Quality Improvement Proposal

Quality Improvement Proposal

Problem/Issue in Practice or Organization

Typically, the healthcare sector is riddled with regulatory and administrative challenges that make it difficult to achieve better and quality healthcare outcomes. In most instances, the complexities enshrined in outcome improvement are complex and extremely difficult to achieve because healthcare systems assess and report on hundreds of these results yearly (Ambrose, 2018). In general, assessing, reporting, and making comparisons of healthcare outcomes aims to achieve four major goals (the Quadruple goal), including reducing staff and clinician burnout, lowering the cost of healthcare, improving the general health of populations, and enhancing patient experience of care (Singh, Meyer, &Thomas (2014).

One important problem of quality improvement in hospitals and clinics – which is also the intent of this QI proposal – is the delivery of safe care to patients. The term patient safety is defined by WHO (n.d.) as the nonexistence of avoidable injury in the process of delivering patient care. WHO (n.d.) also notes that each point in the delivery of care services to patients has a particular level of inherent safety. For that reason, often, safety is achieved through a collaborative effort of data-driven safety improvements, organizational leadership capacity, clear policies, effective patient involvement, and skilled healthcare professionals.

Safety of care, or patient safety, is one of the few healthcare problems impacting the cost of care, reducing patient experiences, as well as increasing medical errors and rates of mortality in care settings. According to WHO (n.d.), about four out of ten patients globally are negatively affected in ambulatory and primary care settings. In addition, the report shows that approximately 134 million adverse harms happen every year in care settings in poor and middle nations, resulting in nearly 2.6 million mortalities each year because of unsafe care. Subsequently, unsafe care is estimated to result in $42 billion worth of medication errors every year (Singh, Meyer, &Thomas (2014). Therefore, patient safety is an important quality improvement problem in medical practice that should be addressed to lower healthcare costs, cut medication errors, better patient experiences, lower hospital readmissions, and flatten the mortality rate curve.

Significance of Quality Improvement in Practice/Organization

Improving the quality of care for safety reasons in hospitals is an important factor that most care providers should take seriously. The term ‘quality improvement’ refers to the formal, systematic tool to analyze not only performance but also focus on the improvement of performance. Usually, several quality improvement tools are used in collecting and analyzing statistics in care settings as well as testing the change. Understanding and effectively rolling out quality improvement measures are important in enhancing patient safety, efficiency, and all other clinical outcomes (AAFP, n.d.). The common approaches used in quality improvement range from the Lean model, Six Sigma, to PDSA (Plan-Do-Study-Act).

Specifically, these techniques serve a significant purpose in improving the safety of care in hospitals and, thus, help reduce the burden of medical harm patients incur. According to the WHO (2019) report, tens of millions of patients die or suffer from injuries caused by poor-quality or unsafe healthcare. Therefore, the first objective of patient safety is to lower the incidences of medical errors, which are some of the primary roots of avoidable injury and harm in hospitals and other care settings. The second benefit of improving the quality of care is lowering the incidence of nosocomial infections (or health-associated infections). According to WHO (2019), about 7-10 hospital-acquired infections occur in a total of 100 hospitalized patients in low-income and high-income nations. The burden of healthcare harm associated with unsafe patient care occurs from diagnostic blunders, unsafe surgical operations and injections, sepsis, radiation mistakes, unsafe transfusions, and blood clots. Effective quality improvement practices can play an important role in lowering all these types of errors in care settings if the right approach is used.

Demonstration of Support from Previous Research

Many studies have shown a significant relationship between quality care and patient safety. Specifically, research has shown a direct connection between low-quality care services and reduced patient safety, resulting in poor patient healthcare outcomes, including high mortality rates, increased cases of hospital-acquired infections, and increased cost of care. For example, research carried out by Choi et al. (2016) showed that a significant cost burden occurs from medication blunders committed deliberately and unintentionally in hospitals, some of which are avoidable. The researchers conducted a case-control trial, recruiting at least 57,554 individuals hospitalized in two New Jersey hospitals between 2005 and 2006. The types of medication errors analyzed by the two researchers included counterfeit medicines, medicine shortages, mismanaged polypharmacy, suboptimal generic use, antibiotic overuse/misuse, medication errors, delayed medicine use, nonadherence, as well as misuse of expensive drugs. The results demonstrated that the rate of medical errors was 0.8/100 hospitalizations, which translates to 1.6/1000 patient days. The treatment costs directly linked with medication blunders ranged between $8,439 and $8,898.

Another study by Haque et al. (2018) showed that at least 7-10 nosocomial infections arise in every 100 patients hospitalized in poor and middle nations. According to the CDC, approximately 1.7 million admitted patients acquire nosocomial infections annually, with more than 98,000 patients likely to die from these diseases. Research by Assiri et al. (2018) also demonstrated the high prevalence of diagnostic errors in medical settings, reducing patient safety and quality care. The study estimated the incidence of adverse drug events to be 15 per 1000 people annually, with the prevalence of preventable causes of adverse drug events at 0.4 percent.

Steps Necessary to Implement the Quality Improvement Initiative

‘Quality improvement’ tools are the formal, systematic methods used not only for the analysis but also for the improvement of performance in practice or organizations (Ambrose, 2018). Many quality improvement tools can be used in collecting and analyzing statistics in care settings as well as testing the change, depending on the type of QI change being targeted. For patient safety (which is the focus of this case study), “The Road to Evidence-Based Practice” technique is the most appropriate tool that can help to identify the areas of concern, implement the change, and evaluate the outcomes. The term evidence-based practice is anchored on the notion that organizational practices must be based on empirical or scientific evidence. Based on this approach, the following steps should be taken to implement the quality improvement process: asking a question, finding the evidence, appraising the evidence, implementing, and evaluating.

For example, the researchers seeking to implement a quality improvement initiative should ask questions such as: can the use of new technologies like health information systems improve patient safety by lowering the rate of hospital-acquired infections, reducing medication errors, and improving patient outcomes? This step is also important because it assists the QI implementers in identifying the variables that should be analyzed, such as how medication errors are related to hospital-acquired infections and the cost of care. The next step is collecting scientific evidence that shows how the use of health information systems, such as electronic health records (EHRs), has improved patient safety by lowering medication errors, improving staff-patient collaboration, and many others. This should be followed by an examination or appraisal of the evidence, implementation, and evaluation of the initiative. Most importantly, implementation is the process of rolling out and overseeing that the new technology is mapped out well and is working to achieve the intended purposes.

Evaluation of Quality Improvement

A quality improvement study can be used to evaluate whether or not the new initiative is working as planned (to improve patient safety). A quantitative quality improvement study (especially a case study) can be formulated to examine whether the new techniques are effective or not and whether there are new areas of modification or not. After identifying the area of improvement, conducting background research on the previous evidence, and formulating the research questions, the next step is identifying the hypothesis of the study (Ambrose, 2018). A possible hypothesis is that “the use of new technologies like health information systems improves patient safety by lowering the rate of hospital-acquired infections, reducing medication errors, and improving patient outcomes.” Statistical methods can then be used to identify the study sample (such as random sampling) and analyze the data (such as inferential methods like t-test and ANOVA) before disseminating.

References

AAFP. (n.d.). Basics of quality improvement. Retrieved from https://www.aafp.org/practice-management/improvement/basics.html

Ambrose, J. (2018). Clinical inquiry and hypothesis testing. Applied Statistics for Health Care. Retrieved from https://lc.gcumedia.com/hlt362v/applied-statistics-for-health-care/v1.1/#/chapter/3

Assiri, G. A., et al. (2018). What is the epidemiology of medication errors, error-related adverse events, and risk factors for errors in adults managed in community care contexts? A systematic review of international literature. BMJ Open, 8(5), e019101. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5942474/

Choi, I., et al. (2016). Incidence and treatment costs are attributable to medication errors in hospitalized patients. Research in Social and Administrative Pharmacy, 12(3), 428-437.

Haque, M., et al. (2018). Healthcare-associated infections – an overview. Infection and Drug Resistance, 11, 2321-2333. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245375/

Helbig, J. (2018). Statistical Analysis. Retrieved from https://lc.gcumedia.com/hlt362v/applied-statistics-for-health-care/v1.1/#/chapter/4

Singh, H., Meyer, A. N., &Thomas, E. J. (2014). The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ Quality & Safety, 23(9), 727–731.

WHO. (2019). Patient safety: Key facts. Retrieved from https://www.who.int/news-room/fact-sheets/detail/patient-safety

WHO. (n.d.). Patient safety. Retrieved from https://www.who.int/patientsafety/en/#:~:text=Medication%20Without%20Harm-,Patient%20Safety,care%20to%20an%20acceptable%20minimum.

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Quality Improvement Proposal

Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice. Apply “The Road to Evidence-Based Practice” process, illustrated in Chapter 4 of your textbook, to create your proposal.

Include the following:

• Provide an overview of the problem and the setting in which the problem or issue occurs.
• Explain why a quality improvement initiative is needed in this area and the expected outcome.
  

  Quality Improvement Proposal

• Discuss how the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes. Include a minimum of three peer-reviewed sources published within the last 5 years, not included in the course materials or textbook, that establish evidence in support of the quality improvement proposed.
• Discuss steps necessary to implement the quality improvement initiative. Provide evidence and rationale to support your answer.
• Explain how the quality improvement initiative will be evaluated to determine whether there was improvement.
• Support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

RUBRIC

• Attempt Start Date: 06-Jul-2020 at 12:00:00 AM
• Maximum Points: 150.0

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