prescription by the provider. The hospital discourages the use of home medications. We ask their loved ones to take their medications back home after comparing the bottles to their home list. NR392 Quality Improvement in Nursing Project Milestone 1 Completed. The only exception to this is, if the patient is taking a medication that is in not in our pharmacy formulary, then the pharmacy has to verify the medication, label it with a barcode and the nurses must lock it up in the medication drawer and administer it to the patient as directed until discharge. Two nurses have to verify insulin prior to administration as well as heparin drip. All medications that are not scanned are reported to the manager at the end of the month an each nurse need s to score 98% scanning rate or above. All medications entered has to be verified by the pharmacy before it could be pulled out of the pyxis or administered to patients.
Reporting the errors as soon as you realize it can produce a better outcome for the patient. For example mistakenly administering 60units of short acting insulin instead of long acting insulin to a patient needs to be reported right away or it might be detrimental to the patient’s life. I will encourage my colleagues to talk to patient about their  home medication regimen on admission and question any orders if they have doubts. If any errors occur, I will encourage the staff to report it in a timely manner and not hide it. Creating a non punitive environment for staff could encourage staff to report the issue without fear of been punished.
 

Reason Issue Selected
 
25 points
In the acute care setting that I work in, I have seen so many mediation errors stemming from different levels of the care team. I recently witnessed an actual medication error which thankfully did not cause any harm to the patient. Two months ago, I had a patient that was misdiagnosed by the Radiologist for having a blood clot in the pelvis.  The patient was started on Coumadin/Lovenox bridge because her INR was 1.0. She was getting 60mg of Lovenox twice daily and Coumadin 5mg daily which was subjected to change based on the daily PT/INR. The Coumadin went as far up as 10mg. The patient goal was to bring the INR between 2-3 NR392 Quality Improvement in Nursing Project Milestone 1 Completed. The PA was assigned to the patient for the first 5 days after her diagnosis. On the 4th day when a doctor took that assignment, he questioned the MRI results based on the images he reviewed. The Radilogist was called and he was later concluded that the patient was misdiagnosed. So the patient did receive such high dosage of blood thinners for no apparent reason. The patient and her family were notified by the hospital. The patient daughter made it very clear she was taking legal actions against the hospital. The patient INR only came up to 1.8 thankfully. In this situation, the medication error stems from the provider esp. the Radiologist who misdiagnosed the patient. I thought this particular incident actually highlighted the fact that medication error still occur in acute care settings even with several measures put in place to prevent errors from happening. Although the person who originated this error was the diagnosing doctor, so many people were held accountable. The radiologist, the prescriber, the nurses who administer the medication. NR392 Quality Improvement in Nursing Project Milestone 1 Completed.

REFERENCES:
https://learn.ana-nursingknowledge.org/products/Preventing-High-Alert-Medication-Errors-in-Hospital-Patients, Retrieved, October 2016.
https://www.ncbi.nlm.nih.gov/pubmed/24981217, Retrieved, October 2016.
 
Course Project Milestone 2 Template
Directions: Prior to completing this template, carefully review Course Project Milestone 2 Guidelines paying particular attention to how to name the document and all rubric requirements. After saving the document to your computer, type your answers directly on this template and save again. This assignment is due by Sunday end of Week 3 by 11:59 p.m. Mountain Time.
Your Name: Latoya Harrison

Assignment Criteria
Answers:
(NOTE: See Milestone 2 Rubric for details required in each area.)

Define:
Approved Nursing Issue from Milestone 1
25 points
My Approved Nursing issue that was thoroughly explained in my Milestone 1 assignment is Nurse Mentoring. Nurse mentoring can be defined as a continuous collaborative relationship between two individuals. One of which is a novice and an expert/senior. Nurse mentoring is a reciprocal learning relationship between two persons, who have mutual goals as it relates to the care being provided. At some point in our lives, many of us go through numerous working experiences where everything is new to us, and to be quite honest, this is a rather unpleasant feeling. It is the fear of the unknown, or just that generalized uncomfortable feeling. We’ve all been there and will continue to experience this as we navigate our way through different working experiences. What would have made these experiences more pleasant, is a mentor. The concept of nurse mentoring continues to be an overlooked issue that is need of Quality improvement. NR392 Quality Improvement in Nursing Project Milestone 1 Completed.
 

Measure:
Identify Measures (Indicators) to Support the Issue
75 points
The lack of nurse mentoring/mentorship is a worldwide issue that affects both patient outcomes, and nurse retention rates in hospital facilities. Take my experience for example. At my former facility, there were always a shortage of new nurses. Over the span of 1 year, the facility has had difficulties retaining nurses. I will briefly explain why. This facility lacked the teamwork/collaboration approach. It was almost as if I was thrown to the wolves as soon as I got to the floor. A warm accepting environment did not exist. I received constant attitudes whenever I asked for help, and had no one to orient me to the areas that I was unfamiliar with. Most of the nurses were in their own little worlds and preferred to work independently. I believe they looked at it as if I would be slowing them down. Myself, along with other new nurses, faced feelings of uncertainty and we all yearned for consistent guidance. We began to feel resistance from the more experienced nurses. It was almost like they were “eating their young”. Retention rates decreased significantly. At this specific time, my facility hired 14 new RN’s. Within a 6-month time frame, 10 quit their positions including myself. There are a multitude of things that could have been better had there been effective mentoring relationships, and or mandatory programs putting this in place. My self confidence level would have been increased, leadership skills enhanced, stress levels reduced, improved networking abilities, and enhanced communication skills. NR392 Quality Improvement in Nursing Project Milestone 1 Completed.
 
 
 

Measure:
List Stakeholders (important persons) in Improving this Nursing Issue
50 points
There are in fact several stakeholders that can impact this continuous issue in a positive way. These include nurses, physicians, advocacy groups, policy makers, professional society groups, health care coordinators and health care administrators.
Experienced nurses are able to improve this issue by using their knowledge and wisdom in order to provide a meaningful learning experience, for novice nurses, in addition to striving to offer warm, accepting environments for new nurses, during their transition phase. This is key. Physicians, advocacy groups and professional societies can all serve as spokespersons as it relates to this issue, by advocating and voicing concerns, as well as the negative impacts for both the health care professional and patient outcomes. Policy makers, health care coordinators and administrators can strive to enforce that there be mandatory orientation and mentorship programs available at all times NR392 Quality Improvement in Nursing Project Milestone 1 Completed. If you really look into it, in the end, everyone is affected by this issue, most importantly, the patients. By having these stakeholders push to make a change, hospital retention rates and the quality of care being provided will make a remarkable turn.

Analyze:
Analyze the Causes of the Nursing Issue
50 points
The cause of this nursing issue is simple. There is a lack of orientation and mentorship programs available in health care facilities. Due to this, policies are not in place that pushes health care providers to help others in need of assistance. Often times nurses also get too caught up with their health care tasks, that they believe helping others will throw their process off or slow their process down. We cannot think like this nor allow others to think this way. It should always feel like a team work approach because ultimately, patient care is what’s affected. “Mentoring has proven to be a successful way of facilitating the professional growth and development of recently graduated nurses and other nurses transitioning to a new role” (Minority Nurse, 2016).
Reference
Mentoring Nurses Toward Success. (2016, March 23). Retrieved March 21, 2018, from https://minoritynurse.com/mentoring-nurses-toward-success/
NR392 Quality Improvement in Nursing Project Milestone 1 Completed

 
 

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