Domain 5: Quality and Safety

Domain 5: Quality and Safety 

Descriptor: Employment of established and emerging principles of safety and improvement science. Quality and safety, as core values of nursing practice, enhance quality and minimize risk of harm to patients and providers through both system effectiveness and individual performance. 

Contextual Statement: Provision of safe, quality care necessitates knowing and using established and emerging principles of safety science in care delivery. Quality and safety encompass provider and recipient safety and the recognition of synergy between the two. Quality or safety challenges are viewed primarily as the result of system failures, as opposed to the errors of an individual. In an environment fostering quality and safety, caregivers are empowered and encouraged to promote safety and take appropriate action to prevent and report adverse events and near misses. Fundamental to the provision of safe, quality care, providers of care adopt, integrate, and disseminate current practice guidelines and evidence-based interventions. 

Safety is inclusive of attending to work environment hazards, such as violence, burnout, ergonomics, and chemical and biological agents; there is a synergistic relationship between employee safety and patient safety. A safe and just environment minimizes risk to both recipients and providers of care. It requires a shared commitment to create and maintain a physically, psychologically, secure, and just environment. Safety demands an obligation to remain non-punitive in detecting, reporting, and analyzing errors, possible exposures, and near misses when they occur. 

Quality and safety are interdependent, as safety is a necessary attribute of quality care. For quality health care to exist, care must be safe, effective, timely, efficient, equitable, and personcentered. Quality care is the extent to which care services improve desired health outcomes and are consistent with patient preferences and current professional knowledge (IOM, 2001). Additionally, quality care includes collaborative engagement with the recipient of care in assuming responsibility for health promotion and illness treatment behaviors. Quality care both improves desired health outcomes, and prevents harm (IOM, 2001). Addressing contributors and barriers to quality and safety, at both individual and system levels, are necessary. Essentially, everyone in health care is responsible for quality care and patient safety. Nurses are uniquely positioned to lead or co-lead teams that address the improvement of quality and safety because of their knowledge and ethical code (ANA Code of Ethics, 2015). Increasing complexity of care has contributed to continued gaps in healthcare safety. 

5.1 Apply quality improvement principles in care delivery.

5.1i Establish and incorporate data driven benchmarks to monitor system performance. 

5.1j Use national safety resources to lead teambased change initiatives. 

5.1k Integrate outcome metrics to inform change and policy recommendations. 

5.1l Collaborate in analyzing organizational process improvement initiatives. 

5.1m Lead the development of a business plan for quality improvement initiatives. 

5.1n Advocate for change related to financial policies that impact the relationship between economics and quality care delivery. 

5.1o Advance quality improvement practices through dissemination of outcomes. 

5.2 Contribute to a culture of patient safety.

5.2g Evaluate the alignment of system data and comparative patient safety benchmarks. 

5.2h Lead analysis of actual errors, near misses, and potential situations that would impact safety. 

5.2i Design evidence-based interventions to mitigate risk. 

5.2j Evaluate emergency preparedness system-level plans to protect safety. 

5.3 Contribute to a culture of provider and work environment safety. 

5.3e Advocate for structures, policies, and processes that promote a culture of safety and prevent workplace risks and injury. 

5.3f Foster a just culture reflecting civility and respect. 

5.3g Create a safe and transparent culture for reporting incidents. 

5.3h Role model and lead well-being and resiliency for self and team. 

(American Association of Colleges of Nursing,, 2021, pp. 39-41)

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. AACNnursing.   https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf

Related Evidence

For the NURS 72133: Quality Outcomes Management course, I worked with two fellow students for my Doctor of Nursing Practice (DNP) quality improvement project. We performed a microsystem evaluation of a mental health organization in Arkansas to assess opportunities for improvement. This evaluation revealed five such opportunities. Of these opportunities, the quality improvement team members (QITMS) chose to focus this project on addressing the high number of complaints the clinic received from patients stating their calls were not answered and their voice messages were not returned in a timely manner. Once we completed this microsystem assessment, QITMs presented clinic administrators with a QI project proposal. The goal of this QI project was to enhance patient satisfaction with the phone-tree services of the behavioral health organization by implementing staff education on communication processes. The project proposal included four specific project aims to address patient satisfaction with the phone-tree services, a detailed project timeline, a data analysis and evaluation plan, and a detailed summary of resources that would be utilized during the project.

For the NURS 72142: Integration of DNP Competencies course, my fellow QITMs and I created a poster presenting comprehensive QI project details including the background, purpose, literature review, theoretical framework guiding the project, specific aims, methods, results, and conclusions and recommendations.

Reflection

Through the organizational assessment, QITMs were able to identify a potential safety concern regarding unanswered calls and voicemails. Patients call the organization because they have various safety concerns ranging from adverse medication responses to self-harming or suicidal ideations. It is imperative that these patients are able to speak with the appropriate representative in a timely manner. This project, my first introduction to the quality QI process, was an invaluable learning experience and enabled me to achieve Domains 5.1i, “Establish and incorporate data driven benchmarks to monitor system performance,” and 5.2h, “Lead analysis of actual errors, near misses, and potential situations that would impact safety” (American Association of Colleges of Nursing, 2021, pp. 39-40).

References

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. AACNnursing.   https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf