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HLT-362V-O503 Topic 4 Quality Improvement Proposal GCU

HLT-362V-O503 Topic 4 Quality Improvement Proposal GCU

Introduction

Quality improvement is the systematic and constant actions that contribute to the enhancement of health care delivery and the health status of target patient populations. Quality improvement is vital in enhancing healthcare delivery, and health systems can learn from effective healthcare quality improvement projects.  This paper aims to describe a quality improvement opportunity in my health care organization and a quality improvement initiative proposal based on evidence-based practice

Overview of the Problem

A major problem I have identified in my current healthcare organization is the inappropriate prescription of drugs to patients. The issue mostly affects nurse practitioners, physicians, and clinicians who diagnose patients and prescribe medications. The problem occurs in the outpatient clinics as well as the inpatient setting. There have been several cases of drug overdose, especially in pediatrics, polypharmacy, severe adverse outcomes, and prescription of drugs that result in adverse drug reactions. Besides, some clinicians prescribe medications that have drug interactions resulting in the poor prognosis of patients’ health conditions. Inappropriate prescription of drugs has adversely affected patients’ health outcomes in the organization, and the issue needs to be addressed to uphold the organization’s objective of promoting the safest patient care possible.

Why a quality improvement initiative is needed

A quality improvement initiative is required in the outpatient and inpatient setting to address the issue of wrong drug prescription and to promote patient safety and better health outcomes. The drug prescription process needs to be enhanced to avoid future cases of adverse drug reactions, polypharmacy, poor prognosis, and adverse health outcomes in our patients. Besides, addressing the issue of wrong drug prescription will help the organization in avoiding medico-legal issues in the future. Furthermore, prescribing clinicians, dispensing pharmacists, hospital management risk facing disciplinary issues for not upholding patient safety in their practice.

Quality Improvement Initiative Proposal and the expected outcome

My quality improvement initiative proposal will be on Pharmacist-led Medication Therapy Management. Medication therapy management (MTM) is a service given by health care providers and aims at ensuring the best therapeutic outcomes (Moon, Walek & Walburg, 2018). It consists of five core elements, namely, pharmacological therapy review, personal medication record, drug-related action plan, interventions or referral, and documentation and follow-up (Moon, Walek & Walburg, 2018). My proposal will involve pharmacists collaborating with clinicians during drug prescription and reviewing the pharmacological plan. The pharmacists will have patients’ medication records that will help in identifying the drugs that have been effective in controlling a patient’s condition and those that did not demonstrate the desired outcome.

The expected outcome of the quality improvement initiative on drug prescription and dispensing will be improved patient safety, decreased hospital stay, patient satisfaction, and better health outcomes. Prescribing the correct drugs will result in reduced hospitalization and hospital stays as well as reduce medical costs. Furthermore, it is expected that clinicians and pharmacists will be keener when prescribing and dispensing drugs to minimize the incidences of drug overdose, drug interactions, and adverse drug reactions. By involving pharmacists in the care of patients with multiple chronic diseases, I will expect that polypharmacy will decrease and that patients will be managed with medications that show the best therapeutic outcome.

Results of Previous Research

Bitter et al. conducted a study to assess the effects and the quality of medication reviews given by community pharmacists for patients of long-term care facilities. In the study, community pharmacists dispensing drugs to the long-term care facilities conducted a medication review for patients above the age of 65 years who were taking five and more medications per day (Bitter et al., 2019). The pharmacists evaluated the documented potential drug-related problems (DRPs) and the rate of implementation of pharmaceutical interventions.  The pharmacists recorded 154 potential drug-related problems, with the most common being drug to drug interactions (Bitter et al., 2019). The second most common DRP was potentially inappropriate medication, followed by incorrect dosages (Bitter et al., 2019). The study revealed that MTC by community pharmacists facilitated the identification of DRPs.

According to a study by Maeng et al. (2018), increased monitoring in MTM is associated with lower healthcare costs and fewer hospitalizations. The study aimed at evaluating the impact of a pharmacist-led MTM program on clinical outcomes, health care utilization, and cost of care among diabetic patients (Maeng et al., 2018). A retrospective cohort study was employed with a total of 5500 participants (Maeng et al., 2018). The study findings revealed that MTM was associated with a decreased hospitalization rate, increased primary care physician follow-ups, and a reduced average monthly medical costs.

Viswanathan et al. conducted a study to assess the effect of MTM interventions among outpatients with chronic illnesses. The study obtained data sources from the Cochrane Library, MEDLINE, and International Pharmaceutical Abstracts (Viswanathan et al., 2018). The study found that MTM interventions improved measures of DRPs and health care use and expenses compared to the usual care (Viswanathan et al., 2018). Besides, the interventions enhanced medication appropriateness, adherence, and the number of patients attaining a threshold adherence level (Viswanathan et al., 2018).  The MTM interventions reduced medication dosing, healthcare costs, and decreased the risk of hospitalization among patients with diabetes and cardiovascular diseases.

Steps Necessary to Implement the Quality Improvement Initiative

The first step will be to develop a plan that will guide the implementation of the initiative. This will be identifying the changes that will occur, such as the involvement of pharmacists in drug prescription and collaboration between pharmacists and clinicians (McQuillan et al., 2016). I will then identify who will be responsible for making the change; in this initiative, it will be pharmacists, nurse practitioners, and physicians (McQuillan et al., 2016). I will plan when and how the initiative will be implemented, such as beginning with the inpatient units then move to outpatient clinics where pharmacists will review the prescriptions for all patients. I will also communicate and train the pharmacists and clinicians about the initiative and ensure they accept it (McQuillan et al., 2016). In addition, I will collect baseline data that will facilitate measuring the effects of the initiative (Chan et al., 2016). The second step will involve putting the initiative into action. Lastly, I will collect feedback from the staff on the impact of the initiative, challenges encountered during implementation, and their views.

Evaluation of the Quality Improvement Initiative

The quality improvement initiative will be evaluated through data collection methods. I will start by verifying that the initiative was implemented according to the plan. The next step will be to administer questionnaires to clinicians and pharmacists to obtain data on the impact that the initiative has had on improving drug prescription, promoting patient safety, and reducing DRPs (Chan et al., 2016). In addition, I will compare the baseline data collected in the implementation stage with the current data to look for improvement. A Run Chart will be used evaluation of the initiative to determine if the observed changes are probably related to the initiative or whether they occurred be due to chance (McQuillan et al., 2016). A Run chart establishes whether an intervention affects the desired outcome by illustrating the point in time that the intervention was applied.

Conclusion

Quality improvement initiatives play a significant role in improving health outcomes for target patient groups. A pharmacist-led MTM is a practical approach to preventing drug-related problems and promoting patient safety in the prescription of drugs. Previous research on pharmacy-led MTMs has revealed that pharmacy-led programs in healthcare facilities are associated with lower healthcare costs and fewer hospitalizations. Moreover, MTM promotes medication adherence, prescription appropriateness, and achievement of a threshold adherence level. MTM can be useful in the management of patients with multiple conditions to prevent drug-drug interaction and improve health outcomes.

References

Bitter, K., Pehe, C., Krüger, M., Heuer, G., Quinke, R., & Jaehde, U. (2019). Pharmacist-led medication reviews for geriatric residents in German long-term care facilities. BMC geriatrics19(1), 39.

Chan, C. T., Chertow, G. M., Nesrallah, G., & Bell, C. M. (2016). How to use quality improvement tools in clinical practice: A primer for nephrologists. Clinical Journal of the American Society of Nephrology11(5), 891-892.

Maeng, D. D., Graham, J., Bogart, M., Hao, J., & Wright, E. A. (2018). Impact of pharmacist-led diabetes management on outcomes, utilization, and cost. ClinicoEconomics and outcomes research: CEOR10, 551.

McQuillan, R. F., Silver, S. A., Harel, Z., Weizman, A., Thomas, A., Bell, C., Chertow, G.M., Chan, C.T., & Nesrallah, G. (2016). How to measure and interpret quality improvement data. Clinical Journal of the American Society of Nephrology11(5), 908-914.

Moon, J. Y., Walek, S., & Walburg, K. (2018). Meeting the Criteria for Medication Therapy Management. JAMA internal medicine178(11), 1562-1563.

Viswanathan, M., Kahwati, L. C., Golin, C. E., Blalock, S. J., Coker-Schwimmer, E., Posey, R., & Lohr, K. N. (2015). Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis. JAMA internal medicine175(1), 76-87.

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HLT-362V-O503 Topic 4 Quality Improvement Proposal GCU

HLT-362V-O503 Topic 4 Quality Improvement Proposal GCU

Topic 4 DQ 1

Sep 5-7, 2022

Provide an example of experimental, quasi-experimental, and nonexperimental research from the GCU Library and explain how each research type differs from the others. When replying to peers, evaluate the effectiveness of the research design of the study for two of the examples provided.

REPLY TO DISCUSSION

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Hello Class,

Experimental Research: Experimental or Trial- Research is a form of research or study in which “the investigator directly controls selected conditions or characteristics of the environment, and observes the effects these changes have on other features of the problem at hand in order to determine causal relations” (Stoica, 2021). As the name implies Experimental research relies on running various tests and trials to come to a conclusion.

Example of an Experimental research study:

The Institute of Electrical and Electronics Engineers has conducted a study to research the effectiveness of cable-driven hip joint power-assisted exoskeletons. The experiments conducted to research this required three different conditions. The first condition was no exoskeleton, the second was exoskeleton opening and closing, The third condition was the effects of different experimental conditions on human joint angle, carbon dioxide exhalation, and sEMG. The results of these experiments showed the maximum angle difference of hip and knee was almost halved with the exoskeleton (3.6° with VS 6.1° without). Results also showed a 3.5% decrease in the overall carbon dioxide content in exhaled gas. Lastly, results showed The RMS values of the inferior gauze tail muscle and the quadriceps femoris muscle decreased by 51.40% and 42.55%, respectively (Ma et. al, 2022). With this information a conclusion can be reached that cable-driven hip joint power-assisted exoskeletons showed that motion deviation was small, muscle consumption was greatly reduced, and exoskeletons play a good auxiliary role in human walking.

Quasi-Experimental Research: Quasi-Experimental research is a form of study in which the aim is to evaluate interventions but that does not use randomization. “Quasi-experimental studies encompass a broad range of nonrandomized intervention studies. These designs are frequently used when it is not logistically feasible or ethical to conduct a randomized controlled trial” (Harris et. al, 2006).

Example of a Quasi-Experimental research study:

The National University of Singapore conducted a quasi-experimental research study to find the impact of the Scholarly Project® on medical students’ perception of research skills in Vietnam. To test this “A questionnaire evaluating the perception of fourteen research skills was given to participants in the first week, at midterm, and after finishing the Scholarly Project; students assessed their level on each skill using a 5-point Likert scale from 1 (lowest score) to 5 (highest score)” (Nguyen et. al, 2022). The results showed significantly high scores for 11 skills after participation in the Scholarly Project®.

Non-Experimental Research: Non-experimental research is research without the manipulation of independent variables, random assignment of participants to conditions, and/or orders of conditions.

Example of Non-Experimental research study: 

A non-experimental research study was conducted by the BMJ journal to measure the effect of including OAT in The Joint Commission’s NPSGs on historically low rates of OAT initiation for individuals with incident atrial fibrillation (AF). This test was conducted using North Carolina State Health Plan claims data from 944 500 individuals enrolled between 1 January 2006 and 31 December 2010, supplemented with data from the Area Resource File and Online Survey, Certification and Reporting data network (Beadles et. al, 2014). The results showed OAT initiation was decreased (26.8%) for eligible individuals with incident atrial fibrilation in 2006–2008 but increased after NPSGs implementation (31.7%, p=0.022). OAT initiation was high but was lowered in the positive control group (67.5% vs 62.0%, p=0.003). Multivariate analysis resulted in a relative 11% (95% CI (4% to 18%), p<0.01) increase in OAT initiation for incident AF patients.

References:

Beadles CA, Hassmiller Lich K, Viera AJ, et alA non-experimental study of oral anticoagulation therapy initiation before and after national patient safety goalsBMJ Open 2014;4:e003960. doi: 10.1136/bmjopen-2013-003960

Harris, A. D., McGregor, J. C., Perencevich, E. N., Furuno, J. P., Zhu, J., Peterson, D. E., & Finkelstein, J. (2006). The use and interpretation of quasi-experimental studies in medical informatics. Journal of the American Medical Informatics Association : JAMIA13(1), 16–23. https://doi.org/10.1197/jamia.M1749

Nguyen Tran Minh Duc, Khuu Hoang Viet, & Vuong Thi Ngoc Lan. (2022). Impact of Scholarly Project on students’ perception of research skills: A quasi-experimental study. The Asia Pacific Scholar7(4), 50–58. https://doi-org.lopes.idm.oclc.org/10.29060/TAPS.2022-7-4/OA2748

  1. Ma, A. Zhu, Y. Tu, J. Song, D. Dang and Y. Zhang, “System Design and Experimental Research of Cable-driven Hip Joint Power-assisted Exoskeleton,” 2022 19th International Conference on Ubiquitous Robots (UR), 2022, pp. 237-242, doi: 10.1109/UR55393.2022.9826254.

Stoica, I. (2021). Experimental (Trial) Research. Salem Press Encyclopediahttps://eds-p-ebscohost-com.lopes.idm.oclc.org/eds/detail/detail?vid=1&sid=d01c6dab-6686-47c9-b2fe-2f9a5c973400%40redis&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=89164212&db=ers

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