Improving Quality of Care and Patient Safety

Running head: IMPROVEMENT PLAN TOOL KIT 1
Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.
Improvement Plan Tool Kit
Learner’s Name
Capella University
Improving Quality of Care and Patient Safety
Improvement Plan Tool Kit
April, 2019
IMPROVEMENT PLAN TOOL KIT 2
Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.
Improvement Plan Tool Kit
This improvement plan tool kit aims to enable nurses to implement and sustain safety
improvement measures in health care settings in a geropsychiatric unit. The tool kit has been
organized into four categories with three annotated sources each. The categories are as follows:
general organizational safety and quality best practices, environmental safety and quality risks,
staff-led preventive strategies, and best practices for reporting and improving environmental
safety issues.
Annotated Bibliography
General Organizational Safety and Quality Best Practices
Sherwood, G., & Horton-Deutsch, S. (2015). Reflective organizations: On the front lines of
QSEN and reflective practice implementation. Retrieved from https://ebookcentralproquest-com.library.capella.edu/lib/capella/detail.action?docID=3440207#
This e-book presents the paradigm shift required for organizations to provide QSEN
(quality and safety education to nurses). It provides readers with the innovative
pedagogical approaches required to change traditional content-based health care
education methods to interactive methods that engage learners. These approaches
include facilitative teaching, visual thinking strategies, creating a presence that is
authentic, and meaningful learning through debriefing. Concrete examples in the
resource demonstrate the application of reflective learning. Additionally, the reflective
questions in the resource guide readers to evaluate their own practice, either
independently or in groups, to implement formal education programs with a focus on
self-improvement. The resource prepares nursing students for advanced competency,
IMPROVEMENT PLAN TOOL KIT 3
Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.
which will help them adopt reflective thinking, develop a safety culture, and therefore
qualitatively improve practices in critical health units such as geropsychiatry units.
Fleiszer, A. R., Semenic, S. E., Ritchie, J. A., Richer, M.-C., & Denis, J.-L. (2016). A unit-level
perspective on the long-term sustainability of a nursing best practice guidelines
program: An embedded multiple case study. International Journal of Nursing Studies,
53, 204–218. https://doi.org/10.1016/j.ijnurstu.2015.09.004
This article helps analyze the sustainability of a best practice guidelines program
implemented in acute health care settings. The sustainability of the program was
characterized by the following: benefits for patients as the rate of incidence of falls
reduced; routinization of best practices as the team’s adherence to guidelines improved;
and, in the long term, the development of the team’s adaptability to changes in
circumstances that threatened the program. Seven key factors that accounted for the
sustainability of the program were also identified. The source explains how
relationships between the characteristics of sustainability (benefits, routinization, and
development) and the seven key factors contributed toward the sustainability of the
improvement program. This source is valuable for nursing students as it helps them
understand how safety programs can be sustained to ensure the long-term reduction of
the incidence of sentinel events in geropsychiatric units.
Kossaify, A., Hleihel, W., & Lahoud, J.-C. (2017). Team-based efforts to improve quality of
care, the fundamental role of ethics, and the responsibility of health managers:
Monitoring and management strategies to enhance teamwork. Public Health, 153, 91–98.
https://doi.org/10.1016/j.puhe.2017.08.007
IMPROVEMENT PLAN TOOL KIT 4
Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.
This paper discusses the benefits of teamwork in improving the quality of health care. It
presents a review of 33 papers identified after performing a search on PubMed. The paper
discusses the important ingredients of efficient teamwork such as self-awareness and the
individual behavior of team members, the ethical climate within the team, the work
environment and institutional infrastructure, positive moderation from leadership, and
communication and coordination among team members. Effective teamwork can help
reduce the incidence of sentinel events that result from preventable medical errors, which
are often caused by dysfunctional communication among team members. Teamwork is
more reliable and efficient than individual work in high-risk environments such as a
geropsychiatry unit. Although the specific contexts of readers’ practices may be different,
this resource is valuable for nursing administrators and professionals as it discusses the
implementation of values needed for positive teamwork as well as the monitoring and
management of teamwork.
Environmental Safety and Quality Risks
Powell-Cope, G., Quigley, P., Besterman-Dahan, K., Smith, M., Stewart, J., Melillo, C.,
Friedman, Y. (2014). A qualitative understanding of patient falls in inpatient mental
health units. Journal of the American Psychiatric Nurses Association, 20(5), 328–339.
https://doi.org/10.1177/1078390314553269
This source mentions a study conducted to analyze falls in geropsychiatric patients. The
study also focused on selling falls prevention in psychiatric units. The risk factors that
lead to the falls were identified by a focus group. The focus group formulated an
improvement plan to reduce the number of falls, and it was found that implementing
IMPROVEMENT PLAN TOOL KIT 5
Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.
infrastructural changes such as the use of geriatric-friendly sanitary ware such as raised
toilet seats helped reduce the rate of incidence of falls. Although all the changes may not
be feasible in a given setup, many of the strategies mentioned in this study could serve as
a starting point for the prevention of falls. The article helps nursing students understand
the challenges that occur in an adult mental health unit and the quality improvement
measures taken to resolve these challenges.
Wong Shee, A., Phillips, B., Hill, K., & Dodd, K. (2014). Feasibility, acceptability, and
effectiveness of an electronic sensor bed/chair alarm in reducing falls in patients with
cognitive impairment in a subacute ward. Journal of Nursing Care Quality, 29(3), 253–
262. https://doi.org/10.1097/NCQ.0000000000000054
This source is a preliminary study conducted to determine the effectiveness of electronic
sensor bed/chair alarms to reduce the occurrence of falls in patients with cognitive
impairment. These alarms can be attached to the patient’s body or to the bed/chair the
patient uses to alert the nursing staff every time the patients move or leave their seat.
Nurses were educated about the alarms and asked to document their observations and
provide feedback. Although effective at preventing falls in patients with cognitive
impairment, the electronic sensors needed improvements such as the elimination of cords
that may be hazardous to patients and the additional provision of alerting nurses through
pagers. This source helps nursing students understand both the effectiveness and the
limitations of electronic sensor alarms in reducing the occurrence of falls.
Chari, S. R., Smith, S., Mudge, A., Black, A. A., Figueiro, M., Ahmed, M., . . . Haines, T. P.
(2016). Feasibility of a stepped wedge cluster RCT and concurrent observational sub-
IMPROVEMENT PLAN TOOL KIT 6
Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.
study to evaluate the effects of modified ward night lighting on inpatient fall rates and
sleep quality: A protocol for a pilot trial. Pilot and Feasibility Studies, 2(1).
https://doi.org/10.1186/s40814-015-0043-x
Inadequate lighting at night in geropsychiatric wards is one of the important causes of
falls in geropsychiatric units. Psychotropic medications can cause cognitive impairments
and blurring of vision, which can be aggravated by dim lighting in the units. The article
presents a trial pilot study conducted to evaluate the effects of the use of modified night
lighting in inpatient wards to prevent falls. LED lights were installed in the vicinity of the
beds and the toilets, where falls were likely to occur. The study provides valuable insights
that could inform design and refurbishment efforts at geropsychiatric units. An important
limitation of the study is that a stepped wedge, cluster randomized controlled trial has not
yet been applied to test environmental modifications in any setting. However, the
modifications discussed could still be implemented as an important intervention strategy
for preventing falls in older adults with cognitive impairment.
Staff-Led Preventive Strategies
Morgan, L., Flynn, L., Robertson, E., New, S., Forde‐Johnston, C., & McCulloch, P. (2016).
Intentional rounding: A staff‐led quality improvement intervention in the prevention of
patient falls. Journal of Clinical Nursing, 26(1–2), 115–124.
https://doi.org/10.1111/jocn.13401
This article highlights an intervention strategy called intentional rounding to reduce the
occurrence of inpatient falls. Intentional rounding is a specific strategy in which nurses
conduct a routine check on patients at certain time intervals based on the needs of the
IMPROVEMENT PLAN TOOL KIT 7
Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.
patient. The rounding was implemented through effective communication and teamwork
among the nursing staff and iterations of plan-do-check-act measures. This proactive
staff-led strategy helped reduce the rate of falls by 50%. This study achieved success
through the combined efforts of the research team that conducted the analysis of the
system to design the rounding format and the frontline nursing staff who conducted the
intentional rounds. Although its sample size was small and not entirely representative, the
study does establish intentional rounding as an effective falls-prevention strategy, which
when implemented with adequate staff engagement and support from leadership
definitively reduces the occurrence of falls.
Moncada, L. V. V., & Mire, G. L. (2017). Preventing falls in older persons. Am Fam Physician,
96(4), 240–247. Retrieved from https://www.aafp.org/afp/2017/0815/p240.pdf
The article posits that a history of falls in older persons is associated with an increased
risk of a future fall. The American Geriatrics Society recommends that older adults aged
65 and above should undergo annual screening for balance impairment and a history of
falls as a preliminary intervention for the prevention of falls. The article also highlights
an algorithm developed by the Centers for Disease Control and Prevention. The
algorithm suggests assessment and multifactorial interventions to prevent falls in patients
who have had more than two falls and more than one fall-related injury. The
multifactorial interventions include exercise routines that include balance and gait
training, the use of vitamin D supplements with or without calcium based on the
community in which the patients dwell, and the management of psychotropic medication.
These interventions have been known to cause a significant decrease in the rate of falls
IMPROVEMENT PLAN TOOL KIT 8
Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.
and can be implemented across all geropsychiatric wards to prevent sentinel events. The
source is authentic and hence can be referred to by nursing students to understand
multifactorial interventions in the prevention of falls.
Isaac, L. M., Buggy, E., Sharma, A., Karberis, A., Maddock, K. M., & Weston, K. M. (2018).
Enhancing hospital care of patients with cognitive impairment. International Journal of
Health Care Quality Assurance, 31(2), 173–186. https://doi.org/10.1108/IJHCQA-11-
2016-0173
This paper evaluates the TOP5 intervention strategy of improving patient care. The
strategy involves engaging with carers of geriatric patients (individuals who are family
members or friends of the patients) to collect characteristic non-clinical information
about patients to personalize care and reduce falls. The carers of patients narrated to the
nursing staff five important and distinct characteristic details such as the patients’ needs
and past emotional experiences. The nursing staff then prepared a customized plan of
care for each patient based on this information. This study reported a significant
reduction in falls and qualitatively improved care. The study enables nursing students to
meaningfully involve the carers of cognitively impaired patients and reduce the incidence
of falls.
Best Practices for Reporting and Improving Environmental Safety Issues
Tan, A. K. (2015). Emphasizing caring components in nurse-patient-nurse bedside reporting.
International Journal of Caring Sciences, 8(1), 188–193. Retrieved from
https://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocvie
w%2F1648623547%3Faccountid=27965
IMPROVEMENT PLAN TOOL KIT 9
Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.
This source provides a review of strategies that improve bedside reporting and transfer of
duties after a change of shift among nursing staff. The source also emphasizes team
engagement that can help reduce the incidence of sentinel events, especially in health
care units such as geropsychiatry units. Bedside reporting is a vital concern in
geropsychiatric units as patients are prone to behavioral changes and unpredictable
behavior may affect other patients in the unit. During a shift change, the nursing staff can
alert the incoming staff about the condition of such patients to proactively prepare the
staff to address any forthcoming issue. Barriers to bedside reporting were also analyzed,
and barriers perceived by patients and those perceived by nurses were identified. These
barriers can be eliminated through open communication and by educating the nursing
staff. The article provides a valuable discussion of factors that influence bedside
reporting such as patient-centered care philosophy, guidelines of the Joint Commission
Institute, demand for patient participation in making health care decisions, and the
shortcomings of traditional handover practices.
Stergiopoulos, S., Brown, C. A., Felix, T., Grampp, G., & Getz, K. A. (2016). A survey of
adverse event reporting practices among US healthcare professionals. Drug Safety,
39(11), 1117–1127. https://doi.org/10.1007/s40264-016-0455-4
This article highlights the severity of underreporting of adverse drug events. An adverse
drug event is defined by the World Health Organization as “a response to a medicine
which is noxious and unintended, and which occurs at doses normally used in man.”
Adverse drug events are estimated to cause 7,000 deaths across health care settings in the
United States each year. It is also said that half of these adverse drug events result from
IMPROVEMENT PLAN TOOL KIT 10
Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.
preventable medication errors. The article also identifies factors that lead to the
underreporting of the adverse drug events such as lack of training among health care
professionals and standardized reporting processes. Underreporting of adverse drug
events can be a critical problem, especially in health care units such as geropsychiatry
units. Individual patients may react differently to psychotropic drugs; reactions may
include overdoses or allergic reactions. These reactions need to be monitored closely and
reported efficiently to avoid complications including falls. Nursing students can
understand the importance of reporting adverse drug events through this source.
Lozito, M., Whiteman, K., Swanson-Biearman, B., Barkhymer, M., & Stephens, K. (2018).
Good catch campaign: Improving the perioperative culture of safety. AORN Journal,
107(6), 705–714. https://doi.org/10.1002/aorn.12148
This article provides evidence-based results to show that the culture of safety in a
perioperative unit was improved after implementing the good catch campaign. Good
catch is the ability of nursing staff to point out mistakes and report them to avoid sentinel
events. The campaign described in the article involves implementing a standardized
electronic reporting system and debriefing process. The nursing staff discusses the plan
of care for each patient at the end of the day during debriefing. This helps the nursing
staff note characteristic risks involved with each patient and provide better care. Training
nursing staff to implement the good catch campaign in health care units such as
geropsychiatry units should enable the effective reporting of factors that could cause falls
with a view to avoid them. This source enables nursing students to implement electronic
reporting systems to report good catches and thereby reduce falls.
IMPROVEMENT PLAN TOOL KIT 11
Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.
References
Chari, S. R., Smith, S., Mudge, A., Black, A. A., Figueiro, M., Ahmed, M., . . . Haines, T. P.
(2016). Feasibility of a stepped wedge cluster RCT and concurrent observational substudy to evaluate the effects of modified ward night lighting on inpatient fall rates and
sleep quality: A protocol for a pilot trial. Pilot and Feasibility Studies, 2(1).
https://doi.org/10.1186/s40814-015-0043-x
Fleiszer, A. R., Semenic, S. E., Ritchie, J. A., Richer, M.-C., & Denis, J.-L. (2016). A unit-level
perspective on the long-term sustainability of a nursing best practice guidelines program:
An embedded multiple case study. International Journal of Nursing Studies, 53, 204–
218. https://doi.org/10.1016/j.ijnurstu.2015.09.004
Isaac, L. M., Buggy, E., Sharma, A., Karberis, A., Maddock, K. M., & Weston, K. M. (2018).
Enhancing hospital care of patients with cognitive impairment. International Journal of
Health Care Quality Assurance, 31(2), 173–186. https://doi.org/10.1108/IJHCQA-11-
2016-0173
Kossaify, A., Hleihel, W., & Lahoud, J.-C. (2017). Team-based efforts to improve quality of
care, the fundamental role of ethics, and the responsibility of health managers:
Monitoring and management strategies to enhance teamwork. Public Health, 153, 91–98.
https://doi.org/10.1016/j.puhe.2017.08.007
Lozito, M., Whiteman, K., Swanson-Biearman, B., Barkhymer, M., & Stephens, K. (2018).
Good catch campaign: Improving the perioperative culture of safety. AORN Journal,
107(6), 705–714. https://doi.org/10.1002/aorn.12148
IMPROVEMENT PLAN TOOL KIT 12
Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.
Moncada, L. V. V., & Mire, G. L. (2017). Preventing falls in older persons. Am Fam Physician,
96(4), 240–247. Retrieved from https://www.aafp.org/afp/2017/0815/p240.pdf
Morgan, L., Flynn, L., Robertson, E., New, S., Forde‐Johnston, C., & McCulloch, P. (2016).
Intentional rounding: A staff‐led quality improvement intervention in the prevention of
patient falls. Journal of Clinical Nursing, 26(1–2), 115–124.
https://doi.org/10.1111/jocn.13401
Powell-Cope, G., Quigley, P., Besterman-Dahan, K., Smith, M., Stewart, J., Melillo, C.,
Friedman, Y. (2014). A qualitative understanding of patient falls in inpatient mental
health units. Journal of the American Psychiatric Nurses Association, 20(5), 328–339.
https://doi.org/10.1177/1078390314553269
Sherwood, G., & Horton-Deutsch, S. (2015). Reflective organizations: On the front lines of
QSEN and reflective practice implementation. Retrieved from https://ebookcentralproquest-com.library.capella.edu/lib/capella/detail.action?docID=3440207#
Stergiopoulos, S., Brown, C. A., Felix, T., Grampp, G., & Getz, K. A. (2016). A survey of
adverse event reporting practices among US healthcare professionals. Drug Safety,
39(11), 1117–1127. https://doi.org/10.1007/s40264-016-0455-4
Tan, A. K. (2015). Emphasizing caring components in nurse-patient-nurse bedside reporting.
International Journal of Caring Sciences, 8(1), 188–193. Retrieved from
https://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocvie
w%2F1648623547%3Faccountid=27965
Wong Shee, A., Phillips, B., Hill, K., & Dodd, K. (2014). Feasibility, acceptability, and
effectiveness of an electronic sensor bed/chair alarm in reducing falls in patients with
IMPROVEMENT PLAN TOOL KIT 13
Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.
cognitive impairment in a subacute ward. Journal of Nursing Care Quality, 29(3), 253–
262. https://doi.org/10.1097/NCQ.0000000000000054

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