This document discusses quality and safety in healthcare. It defines key terms like quality of care, errors, adverse events and sentinel events. It describes national organizations that influence quality and safety like AHRQ, CMS and FDA. It discusses measuring quality and safety through core measures and indicators. Unwanted variation in healthcare is described. The importance of transparency and reporting performance is covered. The consequences of errors are outlined. Professional responsibilities for nurses in quality and safety are discussed, including preventing and responding to adverse events.
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, DioneWang844
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, AND PROJECT INSTRUCTIONS
Page | 1
Quality
Nearly fifteen years ago, the Institute of Medicine published the “To Err Is Human” report, which exposed the substantial impact of medical errors in the US healthcare system and called for a dramatic system change, including an improved understanding of those errors (McCarthy, Tuiskula, Driscoll, & Davis, 2017). Medical errors are considered to be failure to achieve the original goal or plan of action, and these errors may range from a patient falls to a mistake in the operating room. Not only do medical errors cause harm to the patient and jeopardize the patient’s trust, but they also cause a financial strain for the health system (“To Err is Human,” 1999). One of the contributing factors to medical errors is the lack of effective communication between doctors who are treating the same patient. This results in healthcare providers overprescribing medications for patients as well as increases the possibility of a patient having unnecessary tests or procedures performed. The report’s four-tiered approach includes:
· Focusing on creating a stronger foundation of education on patient safety
· Mandating a nationwide reporting system to encourage timely reporting of errors
· Increasing the standards of performance for healthcare providers
· Taking advantage of the security that safety systems offer (“To Err is Human,” 1999)
Creating a strong educational foundation for patient safety is most important. Healthcare personnel are much more likely to actively participate in reporting systems, encourage one another to perform at a higher level, and take advantage of safety systems when they are well educated on patient safety and the implications of medical errors. The reporting system seems to provide the least amount of impact on patient safety as they can result in losing patient trust in certain healthcare systems. The healthcare system as a whole has made progress in establishing a safe environment for patients when they are in need of care.
Challenges for Patient Safety and Steps for Improvement
Despite continuing evidence of problems in patient safety and gaps between the care that patients receive and the evidence about what they should receive, efforts to improve quality in healthcare show mostly inconsistent and patchy results.
Tap each image to know more.
Data Collection and Monitoring Systems
This always takes much more time and energy than anyone anticipates. It is worth investing heavily in data from the outset. Assess local systems, train people, and have quality assurance.
Tribalism and Lack of Staff Engagement
Overcoming a perceived lack of ownership and professional or disciplinary boundaries can be very difficult. Clarify who owns the problem and solution, agree roles and responsibilities at the outset, work to common goals, and use shared language.
Convince People That There's a Problem
Use hard data to secure emotional e ...
Professional Association MembershipExamine the importance ofdavieec5f
Professional Association Membership
Examine the importance of professional associations in nursing. Choose a professional nursing organization that relates to your specialty area, or a specialty area in which you are interested. In a 750-1,000 word paper, provide a detailed overview the organization and its advantages for members. Include the following:
Describe the organization and its significance to nurses in the specialty area. Include its purpose, mission, and vision. Describe the overall benefits, or "perks," of being a member.
Explain why it is important for a nurse in this specialty field to network. Discuss how this organization creates networking opportunities for nurses.
Discuss how the organization keeps its members informed of health care changes and changes to practice that affect the specialty area.
Discuss opportunities for continuing education and professional development.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
References:
Explore the Advocacy page of the American Nurses Association (ANA) website.
URL:
https://www.nursingworld.org/practice-policy/advocacy/
Read Chapter 5 in
Dynamics in Nursing: Art and Science of Professional Practice.
URL:
https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/dynamics-in-nursing_art-and-science-of-professional-practice_1e.php
this is the chapter 5
By June Helbig
“… nurses provide services that maintain respect for human dignity and embrace the uniqueness of each patient and the nature of his or her health problems, without restriction with regard to social or economic status.” (American Nurses Association, n.d.a, para 1)
Essential Questions
What significance does joining a professional organization have on nursing practice?
How can nurses contribute to legislative changes that impact nursing practice and patient outcomes?
Why is evidence-based practice (EBP) the gold standard in patient care protocol improvements?
Introduction
According to the American Nurses Association (ANA) there are currently 3.6 million registered nurses in the United States (American Nurses Association [ANA], n.d.b, para 12). The ANA is a professional nursing organization, which began when fewer than 20 nurses attended a convention in 1896. Nurses at the time were concerned with nursing practice standards and nurse competency. The ANA has since grown into an organization with interests in improving health care and setting standards for nursing practice. All nurses are represented regardless of status within the organization. The goal of professional organizations is to support nurses and improve the profession (ANA, n.d.c).
This chapter will explore the significance of joining professional organizati ...
Top seven healthcare outcome measures of healthJosephMtonga1
The seven healthcare outcome measures are meant to understand the quality of health systems and how they could be measured and how quality care could be provided to clients.
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, DioneWang844
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, AND PROJECT INSTRUCTIONS
Page | 1
Quality
Nearly fifteen years ago, the Institute of Medicine published the “To Err Is Human” report, which exposed the substantial impact of medical errors in the US healthcare system and called for a dramatic system change, including an improved understanding of those errors (McCarthy, Tuiskula, Driscoll, & Davis, 2017). Medical errors are considered to be failure to achieve the original goal or plan of action, and these errors may range from a patient falls to a mistake in the operating room. Not only do medical errors cause harm to the patient and jeopardize the patient’s trust, but they also cause a financial strain for the health system (“To Err is Human,” 1999). One of the contributing factors to medical errors is the lack of effective communication between doctors who are treating the same patient. This results in healthcare providers overprescribing medications for patients as well as increases the possibility of a patient having unnecessary tests or procedures performed. The report’s four-tiered approach includes:
· Focusing on creating a stronger foundation of education on patient safety
· Mandating a nationwide reporting system to encourage timely reporting of errors
· Increasing the standards of performance for healthcare providers
· Taking advantage of the security that safety systems offer (“To Err is Human,” 1999)
Creating a strong educational foundation for patient safety is most important. Healthcare personnel are much more likely to actively participate in reporting systems, encourage one another to perform at a higher level, and take advantage of safety systems when they are well educated on patient safety and the implications of medical errors. The reporting system seems to provide the least amount of impact on patient safety as they can result in losing patient trust in certain healthcare systems. The healthcare system as a whole has made progress in establishing a safe environment for patients when they are in need of care.
Challenges for Patient Safety and Steps for Improvement
Despite continuing evidence of problems in patient safety and gaps between the care that patients receive and the evidence about what they should receive, efforts to improve quality in healthcare show mostly inconsistent and patchy results.
Tap each image to know more.
Data Collection and Monitoring Systems
This always takes much more time and energy than anyone anticipates. It is worth investing heavily in data from the outset. Assess local systems, train people, and have quality assurance.
Tribalism and Lack of Staff Engagement
Overcoming a perceived lack of ownership and professional or disciplinary boundaries can be very difficult. Clarify who owns the problem and solution, agree roles and responsibilities at the outset, work to common goals, and use shared language.
Convince People That There's a Problem
Use hard data to secure emotional e ...
Professional Association MembershipExamine the importance ofdavieec5f
Professional Association Membership
Examine the importance of professional associations in nursing. Choose a professional nursing organization that relates to your specialty area, or a specialty area in which you are interested. In a 750-1,000 word paper, provide a detailed overview the organization and its advantages for members. Include the following:
Describe the organization and its significance to nurses in the specialty area. Include its purpose, mission, and vision. Describe the overall benefits, or "perks," of being a member.
Explain why it is important for a nurse in this specialty field to network. Discuss how this organization creates networking opportunities for nurses.
Discuss how the organization keeps its members informed of health care changes and changes to practice that affect the specialty area.
Discuss opportunities for continuing education and professional development.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
References:
Explore the Advocacy page of the American Nurses Association (ANA) website.
URL:
https://www.nursingworld.org/practice-policy/advocacy/
Read Chapter 5 in
Dynamics in Nursing: Art and Science of Professional Practice.
URL:
https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/dynamics-in-nursing_art-and-science-of-professional-practice_1e.php
this is the chapter 5
By June Helbig
“… nurses provide services that maintain respect for human dignity and embrace the uniqueness of each patient and the nature of his or her health problems, without restriction with regard to social or economic status.” (American Nurses Association, n.d.a, para 1)
Essential Questions
What significance does joining a professional organization have on nursing practice?
How can nurses contribute to legislative changes that impact nursing practice and patient outcomes?
Why is evidence-based practice (EBP) the gold standard in patient care protocol improvements?
Introduction
According to the American Nurses Association (ANA) there are currently 3.6 million registered nurses in the United States (American Nurses Association [ANA], n.d.b, para 12). The ANA is a professional nursing organization, which began when fewer than 20 nurses attended a convention in 1896. Nurses at the time were concerned with nursing practice standards and nurse competency. The ANA has since grown into an organization with interests in improving health care and setting standards for nursing practice. All nurses are represented regardless of status within the organization. The goal of professional organizations is to support nurses and improve the profession (ANA, n.d.c).
This chapter will explore the significance of joining professional organizati ...
Top seven healthcare outcome measures of healthJosephMtonga1
The seven healthcare outcome measures are meant to understand the quality of health systems and how they could be measured and how quality care could be provided to clients.
2 8 5L e a r n I n g o b j e c t I v e sC H A P T E R.docxlorainedeserre
2 8 5
L e a r n I n g o b j e c t I v e s
C H A P T E R 1 0
Q U A L I T Y M A N A G E M E N T I N
T H E P H Y S I C I A N P R A C T I C E
Quality and reliability are system properties.
—W. Edwards Deming
➤ Articulate the nature of performance management.
➤ Describe the approaches to performance improvement.
➤ Appreciate the impact of variation on performance.
➤ Discuss the components of the Triple Aim.
➤ Describe process improvement.
In t r o d u c t I o n
One of the most important issues to address in the medical practice is the quality and
safety of the care provided to patients. The Institute of Medicine (IOM 2001), a presti-
gious branch of the National Institutes of Health, stated in its landmark report Crossing the
Quality Chasm: A New Health System for the 21st Century, “In its current form, habits, and
environment, American health care is incapable of providing the public with the quality
health care it expects and deserves.”
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EBSCO Publishing : eBook Academic Collection (EBSCOhost) - printed on 4/16/2020 7:48 PM via SUNY CANTON
AN: 1839064 ; Wagner, Stephen L..; Fundamentals of Medical Practice Management
Account: s8846236.main.ehost
F u n d a m e n t a l s o f M e d i c a l P r a c t i c e M a n a g e m e n t2 8 6
Another historic IOM (2000) report, To Err Is Human: Building a Safer Health
System, indicated that a shocking number of people—an estimated 44,000 to 98,000 per
year—are harmed by the healthcare system. A more recent study found that this number
has increased since publication of the 2000 IOM report despite substantial efforts to
improve. Medical errors have now become the third leading cause of death in the United
States (Makary and Daniel 2016).
The complexity of medical service and the inconsistency with which these services
are delivered, not to mention the fragmented nature of the system, have led to a number
of quality concerns (Mosadeghrad 2014), including a lack of systematic approaches to care
delivery and quality improvement. Efforts to improve quality in the medical profession
have a long tradition of focusing on individual performance versus system performance.
Exhibit 10.1 illustrates the potential flaw in this thinking. The bell-shaped curve, P-1,
represents the overall performance of any given system. Curve P-2 illustrates an improved
system of performance where the median performance is moved from M-1 to M-2. If an
organization seeks to improve by only focusing on the low performers, it experiences only
a small improvement, shown as I-1. By improving th ...
Nephrology Nursing Journal September-October 2014 Vol. 41, No. 5 447
Patient Safety and Patient Safety
Culture: Foundations of Excellent
Health Care Delivery
Primum non nocere. First do no harm.
Patient safety forms the founda-tion of healthcare delivery justas biological, physiological,and safety needs form the
foundation of Maslow’s hierarchy
(Maslow, 1954). Little else can be
accomplished if the patient does not
feel safe or is, in fact, not safe. But the
healthcare system is extremely com-
plex, and ensuring patient safety
requires the ongoing, focused efforts
of every member of the healthcare
team.
Patient safety moved to the fore-
front in health care with the release in
1999 of the Institute of Medicine (IOM)
landmark report, To Err is Human:
Building a Safer Health System, which
estimated that annually in the United
States, up to one million people were
injured and 98,000 died as a result of
medical errors (IOM, 2000). The re -
port caught the attention of the media,
and there were headlines across the
nation about the safety (or lack of safe-
ty) for patients in healthcare organiza-
tions. In 2013, James updated the esti-
mate of patient harms associated with
Beth Ulrich
Tamara Kear
Continuing Nursing
Education
Beth Ulrich, EdD, RN, FACHE, FAAN, is
Editor, the Nephrology Nursing Journal, and a
Professor, the University of Texas Health Science
Center at Houston School of Nursing. She is a Past
President of ANNA and a member of ANNA’s
Sand Dollar Chapter. She may be contacted direct-
ly via email at [email protected]
Tamara Kear, PhD, RN, CNS, CNN, is an
Assistant Professor of Nursing, Villanova
University, Villanova, PA, and a Nephrology
Nurse, Liberty Dialysis. She is on the Editorial
Board for the Nephrology Nursing Journal,
serves as the ANNA Research Committee chairper-
son, and is a member of ANNA’s Keystone Chapter.
Statements of Disclosure: Please refer to page
457.
Note: Additional statements of disclosure and
instructions for CNE evaluation can be found on
page 457.
This offering for 1.4 contact hours is provided by the American Nephrology Nurses’
Association (ANNA).
American Nephrology Nurses’ Association is accredited as a provider of continuing nursing
education by the American Nurses Credentialing Center Commission on Accreditation.
ANNA is a provider approved by the California Board of Registered Nursing, provider number
CEP 00910.
This CNE article meets the Nephrology Nursing Certification Commission’s (NNCC’s) continu-
ing nursing education requirements for certification and recertification.
Copyright 2014 American Nephrology Nurses’ Association
Ulrich, B., & Kear, T. (2014). Patient safety and patient safety culture: Foundations of ex -
cellent health care delivery. Nephrology Nursing Journal, 41(5), 447-456, 505.
In 1999, patient safety moved to the forefront of health care based upon astonishing sta-
tistics and a landmark report released by the Institute of Medicine (IOM). This report,
To Err.
Simple and Safe Approaches Towards Patient SafetyEhi Iden
A conference presentation on simple approaches and steps in achieving and managing patient safety in health. It talks about team approach, mutual support, just system, leadership commitment, complications of blame game and case study of the popular Kimberly Hiatt story.
This presentation has the measures to be taken for the safety of patients. It covers the 6 goals
Goal 1: Identify patients correctly
Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
Healthcare organizations including hospitals were founded to give care to those who need it and to keep patients safe.
It is generally agreed upon that the definition of patient safety is…
"DO NO HARM"
patient safety and staff Management system ppt.pptxanjalatchi
Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
patient safety and staff Management system ppt.pptxanjalatchi
What is Patient Safety? Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
2 8 5L e a r n I n g o b j e c t I v e sC H A P T E R.docxlorainedeserre
2 8 5
L e a r n I n g o b j e c t I v e s
C H A P T E R 1 0
Q U A L I T Y M A N A G E M E N T I N
T H E P H Y S I C I A N P R A C T I C E
Quality and reliability are system properties.
—W. Edwards Deming
➤ Articulate the nature of performance management.
➤ Describe the approaches to performance improvement.
➤ Appreciate the impact of variation on performance.
➤ Discuss the components of the Triple Aim.
➤ Describe process improvement.
In t r o d u c t I o n
One of the most important issues to address in the medical practice is the quality and
safety of the care provided to patients. The Institute of Medicine (IOM 2001), a presti-
gious branch of the National Institutes of Health, stated in its landmark report Crossing the
Quality Chasm: A New Health System for the 21st Century, “In its current form, habits, and
environment, American health care is incapable of providing the public with the quality
health care it expects and deserves.”
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EBSCO Publishing : eBook Academic Collection (EBSCOhost) - printed on 4/16/2020 7:48 PM via SUNY CANTON
AN: 1839064 ; Wagner, Stephen L..; Fundamentals of Medical Practice Management
Account: s8846236.main.ehost
F u n d a m e n t a l s o f M e d i c a l P r a c t i c e M a n a g e m e n t2 8 6
Another historic IOM (2000) report, To Err Is Human: Building a Safer Health
System, indicated that a shocking number of people—an estimated 44,000 to 98,000 per
year—are harmed by the healthcare system. A more recent study found that this number
has increased since publication of the 2000 IOM report despite substantial efforts to
improve. Medical errors have now become the third leading cause of death in the United
States (Makary and Daniel 2016).
The complexity of medical service and the inconsistency with which these services
are delivered, not to mention the fragmented nature of the system, have led to a number
of quality concerns (Mosadeghrad 2014), including a lack of systematic approaches to care
delivery and quality improvement. Efforts to improve quality in the medical profession
have a long tradition of focusing on individual performance versus system performance.
Exhibit 10.1 illustrates the potential flaw in this thinking. The bell-shaped curve, P-1,
represents the overall performance of any given system. Curve P-2 illustrates an improved
system of performance where the median performance is moved from M-1 to M-2. If an
organization seeks to improve by only focusing on the low performers, it experiences only
a small improvement, shown as I-1. By improving th ...
Nephrology Nursing Journal September-October 2014 Vol. 41, No. 5 447
Patient Safety and Patient Safety
Culture: Foundations of Excellent
Health Care Delivery
Primum non nocere. First do no harm.
Patient safety forms the founda-tion of healthcare delivery justas biological, physiological,and safety needs form the
foundation of Maslow’s hierarchy
(Maslow, 1954). Little else can be
accomplished if the patient does not
feel safe or is, in fact, not safe. But the
healthcare system is extremely com-
plex, and ensuring patient safety
requires the ongoing, focused efforts
of every member of the healthcare
team.
Patient safety moved to the fore-
front in health care with the release in
1999 of the Institute of Medicine (IOM)
landmark report, To Err is Human:
Building a Safer Health System, which
estimated that annually in the United
States, up to one million people were
injured and 98,000 died as a result of
medical errors (IOM, 2000). The re -
port caught the attention of the media,
and there were headlines across the
nation about the safety (or lack of safe-
ty) for patients in healthcare organiza-
tions. In 2013, James updated the esti-
mate of patient harms associated with
Beth Ulrich
Tamara Kear
Continuing Nursing
Education
Beth Ulrich, EdD, RN, FACHE, FAAN, is
Editor, the Nephrology Nursing Journal, and a
Professor, the University of Texas Health Science
Center at Houston School of Nursing. She is a Past
President of ANNA and a member of ANNA’s
Sand Dollar Chapter. She may be contacted direct-
ly via email at [email protected]
Tamara Kear, PhD, RN, CNS, CNN, is an
Assistant Professor of Nursing, Villanova
University, Villanova, PA, and a Nephrology
Nurse, Liberty Dialysis. She is on the Editorial
Board for the Nephrology Nursing Journal,
serves as the ANNA Research Committee chairper-
son, and is a member of ANNA’s Keystone Chapter.
Statements of Disclosure: Please refer to page
457.
Note: Additional statements of disclosure and
instructions for CNE evaluation can be found on
page 457.
This offering for 1.4 contact hours is provided by the American Nephrology Nurses’
Association (ANNA).
American Nephrology Nurses’ Association is accredited as a provider of continuing nursing
education by the American Nurses Credentialing Center Commission on Accreditation.
ANNA is a provider approved by the California Board of Registered Nursing, provider number
CEP 00910.
This CNE article meets the Nephrology Nursing Certification Commission’s (NNCC’s) continu-
ing nursing education requirements for certification and recertification.
Copyright 2014 American Nephrology Nurses’ Association
Ulrich, B., & Kear, T. (2014). Patient safety and patient safety culture: Foundations of ex -
cellent health care delivery. Nephrology Nursing Journal, 41(5), 447-456, 505.
In 1999, patient safety moved to the forefront of health care based upon astonishing sta-
tistics and a landmark report released by the Institute of Medicine (IOM). This report,
To Err.
Simple and Safe Approaches Towards Patient SafetyEhi Iden
A conference presentation on simple approaches and steps in achieving and managing patient safety in health. It talks about team approach, mutual support, just system, leadership commitment, complications of blame game and case study of the popular Kimberly Hiatt story.
This presentation has the measures to be taken for the safety of patients. It covers the 6 goals
Goal 1: Identify patients correctly
Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
Healthcare organizations including hospitals were founded to give care to those who need it and to keep patients safe.
It is generally agreed upon that the definition of patient safety is…
"DO NO HARM"
patient safety and staff Management system ppt.pptxanjalatchi
Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
patient safety and staff Management system ppt.pptxanjalatchi
What is Patient Safety? Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
3. LEARNING OBJECTIVES
Upon completion of this chapter, the student should be able to:
1. Define quality of care and patient safety.
2. Discuss key terms used to define quality of care and patient safety.
3. Identify national healthcare organizations influencing quality and safety.
4. Discuss measuring quality and safety.
5. Discuss core measures, sentinel events, and never events.
6. Discuss healthcare quality and safety in industrialized countries.
7. Describe the costs of achieving patient safety and quality of care.
8. Describe key programs that recognize hospital excellence.
9. Discuss the influence of the Institute of Medicine’s (IOM) Quality Chasm series of reports.
10. Discuss the role of nurses at the “sharp” end of healthcare.
11. Discuss efforts to increase healthcare transparency, improve public reporting of healthcare, and
reduce unwarranted variation in healthcare safety and quality.
5. Healthcare quality
“the degree to which healthcare services for individuals
and populations increase the likelihood of desired
health outcomes and are consistent with current
professional knowledge” (IOM, 2001).
6. High-quality care
“Care that is safe, timely, effective, efficient, equitable, and patient
centered (also referred to as STEEEP) with no disparities between racial
or ethnic groups” (IOM, 2001).
AHRQ expanded the definition of quality to include, “doing the right
thing, at the right time, in the right way, to achieve the best possible
results” (AHRQ, 2011).
The IOM has recommended that quality can be improved on four levels:
• The patient level
• The health-delivery “microsystems” level, such as a surgical team or
acute-care unit
• The organizational level, such as hospitals and healthcare systems
• The regulatory and financial environment level in which those
organizations operate (IOM, 2001)
7. Errors
“An act of commission (doing something wrong) or omission (failing to do the
right thing) leading to an undesirable outcome or significant potential for such an
outcome” (Wilson, Harrison, Gibberd, & Hamilton, 1999).
Unfortunately, most errors in healthcare are viewed as a reflection of an
individual’s lack of knowledge or skill.
Thus, when an error occurs, you will see efforts to blame or punish an individual.
Yet, when considering the context in which healthcare errors occur, errors are
usually a reflection of human failings within poorly designed systems.
From this systems perspective, after an error occurs, we must try to identify
factors that most likely led to the error and find solutions and changes to current
healthcare processes so that we can reduce the possibility of a recurrence of the
error or reduce the impact of the error on patients.
8. Adverse Event
Any undesirable experience in which harm resulted to a person receiving
healthcare that “requires additional monitoring, treatment, or
hospitalization, or that results in death” (IOM, 1999).
May be considered either preventable or not.
Preventable adverse events are considered to reflect care that falls below
the standard of care.
Serious preventable adverse events are generally defined as an adverse
event that is preventable and results in a patient death, loss of a body part,
disability, or loss of bodily function lasting for more than 7 days or still
present at the time of discharge.
The U.S. Food and Drug Administration (FDA), expands this definition to
focus on any undesirable experience associated with a medical product,
such as a medication or medical device.
9. Adverse Event
The undesirable experience is considered an adverse event and should be
reported to the FDA when, for example, the patient:
• Dies
• Experiences a life-threatening reaction
• Has an initial or prolonged hospitalization resulting from the adverse event
• Experiences “significant, persistent or permanent change, impairment,
damage or disruption” of normal function
• Needs a “medical or surgical intervention” because of an adverse event
(FDA, 2016)
10. Sentinel Events
sometimes referred to “never events” or “serious reportable events”
Any unanticipated event in a healthcare setting that reaches a patient and
results in any of the following:
• Death
• Permanent harm
• Severe temporary harm and intervention required to sustain life (The Joint
Commission [TJC], 2017a)
When a sentinel event occurs that results in death or serious physical or
psychological injury to a patient that is not related to the natural course of
the patient’s illness, it should be (but is not required to be) reported first
within the organization according to policy because these types of events,
which are rare occurrences, should never happen.
11. Sentinel Events
There are 29 types of sentinel events/serious reportable events (the full list
is available at http://www.qualityforum.org/Topics/SREs/List_of_SREs.aspx),
including:
• Surgery on the wrong patient, at the wrong site, or a wrong procedure
surgery
• Suicide in a hospital or within 72 hours of discharge
• Falls
• Delay in treatment
• Medication errors
• Surgical instrument or object left in a patient after a surgery or other
procedure (National Quality Forum [NQF], 2017)
12. Sentinel Events
When a sentinel event occurs, the healthcare organization is “strongly
encouraged,” but not required, to report the sentinel event to The Joint
Commission (TJC) and is “expected to conduct thorough and credible
comprehensive systematic analyses (e.g., root cause analyses), make
improvements to reduce risk, and monitor the effectiveness of those
improvements” (TJC, 2017b).
Patients, family members, staff, and the media can also report patient
safety events to TJC.
Note that the reporting of most sentinel events to TJC is voluntary and
represents only a small proportion of actual events.
13. CAUSES OF ERRORS
Everyone can make mistakes.
Errors in providing healthcare to patients and their families are caused by a
variety of factors, such as incompetency, lack of education or experience,
inaccurate documentation, language barriers, fatigue, and inadequate
communication among clinicians (Weingart, Wilson, Gibberd, & Harrison,
2000).
Errors are also associated with extremes of age, new procedures, urgent
conditions, and the severity of the medical condition being treated
(Palmieri, DeLucia, Ott, Peterson, & Green, 2008).
14. NATIONAL HEALTHCARE ORGANIZATIONS INFLUENCING
QUALITY AND SAFETY
There are three key agencies within the U.S. Department of Health
and Human Services that are influential in encouraging
improvements in healthcare quality and patient safety.
These agencies include AHRQ, CMS, and FDA.
The (AHRQ) Agency for Health Care, Research and Quality
(www.ahrq.gov) is focused on producing evidence to make
healthcare safer, higher quality, more accessible, and equitable,
and working to make sure that evidence is understood and used.
15. NATIONAL HEALTHCARE ORGANIZATIONS INFLUENCING
QUALITY AND SAFETY
The (CMS) Centers for Medicare & Medicaid Services (www.cms.gov) has
multiple roles in influencing the quality of care and patient safety.
• The CMS works with both public and private organizations to ensure quality
care, promote efficient health outcomes, and make sure that CMS policies are
used by healthcare organizations and clinicians to receive reimbursement
payments for their services to improve patient outcomes.
The (FDA) Food and Drug Administration (www.fda.gov) is responsible for
protecting the public health by ensuring the safety, efficacy, and security of
human and veterinary drugs, biological products, and medical devices; and
by ensuring the safety of our nation’s food supply, cosmetics, and products
that emit radiation (FDA, 2017).
16. NATIONAL HEALTHCARE ORGANIZATIONS INFLUENCING
QUALITY AND SAFETY
Several organizations, particularly the organizations listed in the following section,
have significant roles in influencing the quality of care and patient safety.
These organizations influence healthcare safety and quality by working with
government organizations, healthcare organizations, and healthcare clinicians, as
well as accreditation organizations (see Textbook Pages 8-9 for more details):
1. The Institute for Safe Medication Practices (ISMP)
2. The National Academy of Medicine (NAM)
3. The National Quality Forum (NQF)
4. The Institute for Healthcare Improvement (IHI)
5. The Joint Commission on Accreditation of Healthcare Organizations (TJC)
6. The Leapfrog Group
7. Healthcare Financial Management Association (HFMA)
17. MEASURING QUALITY AND SAFETY
Work by the AHRQ, CMS, and NQF has led the development of measures for
improving the quality of care and patient safety.
Many of these measures depend on the occurrence of adverse patient
outcomes or injury (measures of patient safety) while others raise the
standard of care by ensuring that recommended care is available and used by
all patients at the right time (measures of quality of care).
The major sets of measures include the CMS Core Measures, AHRQ Quality
Indicators, AHRQ Patient Safety Indicators, NQF and American Nurses
Association (ANA) Nurse Sensitive Indicators, and the National Committee for
Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set
(HEDIS) Measures (Table 1.3).
18.
19.
20. UNWANTED VARIATION IN HEALTHCARE QUALITY AND
SAFETY
Unwanted variation is variation in the use of medical care that cannot be explained
on the basis of illness, medical evidence, or patient preferences.
Wennberg, as reported by McCue (2003) has categorized four types of variation:
1. Variations from the underuse of effective treatments or intervention that has been
shown in clinical studies to improve health status or quality of life, for example, the
use of beta blockers post-myocardial infarction
2. Variations in outcomes attributable to the quality of care, for example, increased
mortality following surgery
3. Variations from the misuse of preference-sensitive services, for example,
hysterectomy versus hormone treatment
4. Variations from the overuse of supply-sensitive services, for example supplies that
are overused because they are easily available to patients and healthcare
practitioners, for example, medications and various technologies
Nurses and the interprofessional team must work to reduce variation and improve
healthcare service delivery to all patients.
21. TRANSPARENCY AND REPORTING PERFORMANCE
National and state efforts to motivate improvements in healthcare have
included financial incentives, regulation, accreditation, and public reporting.
Public reporting of performance is thought to be the best motivator for
improving patient safety and quality of care.
When organizations and clinicians are transparent in reporting their
performance against quality measures, it is believed that they are being
accountable, that they ethically respond to failures (Leape, 2010), and that
they are informing consumer choice (Berwick, James, & Coye, 2003).
Transparency is considered to include reporting not only the real cost of care,
but also clearly reporting information about performance failures as well as
successes (Pronovost et al., 2016).
22. TRANSPARENCY AND REPORTING PERFORMANCE
Major domains of healthcare transparency include the following:
• Clinical quality
• Resource use
• Efficiency
• Patient experience of care
• Professionalism
• Healthcare system/facility recognition and accreditations for meeting national
standards
• Financial relationship of physicians and other healthcare professionals
• Financial relationship between physicians and other healthcare professionals, and
industry
• Health insurance company processes (American College of Physicians [ACP], 2010)
23. TRANSPARENCY AND REPORTING PERFORMANCE
Improvement processes include accurately looking at errors that occur from
providing care; looking at areas where the quality of care can be improved through
the early detection, prevention, and reporting of errors; and looking at improving
performance on measures of quality care.
Yet reporting errors or problems in quality of care is not straightforward.
Mortality (i.e., death), morbidity (i.e., disease), and adverse events are considered
negative outcomes by both clinicians and external organizations.
Reporting successes can be helpful in understanding if an organization or clinicians
are able to sustain and attain goals in safety and quality.
The barriers for attaining a culture of safety include:
1. lack of leadership,
2. a culture where low expectations prevail,
3. poor teamwork,
4. poor communication.
24. TRANSPARENCY AND REPORTING PERFORMANCE
Optimally, everyone, at all levels within an organization, would work in a culture of
safety where there is:
1. Acknowledgment of the high-risk nature of an organization’s activities and the
determination to achieve consistently safe operations
2. A preoccupation with safety
3. An emphasis on systems improvement to support performance
4. Organizational commitment of resources and encouragement of collaboration
across ranks and disciplines to seek solutions to patient safety concerns
5. Encouragement of collaboration to find solutions for patient safety problems
6. Proactive reporting of unsafe conditions
7. A just culture (or culture of justice) response to error, which includes frequent
debriefing and sharing of “lessons learned,” and which has an atmosphere of
teamwork within a blame-free environment with mutual respect, which enables
candid discussion among employees, where patient safety concerns are dealt with
quickly (AHRQ, 2017c)
25. TRANSPARENCY AND REPORTING PERFORMANCE
Safety culture is generally measured by surveys of providers at all levels.
Available validated surveys include AHRQ’s Patient Safety Culture Surveys
(available at psnet.ahrq.gov/resources/resource/5333) and the Safety
Attitudes Questionnaire (available at
psnet.ahrq.gov/resources/resource/3601).
26. THE CONSEQUENCES OF WHEN THINGS GO WRONG
Errors in healthcare that harm patients cost approximately $17.1 billion each year (Van Den
Bos et al., 2011).
It has been estimated that, while hospitalized, about one in four patients experience one or
more adverse events that result in a longer hospital stay, permanent harm, the need for a life-
sustaining intervention, or death.
Of these adverse events that resulted in injury, almost half were preventable (Office of the
Inspector General [OIG], 2010).
Errors happen because of a multitude of factors, such as lack of education or experience,
misdiagnosis, under-and over-treatment, urgency, and fatigue (IOM, 1999).
Patient harm during a hospitalization is also impacted by nurses.
The more times a hospitalized patient is exposed to below targeted nurse staffing levels, the
greater the risk for patient mortality (Needleman et al., 2011).
While nurses are capable of preventing the majority of errors from harming a patient, all
errors need to be reported (Wolf & Hughes, 2008) by the members of the healthcare team,
not just nurses.
The team needs to work together to mitigate (or minimize the amount of) the effects of an
error for the patient.
27. PROFESSIONAL RESPONSIBILITIES FOR NURSES
Nurses are key to ensuring and improving quality of care and patient safety for
patients and families, as well as for the organizations in which they work.
Quality and Safety Competencies, developed as part of the Quality and Safety
Education for Nurses (QSEN) initiative, that identify knowledge, skills, and attitudes
that nursing students should achieve as part of their prelicensure programs and be
able to exemplify in practice.
They include the following:
• Patient-centered care
• Teamwork and collaboration
• Evidence-based practice (EBP)
• QI
• Safety
• Informatics (QSEN, 2014)
28. PROFESSIONAL RESPONSIBILITIES FOR NURSES
It is important to understand that the best way to exemplify these six competencies
in practice is to apply each competency within the wider context of complex
healthcare systems, which has not been the traditional approach for healthcare
clinicians that have been educated to focus at the individual point of care (Dolansky
& Moore, 2013).
In other words, clinicians tend to focus on the individual patient and their family, not
necessarily how that patient and their family affect and are affected by the larger
population and system of care.
To effectively apply each of the six competencies within the wider context of complex
healthcare systems, nurses need to think about:
1. How performance can be measured,
2. How the strengths of each team member can be maximized to improve care
delivery to patients and improve their outcomes
3. What can be done in the healthcare system to assure quality and safety and prevent
harm from unintended consequences from errors.
29. PREVENTING AND RESPONDING EFFECTIVELY TO
ADVERSE EVENTS
Strategies to reduce unwarranted variation and ensure predictable and
favorable patient-care outcomes have proven successful in improving
healthcare quality and patient safety.
These strategies include:
1. developing checklists and other standardized tools, using best practices, and
2. working in an organization with a culture of safety and communication when
an error does occur.
Checklists have been proven successful particularly in operating rooms and
other areas where multiple tasks need to be accomplished consistently to
ensure quality and safety.
Checklists have demonstrated that they protect against failure, they establish
a higher standard of baseline performance, and they are only an aid if they
are done right to begin with (Gawande, 2011).
30. PREVENTING AND RESPONDING EFFECTIVELY TO
ADVERSE EVENTS
Standardized communication tools such as the SBAR (Situation, Background,
Assessment, Recommendation) technique
(www.ihi.org/resources/Pages/Tools/SBARTechniqueforCommunicationASituati
onalBriefingModel.aspx), and using standardized order sets, protocols, and
other best practices can be used by nurses and other members of the
healthcare team to prevent errors, ensure quality care, and reduce variability
in patient care and the potential for error.
It is important for nurses to work in organizations dedicated to a culture of
safety and communication when an error does occur.
Organizations that have a culture of safety are nonjudgmental, acknowledge
the risk and error-prone nature associated with healthcare, and focus on
improving healthcare systems and processes.
31. PREVENTING AND RESPONDING EFFECTIVELY TO
ADVERSE EVENTS
The first thing to remember is that when an adverse event occurs, it is important to respond
in a timely manner, and as the Leapfrog Group recommends, do the following:
1. “Apologize to the patient and family
2. Waive all costs related to the event and follow-up care
3. Report the event to an external agency
4. Conduct a root-cause analysis of how and why the event occurred
5. Interview patients and families, who are willing and able, to gather evidence for the root
cause analysis
6. Inform the patient and family of the action(s) that the hospital will take to prevent future
recurrences of similar events based on the findings from the root cause analysis
7. Have a protocol in place to provide support for caregivers involved in Never Events, and
make that protocol known to all caregivers and affiliated clinicians
8. Perform an annual review to ensure compliance with each element of Leapfrog’s Never
Events Policy for each never event that occurred
9. Make a copy of this policy available to patients upon request” (Leapfrog Group, 2017)
32. PREVENTING AND RESPONDING EFFECTIVELY TO
ADVERSE EVENTS
One tool that health care organizations and providers can consider using to
learn more about being successful after an adverse event occurs is the
Communication and Optimal Resolution (CANDOR) kit.
CANDOR is a communication and resolution process designed to open lines
of communication between clinicians, patients, and their families after patient
harm occurs.
The free program (available at www.ahrq.gov/professionals/quality-patient-
safety/patient-safety-resources/resources/candor/introduction.html), includes
eight training modules and also encourages clinicians to report near misses
and errors to better inform patients (AHRQ, 2016).
33. WHY IS IT WRONG TO BLAME AND POINT FINGERS?
If a nurse is unable to stop an error from happening, the nurse is seen as
literally at the sharp end of the arrow of blame.
The term “sharp end” has been used to identify the important and significant
direct contact role that nurses at the bedside, closest to clinical activities, play
in recognizing the need for and potential impact of practice changes.
Nurses may see the sharp end effects on patients and others first when the
right care is not provided.
Front line clinical nurses (as well as nurses in formal leadership positions)
often assume leadership at the “sharp end” of care in direct contact with
patients to assure safety and quality.
34. WHY IS IT WRONG TO BLAME AND POINT FINGERS?
Nurses are qualified to offer invaluable insights and perspectives about what
is preventing effective and efficient care as well as how the quality and safety
of care can be improved based on their skills and experience.
Other contributing factors, whether individual or health system related (e.g.,
such as the physician who may have ordered the wrong medication, or the
design flaw in the infusion pump that malfunctioned), while maybe not in
direct contact with the patient when the error occurred, also contribute to
errors.
35. CAN HEALTHCARE BE PERFECT?
A key goal of healthcare is to reduce unwarranted variation in healthcare
safety and quality to ensure optimal patient outcomes.
One of the challenges we have in improving healthcare is that nurses tend to
be resilient—meaning that if something does not work well while they are
providing care to a patient, they work around the “normal” way of doing
things.
These workarounds increase the opportunities for inconsistent care and
inconsistent outcomes.
Patients can also at times be resilient. For example, some patients can take
the wrong medication at the wrong time and have no effects.
The resiliency of nurses coupled with the resiliency of patients does not
guarantee the best possible outcomes nor does it ensure safe quality care.
36. CAN HEALTHCARE BE PERFECT?
Over the years, healthcare has become very complex.
It involves multiple healthcare professionals and information from many
sources.
This complexity is closed linked with increased opportunities or increased risk
for something going wrong and patients being harmed or the quality of care
being compromised.
Patients in hospitals and those that receive care from multiple healthcare
providers at multiple sites of care are particularly vulnerable to safety and
quality errors.
In an effort to ensure that safety is fundamental for every healthcare system,
the IOM asserted that “Patients should not be harmed by the care that is
intended to help them, nor should harm come to those who work in health.
37. CAN HEALTHCARE BE PERFECT?
IOM stated in its Crossing the Quality Chasm: A New Health System for the
21st Century (IOM, 2001) report that the healthcare system should focus on
six aims (Table 1.4).
38. CAN HEALTHCARE BE PERFECT?
The 2001 IOM report further noted that by focusing on these six aims, a
transformation will begin to occur in the healthcare system.
The IOM stated that healthcare systems needed to be redesigned to improve
quality of care and patient safety, but to do so, organizations needed to meet
these six challenges:
1. Redesign care processes
2. Make effective use of information technologies
3. Manage clinical knowledge and skills
4. Develop effective teams
5. Coordinate care across patient conditions, services, and settings over time
6. Incorporate performance and outcome measurements for improvement and
accountability (IOM, 2001)
39. INTERNATIONAL ADVANCES IN QUALITY AND
SAFETY
While organizations focused on improving the quality and safety of care have been previously
mentioned in this chapter, there are similar organization outside the United States and even
organizations within the United States that are focusing on either country-specific goals or
global initiatives.
For example, the European Medicines Agency and Health Canada have similar functions as
the FDA in the United States
The U.S.-based Joint Commission, has an international component that has established the
International Patient Safety Goals that are used worldwide, including:
1. Identify patients correctly
2. Improve effective communication
3. Improve the safety of high-alert medications
4. Ensure safe surgery
5. Reduce the risk of healthcare-associated infections
6. Reduce the risk of patient harm resulting from falls (Joint Commission International [JCI],
2017)
40. INTERNATIONAL ADVANCES IN QUALITY AND
SAFETY
The World Health Organization (WHO) also continues to lead worldwide
efforts to improve patient safety (see www.who.int/patientsafety/en as an
example).
And since 1998, the Australian Patient Safety Foundation has also led key
initiatives to improve patient safety (see apsf.net.au).
The World Alliance for Patient Safety, a part of the WHO, developed the
International Patient Safety Classification framework to facilitate a common
understanding and use of definitions and preferred terms for patient safety
(WHO, 2009; see
www.who.int/patientsafety/taxonomy/icps_statement_of_purpose.pdf).
The OECD developed a set of indicators for comparing the quality of health
across OECD member countries through its Health Care Quality Indicator
Project (see www.oecd.org/els/health-systems/health-care-quality-
indicators.htm).
41. RECOGNIZING HOSPITAL EXCELLENCE
The most recognized award for excellence within a hospital is the Baldrige Award.
The Baldrige Health Care Criteria for Performance Excellence have been used by many healthcare
organizations to improve quality.
Recipients of the Baldrige Award are selected based on the following Criteria for Performance
Excellence:
1. Leadership: How upper management leads the organization and how the organization leads
within the community.
2. Strategy: How the organization establishes and plans to implement strategic directions.
3. Customers: How the organization builds and maintains strong, lasting relationships with
customers.
4. Measurement, analysis, and knowledge management: How the organization uses data to support
key processes and manage performance.
5. Workforce: How the organization empowers and involves its workforce.
6. Operations: How the organization designs, manages, and improves key processes.
7. Results: How the organization performs in terms of customer satisfaction, finances, human
resources, supplier and partner performance, operations, governance and social responsibility,
and how the organization compares to its competitors” (ASQ, 2017).
42. RECOGNIZING NURSING EXCELLENCE
The American Nurses Credentialing Center’s (ANCC, 2017) Magnet
Recognition Program awards healthcare organizations that have achieved
superior performance and is often referred to as the ultimate credential for
high-quality nursing.
The Magnet Recognition Program evaluates sources of evidence that create
the foundational infrastructure for excellence, while its focus on results fosters
a culture of quality and innovation.
To achieve Magnet Recognition, organizations participate in a rigorous review
process where organizations must demonstrate support of professional
clinical practice, promote excellence in the delivery of nursing services to
patients, and have processes to promote best nursing practices (ANCC, 2017).
43. RECOGNIZING NURSING EXCELLENCE
The Pathway to Excellence Program is another recognized nursing excellence
program.
To be nationally recognized and designated, a healthcare organization must
meet specific practice standards, including:
1. Shared decision making
2. Leadership
3. Safety
4. Quality
5. Well-being
6. Professional development (ANCC, 2017).
44. RECOGNIZING NURSING EXCELLENCE
There are also numerous opportunities for individual credentialing, where
licensed nurses complete a specific number of education hours and/or hours
of experience and take a test to demonstrate mastery of a body of knowledge
and acquired skills in a particular specialty (McHugh et al., 2014).
The ANCC, among many other organizations, offers numerous certification
for the various types of nursing care (see http://www.
nursecredentialing.org/Certification).
45. ROLE OF NURSE LEADERS IN ENSURING QUALITY AND
SAFETY
In 2010, the IOM released the report, The Future of Nursing: Leading Change, Advancing
Health (IOM, 2010).
The key message of the report was for nurses to take a greater leadership role across care
settings in the increasingly complex U.S. healthcare system.
As the population ages and becomes increasingly diverse and to effectively respond to the
changes and complexity of healthcare, the report examines how the roles, responsibilities and
education of nursing should change to improve healthcare for everyone.
In that nurses represent the largest segment of the healthcare workforce, the IOM
recommended that nursing:
1. Be able to practice “to the full extent of their education and training
2. Improve nursing education
3. Assume leadership positions and serve as full partners in healthcare redesign and
improvement efforts
4. Improve data collection for workforce planning and policy making” (IOM, 2010)
46. ROLE OF NURSE LEADERS IN ENSURING QUALITY AND
SAFETY
The IOM released a report on the progress achieved on the IOM 2010 report
recommendations (see Table 1.10), focusing on the areas of removing barriers
to practice and care; transforming education; collaborating and leading;
promoting diversity; and improving data.
The IOM committee concluded that “no single profession, working alone, can
meet the complex needs of patients and communities.
Nurses should continue to develop skills and competencies in leadership and
innovation and collaborate with other professionals in healthcare delivery and
health system redesign.
To continue progress on the implementation of The Future of Nursing
recommendations and to effect change in an evolving healthcare landscape,
the nursing community must build and strengthen coalitions with
stakeholders both within and outside of nursing” (IOM, 2015).
47. ROLE OF NURSE LEADERS IN ENSURING QUALITY AND
SAFETY