The Economics of Health Care Quality and Medical Errors, Essay Example

Part I

Patient quality of care and patient safety could be improved significantly if nursing units work towards the reduction of medication errors. Studies have shown that more than 150,000 deaths occur annually as a consequence of medical error (Windrum, 2013). An even higher number of patients become injured as a consequence of these mistakes. It is therefore necessary to develop strategies that could reduce this the mortality and morbidity rate related to medication error at the unit level. It is therefore the responsibility of the team to alter practice is a manner that supports this initiative. The goal of this protocol is to reduce the amount of medication errors made by 30% in a one year period.

Due to the wealth of responsibilities that the average health care professional is provided daily, it is often difficult to ensure that all patients are receiving the best possible care. Nurses are required to work quickly and efficiently, which becomes challenging when many patients have urgent needs. Despite these challenges, nurses are required to act according to nursing best practices in order to ensure that all patients are receiving the care they need. Often, nurses are not given the tools that they need to do so, which could potentially result in error. One of the most common mistakes made is the application of the wrong medication type or dose. Research has indicated that, on a national level, 64.55% of all nurses have made a medication error in their career and 31.37% of the population has nearly made a mistake (Cheragi et al., 2013). Since nearly all nurses have at minimum come close to making a medication error, it is necessary to reevaluate how these professionals communicate and receive unit specific training to determine how the frequency of these occurrences can be reduced.

While a reduction in the amount of medication errors that occur is a concern for the health care institution as a whole, it is more realistic to address this issue at the unit level to ensure that specific practice changes could be implemented. The FADE method of quality improvement, developed by researchers at the Organizational Dynamics Institute in Wakefield, MA will be utilized to assess and resolve root causes of medication errors in my unit (Duke University Medical Center, 2014).

There are four main steps that are followed in this quality improvement model. After identifying a quality improvement issue to be resolved, appropriate data should be selected in order to establish baselines, root causes of the issue, and inferences that will help the research team understand potential solutions. Based on this collected information, it is then necessary to develop plans for improvement. In this phase, an emphasis is on implementing the solution, improving communication between team members, and measuring and monitoring the results. Next, action plans will be implemented on a pilot basis to determine if the proposed intervention is effective. Last, the intervention will be evaluated and the plan will be revised and re-executed as needed.

To effectively reduce the rate of medication errors at the unit level, it is necessary to first measure the baseline medication errors in terms of percent of nurses that have made a medication error or nearly made a medication error in the unit. Furthermore, reported mortality and morbidity that has occurred as a consequence of these errors will be collected as well. A medication error will be defined as an action that has resulted in the application of the incorrect medication, provision of an incorrect dosage, or provision of medication that is known to interact with one or more of the drugs that the patient has already been prescribed. This information represents the baseline knowledge that will be necessary to utilize FADE as a quality improvement model.

The improvement plan will involve increasing the communication between members of staff to ensure that medication mistakes will be caught before they cause a health detriment. In addition, nurses will be retrained on the unit’s electronic health record system to ensure that adequate notes are being taken for each case. Last, staff will be instruction to conduct patient interviews more thoroughly to determine any medications that patients are currently taking that have been prescribed outside of the context of the health care institution. FADE is a reasonable model for this component of the quality improvement plan because improving communication between workers is a key factor in reducing the rate of medication errors that occur.

Under FADE, these improvement plans are implemented on a pilot basis. While the goal of the project is to determine whether nursing practices can be changed to reflect a decreased medication error rate over a one year period, it is necessary to implement the plan on a small scale to determine whether it has potential for demonstrating results. If the improvement plan is not effective after one month, it will be necessary to revise nursing practices in a manner that is better suited to cause a change. It would be unreasonable for an ineffective study to continue for a year, as this will work against the goal of improving patient health and safety.

After a one month period, it is anticipated that the medication error rate will drop by at least 5%, as self-reported by the nursing staff in the local unit. While this is a small change, it is anticipated that the medication error rate will increase the most significantly as soon as the research intervention is applied and that the error rate will slowly continue to decrease as it trends towards the goal through the remainder of the year. The goal is to reduce the self-reported error rate by 30% for both achieved errors and errors that have nearly occurred. Furthermore, the morbidity and mortality rate of patients who enter the unit is expected to drop by 30% as well. During the first one month trial period, only the morbidity rate is expected to be reduced by 5%, as there is low statistical likelihood that a significant number of deaths will occur within the unit at baseline or at the start of the application of the intervention.

To ensure that this project will receive exempt status from the Institutional Review Board, patient identifiers will be removed before utilizing their medication error statistics. In addition, the nurses who participate in the self-reporting medication error survey will be subject to the same treatment in order to ensure that the privacy of all participants remains protected. This is the only ethical consideration necessary for this research, as it is not expected that participation in the study will cause any detriment. The participating nurses will be provided with informed consent before becoming involved with this research.

Part II

It will be necessary to collaborate with the hospital administration and unit supervisors in order to ensure the success of this project. The primary goal that this cooperation will achieve is approval of the ability to enact practice changes in the unit and insurance that the nursing staff will be able to engage in regular meetings to discuss the progress of the attempt to reduce the medication error rate. During the first phase of the project, it will be necessary to meet with the nursing staff weekly in order to provide them with the training and knowledge needed for the project to be completed successfully. This time will be utilized to retrain all staff members on the electronic health record system and to allow them to increase the level of detail that they provide on their cases. Furthermore, they will be informed of an established protocol that will allow them to verbally relay messages for problematic cases. In addition, they will be reminded how to appropriately conduct patient interviews in order to ensure that all information related to the medications that the patients are taking is collected.

The first meeting will be used to provide the nurse study participants with informed consent and to establish baseline statistics regarding self-reported medication errors. Meetings will continue weekly until the pilot component of the project is completed. At this point, the group will assess whether the changes in practice have contributed to an effective reduction in medication error within the unit. If the results indicate that the intervention is not successful, the team will work as a group to determine further changes that could be made. At this point, the pilot period will begin again and meetings will occur each week. If the pilot is successful, the nurse team will meet monthly to review data and best practice related to the research endeavor. Eleven meetings will occur after the pilot month has ended.

While the research project will be designed by myself and approved by the health care administration and supervisory staff at my health care institution, the success of the project is dependent upon the participation of all members of staff. Therefore, after the initial establishment of the research protocol, the sponsor of the project will enact a forum for democratic leadership so that all team members can contribute their knowledge to the further development of the research intervention, which will contribute to an increased likelihood for success. It is necessary for all members of the team to collaborate, as the proposed interventions must be followed closely by all members of staff. Thus, while the sponsor of the project will make a majority of the decisions, the team will be allowed to decide how the intervention should be modified or improved upon throughout the duration of the project.

It is important that the sponsor of the project have skills and abilities that are similar to the other members of the team. However, this individual is responsible for the creation of the initial protocol and is therefore required to have conducted research regarding the topic so that all practices are evidence-based. In a sense, the sponsor can function as a transformational leader because he or she has the ability to develop the professional knowledge of the team by exposing them to critical thinking regarding the practice change. However, under the proposed model, it seems more likely that each member of the team will be responsible for their own personal development. Therefore, while the leader has some traits of a transformational leader, this project will benefit the most if democratic leadership is enacted.

Members of staff will likely wish to participate in these workplace changes because they are all being held accountable for the success of the project. Since each member of the team will work with the sponsor during the pilot period, providing modifications to the protocol as necessary, they will feel that the actions that they are taking can directly contribute to both the success of the project and the improvement of the unit. Furthermore, these individuals are being provided with the opportunity to undergo professional development in a manner that will allow them to be more effective nurses. As a consequence, it is likely that they will continue to feel challenged in their position in a manner that keeps them interested in the day to day functions of their position.

Throughout the quality improvement journey, the senior leader role will evolve as one that employs transformational leadership to one that employs democratic leadership. The leader will take on more direct control over the project at the beginning to ensure that the protocol is well designed, but as time goes on, this leadership position will effectively dissolve and the team as a whole will be responsible for making decisions. At the end of the project, the leadership position will turn back to a transformational role, as a larger degree of guidance will be needed for compiling the final results of the project. However, the leader will continue to take all input from the team to ensure that the report is well-written and reflects the goals of the project and of the unit.

Part III

According to a recent report, nurses spend on an average of 10 to 15 minutes interviewing their patients (Hemsley et al. 2012). It would be beneficial for nurses to utilize closer to 15 minutes with each patient in order to ensure that the account of their health provided is adequate. Of particular concern is determining the patients’ medication history. Often, patients are not aware of the name of their medications or the doses that they have been provided. In these instances, it is necessary to have a longer conversation with these individuals to determine how more information on this topic could be received or who could be contacted to find these answers.

A second problem related to the high rate of medication errors is that the time that nurses spend with their patients is highly variable depending upon the needs of the patient and the amount of time that the individual nurse has available (Wright et al., 2013). On the occasions in which patients only see their nurses for a short period of time, it becomes more likely that that they will be subject to a medication error due to the nurse’s lack of understanding of their case. It is therefore necessary to improve the length or quality of these interactions in order to ensure that these mistakes could be avoided. It has been shown that the use of electronic health record systems can reduce these medication errors and allow nurses to spend less time with each patient while maintaining quality care (Grossman et al., 2014). Therefore, it is reasonable to implement the use of these systems in order to facilitate the communication between nurses within the unit, whether there are multiple nurses caring for one patient during the same shift or a need to communicate patient needs as shifts are changed.

To diagnose the problem, it will be necessary to gather quantitative data concerning the number of nurses who believe that they have been responsible for causing a medication error in addition to the number of nurses who have not caused an error but have come close to doing so. Furthermore, a report of how many times this has occurred during the previous year will be generated. A student’s t-test will be utilized to determine whether a variance exists between the baseline data and the measurements that have been retrieved after the yearlong trial. Nurses will be asked to self-report medication errors made or nearly made once a month, and these numbers will be tracked to determine whether the number of errors are increasing, decreasing, or remaining the same as a consequence of the intervention. A line graph will be created to depict this information; the month will be placed on the x-axis and the number of self-reported medication errors will be placed on the y-axis.

Qualitative data will be gathered to determine the degree to which the nursing staff is receptive of the changes in practice that will be established during this project. Ultimately, this is necessary to understand because the degree to which the nurses are willing to enforce these policies will reflect the success of the study. A barrier analysis will therefore be performed as a focus group in order to receive feedback from all nurses (Food for the Hungry, n.d.). This will occur during the weekly meetings during the pilot phase of the project and once every two months following this initial phase.

One of the main supporting characteristics of this project is that it will allow the health care institution to save money. Studies have shown that medical errors have cost the United States more than $19.5 billion as a whole (Andel et al., 2012). While the health care institution will not be responsible for funds of this size, it is important to consider that lawsuits related to medical error can comprise a significant percentage of an organization’s budget. If these expenditures are reduced, it would allow the health care institution to become more efficient, as these monetary resources could be invested into directly improving patient quality of care by acquiring new equipment and technology. Furthermore, the training that the nurses will undergo as a component of this initiative will allow the organization’s operations as a whole to become more efficient. Increasing the ability of the staff to communicate and record precise medical records will allow more patients to be seen in a smaller amount of time, which will help decrease recovery time and reduce the likelihood of death or injury.

Part IV

It was concluded that the rate of medication errors was reduced each month during the trial period for a total of 30% reduction at the end of the year. Furthermore, the barrier analysis indicated that members of staff remained consistently motivated to be on the project team. The number of medication errors that had occurred in the hospital was 200 according to the baseline statistics, and this number was reduced to 140 at the end of the trial period. Furthermore, the number of self-reported near incidents was 50 according to the baseline statistics, and this number was 35 at the end of the trial period. Therefore, this number was reduced by exactly 30% in both cases.

During the first month of the trial period, there were 30 medication errors. During the next month, there were 20. The third month of the study revealed that only 10 medication errors were made. This demonstrates that the nursing team was able to implement the change in practice more effectively as time went on. The months following the third month of the trial period either resulted in 10 medication errors or less. This indicates that the trend towards medication error reduction remained consistent. Furthermore, during each weekly and monthly team meeting, the members of the nursing staff reported that they held a positive morale. This is significant compared to the data reported at the same time last year in the health care organization. During the first month of the year, there were 40 medication errors. Therefore, the implementation of the intervention resulted in the immediate reduction of medication errors by 10. The student’s t-test revealed that the difference between the baseline year’s medication errors and the trial periods medication errors is statistically significant, as this calculation yielded a p-value of less than 0.5. It appeared that the participation of the team was a major factor in the success of this project.

A timeline of important milestones follows:

Figure 1

The trend of medication errors over the 12 month study period

Figure 1 shows the distribution of medication errors that occurred over the one year study period. The first month of the trial resulted in 30, the highest number of medication errors. However, in December of the same year, only 5 medication errors were made. This diagram demonstrates that the intervention was effective in reducing the amount of medication errors made within the unit.

Part V

There were many positive attributes of the team process that helped establish overall improvement in practice. Since this project involved changing practice across the board, it was necessary for every member of the team to participate. As a consequence, the success of the project was due to the ability of the team to be able to work together effectively and to communicate ideas both in terms of the project and in terms of the communication necessary to achieve quality patient care.

Throughout the process, the team appeared to remain motivated as a direct consequence of their involvement in the project. All nurses were invited to participate in the weekly and monthly meetings related to the project and all were asked to provide input into the project that would help shape the actual research practices. A survey indicated that all members of the staff felt that their dedication to the project would help yield a positive result, which they believed would help them further their ability to perform well in practice. Furthermore, all members of staff recognized that this project would directly benefit them in the long term, because a reduction in medication errors would allow the health care institution to appropriate more funds to the local unit and this accuracy would allow nurses to spend more time with patients to diagnose their primary concerns rather than trying to prevent detriment related to medication error.

The nurses were pleased with the increased use of the electronic health record system to record and maintain patient records, as they believe that this process allows them to save more time than the paper based method would allow them to. Furthermore, they reported that this system made it easier to communicate with nurses across shifts, which was difficult prior to this exercise. The team felt that they were able to utilize the electronic health record system more efficiently after training, which improved their confidence. Many of the nurses had reported that the system confused them when it was first implemented, but now a majority of them understand and appreciate its use.

Based on this information, the nursing team can continue to be motivated and engaged by participating in these types of projects that directly shape their practice. By becoming involved, these individuals are aware that they will continue to grow professionally. Furthermore, they were motivated by knowing that the work that was done in this individual unit had the potential to influence practice in other units as well.

Another reason for the success of this project is that the senior leader was able to effectively secure resources for the team. Since the project leader developed the quality improvement plan independently before bringing it to the attention of the team, there was an opportunity to create framework based on evidence-based practice and the needs of the unit. In addition, since this individual is highly experienced in the field, there was an opportunity to assess the needs of the team members. This resulted in the development of an effective electronic health record system training program in addition to the provision of information related to medication errors and enhanced communication. Therefore, when the team was introduced with the idea of the project, they were supportive because it allowed them to see how this project would help them improve professionally in addition to how they would be able to support it personally.

The dynamics of the team was very strong, which is why the senior leader chose to implement democratic leadership in a majority of the project’s phases (Howell, 2012). Because the team had a history of working well together before the implementation of the project, the leader was aware that the unique personalities of the team would be able to come together in an effective manner to further develop the research protocol. However, since the leader had more experience, the plan was made in accordance to this knowledge. This created an excellent balance among members of the team because even though the senior leader contributed to a majority of the project in its initial phases, this individual participated in the same role as the other team members during the implementation of the project. This helped increase morale and promoted the ability of the team to work together effectively.

It would be beneficial to utilize this type of leadership methodology in future projects with this group because it allows them to work accurately and efficiently. It would be necessary to reconsider leadership styles if certain members of the team are replaced in the future, as doing so may not result in the same team dynamics (Markwell, 2013). However, this project indicates that if variables are kept similar, this unit will be able to ensure that quality improvement occurs on many fronts within the organization. This project also serves as an effective model for other units in the health care organization, and it is also possible that this model could be applied to different institutions altogether. These findings are important because they help contribute to the field’s understanding of evidence-based practice, which will allow the nursing profession to continue to improve as a whole.

References

Andel C, Davidow SL, Hollander M, Moreno DA. (2012). The economics of health care quality and medical errors.J Health Care Finance, 39(1):39-50.

Cheragi MA, Manoocheri H, Mohammadnejad E,Ehsani SR. (2013). Types and causes of medication errors from nurse’s viewpoint. Iran J Nurs Midwifery Res.,18(3): 228–231.

Duke University Medical Center. (2014). Methods of Quality Improvement. Retrieved from http://patientsafetyed.duhs.duke.edu/module_a/methods/methods.html

Food for the Hungry. (n.d.). Barrier Analysis. Retrieved from http://barrieranalysis.fh.org/

Grossman JM, Gourevitch R, Cross D. (2014). Hospital Experiences Using Electronic Health Records to Support Medication Reconciliation. National Institute for Health Care Reform. Retrieved from http://www.nihcr.org/Medication-Reconciliation

Hemsley B, Balandin S, Worrall L. (2013). Nursing the patient with complex communication needs: time as a barrier and a facilitator to successful communication in hospital. Journal of Advanced Nursing, 68(1): 116-126.

Howell JP. (2012). Snapshots of Great Leadership. London, GBR: Taylor and Francis.

Markwell M. (2013). “Instincts to Lead”: On Leadership, Peace, and Education. Connor Court: Australia.

Windrum B. (2013). It’s Time to Account for Medical Error in “Top Ten Causes of Death” Charts. Journal of Participatory Medicine, 5.

Wright S, McSherry W. (2013). How much time do nursesspend on patient care?Nursing Times, 109 online issue.