Quality and Safety

Discussion

• Describe a problem in your workplace and apply the concepts of safety and quality from this module in solving the problem.
• Discuss the importance of evidence-based practice for advanced practice nurses.
• Identify barriers to using evidence in clinical practice.
• Discuss ways to promote use of evidence in clinical practice.
This activity will be graded using the discussion rubric.
• Graduate Discussion Rubric
Instructor’s Commentary
“We can’t solve problems by using the same kind of thinking we used when we created them.” – Albert Einstein
Advanced practice nurses (APN) are nurse leaders and therefore in a position to influence a commitment within an organization for a culture of safety. There are several competencies that the graduate nurse needs to achieve in quality and safety. These include expertise in integration of the patient’s values and needs into care and being culturally competent in patient centered care. The APN is an expert on teamwork and collaboration and exhibits the ability for self-reflection and systems analysis for safe care. The Masters prepared nurse is expected to practice in an evidence-based milieu, using evidence and policy to support practice. Quality improvement and safety measures from a systems perspective are a lynchpin of practice. Informatics literacy is an important component of the toolkit the APN needs in quality and safety.
The APN asks systems’ questions when examining safety issues, does not accept that things should be done a certain way because ‘we always did it this way’, and asks the bigger questions about evidence-based practice. The Masters prepared nurse also accepts that there may be tensions in the work environment, including a divergence of opinion about what is best for the patient, but values shared decision making, regardless of conflict. The APN accepts Quality Improvement initiatives as a vital part of practice.
The Institute of Medicine (IOM) published a text about healthcare errors that is truly shocking in To Err is Human (1999). The text focused on errors in acute care settings, some so egregious that they are termed those that should be considered ‘never event’, such as amputating the wrong leg. The IOM focuses on system wide problems, because most errors are the result of a constellation of events across the system- not through a single individual error. Although there are some practitioners who are incompetent or sloppy, these are few and far between. Even nurses who cut corners often do so because they represent a problem of understaffing or wrong mix of complexity and are in a hurry. Imagine being assigned six patients, all with complex care, or having to rely primarily on memory for drug interactions. The IOM asks us to move from a culture of individual blame to a culture of collective safety. To accomplish a culture of safety, six interrelated areas need to be considered.

1. Quality Improvement
2. Patient Centered Care
3. Informatics
4. Teamwork and Collaboration
5. Evidence-Based Practice
6. Safety
   • The Agency for Health Care Research and Quality (AHRQ) also recommends that organizations focus on development of a culture of safety. In other words, organizations need to examine and acknowledge the Agency for Healthcare Research and Quality: Patient Safety Network’s web site.
   References
   Cronenwett, L., Sherwood, G., & Gelmon, S. (2009). Improving quality and safety education: The QSEN learning collaborative. Nursing Outlook, 57(6), 304-312.

Institute of Medicine. (1999). To err is human: Building a safer health system.
predisposed and high-risk possibility for errors inherent in healthcare. They also need to create an environment where individuals feel free to report errors without the concern of retaliation. All sectors of an organization should form an environment of collaboration to help alleviate susceptibility to errors. At the same time, it is imperative that adequate resources be provided to help address safety and quality concerns (Cronenewett, Sherwood, & Gelmon, 2009).
• View The Swiss Cheese Model from BMC Health Service.
• View QSEN.org’s website.
• View