NURS 8302 Discussion Identifying Practice Gaps for Quality Improvement
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.
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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.
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.
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 geriatrics, 19(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 Nephrology, 11(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: CEOR, 10, 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 Nephrology, 11(5), 908-914.
Moon, J. Y., Walek, S., & Walburg, K. (2018). Meeting the Criteria for Medication Therapy Management. JAMA internal medicine, 178(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 medicine, 175(1), 76-