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Quality and safety are among the most inherent and critical terms in the healthcare field relating to the nursing practice and profession. The concepts define the most sought patient outcomes, which represent the essence of the nursing profession while determining organizational performance. Due to their immense significance, nurses should always strive to provide high-quality services while maintaining high safety standards. With this in mind, health providers still experience massive quality and safety issues. Patient falls and hospital-acquired infection are among the significant problems that affect the delivery of desired safety outcomes.
For this reason, organizations have designed and adopted programs, including risk evaluation and nurse education, to reduce their incidence. They have also established specific measures to track their performances, such as documenting falls over time. Nurses’ quality and safety performance and measures determine both patient and organizational outcomes.
Quality and Safety Measures
Nursing practice is under the influence of various factors within the healthcare setting. Quality and safety are among these critical elements which define nurse experiences and performance. Quality measures encompass all the strategies to improve the overall health and administrative outcomes. Conversely, safety measures represent specific solutions meant to ensure that patients are safe. These factors have an immense relationship, considering their relevance and significance. For the most part, quality and safety have a mutual relationship. Quality measures are necessary for attaining safety outcomes. For example, when she provides quality care to a surgical patient by maintaining high hygiene standards, a nurse would achieve desired safety outcomes by preventing hospital-acquired infections.
Similarly, safety is a vital outcome that will affect the quality of nursing services. It serves as a significant determinant of the quality of delivery. In a way, quality is an umbrella term that encompasses all the initiatives, strategies, and processes put into a specific task to attain a defined aim. In this case, safety is an initiative within quality measures to improve performances. The relationship establishes the levels of comprehensiveness between quality and safety measures. In this case, quality measures focus on the overall nursing practice performance. It strives to ensure that every area of nursing seeks to achieve the quintessential aims of the profession. On its part, safety is focused on specific areas of the nursing practice. These attributes make it an element within the composite concept of quality measures. In short, quality measures incorporate safety initiatives within the nursing practice.
Barriers and Facilitators/Methods
Table 1 (See Appendix) illustrates three barriers that influence outcomes in the healthcare field and related methods for their resolution. These factors undermine the quality and safety outcomes of both clients and the organization. Patient falls are among the most significant barrier to desired outcomes in the field. Its incidence is significant across health settings, with some being more vulnerable than others are. For example, in acute settings, the prevalence is just 2-5%, while in rehab, the incidence can be as high as 46% (Stephenson et al., 2016). These factors illustrate the potential of patient falls to affect nursing practice. Indeed, patient falls lead to adverse health outcomes among patients. According to King et al. (2018), its incidence often leads to moderate consequences such as pain to more severe issues, including death. Subsequently, these adverse safety outcomes affect organizational performances. Increased cases of patient falls have a dire impact on the image of various hospitals. Besides, possible litigations may result in massive financial losses.
For this reason, concerned stakeholders need to implement practical solutions related to its fundamental causes. As King et al. (2018) report, one of the causes is unbalanced staffing ratios. Hospitals that experience increased prevalence is likely to be understaffed. Such issues undermine the capacity of nurses to achieve their safety goals leading to patient falls. Consequently, an effective solution to the problem is improved staffing ratios. Beyond staffing, improved monitoring can solve the issue. Bed alarms and increased frequency of nurse rounds enhance the monitoring of vulnerable patients.
Hospital-acquired infections are also among the barriers to desired healthcare field outcomes. Despite improved knowledge about the negative HAI impact on outcomes, its incidence is still high. The current coronavirus pandemic has aggravated its incidence, primarily due to increased hospitalization and burden on the existing healthcare workforce. A CDC (2021) report suggests that due to the infection, the incidence of HAI has risen by 47%. These statistics indicate a serious issue and threat to patient quality and safety outcomes. The incidence of HAIs leads to adverse outcomes, including increased hospital stay and even mortality in extreme cases.
Consequently, an immediate resolution is necessary to spur healthcare providers to success. One of the best resolution methods is improved hygiene (Haque et al., 2018). HAIs occur due to a lack of hygiene in the healthcare setting for the most part. For this reason, enhancing hand and setting cleanliness can help resolve the issue, hence facilitating improved patient and organizational outcomes.
Table 1: Barriers and Related Resolution Methods
Barriers
Methods for Resolution
Patient Falls
Enhanced staffing and monitoring
Hospital-Acquired Infections
Improved hygiene
Medical Errors
Enhanced communication and attention
Healthcare Entity
ABC is a large facility that caters to the health needs of patients in and outside the country. The health provider functions as a nonprofit agency aiming for improved health outcomes in various health-related areas. It operates primarily in the country, receiving clients from other nations. However, it has expanded to different locations, including the UK and the UAE. These locations have improved ABC’s capacity to deliver its promise of excellent service to the healthcare industry. ABC has operated for many years since its establishment in 1992, amassing an immense reputation for its excellence in care provision. ABC does not practice as a health provider alone. Instead, it has diversified its operations into research and education. Its comprehensive approach to healthcare needs explains its success over the years. Indeed, the entity implements modern, evidence-based solutions in its centers nationwide. For instance, ABC is famous for its holistic approach to client needs – a model that explains its tremendous success. ABC continues to innovate in various health-related areas. However, it still faces problems that undermine its clients’ quality of care and safety.
Quality and Safety Issue at ABC
Despite its tremendous performances over the years, ABC experiences patient falls. The organization recognizes its significant incidence, noting that it often causes adverse impacts on both patients and the hospital. This recognition is in tandem with scholarly reports on the incidence of patient falls across the country, with LeLaurin and Shorr (2019) noting that the issue affects 700,000-1million healthcare clients annually. ABC recognizes the negative impact of the falls. It suggests that the falls may cause serious injuries to patients. Knight (2021) reports that the issue is among the primary causes of unintentional injuries. These impacts may be mild or severe, depending on the severity of the fall. According to Constantinou and Spencer (2020), a significant number of falls result in serious injuries. These incidences affect patients of all ages, albeit those aged between 60-69 experience higher susceptibility. These factors place patient falls as a contemporary issue undermining outcomes in health. It also illustrates the high level of awareness among ABC administrators on its occurrence and impact on their operations. This issue has an immense implication for the nursing practice within both ABC and the entire profession. As Heng et al. (2020) allude, the topic relates to nurses. Its incidence emanates from nurse-related experiences and outcomes – a fact that explains the impact of staffing ratios on its causation, as King et al. (2018) suggest.
For this reason, ABC relates the issue to the performance of nurses. The measurement of patient falls relates to the experiences and performance of nurses within the institution. Besides, ABC takes a comprehensive perspective into the issue by including the effect of environmental factors on nurses. Therefore, its interventions focus on elevating nursing competence and other related matters.
Quality and Safety Program at ABC
The nonprofit health provider has instituted an initiative to prevent and counter the incidence of patient falls. ABC recognizes the negative impact of the issue. For this reason, it has moved to create a program with four quality measures. First, ABC conducts risk assessments in vulnerable areas to facilitate proper planning. The evaluation offers vital information on susceptible patients and settings. ABC uses the data to create prevention programs, including installing bed rails or non-slippery floors. Secondly, the organization facilitates clinician education to address apparent knowledge gaps. Understandably, patient falls occur at times due to competence issues. Nurses may not have a clear idea of preventing the problem, mainly due to a lack of elaborate training. ABC aims at reducing g the gap through in-house training. This quality measure has achieved massive success in arming clinicians with the required knowledge. Thirdly, ABC utilizes multidisciplinary collaboration to prevent falls among its clients. The health provider recognizes the impact of professional interactions on health outcomes.
For this reason, it came up with a strategy to improve these relationships, facilitating improved unity and competence in handling patients. Lastly, the provider employs data to enhance its capacity to prevent falls. Through seamless reporting, ABC aims at timely responses to issues that often lead to falls. Overall, the organization has created a comprehensive program that brings together different stakeholders in preventing falls even after focusing on nurses. This comprehensiveness elevates its success chances, explicating ABC’s capacity to handle quality and safety-related issues.
Improvement Tracking Variables
ABC has two measures to evaluate its success level in preventing patient falls. Indeed, the organization tracks reportable adverse events as a critical measure of its performance. The variable offers an excellent view of patient fall cases that still occur. In turn, the hospital references present data with past statistics to gather information concerning their performance. The hospital also measures events that rarely happen to patients. These “Never Events” are not expected within the field. For this reason, their occurrence signals a major patient fall issue. Combining these variables provides adequate data for ABC to track its progress. The organization can analyze the data to ascertain the state of falls while identifying their primary causes.
Conclusion
Quality and safety are highly significant concepts relating to health and administrative performances. The nursing practice-related ideas explain the factors that limit or facilitate the desired outcomes. This importance is apparent in how patient falls affect various outcomes in the setting. For this reason, organizations, such as the ABC, have established measures to curb its incidence and negative impact. As its example shows, health providers should exhibit broad knowledge of the issue to facilitate comprehensive solutions.
References
CDC. (2021, October 26). Current HAI Progress Report 2020 National and State Healthcare-Associated Infections Progress Report. https://www.cdc.gov/hai/data/portal/progress-report.html. https://www.cdc.gov/hai/data/portal/progress-report.html.
Costantinou, E., & Spencer, J. A. (2021). Analysis of inpatient hospital falls with serious injury. Clinical Nursing Research, 30(4), 482-493. https://doi.org/10.1177/1054773820973406.
Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Health care-associated infections–an overview. Infection and Drug Resistance, 11, 2321-2333. DOI: 10.2147/IDR.S177247.
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20(1), 1-12. https://doi.org/10.1186/s12877-020-01515-w.
King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2018). Impact of fall prevention on nurses and care of fall risk patients. The Gerontologist, 58(2), 331-340. https://doi.org/10.1093/geront/gnw156.
Knight, K. M. (2021). Implementation and initial evaluation of falls risk reduction resources in a rural Native American Community. Injury Epidemiology, 8(2), 1-7. https://doi.org/10.1186/s40621-021-00359-1.
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: State of the science. Clinics in Geriatric Medicine, 35(2), 273-283. DOI: 10.1016/j.cger.2019.01.007.
Stephenson, M., Mcarthur, A., Giles, K., Lockwood, C., Aromataris, E., & Pearson, A. (2016). Prevention of falls in acute hospital settings: a multi-site audit and best practice implementation project. International Journal for Quality in Health Care, 28(1), 92-98. https://doi.org/10.1093/intqhc/mzv113.