This document provides an executive summary of a nursing leadership paper addressing quality and safety issues. It discusses medication errors as a systematic problem that can harm patients and impact healthcare providers and organizations. The author recommends strategies to minimize errors such as establishing a safety culture and acknowledging that humans are fallible. As a nursing leader, the author will work to identify gaps, improve outcomes through evidence-based practices, and address systematic issues and their impacts.

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6
EXECUTIVE SUMMARY
Jessica Ramos
Capella University
NURS-FPX6212: Health Care Quality Safety Management
Dr. Mary Ellen Cockerham
August 18, 2021
Executive Summary
Medication error being a systematic problem is not a new
case. It is something that nurses and other healthcare providers
have experienced. The error could be a result of recurring issues
of just human error. It could also lead to more severe injuries
where the patient could find themselves with a new condition
such as itching rashes or skin problems that could either be
temporary or permanent. These medication errors could even
lead to death in some cases, significantly hurting the patient's
family, especially when they know that the death of their loved
one could have been prevented. It could make the healthcare

2. provider responsible for the error start doubting themselves and
start feeling guilty and ashamed for the action. It could even
lead to depression throughout their life. If the deceased's family
decides to file a lawsuit against the nurse or the one who was
responsible, it could result in them losing their license.
Medication errors can also impact the hospital where the
healthcare provider is working, and patients even lose trust in
the kind of treatment offered in that hospital. The occurrence of
medication errors could cause the organization not to achieve its
goals and objectives of providing quality care to patients for
better results. Since human is to error, a medication error of not
greater than 5% is allowed, but currently, it is at 39.5% (Barker
et al. 2020)
As a nursing leader, I would recommend using various
strategies to help minimize the occurrence of such medication
errors in the future. The management should make it their
responsibility to establish a safety culture and constantly report
the current system and how it is performing. Healthcare
providers should understand that humans are to error, and no
one is to be blamed or receive a harsh form of punishment. The
healthcare provider responsible for the medication error should
acknowledge their mistake and report to the nursing leaders or
the supervisor in charge to ensure patient safety before things
get worse.
Nursing is a vital profession in the healthcare sector, mainly
concerned with providing quality care to individuals and
families. However, it has been discovered that there is a gap
between the expected outcomes and the actual results. As a
nursing leader, I will present the matter before other executive
leaders to ensure care has been improved. Even though care is
the primary concern of nurses, other healthcare providers should
also work to ensure quality and safety outcomes. It is the
responsibility of every individual in the organization. They
should ensure to utilize evidence-based information and apply
this knowledge to assess the ability of the entire organization to
provide evidence-based care delivery. I will also look at

3. systematic problems and specific medication errors and what
impact this could have on the patient: health care provi ders, and
the entire organization.
Executive Summary on the Gap
Quality outcome measures on care in nursing are tools used to
weigh or quantify processes and outcomes in the healthcare
sector. These outcomes are essential as they help in
understanding the patients' perception towards care they are
receiving. It is through the outcomes that we are able to
understand the organizational structure and check whether it has
the ability of providing high-quality care and meet the
organizational goals and objectives. The outcomes are measured
to help in bridging the gap that has been identified. Through
measuring we can improve the entire nursing practice in terms
of quality care, patient safety, patient experience on care and
future healthcare outcomes expected (Sim et al. 2019) Data on
outcomes in nursing indicates that the patients’ results depend
on how sensitive the nurse is on issues such as pressure and
ulcers. It also depends on the relationship established between
nursing and patient that builds on trust.
These measures significantly impact patient care, where
the effect can either be positive or negative. The steps evaluate
and examine the communication between team members among
healthcare providers concerned about patient care. If the
transmission is effective, then the results on patient care would
also be positive and vice versa. The implication on a culture of
quality and safety depends on whether the organization
embraces the safety and quality of all staff, which will impact
patient quality care and protection. When the staff's well-being
has been catered for, leading to job satisfaction, and reducing
burnout, then the safety of the patients will also be favorable. It
is vital to continue measuring these outcomes to try and
improve both quality and safety for patients and even healthcare
providers. If the consequences are not counted, it would
negatively impact the patient results. The reason for saying that
is that no gap would be identified. Together with other

4. executive leaders, nursing leaders would not know the areas that
need improvement or what the patients think about the kind of
treatment (Pappas, 2016).
The specific outcomes measures related to performance
issues in healthcare include evaluating the performance of
nurses by asking patients to give out their opinions on the kind
of care that they receive from nurses. How effective
communication is among healthcare providers is also another
measure that is connected to performance. The more effective
communication is, the higher the performance because nurses
are exchanging shifts communicate on the progress of the
patient and the subsequent medication expected to be
administered to the patient. The overall performance of nurses
and other healthcare professional practitioners is measured on
the outcomes of the patients. There is a positive and direct
relationship between the effects and performance (Werner,
Konetzka & Kim, 2015). This is because without measuring the
results, it would be a challenge to determine the performance
level.
Strategic planning in organizations dealing with healthcare
is very crucial as it involves stating the steps that need to be
taken to achieve specific goals set. Through strategic planning,
an organization can ensure that all activities are directed
towards the mission and vision of the organization. Healthcare
organization has created a competent strategic planning team to
ensure they set goals that are SMART and measurable, and at
the same time develop strategies to meet these goals. There is a
relationship between outcome measures and strategic planning.
To improve quality and safety through strategic planning, we
need to measure the outcomes of strategic plans to examine
whether they were a success or not. These measures ensure that
the organizational culture on safety and quality is well
preserved and improved where need be. Through these
outcomes’ measures, variances can be detected and corrected
immediately before the impact on quality and safety is adverse
(Schaffner, 2017).

5. Nursing leaders should be ready to adapt to any change in
the practice before their juniors do. They are supposed to lead
by example. All nurses and other healthcare providers should
adapt to the changes affecting specific outcomes to ensure
effectiveness. The following steps should be taken to ensure the
adoption process is successful. It is essential first to
communicate the transition to other nurses to become aware of
it. After communication, they need to be involved in the entire
process to avoid resistance that could lead to failure of the
adoption process. The need for change in the specific outcome
should be communicated, and then they are given a chance to air
their views on whether the difference is vital and whether it will
impact patient care, which is the main focal point of the
practice setting as a whole. Later, the strategic plans to adopt
the proposed change are communicated to ensure that every
nurse and other practitioners make the adoption and
implementation process a success. And lasting the proposed
change will be implemented without any resistance from any
staff. The approach will be practical as it will help reduce the
cost implication of change adoption and implementation (Baloh,
Zhu & Ward, 2018).
Conclusion
In conclusion, measuring outcomes is essential in nursing
practice and other organizations to ensure they constantly
improve weak areas and strengthen their achievements.
However, measuring methods should also be critically evaluated
to ensure they are not designed to favor a particular group of
people while others get discriminated by the same. Without
measuring its performance and outcomes, no organization can
succeed after a specific duration specified in its strategic plan.
Lack of measuring tools would only mean that the organization
has goals and mission written or stated only to fulfill an
unquestionable requirement for the law and not to guide their
operations in both the short and long run.

6. References
Baloh, J., Zhu, X., & Ward, M. M. (2018). Implementing team
huddles in small rural hospitals: How does the Kotter model
of change apply?. Journal of Nursing Management, 26(5),
571-578.
Barker, K. N., Flynn, E. A., Pepper, G. A., Bates, D. W., &
Mikeal, R. L. (2020). Medication errors observed in 36 health
care facilities. Archives of Internal Medicine, 162(16), 1897-
1903.
Pappas, S. H. (2016). Value, a nursing outcome. Nursing
Administration Quarterly, 37(2), 122- 128.
Schaffner, J. (2017). Roadmap for success: the 10-step nursing
strategic plan. JONA: The Journal of Nursing
Administration, 39(4), 152-155.
Sim, J., Joyce‐ McCoach, J., Gordon, R., & Kobel, C. (2019).
Development of a data registry to evaluate the quality and
safety of nursing practice. Journal of Advanced Nursing, 75(9),
1877-1888.
Werner, R. M., Konetzka, R. T., & Kim, M. M. (2015). Quality
improvement under nursing home compare: the association
between changes in process and outcome
measures. Medical Care, 51(7), 582.
SOAP NOTE
Name: Y. U
Date: 09/20/2018
Time: 11:30 AM
Age: 45 y/o

7. Sex: F
SUBJECTIVE
CC: Follow up Lab result and fatigue
HPI:
Y.U is a 45-year-old female, who comes to the office today for
lab review. She stated that she has gained 10 pound in the last
three months and she feels fatigued.
Medications:
· Synthroid tab 100mcg tab 1 tab q/am PO whit empty stomach
· Citalopram tab10 mg tab 1 tab PO OD
PMH
Allergies: Denies any allergies to food or medication and
environmental allergies.
Medication Intolerances: NKDA
Chronic Illnesses/Major traumas: Depression and
hypothyroidism
Hospitalizations/Surgeries: Denies
Family History
Mother: Alive, HTN
Father: Alive, CAD
Brothers: 1, alive and healthy
Social History
Patient is married and lives with her husband and two children.
She works as a manicure. She does not smoke cigarettes. She
drinks alcohol socially, denies use of illicit drugs. She normally
makes a regular checkup for her health chronic conditions.
Family attends church on a regularly and has a good support
system. Pets: No. Travel: No.
ROS
General
Patient is a 45 y/o Hispanic female. Patient complains of fatigue
and weight gain. No distress noted at this moment. Appetite
decreased

8. Cardiovascular
Denies chest pain, palpitations, PND, orthopnea, edema, denies
palpitations
Skin
Warm and dry. No rashes bruising or bleeding noticed, skin is
appropriated color for ethnicity.
Respiratory
Denies cough, wheezing, hemoptysis, dyspnea
Eyes
Denies changes in vision, denies blurred vision
Gastrointestinal
Denies vomit or diarrhea.
Ears
Denies ear pain, hearing loss, ringing in ears, discharge
Genitourinary/Gynecological
Patient denies urinary symptoms (urgency, frequency burning,
change in color of urine). No hematuria
Nose/Mouth/Throat
Denies difficulty in smelling, sinus problems, nose bleeds or
discharge. Denies dysphagia, hoarseness, throat pain
Musculoskeletal
No limitation of range of motion. Denies any joint pain or any
muscle pain
Breast
No changes
Neurological
Denies syncope, seizures, transient paralysis, paresthesia, black
out spells
Heme/Lymph/Endo
No bruises, no hematomas, ecchymosis, lymph nodes or mass.
Cold intolerance.

9. Psychiatric
Decrease level of energy.
OBJECTIVE
Weight 140 BMI 25.6 Overweigh
Temp 98.8 F
Pain: 0/10
BP 121/74 mmHg
Height 5’.2” in
Pulse 84 bpm
Resp 18 bpm
General Appearance
Head is normocephalic, atraumatic and without lesions; hair
evenly distributed.
Skin
Good turgor, no rashes, well perfused.
HEENT
Head is normocephalic, atraumatic and without lesions; hair
evenly distributed. Eyes: PERRLA. EOMs intact. No
conjunctival or scleral injection. Ears: Canals patent. Nose:
Nasal mucosa pink; normal turbinates. No septal deviation.
Throat: Oral mucosa pink and moist. Pharynx is no
erythematous and without exudate. Neck: Supple. Full ROM;
no cervical lymphadenopathy.
Cardiovascular
Regular rhythm and rate, normal S1S2, no murmurs.
Respiratory
Symmetric chest wall. Respirations regular and easy; lungs
clear to auscultation bilaterally.
Gastrointestinal
Abdomen soft, non-tender, no distended, bowel sound present.
No organomegaly, mass, or herniation
Breast
No mass.
Genitourinary

10. Bladder is non-distended. External genitalia deferred.
Musculoskeletal
Full ROM seen in all 4 extremities as patient moved about the
exam room. Steady gate, no limping or musculoskeletal
deformities.
Neurological
Speech clear. Good tone. Posture erect. Balance stable; gait
normal.
Psychiatric
Alert, awake.
Lab Tests
CBC, CMP, Lipid profile, TSH, US of the neck and thyroid,
screen mammogram
Special Tests
None.
Diagnosis
Diagnosis
· Uncontrolled Hypothyroidism
· Depression
· Overweight
Differential diagnosis
1. Ischemic heart disease
2. Hypothyroidism secondary to treatment
3. Nephrotic syndrome
4. Cirrhosis
5. Depression
Plan/Therapeutics
· Plan:
Illness counseling
Discussed compliance with medication
TSH prior appointment next month, Lab
result follow up
RTC or call if no improvement

11. Patient instructed about the nature and course of
hypothyroidism, s/s of disease and medication management.
Review the labs: TSH 13 Uu/ml. Rest of the lab normal.
New medication: Increase Synthroid 100mcg to 120 mcg daily
q/AM. PO whit empty stomach. Patient continue with the same
medication for depression.
References:
McCance, Kathryn, Sue Huether. Pathophysiology: The Biologic
Basis for Disease in Adults and Children, 7th Edition. Mosby,
2014. Vital Book file.
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FPX6212/210700/Scoring_Guides/a02_scoring_guide.html