Health Care Indicators Report: Error Analysis and PDSA Cycle

This report provides a comprehensive analysis of healthcare indicators, emphasizing the importance of quality and safety in patient care. It examines various types of indicators, including those related to medication errors, and discusses the potential consequences of such errors. The report includes a literature review of an article focusing on medication error indicators in a private healthcare setting, highlighting the benefits of implementing indicator-based frameworks. Furthermore, it explores the application of the Plan-Do-Study-Act (PDSA) cycle for problem-solving within clinical settings, demonstrating how this iterative process can improve patient outcomes and reduce errors. The evaluation of healthcare setups after the incorporation of such frameworks is also discussed. The report underscores the need for continuous monitoring and improvement in healthcare practices to ensure patient safety and enhance the overall quality of care.

Running head: HEALTH CARE INDICATORS
Health care indicators
Name of the Student:
Name of the University:
Author Note:

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Executive summary:
The aim of the report was to deduce the inference about the importance of analyzing
indicators in the health care set ups. The effectiveness of the indicators are interpreted in the
discussion part of the report. The indicators of medication errors are examined, it requires the
implementation of several procedural steps in the health care centers to deplete the
occurrence of the errors related to medication. The report also contains a literature review of
an article based on the indicators of errors associated with medication in a private health care
center in Indonesia. The literature helps to analyze the importance of the incorporation of
indicator based frame works. The data given in the literature includes the incorporation of
such indicators in a hospital and the effectiveness of it is acknowledged by the authorities of
the considered private health care center. The plan do study and act cycle is also briefly
discussed. The planning procedure by inculcation of the plan do study (PDSA) and act cycle
can high impact on the set up’s working procedure. It yields positive and enhanced results
and decreases the errors that are often found to happen in the centers. The evaluation process
of such organization after the incorporation of such frameworks is also discussed in the
report.

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Table of Contents
Introduction:...................................................................................................................3
Indicator of quality and safety in overall treatment procedure:.................................3
Quality indicator- Medication error:..........................................................................4
Indicators of safety and quality in errors associated with medication:......................4
Literature review of an article on quality indicator of a laboratory setup:.................6
Utilization of PDSA cycle to use medication error indicator for solving problems
related to clinical set ups:.......................................................................................................7
Evaluation of the setup change done by implementation of the PDSA cycle:...........8
Conclusion:................................................................................................................9
References:...................................................................................................................11

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Introduction:
Indicators of safety and quality in the health care systems or centers are the substances
or situations that are considered crucial in administering treatment and care to a patient
(Aiken et al. 2012). The indicators are to be detected before the analytical phase of any
treatment for any type of patient. The detection is important before the initiation process of
the treatment because most of the errors associated to a particular care giving procedure
happens in this particular phase. The indicators help to keep several drastic consequences in
check by highlighting the implications associated with it (Anhang Price et al. 2014). The
safety indicators help the practitioner and caregiver to examine the faulty situation of the
patient and provide the patient with an environment safe for them. The quality indicators are
considered as they are integral in significantly improving the quality of care giving to the
patient under treatment within a center of health care.
The report involves review of a literature that incorporates the two types of indicators
under examination (safety and quality indicators). It puts emphasis on the importance of
inculcation of the indicators in the caregiving process.
The importance of incorporation of indicator is discussed in the report, it also
emphasizes on the ways the indicators are utilized to give care to the patients in an enhanced
way. Solutions of clinical problem done by the usage of Plan to Study Act (PDSA) cycle.
Indicator of quality and safety in overall treatment procedure:
The analysis of indicators in any caregiving set up is important to ensure a smooth
recovery process of a patient. Indicators of quality are termed to be a measurement procedure
that helps in the evaluation process of all the integral domains involved in the laboratory
examinations. It should be able to provide implications from all the critical steps that are
involved in the testing process. It should also increase the effectiveness of caregiving, safety

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of the patient, enhance personalized caregiving, and reduce the time required for the
recovery. During the analysis of indicator especially in the pre-treatment period, several steps
should be kept in check to avoid complication in the procedure of recovery (Blasé and Fixsen
2013). There are several indicators that were drawn by the Agency for health care research
and quality (AHRQ), the agency has incorporated indicators in such a way that it has an
approach that is multi-dimensional. The indicators are supposed to be easily measurable and
accessible (Thao et al. 2015). The ability of the indicator to gage the performance of an
examination process should be high. The indicator of quality should also be based on various
available evidences that can be used to find difference in the quality of protocol and
procedure followed by the care provider. There are different types of modules that are under
implementation, the prevention, inpatient, pediatric and patient safety quality indicators
(Sears et al. 2013). Analysis of the potential indicators is of major importance.
Quality indicator- Medication error:
Out of all the indicators that denotes errors in medication appropriateness or accuracy
of the medicines provided is of major importance. As mentioned in the previous sections that
the medical needs of the patients should be evaluated and commemorated precisely by the
practitioners. Errors in medication can have effect on the professional life of practitioner as
well as caregivers. The life of the patient under treatment is crucial, errors cannot be accepted
as it can have detrimental effect on the patient. Indicator study helps to reduce such faulty
workings in a system (Ramanathan et al. 2013). The process will be elaborated in the
following sections.
Indicators of safety and quality in errors associated with medication:
Medication is integral in the recovery process of any patient irrespective of the
ailment that the patient is dealing with. A treatment cannot be completed without the
incorporation of drugs and medicines. The cases under a care provider requires to be

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administered the right medicine at the right time. The medication can be checked for it
validation in two different setups, firstly the formulation of should be analyzed (Runciman et
al. 2012). The composition of a commercialized drug should always be examined after the
production of the product. Several steps are involved during the making of such medications.
Every step that is incorporated in the process is crucial for examination as each ingredient in
the drug is important. Presence of several different components of drug can produce hyper-
sensitive reactions among the patients, the composition study is crucial before administration
of the drug to the patient. The incorporation of incorrect ingredients in the drug remains
unchecked because of mismanagement of the process of formulation. If the formulation is
fabricated, the patient can be effected due to it and the reason behind the effect will remain
unknown for a longer period of time because the of the fabrication ingredient list provided in
the packaging (Hajibabaee et al. 2014).
During administration of drug to the patient, the prescribed drugs should be kept in
check. The prescription of drugs is of major importance. Sufferers are known to have inimical
effects due to the administration of incorrect drugs to them (Carayon et al. 2014). Several
cases of death are noted annually because of incorrect prescription of drugs. The evaluation
process of the indicator associated with prescription of medication should be made compact
and feasible. The prescribed drugs should be under evaluation of senior practitioner so that
the process yields a positive patient outcome in a short period of time.
The care procedure that has to be provided to a particular person, highly depends on
the medication the person is under. The care provider’s duty exponentially reduces if the
practitioner prescribes the right drug (Hacker and Walker 2013). The medicines act as care
givers by themselves. The medicines act as a catalyst in the recovery process of patients
suffering from any ailment. It can either be a boon or bane to the people. All of it depends on
the formulation and administration of the drug. Other than incorporation of the right

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medication, the timings at which they are meaning consumed by the patients is of
significance too (Unützer et al. 2012).
Narrative of a patient who dealt with medication error:
There are many cases of medication errors that have been noted in the past. A patient
in the city of Sydney, suffered from numerous side effects as an impact incorrect
administration of medicines. The person was suffering from typhoid and was admitted in a
private hospital of Sydney. The medicines that he was administered were of jaundice. For
several weeks the condition of the person did not improve but deteriorated. The impact of the
drugs was so drastic that the patient was unconscious at a stretch of 3 days. After re-diagnosis
of the person’s condition the medicines were changed but as an impact of the wrong
medicines, the person had severe weakness for more than six months. These consequences
can be eradicated by analysis of the indicators.
Literature review of an article on quality indicator of a laboratory setup:
The article that is considered for reviewing includes the important indicators that are
required for improvement of the process of preparation of medicines and administering the
medicines to the patients (Risdiana, Kristin and Utarina 2015). The authors facilitate
understanding of the different indicator of medication errors based on the present evidences
like the process of administration, structure of the care process and the outcome from the
caregiving procedure. The objective was to study the process of caregiving process in terms
of the preparation and administration process of the medicines prescribed by the practitioners.
Several methodologies were studied by the researchers to fulfill their objective. The method
included documentary searches in association with studying the pattern of present health care
set ups like hospital and other clinics.

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According to the authors the process of medication is prone to varied number of errors
and it leads to vulnerable situations. The process requires the inculcation five different step,
beginning with prescription, as described before the practitioner should be precautious while
prescribing the medicines. The patient may have sensitivity towards certain drugs, the doctors
have the duty to examine the past exposure to drugs and if there was any occurrence of
allergy cases (Keers et al. 2013). The next step requires verification of the drugs to be
administered. The third step involves the preparation or dispensing of the drug prescribed.
Fourth step is administration of the drugs to the patient. The sixth and the last step is
monitoring the consumption pattern of the drugs by the patient. The study involved the search
mediated finding to get information about the previous research works on the same findings.
It helps the researchers to comprehend the previously available data and decreases the time it
takes to deduce such notions (Siesling et al. 2015). The researchers. The setup under
consideration is a private hospital situated in the city of Yogyakarta, Indonesia. The setup
study was done and found to have incidences of error in medication even after having an
optimal level work from the staffs.
The authors proposed to twenty three types of indicators to the experts in the hospital
under consideration for inculcation, to improve their situation of medication error crisis. The
indicator were of Delphi method. Out of the twenty three proposed indicators, eighteen were
taken into account by the experts for implementation. Most of the indicators were technically
measurable (sixteen). The incorporation of the indicators were valuated stage by stage by the
examiners. The result of the evaluation was positive. The indicators that were implemented
were declared to be appropriate as the patient outcome immensely improved. The staffs were
also satisfied by the inculcation as it reduced the time taken for recovery of patients which
reduced the work of the caregivers. All the sixteen types of indicators were appreciated and
acknowledged by the authorities of the hospital.

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Utilization of PDSA cycle to use medication error indicator for solving problems related
to clinical set ups:
The plan do study and act cycle is a four stage process for solving problems related to
inculcation of change (Gillam and Siriwardena 2013). The plan to study act cycle includes
the development of procedure or plans to examine a change in set up (plan), carrying the test
out (do), analyzing the resultant by observing the results or the consequences associated with
it (study) and modifying the change according to the necessities (Act). This model is very
commonly used by a large number of institutes to improve care giving process to the patients
(Donnelly and Kirk 2015).
Medication errors can be minimized rather eradicated by the incorporation of systems
like PDSA cycle. Indicators of medication errors like the prescription, formulation and
administration steps are crucial to minimize such errors. The process should be planned in
such way so that no steps of the care process are left from evaluation. The first step of
treatment procedure where errors can occur is during analyzing a patient's condition and
prescribing drugs, in this procedure evaluation is generally found to be faulty when the
practitioner is inexperienced (Risdiana, Kristin and Utarina 2015). In this step the
reevaluation of prescription by senior practitioners can reduce the faulty situation that takes
place due to it.
The second step is the formulation of the prescribed medicines, the process that is
incorporated in making of the rugs is a crucial step to be monitored. The different stages of
the formulation should be inspected by quality analysts regularly, the composition should be
kept intact and the quantities or proportion of ingredients should be carefully assessed by
experienced chemists. This diminishes the faults done by amateur technicians and
compounders (Fox, Sweet and Jensen 2014). There should also be a microbiologist to check

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the microbial load in the formulated medicine. This reduces the chances of incorrect
formulation, as well as keeps interference of microbes in check.
The third step that is prone to medication errors is the administration of the drugs to
the patients, this step can be easily assessed and improved by the caregivers (Chawla and
Davis 2013). This procedure requires patience of the caregiver to evaluate the medicine that
are prescribed by the doctors. Monitoring the action of the caregivers can be done by regular
examination of the procedure by senior caregivers or matrons. All the described indicators are
measureable as the percentage of positive patient outcome can acknowledge the incorporation
of such procedures and indicators.
Evaluation of the setup change done by implementation of the PDSA cycle:
The proposed set up for improvement of the conditions causing medication error can
be evaluated by inculcation of teams in the health care system when the indicators are
incorporated based on the PDSA cycle. The team should comprise of members specialized in
the steps that the set up inculcates ((Zrelak et al. 2012)). To assess problems related
medication errors, the team should consists of health personnel having idea about the
implication of medicines in the initial step, there should be a chemist and microbiologist for
assessing the steps involved the formulation of the drugs. To check the making process and
its improvement percentage. The step of administration of the drug should be evaluated by a
health personnel who has the knowledge of the ideologies that are required to be included
while giving care and administering medicines to a patient. Hence it can be said that the
process can be evaluated by inculcation of a team consisting of four members with
knowledge of the working of health care set ups. The inculcation of PDSA cycle helps in
monitoring process by providing a planned and organized framework for working (Secanell
et al. 2014). The planning, and doing as planned by studying the set up and acting upon the

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necessities yield highly improved results as can be seen in many hospitals around the world
who have implemented such frameworks to assist the clinicians in the care giving process.
Conclusion:
Therefore, from the above discussion it can be concluded that the errors that arise in a
health care set up can be reduced by analyzing the indicators that can help in improving the
condition of the health care centers. The errors related to medication can be reduced by
examining the steps where the faulty situations occur more often. Several ideologies can be
implemented in the live set ups for depletion of the errors. The evaluation of the centers is
also crucial after inculcation of such methodologies to check the effectiveness of the
procedures. Literature review helps in understanding the resultants that the incorporation of
indicators have. It gives an example of actually existing organization that is inculcating the
available indicators for its improvement. Plan do study and act cycle is one of the most
commonly used procedure for enhancing the conditions of a setup. Planning a process for
inculcation in the health care centers doing or implementing the plan studying the setup post
inculcation of the planning and acting accordingly is of major importance. The faulty
situations that arise in the hospital and other health care clinics as a result of medication
errors, can be kept in check by implementing frameworks made according to the PDSA cycle.
The three stages those need assessment, that is, the prescription making process, formation of
medicine and administration of the medicine process should be planned and analyzed
according to the PDSA cycle. It decreases the faulty working in the system that leads to such
errors. After the implementation of steps by incorporation of the cycle, the set ups also need
to be evaluated, the evaluation process is of significance. In case of medication error, four
member teams favorably helps to assess the procedure. Hence it can be deduced from the
report that framework inculcation can exponentially increases the efficiency of a health care

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organization. Betterment of health organization in the present scenario is possible only by the
incorporation of existing frameworks is of at most significance.

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References:
Aiken, L.H., Sermeus, W., Van den Heede, K., Sloane, D.M., Busse, R., McKee, M.,
Bruyneel, L., Rafferty, A.M., Griffiths, P., Moreno-Casbas, M.T. and Tishelman, C., 2012.
Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and
patients in 12 countries in Europe and the United States. Bmj, 344, p.e1717.
Anhang Price, R., Elliott, M.N., Zaslavsky, A.M., Hays, R.D., Lehrman, W.G., Rybowski, L.,
Edgman-Levitan, S. and Cleary, P.D., 2014. Examining the role of patient experience surveys
in measuring health care quality. Medical Care Research and Review, 71(5), pp.522-554.
Blase, K. and Fixsen, D., 2013. Core Intervention Components: Identifying and
Operationalizing What Makes Programs Work. ASPE Research Brief. US Department of
Health and Human Services.
Carayon, P., Wetterneck, T.B., Rivera-Rodriguez, A.J., Hundt, A.S., Hoonakker, P., Holden,
R. and Gurses, A.P., 2014. Human factors systems approach to healthcare quality and patient
safety. Applied ergonomics, 45(1), pp.14-25.
Chawla, N.V. and Davis, D.A., 2013. Bringing big data to personalized healthcare: a patient-
centered framework. Journal of general internal medicine, 28(3), pp.660-665.
Donnelly, P. and Kirk, P., 2015. Use the PDSA model for effective change
management. Education for Primary Care, 26(4), pp.279-281.
Fox, E.R., Sweet, B.V. and Jensen, V., 2014. Drug shortages: a complex health care crisis.
In Mayo Clinic Proceedings (Vol. 89, No. 3, pp. 361-373).
Gillam, S. and Siriwardena, A.N., 2013. Frameworks for improvement: clinical audit, the
plan-do-study-act cycle and significant event audit. Quality in Primary Care, 21(2).

13HEALTH CARE INDICATORS
Hacker, K. and Walker, D.K., 2013. Achieving population health in accountable care
organizations. American journal of public health, 103(7), pp.1163-1167.
Hajibabaee, F., Joolaee, S., Peyravi, H., Alijany‐Renany, H., Bahrani, N. and Haghani, H.,
2014. Medication error reporting in Tehran: a survey. Journal of nursing management, 22(3),
pp.304-310.
Keers, R.N., Williams, S.D., Cooke, J. and Ashcroft, D.M., 2013. Prevalence and nature of
medication administration errors in health care settings: a systematic review of direct
observational evidence. Annals of Pharmacotherapy, 47(2), pp.237-256.
Ramanathan, R., Leavell, P., Stockslager, G., Mays, C., Harvey, D. and Duane, T.M., 2013.
Validity of Agency for Healthcare Research and Quality Patient Safety Indicators at an
academic medical center. The American Surgeon, 79(6), pp.578-582.
Risdiana, I., Kristin, E. and Utarina, A. (2015). Identification of Medication Error Indicators
at a Private Hospitalin Yogyakarta, Indonesia. Journal of Pharmaceutical Sciences and
Research, 7(12), pp.1090-1095.
Runciman, W.B., Hunt, T.D., Hannaford, N.A., Hibbert, P.D., Westbrook, J.I., Coiera, E.W.,
Day, R.O., Hindmarsh, D.M., McGlynn, E.A. and Braithwaite, J., 2012. CareTrack: assessing
the appropriateness of health care delivery in Australia. The Medical Journal of
Australia, 197(2), pp.100-105.
Sears, K., O'Brien-Pallas, L., Stevens, B. and Murphy, G.T., 2013. The relationship between
the nursing work environment and the occurrence of reported paediatric medication
administration errors: A pan Canadian study. Journal of pediatric nursing, 28(4), pp.351-356.
Secanell, M., Groene, O., Arah, O.A., Lopez, M.A., Kutryba, B., Pfaff, H., Klazinga, N.,
Wagner, C., Kristensen, S., Bartels, P.D. and Garel, P., 2014. Deepening our understanding

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of quality improvement in Europe (DUQuE): Overview of a study of hospital quality
management in seven countries. International journal for quality in health care, 26(suppl_1),
pp.5-15.
Siesling, S., Wouters, M.W.J.M., van Dalen, T., Rutgers, E.J.T. and Peeters, P.H.M., 2015.
The value of ipsilateral breast tumor recurrence as a quality indicator: hospital variation in the
Netherlands. Annals of surgical oncology, 22(3), pp.522-528.
Thao, N.H., Tuan, N.D., Heuvel, E.V.D., Ruskamp, F.H. and Taxis, K., 2015. Medication
Errors in Vietnamese Hospitals: Prevalence, Potential Outcome and Associated Factors.
Unützer, J., Chan, Y.F., Hafer, E., Knaster, J., Shields, A., Powers, D. and Veith, R.C., 2012.
Quality improvement with pay-for-performance incentives in integrated behavioral health
care. American Journal of Public Health, 102(6), pp.e41-e45.
Zrelak, P.A., Utter, G.H., Sadeghi, B., Cuny, J., Baron, R. and Romano, P.S., 2012. Using the
Agency for Healthcare Research and Quality patient safety indicators for targeting nursing
quality improvement. Journal of nursing care quality, 27(2), pp.99-108.