Quality Improvement Milestones
Healthcare quality transforms the healthcare system as it focuses on the way care is delivered by creating a culture of service excellence. Quality in healthcare has two dimensions, the technical excellence which is the skill and competence of
professionals and the ability of diagnostic and therapeutic equipment’s, procedures, and systems to accomplish what they are meant to accomplish reliably and effectively, and the patient experience especially in their perception of illness or well
-being and in their encounters with healthcare professionals and institutions. Healthcare organizations’ ability to deliver high quality, patient centered care to their members and patients depends in part on their understanding of basic customer
service principles and their ability to integrate these principles into clinical settings (Nash et al., 2019).
The success of an organization depends on its quality foundation, the levels of performance and the ability of the organization to improve performance when expectations are not being met.
How to Err is Human Has Influenced the Health Care Delivery System and Nursing Practice
“To Err Is Human” launched a series of institute of medicine (IOM) reports on improving quality and reducing errors in the U.S. health care system, with a focus on preventing medical errors to improve the quality of healthcare at all stages of
diagnosis and treatment. To err is human influenced the healthcare delivery system and nursing practice through the error preventive measures that were proposed which serves as a roadmap toward a safer health system and has enabled the
development of highly effective interventions for hospital-acquired infections and medication safety. The frequency of preventable harm to patients is still high in healthcare organizations but there is still much room for improvement in patient
safety (Kohn et al., 2000).
Experience On How the Patient Safety Movement Has Affected My Practice
One profound area from my nursing experience that patient safety movement has affected my practice is in medication errors. As the rate of comorbidities rise, the average patient today tends to be on more medications at one time, this can lead to
medication errors and more potential challenges for patients once they leave the hospital (Thornton,2016).
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds). (2000). To err is human: Building a safer health system. Washington, D.C.: National Academy Press.
Nash, D. B., Joshi, M. S., & Ransom, E. R., & Ransom, S. B., (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Chicago, IL: Health Administration Press.
Thornton, P. (2016). Medication Safety. Journal of Pharmacy Practice & Research, 46(2), 156–168. https://doi-org.ezp.waldenulibrary.org/10.1002/jppr.1215
Quality Improvement Milestone
How many people need to die because of medical error before one is considered too many? According to Nash et al. (2019), 250,000 people die annually in the United States from medical errors. This number can only be compared with the death record of death caused by heart disease and cancer (Nash et al. 2019). Status quo is not an option, therefore heath care providers in strategic positions have to make a difference in ensuring that people who entrust their care to us are provided with the highest level of care possible (Nash et al. 2019).
Laureate Education (2011) further delved into the rationale for care received by patients in the healthcare industries, as he stated, what is the purpose of patients receiving care that is not beneficially created to implicate positive social changes? in other words, all efforts made without the aim to actualize patients’ maximum potential are fruitless. According to Kohn et al. (2000) safety is more than just the absence of errors. Safety has multiple dimensions which illuminate that health care is complex and risky and that solutions are found in the broader systems context for example: (a) set of processes that identify, evaluate, and minimize hazards and are continuously improving, and (b) an outcome that is manifested by fewer medical errors and minimized risk or hazard.
Milestone Influenced on Health care Delivery.
From a chronological perspective the below indicates the efforts made for urgent need to improve health care quality according to the Institute of Medicine (IOM) National Roundtable “The Urgent Need to Improve Health Care Quality” by the Institute of Medicine (IOM) National Roundtable on Health Care Quality (Chassin and Galvin 1998).
(1) IOM’s To Err Is Human: Building a Safer Health System (Kohn, Corrigan, and Donaldson 2000).
(2) IOM’s Crossing the Quality Chasm: A New Health System for the 21st Century (IOM 2001).
(3) The National Healthcare Quality Report, published annually by the Agency for Healthcare Research and Quality (AHRQ) since 2003).
(4) The National Academies of Sciences, Engineering, and Medicine’s Improving Diagnosis in Health Care (National Academies 2015).
Berwick (2002) stated that crossing the Quality Chasm provides a blueprint for the future that classifies and unifies the components of quality through six aims for improvement. Berwick (2002) further delineated that these aims also viewed as six dimensions of quality, provide healthcare professionals and policymakers with simple rules for redesigning healthcare are as follows, (they can be known by the acronym STEEEP (Berwick 2002) :
(1) Safe: Harm should not come to patients as a result of their interactions with the medical system.
(2) Timely: Patients should experience no waits or delays when receiving care and service.
(3) Effective: The science and evidence behind healthcare should be applied and serve as standards in the delivery of care.
(4) Efficient: Care and service should be cost-effective, and waste should be removed from the system.
(5) Equitable: Unequal treatment should be a fact of the past; disparities in care should be eradicated.
( 6) Patient-centered: The system of care should revolve around the patient, respect patient preferences, and put the patient in control
Own Work History and Experience as to how the Patient safety Movement has Affected my Practice.
Though I am living in a country where there is no cost to patients for healthcare provided, the organization that I work for considers the delivery of cutting edge care to patients is paramount. Many safety initiatives are grounded in the fundamental policies of the organization that holds each employee accountable for the care they provide to each patient that enters the organization’s doors.
The Registered Nursing of Ontario plays a major role in ensuring that registered nurses in Ontario are equipped with adequate knowledge to promote the highest quality of care to patients through generous funding to our organization (Grinspun, 2021). Efforts made to the quality of care patients receive is through Quality Assurance Initiates followed by RNs’ educational programs, continued assessment to encourage sustainability of safe practice, and new recommendations to practice based on new research. I have been the champion for multiple Best Practice Guideline and QI projects which impacted increased nursing knowledge increased nursing confidence and most importantly improved patient outcome.
Berwick, D. M. 2002. “A User’s Manual for the IOM’s ‘Quality Chasm’ Report.” Health Affairs (Millwood) 21 (3): 80–9.
Grinspun, D. Transforming nursing through knowledge: Progress on the Registered Nurses’ Association of Ontario (RNAO) best practice guidelines programme. Enfermeria clinica (English Edition), [s. l.], v. 30, n. 3, p. 133–135, 2020. DOI 10.1016/j.enfcli.2020.03.002. Disponível em: https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=mnh&AN=32284179&site=eds-live&scope=site. Acesso em: 1 jun. 2021.
Institute of Medicine. Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy of Sciences. Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds). (2000). To err is human: Building a safer health system.National Academy Press.
Laureate Education, Inc. (Executive Producer). (2011). Organizational and systems leadership for quality improvement: Concepts of quality and patient safety. Baltimore: Author.
Nash, D. B., Joshi, M. S., & Ransom, E. R., & Ransom, S. B., (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press.
Health care-associated infections (HCAIs) are infections that appear during a health care, while a patient is still in the hospital, developing within two weeks of their arrival, or within 30 days of the patient having received health care. Many studies show that common types of hospital adverse events include ADEs, HCAIs, and surgical complications. Nearly 1.7 million patients admitted to the hospital each year acquire hospital-acquired infections while being treated for another medical condition and nearly 98,000 patients die as a result. ( Hague, Sartelli, McKimm & Barkar 2018)
Research studies that took place in countries with a high level of income discovered that 5% to 15% of patients who were hospitalized acquired HCAIs, which could affect 9% to 37% of those who were admitted to ICUs ( Vincent 2003). CDC estimates that about one in 25 U.S. patients who visit the hospital is diagnosed with at least one infection that is only linked to hospital care. This estimate doesn’t include infections that patients get while receiving other forms of healthcare. An overwhelming majority of HAIs originate from the most urgent and deadly antibiotic-resistant bacteria, which may result in sepsis or death.
Healthcare-associated infections (HAIs) strike approximately 2 million people in the US each year, and nearly 90,000 people die from them. HAIs can cost anywhere from $28 billion to $45 billion overall ( Stone, 2010). Many HAIs can be prevented, despite the high morbidity, mortality, and expense associated with them. There have been numerous peer-reviewed publications that detail experiments testing the efficacy of a variety of infection prevention techniques. The CDC, including hand hygiene has produced much of this evidence (Stone, Hasan, Quiros & Larson 2007)
Research shows that both mandatory and voluntary surveillance are utilized for at least 30% reduction target (Pearson, 2009). Beginning in 2009, the federal government mandated that the healthcare system make progress on the National Action Plan to Prevent Health Care-Associated Infections (NAP) by establishing an HHS goal of reducing HAI infection rates in healthcare facilities using CDC’s National Healthcare Safety Network (NHSN) to track results (Health.org 2020). States that received funding for developing infrastructure to support and assist in HAI prevention efforts also received the first time dedicated funding to support and assist in HAI prevention efforts ( CDC.2020).
Conclusion: The patient safety issue of healthcare-associated infections persists, and the financial and social burden is immense. The results have revealed that to ensure a healthier healthcare system for all Americans, preventing HAIs is a key component of the DHHS’s mission and vision.
Haque, M., Sartelli, M., McKimm, J., & Bakar, M. (2018). Health care-associated infections – an overview. Health Care-associated Infections – an Overview, 11, 2321-2333. doi:10.2147/IDR.S177247
Pearson, A. (2009). Historical and changing epidemiology of healthcare-associated infections. Journal of Hospital Infection, 73(4), 296-304. doi:10.1016/j.jhin.2009.08.016
Stone, P. W. (2009). Economic burden OF healthcare-associated infections: An American perspective. Expert Review of Pharmacoeconomics & Outcomes Research, 9(5), 417-422. doi:10.1586/erp.09.53
Stone PW, Hasan S, Quiros D, Larson EL. Effect of guideline implementation on costs of hand hygiene. Nurs. Econ. 2007;25(5):279–284.
Home of the Office of Disease Prevention and Health Promotion. (n.d.). https://health.gov/.
Vincent, J.-L. (2003). Nosocomial infections in adult intensive-care units. The Lancet, 361(9374), 2068–2077. https://doi.org/10.1016/s0140-6736(03)13644-6
Briefly summarize your selected population health problem and describe how principles of epidemiology are being applied—or could be applied—to address the problem.
The population health problem I have chosen to explore this week is opiate addiction. According to the Centers for Disease Control (CDC, 2021), deaths from opioid overdoses reached almost 50,000 in 2019. Mattson et al. reported in 2021 that deaths related to opioid abuse increased by 1040% between 2013 and 2019. The opioid crisis is incredibly complex, and so attempts to drive any kind of remedy must be multifaceted and interdisciplinary (Blanco et al., 2020)
Current efforts at addressing the problem from an epidemiologic approach begin with an identification of both the rate of occurrences as well as any observable pattern of behaviors or choices that lead to the incidence of opiate addiction (CDC, 2012). Research and efforts towards eliminating opiate addiction are currently focused on exploration of the social determinants that lead to addiction, as well as identification of those most at risk. Development of a realistic understanding of the actual benefit of controlled opiate use versus the risk of long term dependence is underway as well. Research focused on the psychological and biochemical contributors to addiction, as well as any factors that may provide protection from abuse and addiction are also important considerations. Other approaches to combatting the opioid epidemic include publicly-funded rehabilitation therapy and treatment services, as well as policy reforms among multiple agencies, including healthcare, justice, and social services (Blanco et al., 2020).
Are there any lessons learned from the use of epidemiology in the eradication of smallpox that can be applied to your selected problem?
There are several lessons we can take from the population-based approach applied to eradicate smallpox. Smallpox eradication started slowly, and was complicated by multiple issues, including a lack of sufficient reporting to truly understand the real impacts of eradication efforts and a lack of strong leadership towards global efforts (Center for Global Development, n.d.). Some of the most powerful lessons learned from smallpox eradication efforts include comprehensive disease surveillance and rapid outbreak response coupled with strong community involvement. Opiate addiction does not present with a discrete set of detectable symptoms, nor can it be confirmed with any type of set test. Tracking amongst communities is difficult, because a need for treatment often does not emerge until significant dependence has developed. There is a stigma among addicts and seeking help for an addiction can be complicated by access to care and multiple psychosocial issues. Much like smallpox, however, efforts at eradication can focus on unified leadership intent on improving access to care and support to even to most rural and underserved areas, as well as a generalized change in approach to include those most vulnerable and needing of intervention (Rummons et al., 2018).
Evaluate the cost effectiveness of addressing this health problem at the population level versus the individual level.
The goal of population health lies in the achievement of healthy communities and productive populations (Nash et al., 2021). Cost of initiatives focused on addressing any specific public health issue needs to be considered from many perspectives. When we think about the cost to the public measured in loss of productivity, not to mention loss of family stability and ultimate loss of life, the realization is that quantification of the monetary cost of opioid epidemic is nearly impossible. We cannot, however, approach the issue with an “any means necessary” mentality. The goal should be evidence-based abuse prevention coupled with standardized strategies focused on addiction and recovery treatment. Additionally, research should focus on the determinants of opioid abuse and ways to mitigate population risk through identification of the most vulnerable populations. One practical example found by researchers examining the use of opiate antagonist therapy (OAT) noted that publicly funding immediate OAT for all addicts over a four-year period would result in a long term cost saving to the state of California of close to $3.8 billion (Krebs et al, 2018). Efforts aimed at individual care that may be costly on a case by case basis can benefit entire populations and eventually see a reduction in overall cost, much as noted during the smallpox eradication efforts (Henderson & Klepac, 2018).
Centers for Disease Control and Prevention. (2012, May 18). Principles of Epidemiology. Centers for Disease Control and Prevention. https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section1.html#:~:text=Epidemiology%20is%20the%20study%20(scientific,and%20the%20application%20of%20(since.
Centers for Disease Control and Prevention. (2021, March 25). Data Overview. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/data/index.html.
Center for Global Development (n.d.). Eradicating smallpox. Retrieved May 31, 2021 from https://www.cgdev.org/sites/default/files/archive/doc/millions/MS_case_1.pdf
Blanco, C., Wiley, T. R., Lloyd, J. J., Lopez, M. F., & Volkow, N. D. (2020). America’s opioid crisis: the need for an integrated public health approach. Translational psychiatry, 10(1), 1-13.
Henderson, D. A., & Klepac, P. (2013). Lessons from the eradication of smallpox: an interview with DA Henderson. Philosophical Transactions of the Royal Society B: Biological Sciences, 368(1623), 20130113.
Krebs, E., Enns, B., Evans, E., Urada, D., Anglin, M. D., Rawson, R. A., … & Nosyk, B. (2018). Cost-effectiveness of publicly funded treatment of opioid use disorder in California. Annals of internal medicine, 168(1), 10-19.
Mattson, C. L., Tanz, L. J., Quinn, K., Kariisa, M., Patel, P., & Davis, N. L. (2021). Trends and geographic patterns in drug and synthetic opioid overdose deaths—United States, 2013–2019. Morbidity and Mortality Weekly Report, 70(6), 202.
Nash, D. B., Skoufalos, A., Fabius, R. J. & Oglesby, W. H. (2021). The population health promise. In Population health: Creating a culture of wellness (3rd ed.). Jones & Bartlett Learning.
Rummans, T. A., Burton, M. C., & Dawson, N. L. (2018, March). How good intentions contributed to bad outcomes: the opioid crisis. In Mayo Clinic Proceedings (Vol. 93, No. 3, pp. 344-350). Elsevier.