Scenario
Throughout the course, we will focus on a patient safety issue of your choice and work through all six steps of the evidence-based practice (EBP) process. The first step is to “Ask the burning clinical question in PICOT format,” which you will find later in this assessment in the section titled “Mastering the First Step in EBP: PICOT.”
Now, let’s imagine that you are the Director of Clinical Operations and Nursing Excellence at a major metropolitan medical center encompassing many entities, including hospitals and outpatient medical centers. You report directly to the Chief Nursing Officer and serve as the front-line leader for clinical operations, including serving as a clinical resource for all nursing staff levels in both the acute-care and ambulatory settings.
It is your responsibility to ensure that the best practices and protocols are implanted throughout the medical center. Your primary goals are to focus on problems in health care safety and how to solve them with evidence-based interventions as a quality improvement (EBP/QI) project.
INSTRUCTIONS
Introduce your patient safety issue, the supporting research, and possible intervention, using the following steps:
- Consider patient safety issues that you have heard about in your practice, the medical field, the media, or your coursework. Select a patient safety issue to research throughout this course.
- Explain the patient safety issue that needs improvement.
- Describe the problem in detail using creative liberty or give specific examples of the issue in practice.
- Locate and review two examples of internal or practice site sources of evidence that support the need for change to address the patient safety issue.
- Describe how the sources were obtained, including a timeframe or number of patients involved.
- The internal resources will NOT require citations and references.
- Locate and review two sources of evidence that the safety issue exists outside of your institution.
- We call these external resources. This information can come from peer-reviewed literature, clinical practice guidelines, consensus statements, local or national databases, national organizations, Joint Commission, and/or hospital compare (CMS). The external resources will require citations and references.
- Explain how these literature resources support the need for change related to the patient safety issue.
- Describe how each source is directly related to the patient safety issue.
- Determine the organizational priority by describing why this patient care safety problem is of significant concern to stakeholders, patients, or community members. Give specific examples.
- Describe your desired patient outcomes from a proposed intervention and the potential impact of the quality improvement project. Use at least one citation from literature to support the intervention.
- Again, the patient safety issue and intervention or interventions identified for this assessment will also be used for all the assessments in this course, so take a look at those assessments now. Ensure the problem and interventions you select will work for the other four assessments.
- Create slides that reflect the issue you have selected, the evidence, and the possible interventions. You may use the following headings for your slides:
- Title.
- Name, course information.
- Presentation Outline.
- Patient Safety Issue.
- Internal Evidence of Patient Safety Issue.
- External Evidence of Patient Safety Issue.
- Organizational Priority for Intervention.
- Describe why problem is significant to stakeholders and give specific examples.
- Propose a Quality Improvement Project.
- Describe interventions and desired patient outcomes and potential organizational impact.
- Include at least one citation from literature to support proposal.
- References.
- Title.
- Submit PowerPoint slide deck with slide notes
Expert Solution Preview
Introduction: In this assignment, you are required to select a patient safety issue and provide supporting research and possible interventions. You will be creating a PowerPoint slide deck that includes an introduction, presentation outline, patient safety issue, internal evidence, external evidence, organizational priority for intervention, proposed quality improvement project, and references.
Answer:
1. The patient safety issue that needs improvement is medication errors in hospitals. Medication errors are a significant concern in healthcare settings and can have serious consequences for patients. These errors can occur at any stage of the medication process, including prescribing, dispensing, and administering medications. One example of this issue is the improper dosage of medications, which can lead to adverse effects or ineffective treatment. Another example is the miscommunication of medication orders between healthcare professionals, resulting in the wrong medication being administered to the patient.
2. Two examples of internal sources of evidence that support the need for change to address the patient safety issue of medication errors include incident reports and medication error data collected within the hospital. Incident reports provide information about specific medication errors that have occurred within the hospital, allowing for analysis and identification of common causes or patterns. Medication error data collected within the hospital, such as the number of medication errors reported or the types of errors commonly observed, can also highlight the need for change to improve patient safety.
3. Two sources of external evidence that support the need for change related to the patient safety issue of medication errors are peer-reviewed literature and clinical practice guidelines. Peer-reviewed literature includes research studies published in reputable journals that investigate medication errors, their causes, and potential interventions. Clinical practice guidelines are evidence-based recommendations developed by expert panels to guide healthcare professionals in safe medication practices. These external resources provide additional evidence and recommendations for addressing medication errors in a broader context.
4. The patient safety issue of medication errors is of significant concern to stakeholders, patients, and community members because it directly impacts patient outcomes and can result in harm or even death. Medication errors can lead to adverse drug reactions, prolonged hospital stays, increased healthcare costs, and decreased patient satisfaction. For example, if a patient receives the wrong medication or the wrong dosage, it can cause severe side effects or complications. These outcomes are a priority for stakeholders, patients, and community members as they strive to uphold high-quality and safe healthcare.
5. The desired patient outcomes from the proposed intervention to address medication errors include a reduction in medication errors, improved patient safety, and enhanced quality of care. The potential impact of the quality improvement project on the organization includes a decrease in adverse drug events, improved patient satisfaction, and increased trust in the healthcare system. A study by Bates et al. (1995) found that implementing computerized physician order entry systems can significantly reduce medication errors, providing evidence to support this proposed intervention.
6. The patient safety issue of medication errors and the proposed intervention identified for this assignment can be used for the other assessments in this course, ensuring consistency and alignment across all assessments.
Slides:
Title: Patient Safety Issue – Medication Errors
Course Information: [Insert Course Name and Code]
Presentation Outline:
– Introduction
– Patient Safety Issue
– Internal Evidence of Patient Safety Issue
– External Evidence of Patient Safety Issue
– Organizational Priority for Intervention
– Proposed Quality Improvement Project
– References
Patient Safety Issue:
– Medication Errors in Hospitals
– Examples: Improper Dosage, Miscommunication of Medication Orders
Internal Evidence of Patient Safety Issue:
– Incident Reports
– Medication Error Data collected within the hospital
External Evidence of Patient Safety Issue:
– Peer-reviewed Literature
– Clinical Practice Guidelines
Organizational Priority for Intervention:
– Significance of Medication Errors to Stakeholders, Patients, and Community Members
– Examples: Adverse effects, Prolonged hospital stays, Increased healthcare costs
Proposed Quality Improvement Project:
– Interventions to Address Medication Errors
– Desired Patient Outcomes
– Potential Organizational Impact
– Citation from Literature Supporting the Intervention
References:
[Include relevant references]
Please note that this is a sample answer and can be tailored according to the specific patient safety issue selected.
