Improving Quality and Safety in Healthcare: A Clinical Care Activity

This essay discusses the importance of quality and safety in healthcare and highlights a clinical care activity that can be used to improve patient outcomes. It focuses on the implementation of National Safety and Quality Health Service Standards (NSQHSS) and the monitoring of outcomes. The activity discussed is the use of chlorhexidine-alcohol solution to prevent hospital-acquired infections. The essay emphasizes the role of nursing professionals in implementing this activity and highlights the importance of patient satisfaction as an outcome measure.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Introduction
Satisfaction of the service users helps in the determination of quality. Customers or
the service users can be both internal (employees and management) and external (community
level service users and the suppliers) to an organisation. Quality is quality of kind or can be
defined as a service that exceeds the level of consumer's satisfaction. In other words, quality
can be defined as an ongoing process (Radawski, 1991). Under the context of the healthcare
organisation, the level of quality is access on the parameter of the improved patient outcome.
The improvement in the patients' outcome is monitored based on the comprehensive
improvement of mental and physical well-being along with increase in the level of patients;
satisfaction, decreased cost of care and length of stay at the hospital. At community level the
quality is also judged on the parameter of increase in the patients' knowledge and awareness
about the disease along with the development of the self-management skills.
The following essay aims to highlight one clinical care activity that can be used to
improve the quality and safety of the patients under the healthcare setting. In doing this, the
essay will initiate with a critical discussion of quality and safety in healthcare system with a
general perspective. This will be followed by selection on appropriate clinical activity in
order to promote one of the National Safety and Quality Health Service Standards (NSQHSS)
highlighted by Australian Commission on Safety and Quality in Health Care (ACSQH). The
essay will choose standard 3 of NSQHSS in designing the clinical activity. At the end, the
essay will highlight the process assessing the outcome of the clinical care activity. Overall
the essay will highlight how clinical care activity helps to improve patients’ safety and care
standards.

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Critical discussion of quality and safety standards under the Australian Healthcare
system
According to the National Safety and Quality Health Service Standards (NSQHSS) by
the Australian Commission on Safety and Quality in Health Care (ACSQH) (2012), the
improvement in the quality of the healthcare system deals with reduction of the public harm.
This can be done by providing proper quality assurance mechanisms that tests whether
relevant services are in place in order to ensure minimal level of standards of safety. The
assessment of the minimum level of standards in the healthcare system is governed by 10
different parameters (ACSQH, 2012).

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Figure: 10 different standards for maintaining quality healthcare service
(Source: ACSQH, 2012)
However, much before the standards were published by ACSQH in 2012, the editorial
data published by Donabedian (1988) helped in the identification of the parameters on which
the quality standards of healthcare can be determined. According to Donabedian (1988) the
quality standards of healthcare mainly depends in the knowledge, judgement, interpersonal
communication skills and amenities given by the healthcare practitioners. In context of this,
Kutzleb et al. (2015) stated that at present the quality of the healthcare delivery of an
organization is primarily aligned towards the role of the healthcare professionals. The
identification of the early signs and symptoms of disease by the healthcare professionals,
setting of the clinical priority and implementation of the person centred care plan helps to
improve the overall quality of care. Jarrar, Minai, Al‐Bsheish, Meri and Jaber (2018) stated
that person-centred care plan must be followed by safe implementation. In some cases it is
reported that increase in the workload of the nursing professionals, lack of proper availability
of resources or lack of skills of the healthcare practitioners lead to the generation of practice
error or medication error. Such errors are detrimental in healthcare practice as it endangers
the life of the patients. Vrbnjak, Denieffe, O’Gorman and Pajnkihar (2016) recommended
that in order outnumber the manual error; the healthcare organisation must come forward
with trained nursing workforce who is well-equipped to handle the pressure and at the same
time has proper skills to execute the comprehensive implantation of the care plan. Apart from
the clinical approach, the healthcare professionals must also take into consideration of the
mental health of the patients in order to improve the overall quality of care. Blease, Lilienfeld
and Kelley (2016) stated that taking informed consent, indulging into therapeutic
relationships with the patient by the use of effective communication skills enable a patient to
feel empowered. This sense of empowerment helps to improve their mental health and at the

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same time helps to increase their participation in the care plan and thereby helping to increase
the quality of care. Vaismoradi, Jordan and Kangasniemi (2015) stated that improving
patient participation in the process of increasing patients' safety necessitates considering
patient as a person. Patients' knowledge, healthcare conditions and beliefs and experiences
play a significant role in improving the level of patients' safety in healthcare. Donabedian
(1988) also reported that in order to improve the quality of healthcare, the cost of care must
also be taken into consideration. Stammen et al. (2015) stated that for reducing the cost of
care, the healthcare professionals must be trained. For example, a trained healthcare
professional is less likely to encounter medication error or spread of nosocomial infection by
the direct contact or by touch and thereby helping to decrease the unwanted stay at the
hospital and reducing the cost of care.
Critical discussion of a clinical care activity relevant
A clinical care activity in healthcare practice mainly highlights intervention that is
implemented in order to improve the nursing care of any specific standards (Donabedian,
1988). Arefian et al. (2016) are of the opinion that one of the principal threats of decreasing
the overall quality of care and increase in the cost of care is hospital acquired infections
(HAIs). The HAIs are the infections that are acquired during the stay from the hospital like
catheter associated infection and the infection transmitted through wounds from the touch of
the contaminated hands of the nursing professionals. Rahmqvist, Samuelsson, Bastami and
Rutberg (2016) highlighted that HAIs increase the risk of septicaemia along with the
compulsory dosage of broad-spectrum antibiotics to fight against the infection. This use of
the antibiotics and increased length of stay of the hospital endanger patients’ safety along
with increase in the cost of care. ACSQH (2012) stated that use of standard 3 deals with
prevention and controlling of HAIs and the main actions that can be taken in order to prevent

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HAIs include taking precautions for controlling spread or transmission of infection,
maintenance of aseptic techniques and sage handling and disposal of sharps. Other actions
highlighted by ACSQH (2012) include prevention and management of the occupational
exposure towards infected blood, antimicrobial prescribing along with the use of proper
surveillance and reporting data in relevant cases in order to report communicable and
notifiable diseases and thereby taking appropriate action.
Webster and Osborne (2015) reported that intravascular-catheter-related infections
(ICRI) are frequent yet life-threatening infections under the healthcare settings. ICRI are
common among the patients who are in the acute care units of the hospitals for a prolong
period of time. Skin at the site of insertion and the catheter hub or connector is the main
sources for the entry of the pathogens. As skin is the main source for the insertion of catheters
for the insertion of the catheter, the site of the insertion of the catheter becomes one of the
important sources of the HAIs. Catheter associated HAIs increase mortality and morbidity
rate. Prevention of the HAIs like ICRI is a principal contributor towards enhancing resident
safety in the hospital and nursing homes. Heudorf, Gasteyer, Müller, Samoiski, Serra and
Westphal (2016) stated that proper use of the skin antisepsis is crucial for prevention of
HAIs. The study conducted by Mody et al. (2015) reported that in order to reduce the chances
of HAIs spread through catheter the use of antisepsis is found to be of prime importance. The
use of anti-septic falls under the category of standard infection control precautions and
maintenance of aseptic technique for the spread of infection. Mimoz et al. (2015) reported
that under the domain of the skin antisepsis, chlorhexidine-alcohol helps greater protection
against short-term spread of the catheter-related infections in comparison to iodine-alcohol.
The conclusion is based on the results of the randomised control trail showed that patients
scrubbing with the chlorhexidine-alcohol reports lower incidence of catheter-related
infections in comparison to patients who are assigned to scrub with iodine-alcohol. Swan et

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al. (2016) also highlighted similar results. The single-centre pragmatic randomised control
trial highlighted that under quaternary academic medical centre, the patients who undertook
chlro-hexidine bath every day showed decreased risk of acquired catheter associated infection
in comparison to the patients who used only soap and water.
Data collection and analysis for the outcome monitoring
Donabedian (1988) stated that the information from which inferences can be extracted
about the quality of care could be classified under three different categories including
“structure”, “process” and “outcome”.
Structure denotes that characteristics of the settings under which the care occurs. This
mainly highlights the resources used including both human resources and other tools or
equipments (Donabedian, 1988). Zingg et al. (2015) stated that the main human resources
that can be utilised for the implementation of chlorhexidine-alcohol as skin anti-septic for the
prevention of ICRI is the nursing professionals. It is the duty of the nurses to procure safe
care by maintaining aseptic techniques for the prevention of the HAIs. Nurses will also
educate patients about the rationale behind the use of chlorhexidine-alcohol solution for the
prevention of HAIs. Education of the patients helps to increase the level of patients’
participation. Other resources will include chlorhexidine-alcohol solution. However,
recruiting nursing professional to assist patients in preventing HAIs is not comprehensive
multimodal approaches are required to be undertaken for incorporating behavioural changes
among the nurses (Zingg et al., 2015).
Process denotes what is actually done in procuring the care. It encompass patients'
and healthcare professionals activities towards comprehensive procurement of the treatment
(Donabedian, 1988). Here the process will involve scrubbing the area of the skin and taking
bath with chlorhexidine-alcohol solution for disinfection of the skin. However, proper

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dilation of the chlorhexidine-alcohol solution must be done by the nursing professionals in
order to prevent burning of the skin. Swan et al. (2016) stated that chlorhexidine-alcohol
solution used under proper dilation and at desired amount and at desired interval of time will
help to promote comprehensive prevention of the HAIs.
Outcome denotes the overall effect of care on the health condition of the patients.
Improvement in the patients' knowledge and other salutary changes in the behaviour of the
patient must be included under the expanded description of the health status. The definition
of the health status must be aligned with the increase level of patients' satisfaction. This is a
three-part approach for the effective assessment of quality (Donabedian, 1988). Under the
context of the use of chlorhexidine-alcohol solution for the prevention of the HAIs, the
outcome must be monitored by the improvement in the level of patient satisfaction. Decrease
in the occurrence of the catheter associated HAIs will help to reduce the length of stay at
hospital and cost of care and thereby helping to improve the patient satisfaction. Outcome can
also be monitored by the use conducted an interview among the nursing professionals in
order to analyse their level of knowledge towards prevention of the catheter associated HAIs
by the use of chlorhexidine-alcohol solution as a skin rub or in the bathing solution.
Moreover, percentage of the occurrence of catheter associated HAIs can also be monitored
and compared with the baseline data (before the use of chlorhexidine-alcohol solution) in
order to highlight statistically significant outcome in the care (Rahmqvist, Samuelsson,
Bastami & Rutberg, 2016).
Conclusion
Thus from the above discussion, it can be concluded that clinical care activity like use
of chlorhexidine-alcohol solution helps to improve the patients’ safety and the clinical care
standards under the healthcare settings by reducing the chances of occurrence of the HAIs.

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This falls under the scope of the standard 3 of ACSQH (2012). However, for the
comprehensive implementation of the approach, nursing professionals must be educated by
the use of multi-modal approach in order bring a behavioural change in them. Moreover,
increase in the level of patients’ satisfaction can be highlighted as in important parameter for
measuring the outcome of care.

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