Quality Practice Environments and Patient Safety Issues

This article discusses the experiences of compromised healthcare services and patients’ safety in the clinical setting. It also covers safety competencies and thresholds for the nursing service, identification of specific changes to promote patient safety, and an action plan to improve the quality of treatment procedures.

Quality Practice Environments
Past Experiences of Patients’ Safety Issues
I experienced circumstances where the quality of health care services and patients’ safety was
substantially compromised by the healthcare professionals in the clinical setting. Indeed,
elevated workload, reduced nurse-to-patient ratio, and interprofessional conflicts between the
healthcare teams resulted in situations that not only deteriorated the healthcare environment but
also compromised the safety and wellness of the treated patients across the treatment
environment. Missed referrals, incomplete lab analysis, and cancellation of pre-scheduled
surgeries include some of the significant events that delayed treatment administration and
elevated the health risks of patients to a considerable extent. Furthermore, delayed clearance
from the healthcare specialists, incomplete patient preparation for surgery, an absence of
informed consent (for treatment), and delay in medical discharge significantly impacted the
clinical manifestations and wellness outcomes of the concerned patients in the healthcare facility.
The absence of safety checklists in the clinical setting substantially increased the risk of patient-
care adversities due to the inappropriate accomplishment of the patient care requirements. The
development of surgical site abscess, nosocomial infections, bed sores, falls in the clinical
settings, and other procedure-based conditions include some of the patient adversities that
occurred because of significant compromises in patients’ safety measures and quality of clinical
interventions.
Safety Competencies and their Thresholds for the Nursing Service
The safety competencies and thresholds that I effectively shared during my clinical placement
included the following attributes (CPSI, 2009).
1. I recommended the need for establishing a patient safety culture that necessitates the re-
evaluation of patients’ pre-procedural and safety requirements. The threshold of
patients’ safety culture is based on at least 95% reassessment of patients’ safety
attributes prior to procedural administration.
2. I advocated the need for interprofessional collaboration of nurses with other healthcare
specialists to effectively optimize the quality of care and patient safety across the
treatment environment. The threshold for interprofessional collaboration is related to

the mandatory requirement of recording the minutes of interprofessional
communication while catering to the daily patient care requirements.
3. I suggested the requirement of managing an optimal nurse-patient ratio in accordance
with the treatment needs to the patient population. The optimized nurse-patient ratio is a
measurable threshold that requires consistent monitoring to effectively stabilize the
nursing workload in the context of minimizing the risk of safety events.
4. I recommended the requirement of undertaking patients’ risk assessment while
categorically anticipating their healthcare needs and disease predisposition factors. I
advocated the need for recording patients’ medication contraindications, adverse events,
falls, polypharmacy, and age-appropriate risk factors for their qualitative measurement
by the healthcare professionals (Baranzini, et al., 2009).
5. I also recommended the requirement of clinical documentation in the context of
recording the patients’ adverse events, medication dosage, and clinical assessment to
effectively track and minimize safety risks. Furthermore, I advocated the need for 100%
recording of patients’ medical necessities, treatment measures, and wellness outcomes
in the context of establishing the practice standards related to the recommended safety
competencies. The thorough compliance with the documentation threshold is highly
needed to minimize the frequency of adverse events in the clinical setting.
Identification and Threshold Evaluation of Specific Changes to Promote Patient Safety
Identification of safety changes will be based on the evaluation of physicians’/nurses’ safety-
related understanding and perceptions in the clinical setting. Indeed, the patient safety culture is
based on the establishment of health-related behavior, competencies, perceptions, attitudes, and
values of the stakeholders (including patients, physicians, and nurses) (Lawati, Dennis, Short, &
Abdulhadi, 2018). The identification of safety culture changes in the clinical setting would
require the thorough analysis of the patient safety strategies and statistical assessment of the
frequency of reported adverse events across the clinical practice environment. Furthermore, the
utilization of HSOPSC (Hospital Survey On Patient Safety Culture) will be highly required to
determine the acquisition of the desired threshold (i.e.re-evaluation of patients’ safety
parameters) related to the establishment of the patients’ safety culture (Chaneliere, et al., 2016).
Furthermore, the utilization of PSCS (patient safety climate surveys) in the healthcare setting

will assist in evaluating the extent of patient satisfaction and staff perceptions related to the
established safety parameters and their implications across the treatment environment (Ginsburg,
Tregunno, Norton, Mitchell, & Howley, 2014). Furthermore, the utilization of structured
questionnaires will assist in evaluating the informed (safety) culture in the healthcare facility.
The evaluation of this informed culture will assist in understanding the cooperative patient safety
behavior of the healthcare teams, including inter-departmental bridging, innovation, and
problem-solving (Pierre, 2013). The statistical evaluation of the patient safety culture data is also
based on the important attributes including the communication openness, pre-procedural
preparedness, organizational learning, and teamwork of the healthcare employees (Wagner,
Smits, Sorra, & Huang, 2013). The quantitative analysis of incident reporting systems will
substantially assist in measuring the rates of medication errors, inappropriate lab investigation,
missed referrals, and surgery cancellation in the healthcare setting (Pham, Girard, & Pronovost,
2013).
The subjective and objective assessment of the interprofessional communication through semi-
structured interviews will assist in evaluating the collaboration experience of the professional
nurses across the clinical practice environment. The thorough analysis of the interprofessional
conflicts, challenges, difficulty level, inadequacies in relationship pattern, uncertainty,
responsibility, and decision-making capacity of the nurses and other healthcare professionals will
help to determine their interprofessional collaboration level in the clinical practice environment
(Hood, et al., 2017). The statistical assessment of the healthcare professionals’ unmet
expectations will assist in tracking the deficits in interprofessional collaboration and their
sustained impact on the process of medical decision-making. The structured interview sessions
will effectively record the mutual values and shared goals of nurses and other healthcare
professionals. The quantitative assessment of the interdisciplinary patient rounds and their
correlation with safety events and duration of patient stay will provide greater insight of the
interprofessional collaboration pattern between the nurses, physicians, clinicians, and other
healthcare specialists in the clinical practice environment (Muller-Juge, et al., 2013).
Furthermore, survey intervention will effectively record the interprofessional challenges
experienced by the nurses, medication experts, prescribers, diagnosticians in the healthcare
setting. The survey will also quantitatively determine the medical staff shortage and its impact on

interprofessional communication and safety events in the clinical practice environment (Bosch &
Mansell, 2015).
The quantitative assessment of the staffing ratio in the healthcare setting will assist in
understanding the nursing workload and associated odds of survival (Lee, et al., 2017). The
quantitative assessment of nurse staffing level and frequency of adverse events will assist in
identifying the relationship pattern between the safety risk and nurse-patient ratio in the
healthcare setting. The assessment of nursing staffing level and workload along with the patient
care complexities will provide a rational picture of recommended staffing modification in the
context of enhancing the quality practice environment in the medical facility (Rochefort,
Buckeridge, & Abrahamowicz, 2015). Systematic retrieval of the average adverse event and
staffing data will assist in benchmarking the nurse-patient ratio requirement in the treatment
setting. Furthermore, the statistical assessment of nurses’ personal factors, workplace attributes,
and community-based requirements will assist in determining their overall impact on the
healthcare performance outcomes (MacLeod, et al., 2017). Eventually, these findings will
radically assist in designing standardized staffing requirements, performance parameters, and
task allocation strategies in the context of improving the quality of treatment procedures while
concomitantly minimizing the risk of adverse patient events.
The systematic recording of patients’ risk factors including, treatment needs, polypharmacy
pattern, injuries, and contraindications through the electronic health records will assist in
minimizing the frequency of safety events while concomitantly improving the patient care
quality (Oreskovic, Maniates, Weilburg, & Choy, 2017). The provider-centric and patient-centric
clinical records’ implementation in the healthcare setting will facilitate the statistical evaluation
and re-evaluation of patient reminders, computerized provider order entry, pre-surgical
requirements, lab data, referrals, physician schedule, and patient appointment data (Chang &
Gupta, 2015). This will not only assist in tracking the root causes of the previously reported
adverse events but also ascertain the accomplishment of standardized patient safety requirements
prior to treatment/procedure initiation. The assessment of electronic medical records’
interoperability will assist in determining the accessibility of nurses, physicians, and pharmacies
to the individualized patient care records and safety event data in the healthcare setting.
Furthermore, the quantitative assessment of nurses reporting EMR adoption will help in

analyzing the frequency of patient care records utilization by the concerned nurses in the
treatment facility. Indeed, enhanced access to medical records by the healthcare records will
substantially improve the medical decision-making pattern and reduce the risk the risk of safety
events in the clinical setting.
Action Plan and Results Communication
The action plan will be based on the following measures.
1. The nurses and physicians will effectively require documenting patient safety quality
indicators in the context of establishing various benchmarks and standards for the
administration of medical procedures.
2. The nurses will require improving their interprofessional communication with
physicians and other healthcare team members in the context of improving the
precision and quality of medical decision-making and associated treatment
interventions.
3. The nurses in coordination with the healthcare teams will need to develop and promote
an effective patient adverse event reporting system in the context of identifying the
root causes of various adverse events in the context of devising their systematic
mitigation.
4. The nurses will need to promote routine safety culture measurement practices to
facilitate dynamic action planning through an effective leadership in the context of
improving the participation of patients, physicians, and nursing teams in various
patient safety interventions (Campione, 2018).
5. The systematic use of the electronic medical record will not only assist in tracking the
safety incidents but also facilitate disaster planning and customization of safety alerts
and product recalls.
1. The plan outcomes will be systematically circulated within the healthcare teams through
digital notice boards in the context of improving the knowledge and awareness of
stakeholders regarding healthcare strategies that would require modification for
establishing a quality practice environment in the clinical setting.
Plan Summary

1. The establishment of patient safety quality indicators and security alerts will prompt the
nurses and healthcare professionals to cross-validate the safety parameters and ascertain
their implementation prior to the administration of healthcare interventions. The pre-
procedural assessment will not only improve the quality of procedural interventions but
also elevate the wellness outcomes of the treated patients.
2. Interprofessional communication will radically improve the medical decision-making
process and minimize the occurrence of medication errors and polypharmacy issues in
the treatment setting.
3. The development of an effective adverse event reporting system will assist in
identifying the frequency of patient falls, transfusion reactions, pressure ulcers, and
nosocomial infections across the clinical practice environment. Eventually, modified
evidence-based treatment approaches will effectively reduce the frequency of these
events in the healthcare setting.
4. The auditing of patient safety culture will substantially assist in determining the
associated pitfalls for their earliest mitigation in the context of improving the qualitative
patient care outcomes.
5. Electronic medical record implementation will radically improve the precision of
various treatment decisions while minimizing the risk of medication errors across the
clinical practice environment.
Postings’ Feedback
Safety consciousness of nurses substantially minimizes the frequency of serious infusion
incidence in the hospital setting. The analysis and reporting of various safety events and
associated measures are highly required to effectively promote an evidence-based patient safety
culture across the healthcare environment. Indeed, healthcare quality enhancement through
shared decision-making reduces the risk of medication errors, surgery complications, referral
issues, and inadequate laboratory outcomes. Nurses require utilizing transformational leadership
strategies to facilitate the promotion of safe health care practices while establishing the desired
patient care standards in the treatment facility. Categoric utilization of human factors approaches
not only improves the patient care behavior of nurses but also motivate them to effectively

surpass healthcare barriers and treatment challenges for establishing a quality practice
environment in the hospital setting.
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