Running head: QAULITY AND SAFETY SYNTHESIS

Brian Poirier
Quality and Safety Synthesis
Leadership and Management in Professional Nursing
November 21, 2014

QAULITY AND SAFETY SYNTHESIS

The modern healthcare environment of providing quality and safety in practice is shaped
by several competencies to provide best care practices. Six quality and safety competencies
which help direct care are: patient-centered service, teamwork and collaboration, evidenced
based practice, quality improvement, safety, and informatics. The implementation of these
competencies in a post-operative orthopedic med surg unit at local healthcare facility, Bayfront
Medical Center, will be explored in the following discussion.
Patient-centered care is the act of providing the patient, or their designated caregiver, the
most current and appropriate information regarding their medical treatment in order to develop a
plan of care that reflects the patients individual health care preferences and desired outcomes.
Nurses are critical in providing patient centered care as they are the most involved healthcare
team member in day to day care. However, patient centered care can be difficult to implement
when patient beliefs vary from the normal protocol of care established in a particular unit. A
common cause of disagreement between best care and patient desired outcomes care seen in the
unit is the transfusion of blood products to those who refuse based on cultural and religious
beliefs. As the nurses on this unit are urged by their nurse manager to complete cultural
competency courses online, the prudent nurse on the unit knows to offer autologous blood
products during surgery if needed, and to alert the physician. To improve the cultural
competency of the nurse, continuous cultural competency education and training is needed.
Teamwork and collaboration between professions is critical in all aspects of care, and on
the post-op orthopedic unit of Bayfront Medical Center, case management, physical therapy, and
the nursing staff all cooperate to provide the highest inpatient and home healthcare. Every newly

QAULITY AND SAFETY SYNTHESIS

admitted patient is assessed by the physical therapy team for potential risks, physical needs, and
continued care after an inpatient stay. This data is then reported to case management to coordinate and schedule equipment delivery, physical therapy placement (continued care at the
hospital, or outpatient therapy), and home healthcare needs. Together with the nursing staff, case
management manages all of these decisions by an open discussion of choices and information
with the patient in twice weekly bedside discharge rounds which includes physical therapy team
members and the nurse staff.
A major evidenced based practice change that has been implemented within the last year
on this unit (and every unit at Bayfront) has been the adoption of barcode scanning for
medication administration. Previously it was the nurses sole responsibility to confirm patient
information and medication doses before administration; now each medication must be scanned
via a barcode, and each medication signed off on in the electronic chart before administration to
ensure right medication, right dose, right route, right patient, and right time. This method of
administration was found to have decreased adverse drug events by 47% (Morriss Jr. et al., 2008)
in a recent clinical trial. Data on each employees use of the barcode scanner during
administration is calculated and posted monthly; if the minimum threshold of use is not met (as
set by the Hospital Consumer Assessment of Healthcare Providers and Systems initiative), the
hospital is responsible for reimbursement of care costs.
Continuous monitoring of outcomes from current practices leads to quality improvement
initiatives to improve care and decrease safety risks at Bayfront. One case in particular resulted
in an increase of vital sign assessments post-surgery after a patient was over sedated and expired
before Narcan could be administered. Post-op vitals are now recorded every thirty minutes for

QAULITY AND SAFETY SYNTHESIS

two hours immediately post-operative, and every four hours for 24 hours post-op to detect
alterations in vital signs in a more appropriate frame of time.
Safety guidelines are also implemented on the unit to minimize the risk of harm by
following the Joint Commissions National Patient Safety Goals. Following the Joint commission
safety goals also ensures Medicaid reimbursement so being safe is also profitable. An important
safety goal followed by the unit is Goal #7: Reduce the Risk of Health Care Associated
Infections; specifically in the prevention of surgical site infections. The Joint Commission states
that healthcare providers must: educate patients, and their families as needed, who are
undergoing a surgical procedure about surgical site infection prevention, and conduct periodic
risk assessments for surgical site infections in a time frame determined by the hospital (The Joint
Commission, 2014).
Bayfront Medical Center uses Electronic Medical Records (EMR) to record and manage
patient data, and to provide the most up to date information to providers managing their care.
Although this system is a powerful tool, it is not devoid of issues. Recently, with the addition of
barcode medication administration, issues with reimbursement from Medicaid have been an
ongoing concern as healthcare team members adapted to the new practice. As nurses became
familiar with the system many medications were accidentally not scanned and minimum
thresholds were not met which caused a drop in reimbursement. Compliance also becomes an
issue with new modes of communication and practice, and healthcare team members who have
had extensive experience with paper charting may be slower to adapt to current practice.
Quality and safety competencies are important and intertwining factors necessary to
provide the best patient care possible. These competencies are enforced by several commissions
that guarantee patient safety and facility accountability through reimbursement and accreditation.

QAULITY AND SAFETY SYNTHESIS

Coupled with the personal responsibility of healthcare team members, managerial
encouragement, and governmental incentives, patient safety is always at the forefront of
healthcare at Bayfront Medical Facility.

QAULITY AND SAFETY SYNTHESIS

Reference List
The Joint Commission. (2013). 2014 Hospital National Patient Safety Goals. Retrieved from
http://www.jointcommission.org/hap_2014_npsgs/

Morriss, Frank H. et al. Effectiveness of a barcode medication administration system in reducing

preventable adverse drug events in a neonatal intensive care unit: A prospective cohort
study. The Journal of Pediatrics, 154(3), p. 363 368.