Improving Healthcare: Quality Improvement in Nursing Practices

This report delves into the critical aspects of quality improvement within nursing practices, highlighting prevalent issues such as medication administration errors and inadequate hand hygiene compliance. It underscores the significance of nursing education, staff development, and the integration of health information technology, including electronic medical records and nursing data sets. The report emphasizes the importance of practical training, addressing clinical collaboration challenges, and fostering effective communication among healthcare professionals. Furthermore, it advocates for the implementation of evidence-based practices, staff training on bioethics, and the establishment of supportive workplace policies. The report stresses the role of knowledge enhancement regarding adverse medication events and hospital-acquired infections, alongside the integration of electronic databases and health information technology. It concludes by advocating for improved clinical documentation practices and the alignment of quality improvement protocols with nursing data sets and metrics, while ensuring compliance with data protection regulations such as HIPAA.

Running head: QUALITY IMPROVEMENT
QUALITY IMPROVEMENT
Name of Student
Name of University
Author note

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There exists a diverse range of problems in the health care settings and these problems
ranges from the organizational health care delivery problems to the individual patient
satisfaction problems and the individualistic and collective problems faced by the clinical
staffs and the health assistants in the clinical setting (Vilela, Prado & de Carvalho Jericó,
2016). It is important and also very much critical to understand that the nurses are the clinical
staffs provide the most critical and the core integral patient care services and in collaboration
with the professionals of the other disciplines such as the medical staffs and the allied health
staffs (Nikhithasri, Ramya & Kishore, 2017). There are however, various multi-faceted issues
that arise with the nurses, especially the new graduate nurses who lack the clinical reasoning
skills, the critical thinking skills, the collaborative and the interpersonal skills, the
intrapersonal self-management and the clinical decision making skills that lead to the
causation of various nursing and patient care related problems in the health care organization
framework and very much in the high faced clinical scenario in the acute care wards such as
intensive care units, intensive coronary care units, in the post-surgical and in the
perioperative settings (Schutijser et al., 2018). These issues or rather the severe clinical
service delivery issues are medication administration errors by the nurses and the lack of
hand hygiene compliance by the nurses. The medication administration error leads to the
development or rather the causation of adverse medication or drug events in a clinical
scenario that can be life threatening, demoralizing and dissatisfying as well and the lack of
hand hygiene compliance can lead to the causation of the hospital acquired infections that
only affect the admitted patient adversely but also deteriorates the prognosis of the patient
and also decreases the rate of recovery of the patient – by complicating the clinical recovery
process. Health information technology play a crucial role in the development of the more
secure nursing and healthcare database management and a basic data set in nursing consists
of the patient’s data, interpersonal data, and institutional data and at the tertiary level – the

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community level data of a certain disease affecting a certain population (Alomari et al.,
2018).
There are various quality improvement parameters that can be incorporated to
improve these nursing problem areas. Workplace disruptions, negative perception amongst
the new graduate nurses about the hand hygiene compliance and about the right and lengthy
procedures to be followed to administer the right medications to the patient are the various
key issues that to the complications and disruptions of safe and secure patient centered
nursing practice. Lack of compliance with the health information technology tools, negative
attitudes about the right ways of medication administration, lack of application of practical
knowledge and lack of translation in nursing practice pertaining to the hand washing
guidelines are the various complex challenges to the health quality improvement and delivery
of a safe nursing service (Stevens, 2017). First and the foremost quality improvement change
would be involved is nursing education. Nursing education through the staff development
sessions and by incorporation the seminars, workshops is critical also very important as a
primary tool in the management of medication administration errors, hand hygiene
compliance and safe patient centered care practice. The nurses should be trained with the
electronic medical records so that they can access the right data at the right time (Rouse,
2017). Nursing Minimum data set that consist of the essential data pertaining to nursing roles
and functions in a specific clinical case scenario is a great tool and the quality change should
surely incorporate the use of electronic medical records, the use of nursing data sets in order
to compare the nursing functions and nursing performances across various departments of the
same organization is a vital aspect of quality improvement in the health care organization
(.Edemekong & Haydel, 2019) Practical training of the new graduate nurses is critical and
important area of quality improvement. A nurse often faces the clinical collaboration
problems with other members of the multidisciplinary team (MDT) and this is due to chiefly

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three factors – knowledge gap, communication gap, lack of cultural competence and due to
negative perceptions about each other’s professionals and due to lack of interpersonal skills
(Boyce, 2017). Hence, the quality improvement parameters should include the effective
policies that shape the collective thinking skills, effective collective imagination and
interpersonal risk taking and empathic skills towards the improvement of the collective
team’s behavior in clinical decision making with an appropriate demonstration of
interpersonal communication, intercultural communication and most importantly
interdisciplinary communication in reaching of consensus. The organization nursing quality
change and improvement policy should also include a collective thinking towards an
evidence based, safe and ethical patient care servicing and this is important that the new
graduate nurses along with the other staffs of other disciplines are trained on the right
application of principles of the bioethics such as autonomy, totality, beneficence, non –
maleficence, informed consent, integrity and they the staff training sessions should also be
put in the nursing data sets in the electronic health records to order to promote self-skills
develop in the nurses (Heart, Ben-Assuli & Shabtai, 2017). Following this, workplace
disruption due to lack of cultural competences, sociocultural differences and differential
group dynamics, negative attitude towards each other amongst the nurses and between the
nurses and the professionals of other disciplines led to the disruption of psychological safety
amongst the new graduate nurses and these are the critical areas of concern in a clinical
scenario and it is to be noted that the quality improvements QI parameters should focus to
bridge this collaboration, interpersonal communication and sociocultural gaps between the
clinicians including the nurses and the assistant healthcare staffs. It is to be noted that the
quality improvement interventions should incorporate new organizational and staff policies
that should make peer support, second check by a second nurse (in case of medication
administration by the new graduate nurses), supervisor and senior nurses support to the new

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nurses mandatory. It is critical to note that core areas of the quality improvement parameters
change would include staff development sessions with staff training in pertinence to the
effective intercultural communication, interpersonal communication, mutual good will and
respect for each other, effective and professional clinically safe communication during the
patient handover and demonstration of cultural competence skills while communicating with
the patients and the staffs who are from a culturally diverse background. These quality
improvement areas if undertaken with practical and theoretical training would ensure more
safe and effective communication with hand hygiene and medication administration in a
clinical scenario. The third huge problem that attributes to the lack of compliance by the new
inexperienced graduate nurses with the evidence based practice guidelines in pertinence to
hand hygiene and with respect to the hand hygiene are the lack of knowledge and awareness
about the adverse medication events and about the hospital acquired infections (Chilian-Hof
et al., 2019). That is why, again the quality improvement parameters should target and focus
at transforming the knowledge and the awareness of the new graduate nurses with respect to
safety communication skills, problem solving skills, clinical decision making skills, the quick
critical thinking skills and about the knowledge and the awareness of the disease and more
staff trainings, staff development sessions, poster presentations, nursing speeches, more
seminars should be undertaken by the administrators and the health care managers and
officers at the health care institutions as a part of the quality improvement change and
transformation. The next challenge to the quality improvement and the major problems of the
nurses, the new graduate nurses with the right and appropriate medication administration to
each and every patient in a high paced clinical care settings such as the intensive care units
where the patients have to be administered with a lot of medications at the same time and the
risk of wrong medication administration is very high – the non- compliance with the nursing
practice policies pertaining to use and application of the electronic medical records, health

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management databases and with the overall health information system poses the most severe
threats to the safe nursing service administration (Nilsson, Törner & Pousette, 2018). Health
information technology play a huge role in the operations and execution of the modern day to
day to clinical care practices and lack of compliance of the new graduate nurses with the
health information technology guidelines poses another level of threat to the safe and quality
patient servicing in a clinical care scenario. Thus, the quality improvement parameter change
would incorporate the electronic databases, the health information technology into the
infrastructure of the health care organization and it is very vital to understand that the nurses
including the new graduate nurses should be trained on the same that is the electronic medical
records, health management databases and with the overall health information system in
order to develop an organizational level nursing practice and quality change and the effort
should come from all the nursing managers, the health care officers and the health care
administrators in order to develop and a holistic quality change in pertinence to nursing.
Referring to the electronic medical records of the patient and knowing and developing a clear
idea about the disease and the health condition of the patient and what medications has been
prescribed and what actions do they have in the patient’s body and how does it correlated
with the patient’s signs and symptoms is critical (Bullard, 2016). The procedure of checking
with the electronic medical records to ensure patient safety and with the patient care policies
not only eases the nursing care delivery but also diminishes the levels of stress, anxiety,
psychological and the psychosocial disruptions that the new graduate nurses go through and
which also leads to nursing burnout thus comprising on the nursing performances. The
behavioral training pertaining to the same nursing electronic medical records and electronic
reminders ( in cases of medication administration and following the hand hygiene
procedures) compliance is necessary and an inherent part of the quality improvement and
organization safety culture transformation process. Clinical documentation is the final area of

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the quality change and it is the lack of paper and electronic documentation practices by the
nurses, especially by the new graduate nurses who lack self-management and time
management skills and this is where it is very important and also very vital that the staff
workshops and the training sessions should transcend the nursing knowledge thus translating
the same into an effective nursing practice and this quality improvement protocol would
control the prevalence rates of nursing medication administration errors and the lack of hand
hygiene as well. Incorporation of electronic posters is an important strategy for compliance
(Goreva et al., 2016)
The quality improvement and operational and integration of the same above
mentioned nursing practice and health care change protocols should be tallied and
synchronized with the nursing data sets and the nursing metrics parameter in order to deliver
a positive and an effective patient centered outcome. Hence, the minimum data set of the
nurses and the proposed quality improvement changes should be in compliance with the
technical and the physical safeguarding policies and the regulations, with the restriction and
the accessi9bility to the electronic systems and with the patient data protection as per the
health, data and safety guidelines provided by the Health Insurance Portability and
Accountability Act (HIPPA). According to the act, the nurses should be trained on the
prevention of clinical errors, fraudulent care, codes of safety code and about the effects of the
missed clinical care and the consequences and the penalties when it happens. Based on the
same, the nursing metrics should be set and in this to measure and evaluate the changing
nursing practices and to check whether there is a rise in the quality standards of the delivered
health care and the nursing care delivery – an electronic audit as well the manual on paper
audit is critical to the help and guide the new nursing staffs comply with the best practice
guidelines and it is highly important that these nursing metrics are strongly incorporated into
the change quality improvement system in order to deliver a more safe and ethical care. Other

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areas of nursing metrics that is to be incorporated in the nursing system is the appraisal and
the penalty system (Froehlich et al., 2020). Incentivising nurses, giving points to the nurses
and providing the nurses with performance rewards and recognitions for complying with
electronic medical records and the electronic records and delivering a quality service to the
patient – is a very vital service. On the other hand, if nursing staffs fails to comply with the
same, penalty and negative points should be given to the nurse for non-compliance and these
are the important nursing metrics and strategies to improve the service quality. Direct
interviews and conducting meetings are important ways of evaluating and measuring the
quality of service.
It can be concluded saying that the the new nurses however are at the greatest risk of
committing these severe clinical errors that not only decreases the patient safety and security
and threatens the life of the patient but also increases the chances of readmission and
increases the length of hospital stay of the patients and also increases the rates of mortality
and morbidity in the hospitals and in the nursing homes as well. But the use of electronic
medical records, health information system and proper accessing the nursing data sets can
surely help the situation.

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