Quality and safety: Nursing

Nurse Kendra works in the pediatric intensive care unit and is caring for Jonah who is being treated for cellulitis. While preparing to administer Jonah’s medications, Nurse Kendra accidentally reconstitutes the prescribed antibiotic with a 0.45% saline solution instead of the 0.9% normal saline as ordered. As Nurse Kendra spikes the bag, she notices the error and returns to the medication room. Nurse Kendra knows that if she had not noticed the medication error, it could have led to serious consequences for her client. Because of this near-miss event, Nurse Kendra decides to begin a quality improvement initiative on her unit to prevent errors like this from happening in the future.

Quality and safety are closely related concepts in healthcare. Quality is how well health services achieve the desired outcomes for a client or population. Safety refers to protecting clients from risk and harm while they’re receiving care. So, safety can be considered a component of quality. When Nurse Kendra discovered the medication error, she identified a safety issue because administering the medication as she prepared it would have resulted in client harm. If that had occurred, the quality of Jonah’s care would also be compromised since providing safe care is part of quality care.

Now, quality and safety are highly regulated and monitored within healthcare institutions. Two of the major regulatory bodies include the Centers for Medicare and Medicaid Services and The Joint Commission.

The Centers for Medicare and Medicaid Services is a national organization that collects data on quality measures, for example the percentage of their hypertension clients whose blood pressure is adequately controlled. These data points are used to ensure that all healthcare organizations receiving Medicare and Medicaid funding are compliant with current standards when providing care.

The Joint Commission is an independent, non-profit organization that develops standards of safety as a measure of quality. They accredit healthcare institutions like hospitals and assisted care facilities when they meet the determined standards of quality and safety. For example, in order for an organization to earn accreditation, they must have written safety plans for the management and administration of high-risk medications, like chemotherapeutics, to reduce the risk of adverse medication events for clients and staff.

Another agency that focuses on client safety is The Agency for Healthcare Research and Quality, which is a division of the Department of Health and Human Services. They spearhead safety initiatives, provide grant funding for quality and safety research, and provide education on how to improve healthcare delivery using best practices.

Now, a framework can help institutions focus on the key factors that affect quality care. One of the most widely used quality frameworks is the six domains of quality healthcare: Safe, Effective, Client-centered, Timely, Efficient, and Equitable. Safe means that we avoid harming our clients. Effective means that we only use evidence-based data when making clinical decisions. Client-centered means that we are respectful and responsive to client needs and values and that we place the client in the center of decision-making.

Timely means that we should reduce delays in care. Efficient means we avoid waste of supplies or personnel. Lastly, equitable means that the quality of care we provide should not change because of personal characteristics of the client like age, race, gender, or socioeconomic status.