HQS-640 Quality Improvement and Patient Safety Practicum Journal 5 Essay
Advanced nursing students carry out practicums under their mentors and supervisors to enhance their overall skills, competencies, and knowledge to deliver quality care for patients. Positive quality and safe patient outcomes are critical components of enhanced care delivery and patient satisfaction. Based on practicum activities covering weeks 9 and 10, this reflective journal discusses the importance of purposeful hourly rounding as an EBP intervention to lower, prevent, and mitigate patient falls in the neuroscience unit.
Practicum Activities Reflection
The practicum activities for weeks 9 and 10 implores nurses as care providers to be observant and develop effective analytical skills when implementing their practicum projects. Observation of critical project elements in this purposeful hourly rounding is meant to improve the overall implementation of the intervention for quality care delivery, patient safety, and increased patient satisfaction. The activities for the last two weeks entailed making critical observations and audits on the implemented initiative. I did 25 observations and audits during the implementation of the interventions. Twenty of these audits were complete while five were incomplete. However, no falls occurred to demonstrate the efficacy of the purposeful hourly rounding in reducing and preventing such events.
The observations and audits for the two weeks when implementing the project show that providers can reduce falls and susceptibility by following such interventions. Studies show that purposeful and timely rounding is the most appropriate intervention to routinely meet patient care needs, ascertain patient safety, and lower the occurrence of preventable events. The hourly rounding model also provides a proactive approach to addressing problems associated with falls before implementation (Montejano-Lozoya et al., 2020). The audits and observations demonstrate that hourly rounding is the most appropriate way to mitigate call lights and alarms, fall injuries and enhances both quality of care and patient satisfaction. Imperatively, nurse knowledge concerning this intervention and infrastructure supporting it all the time are critical aspects for consistency to attain patient-centered care.
Health Care Quality and Patient Safety
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Models like value-based care implore healthcare organizations and providers to prioritize quality service provision as opposed to quantity. The implementation of any intervention like purposeful hourly rounding focuses on quality care intending to improve patient experiences in a systematic and structured manner that provides feedback on progress and attainment of set goals and objectives. Organizations that adopt an established quality improvement model can apply the system and methods to improve patient experiences (Morley & Cashell, 2018). Different quality process improvement tools exist to help project managers assess if the implementation of their interventions is meeting the set goals and objectives.
The Plan-Do-Study-Act (PDSA) cycle is a process improvement tool that details four steps for the implementation of sustainable improvements. These steps include planning, doing, studying, and acting. Planning implies that the team determines the changes required while doing means executing the improvements (AHRQ, 2020). Studying entails comparing the improved process with an old process to determine I the changes made have resulted in better outcomes. Acting means that all involved in the process are accountable and play their part to attain sustainable improvement. At the core of this cycle is that change teams can do more always to enhance quality outcomes.
The second process improvement tool is the Institute for Healthcare Improvement’s Model for Improvement. The model is a simple and powerful approach as it aims at setting goals and selecting or developing measures to demonstrate if changes have led to improvement. At the core of this model is the PDSA cycle. The initial part of the Model for Improvement is the “trial and learning” approach that entails using rapid cycle improvement (RCI). The second component of the model uses RCI and the PDSA cycle in implementing an action plan with small-scale intervention executed quickly to test change, learn from the tests, and modify the intervention for implementation in the next cycle (AHRQ, 2020). The implication is that this model aligns with the PDSA cycle as its implementation is incremental (Andrew et al., 2020). The third quality process model is Six Sigma whose main goal is to eliminate defects, waste and improve not only quality but also efficiency through streamlining and improving all processes. Sigma rating shows the percentage of defect-free products emanating from a process. The model improves the quality of process outputs through the identification and removal of errors and minimization of variability in processes.
The three models are all critical as they focus on improving quality outcomes based on process measures. The implementation of hourly rounding is a process that will culminate in the prevention and reduction of falls in the neuroscience unit. Therefore, these models are structured, focus on the process items, and require increased leadership accountability and effective implementation by respective care teams. The models also focus on minimizing errors to offer the best outcomes. Therefore, they all have benefits to the EBP intervention of hourly rounding. However, the best method for the process quality is the Model for Improvement by the Institute for Health Improvement. The model incorporates the PDSA approach which allows one to evaluate changes and their effects on the process. The Model for Improvement also demonstrates the need for healthcare providers to audit different processes and align them with set goals and objectives to reduce patient falls’ susceptibility.
Practicum Project Preparation
Staff development is a critical part of effective quality process improvement in healthcare settings. Staff development entails efforts to improve competencies, abilities, skills, and knowledge to execute identified tasks and interventions. Staff development ensures that staff is well-positioned to implement quality improvement interventions to enhance patient care and safety. The implementation of the purposeful hourly rounding will require staff development that includes training, coaching, simulations, and the task or job rotations (Andrew et al., 2022). Training focuses on improving employee skills through different approaches that include lectures, simulations, and hands-on exercises.
Coaching entails senior staffers working one-on-one with less experienced employees to execute process improvement. Simulations in this initiative will entail learning how to use some aspects of the intervention, especially the interfaces for nurses and even patients (Neumeier et al., 2020). Through simulations, the nursing staff will learn how to implement purposeful rounding to reduce susceptibility to falls. Task and job rotations will also occur as nurses will volunteer roles to help impart new skills to their colleagues for effective implementation of the project. These staff development approaches will be ongoing based on the employee demand for identified skills gaps existing at each level of the implementation. Staff development will be completed by ensuring that all nursing staff members engage and participate in sessions and collaborate to execute the project.
The quality improvement provides great potential to integrate other aspects of care to ensure that patient outcomes are good and have long-term sustainability. In their article, Hut-Mossel et al. (2021) observe that nurses and other change agents implementing quality improvement projects should understand the working of audits to enhance care among patients. Using a systematic review and literature synthesis, the authors identify factors that impact quality improvement based on the mechanisms and contexts of organizations and stakeholders. The authors assert that having audits legitimizes feedback provision to colleagues and leads to better integration and engagement. Through audits, change implementers can make observations on the areas that need change and collaborate with the rest of the stakeholders to attain set goals and objectives. Again, Alyacoubi et al. (2020) observe that audits are essential in improving patient care quality as they demonstrate if the suggested interventions lead to desired outcomes. The implication is that audits ensure that organizations and their providers implement better interventions, and make necessary adjustments to attain quality care outcomes.
The studies’ findings align with my experience in the last two weeks of practicum by emphasizing the role of audits. The last two weeks entailed making observations about the implementation of purposeful hourly rounding in reducing patient falls. The article shows that audits are a fundamental part of effective quality improvement processes as they ascertain if the interventions are working and resulting in quality outcomes for patients and healthcare facilities. The articles show that conducting audits improves the overall perception of attaining set goals and objectives.
The practicum activities for weeks 9 and 10 entailed making audits about the implementation of an intervention to reduce falls. These audits show that purpose hourly rounding is an effective approach to minimize falls and improve desired patient quality outcomes. The implication is that nursing students undertaking their practicums should identify effective quality process tools to audit their proposed interventions aimed at enhancing patient outcomes.
Agency for Healthcare Research and Quality (AHRQ) (2020). Section 4: Ways to Approach the
Quality Improvement Process (Page 2 of 2). https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi-process/sect4part2.html
Alyacoubi, S., Albaraqouni, L., Elessi, K., & Bottcher, B. (2021). The Introduction of Clinical
Audit as a Quality Improvement Tool in Gaza. Clinical Audit, 13, 15. DOI https://doi.org/10.2147/CA.S262619
Andrew, L., Dare, J., Robinson, K., & Costello, L. (2022). Nursing practicum equity for a
changing nurse student demographic: a qualitative study. BMC nursing, 21(1), 1-8. DOI: 10.1186/s12912-022-00816-2
Hut-Mossel, L., Ahaus, K., Welker, G., & Gans, R. (2021). Understanding how and why audits
work in improving the quality of hospital care: A systematic realist review. PloS one, 16(3), e0248677. https://doi.org/10.1371/journal.pone.0248677
Montejano-Lozoya, R., Miguel-Montoya, I., Gea-Caballero, V., Mármol-López, M. I., Ruíz-
Hontangas, A., &Ortí-Lucas, R. (2020). Impact of nurses’ intervention in the prevention of falls in hospitalized patients. International Journal of Environmental Research and Public Health, 17(17), 6048. https://doi.org/10.3390/ijerph17176048
Morley, L., & Cashell, A. (2018). Collaboration in health care. Journal of medical imaging and
radiation sciences, 48(2), 207-216. DOI: 10.1016/j.jmir.2017.02.071.
Neumeier, A., Levy, A. E., Gottenborg, E., Anstett, T., Pierce, R. G., & Tad-y, D. (2020).
Expanding Training in Quality Improvement and Patient Safety Through a Multispecialty Graduate Medical Education Curriculum Designed for Fellows. MedEdPORTAL, 16, 11064. DOI: 10.15766/mep_2374-8265.11064
Journaling provides a valuable tool for recording, reflecting on, and reviewing your learning. This approach provides an opportunity for you to “connect the dots” and observe the relationships between activities, interactions, and outcomes.
Unlike a personal journal of thoughts and feelings, this practicum journal is a record of your activities, assessments, and learning related to this academic experience. Journal entries should include a record of the number of hours spent with your nurse preceptor each week.
Write a reflective journal entry of 750-1,500 words answering the following:
Practicum Activities Reflection: Provide observations and thoughts on the activities in your practicum setting during Weeks 9-10.
Health Care Quality & Patient Safety: Compare and contrast three quality process improvement tools. Which one is most applicable to your project?
Practicum Project Preparation: Discuss what type of staff development is necessary for your project. Will this be one-time or ongoing? How will you ensure it is completed?
Evidence: Find a current article related to something you have done in your practicum during the past two weeks. Relate the article to your experience.
APA format is not required for the body of this assignment, but solid academic writing is expected. The “Practicum Journal Template” is required for this assignment. All citations and references must be written in APA format.
This assignment uses a rubric. 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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.