Finding Your Way in Continuous Quality Improvement

Quality ImprovementPlease welcome guest blogger, Anita Finkelman, author of Quality Improvement: A Guide for Integration in Nursing, for a new series on quality improvement.

A Beginning: Our Blog

Welcome to the blog Finding your Way in Continuous Quality Improvement! I am going to refer to “quality improvement” as CQI (continuous quality improvement). Upfront, let’s recognize that not only is healthcare a mixed up, changing area but so is CQI—and a new area. I like to use Alice in Wonderland as a background setting to set my mind around the topic of CQI. Why Alice? It actually is not an uncommon source used in leadership and management, but it has implications for CQI, too.

Alice in Wonderland provides a window into a world that is confusing, often viewed as nonsense; where language and terminology are not clear. There is lack of clarity as to who characters are and what they do. They change, and time is not always based on reality. One of the main characters, the Red Queen, makes it clear that you cannot expect to improve if you allow the status quo to continue. Alice, the main character, struggles in this world to find her way, as if in a maze, not knowing where to go or what her destination may be. Alice is full of questions as she tries to make Wonderland clearer to herself and engage others in Wonderland. She does discover that to be shown something improves her understanding. “What is the use of a book,” thought Alice, “without pictures and conversation.” Alice also comments on change, “How puzzling all these changes are! I’m never sure what I’m going to be, from one minute to another.”

So here we are at the beginning—working on making CQI clearer for us and for our students. We want to prepare our students for the real world, as confusing as it might be. We want them to be practicing nurses who engage in CQI.  I will attack various topics for us to consider as we facilitate effective learning and hopefully effective practice and quality care. A dialogue improves our understanding.

What, Another Medication Error?

Medication errors happen every day—and there is much variety in the types and circumstances. Why do we start here? Nurses administer medications. Learning how to do this safely is probably the most critical early learning activity for nursing students. As students get into the clinical area more and more issues come out about medication—increasing risk. What can we do about this?

Getting to Some Solutions

We are busy as faculty. Developing teaching-learning materials take time. As we well know, we sometimes tend to reinvent the wheel or feel we have to start from scratch. I am here to tell you we have a wealth of resources available to us—AND I am sure sharing with colleagues would also go a long way to expedite this prep work and lead to more effective learning.

To begin we must keep at the forefront, at all times, that health care has moved away from the Blame Environment. We know what this is—you make a medication error, and you are blamed with little consideration given to all of the many, many factors that might have led to that error in the system and with individuals. This blog posting is not directed at this major change in error response to a Culture of Safety, but it is important to remember it so that we know this is an overall perspective of errors that now impacts the learning experience.

There are many resources available to us from government resources and through other organizations. I want to begin by highlighting several and what how you might use them.

An Ongoing Update in Medication Administration

We begin with a great resource from the Institute for Safe Medication Practices (ISMP) (http://ismp.org/). This website is rich with resources for us. It not only provides resources but also an update on FDA alerts. For example, here is a list of the tools it features:

  • Special Error Alerts
  • High Alert Medications
  • Confused Drug Name List
  • Error-Prone Abbreviations List
  • Names with Tall Man Letters—to avoid errors with look-alike drugs

Check out the tools on the main website at http://ismp.org/.

An important option on this website: Sign-up for the free Nurse Advise-ERR. This electronic newsletter provides you with resources for effective facilitation of learning about medication administration.

What can you do with these resources? They can be used to provide examples and guidelines that you can incorporate in the cases you develop for students that might be used for individual assignments or team assignments. It is critical to incorporate this type of information in simulation as students engage in learning about medications and administration of medications. Even after they learn about the basics of incorporating them in complex simulation experiences we must remind students that learning about medications and administration of medications is an ongoing process. Students can also be directed to the ISMP website and asked to describe how they might use this information source. These resources are important to us as they reflect current concerns about medications based on evidence from practice and research.

Another resource is the Agency for Healthcare Research and Quality, Patient Safety Network (AHRQ, PSNet). Its Patient Safety Primers offer resources on patient safety, including medication administration, for example, https://psnet.ahrq.gov/primers/primer/23.

Also, when you open the home page at https://psnet.ahrq.gov/ you find a list of current references that are highlighted and abstracts are provided. The topics cover the areas of patient safety, and thus some often relate to medication administration and medications.

This ends our blog for now. What do you do to engage students in the critical need to provide safe and effective medications? How might you use some of these resources to update or change your teaching-learning strategies?

About the text:

Quality Improvement: A Guide for Integration in Nursing serves as a comprehensive resource for teaching practicing nurses and nursing students about the importance of improving patient care and reducing errors through quality improvement.  The text focuses on the practical aspects of quality improvement and the nurse’s role in the process, while acknowledging the importance of an inter-professional approach.  In addition, it focuses on the current state of healthcare quality in the US, critical trends in preventing errors, data, analysis, and planning and implementing change to reach improvement. The author connects quality improvement to technology and the role of the patient while emphasizing the importance of engagement and nursing leadership. Learn more at our website.

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