NURS 8302 WEEK 3 Discussion Identifying Practice Gaps for Quality Improvement INSTRUCTIONS PLUS RUBRIC
Sample Answer for NURS 8302 WEEK 3 Discussion Identifying Practice Gaps for Quality Improvement INSTRUCTIONS PLUS RUBRIC Included After Question
Discussion: Identifying Practice Gaps for Quality Improvement
What should be happening in practice? What is happening or observed in practice?
These two questions help to identify where quality improvement practice gaps might exist in nursing practice. If we know what should be happening does not coincide with what is happening, we know there is an issue, or more appropriately, a practice gap.
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A practice gap is the difference between a desirable or achievable state of practice and current reality. For example, a common gap in practice in healthcare organizations today, are healthcare associated infections (HAIs), such as central line associated blood stream infections (CLABSIs), or catheter associated urinary tract infections (CAUTIs).
The ongoing identification of practice gaps is critical to quality improvement and involves identifying the current state, comparing that current state to the desired state, identifying the causes of the gaps in practice, and validating those gaps to develop a process for improvement.
For this Discussion, reflect on quality improvement practice gaps that may exist in your practice or organization. Consider what quality improvement methods and/or tools might be useful in improving this practice gap. Then, think about how you might address these challenges and what strategies you might implement as a future DNP-prepared nurse.
To Prepare:
- Review the Learning Resources on tools and methods for quality improvement.
- Reflect on a potential quality improvement practice gap, you have seen in your practice or organization, which you might consider using for your DNP project.
- Consider the tools and methods you might use to address this quality improvement practice gap.
By Day 3 of Week 3
Post a brief explanation of how you would identify a quality improvement practice gap in your practice or organization. Describe a potential quality improvement practice gap you might use for your DNP project, and explain why. Then, explain at least two types of tools and/or methods you might use to address this quality improvement practice gap, and explain why. Be specific and provide examples.
By Day 6 of Week 3
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding upon your colleague’s post and suggesting alternative tools and/or methods your colleague might consider using to address the quality improvement practice gap they selected.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 3 Discussion Rubric
Post by Day 3 of Week 3 and Respond by Day 6 of Week 3
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A Sample Answer For the Assignment: NURS 8302 WEEK 3 Discussion Identifying Practice Gaps for Quality Improvement INSTRUCTIONS PLUS RUBRIC
Title: NURS 8302 WEEK 3 Discussion Identifying Practice Gaps for Quality Improvement INSTRUCTIONS PLUS RUBRIC
Practice gaps are the differences that exist between the current state of practice and its intended state. Practice gaps are a helpful tool for identifying issues in the workplace, mainly when performance is falling short of expectations in a healthcare environment (Flodgren et al., 2019). To ensure that the current state of healthcare practice meets or surpasses the expected practice, quality improvement projects can be constructed upon evaluating practice gaps (Robinson et al., 2020). Since they support advancements in critical areas of healthcare practice, like knowledge, skills, and practice, evaluating practice gaps and the ensuing quality improvement initiatives are crucial (Joshi et al., 2018).
Explanation of How I Would Identify Improvement Practice Gap in My Practice Organization
Practice gaps, as previously stated, represent the discrepancy between what is occurring in practice at the moment and what evidence-based practices recommend should be occurring (Flodgren et al., 2019). Finding practice gaps is a crucial first step toward improving healthcare since it serves as the basis for initiatives aimed at improving quality. Gap analysis is one method of detecting practice gaps. To determine where the deviation is, a gap analysis evaluates current processes and compares them to best practices. A gap analysis describes the discrepancy between what is occurring and what ought to occur, which helps identify a practice gap (Joshi et al., 2018). Utilizing data and research findings is another method for identifying gaps in practice. By comparing best practices with existing practices, one can better discover practice gaps by understanding best practices, which is made possible by research findings (Michel et al., 2019). Among other sources, quality improvement statistics, literature reviews on a range of subjects, national clinical recommendations, patient care audits, and current healthcare trends can all be used to identify research findings (Joshi et al., 2018). A variety of data and information sources, including expert and faculty feedback, participant feedback (including needs assessment results and past CME evaluations), and participant feedback, can also be used to guide the comparison of current practice with best practice to identify practice gaps (Robinson et al., 2020). Practice gaps can also be found through data from the several regulatory agencies that oversee different professions. Understanding how current practice differs from best practice and identifying practice gaps might result from knowledge gathered from pertinent boards and state requirements (Michel et al., 2019).
Potential Quality Improvement Practice Gap that Can Be Use for My DNP Project
Medication administration errors are one possible quality improvement practice gap I might employ for my DNP project. By guaranteeing that healthcare services are safe, effective, timely, equitable, efficient, and patient-centered, a quality improvement project to reduce pharmaceutical errors would improve patient outcomes (Hammoudi et al., 2018). The complexity of pharmaceutical safety is the rationale behind the decision to address this practice gap. Medication prescription and administration are intricate procedures with many potential for error. Medication errors are not only quite likely to occur but also harm patients’ health and general well-being. Therefore, it is imperative to develop a less error-prone system to guarantee that the appropriate drugs are administered to the appropriate patients at the appropriate time (Hammoudi et al., 2018). In addition to improving patient outcomes, this would promote patients’ safety, health, and general well-being. The five rights of medicine administration—the appropriate patient, the proper medication, the right time, the proper dosage, and the correct route—can all lead to pharmaceutical errors (Hammoudi et al., 2018). However, there are times when more than one person ensures these five rights are upheld. Various healthcare experts must be involved in prescribing and administering medications (Jember et al., 2018). System modifications are required to guarantee that the five rights are upheld during the prescription and administration of drugs. It is imperative to address systemic problems, such as system misconfiguration, diversions, lengthy processes, and inadequate training of healthcare staff, that may lead to prescription errors. The quality improvement project aims to develop a pharmaceutical error prevention, mitigation, and reduction system that improves patient safety and healthcare outcomes (Hammoudi et al., 2018).
Two Types of Tools/Methods that I Might Use to Address Quality Improvement Practice Gap
The Plan-Do-Study-Act (PDSA) paradigm can be used in quality improvement projects and research endeavors that seek to positively impact healthcare procedures to achieve desired results. The Institute for Healthcare Improvement has made extensive use of this technique for quick cycle improvement (Joshi et al., 2018). The cyclical nature of affecting and evaluating change is one of this model’s distinctive aspects results (Christoff, 2018). Quality improvement projects are thoroughly vetted to ensure that they achieve the intended goal. It is best achieved by periodic, small-scale PDSAs rather than large, slow ones before system-wide changes are implemented. Establishing a functional or causal relationship between changes in processes (more especially, behaviors and skills) and results is the goal of PDSA quality improvement initiatives. Before applying the PDSA cycles, Langley and colleagues put forward the following three questions: What is the project’s aim? How will it be determined if the objective was accomplished? and (3) How will the objective be attained? The first steps in the PDSA cycle are to identify the type and extent of the issue, the changes that may and should be made, the specific change that needs to be planned, the people who should be involved, the things that should be measured to gauge the change’s impact, and the target audience for the strategy. After that, facts and information are gathered and changes are put into practice. Several important metrics that show success or failure are reviewed to evaluate and interpret the implementation study’s results. Finally, the results are put into practice by either starting the process over or executing the modification.
The VA’s National Center for Patient Safety created the health failure modes and effects analysis (HFMEA) tool for risk assessment. In HFMEA, there are five steps: first, establish the topic; second, put together the team; third, create a process map for the topic, numbering each step and substep in turn; and fourth, carry out a hazard analysis (e.g., determine the reason behind failure modes, assign a score to each failure mode using the hazard scoring matrix, and go through the decision tree analysis) formulate plans of action and goals. When performing a hazard analysis, it is crucial to enumerate all probable and actual failure modes for every process, assess if the failure modes call for additional action, and enumerate all causes for each failure mode when it is decided to move forward. Following the hazard analysis, evaluating the necessary steps and result measurements is critical. This includes outlining what will be removed or regulated and assigning accountability for each new action.
Conclusion
Practice gaps denote a difference between what should be happening in practice and what is currently happening (Flodgren et al., 2019) The identification of practice gaps is an essential building block to advance healthcare as it helps form the foundation for quality improvement projects. One way to identify practice gaps is through gap analysis. A gap analysis includes the evaluation of current practices and compares the same to best practices where the deviation is. A gap analysis informs the identification of a practice gap by outlining the difference between what is happening and what should be happening. One potential quality improvement practice gap that I would look to address is medication errors. The prescription and subsequent administration of medication is a complex process with various points of error. In addition to the high risk for errors, the occurrence of medication errors is detrimental to the patients and adversely affects their health and well-being (Hammoudi et al., 2018) As such, it is critical to come up with a system that is less prone to errors to ensure that the right medications are given to the right patients at the right time (Jember et al., 2018).
References
Christoff, P. (2018). Running PDSA cycles.Current problems in pediatric and adolescent health care,48(8), 198-201.
Flodgren, G., O’Brien, M. A., Parmelli, E., & Grimshaw, J. M. (2019). Local opinion leaders:effects on professional practice and healthcare outcomes.Cochrane Database of Systematic Reviews, (6).
Hammoudi, B. M., Ismail, S., & Abu Yahya, O. (2018). Factors associated with medication administration errors and why nurses fail to report them.Scandinavian Journal of Caring Sciences,32(3), 1038-1046.
Jember, A., Hailu, M., Messele, A., Demeke, T., & Hassen, M. (2018). The proportion of medication error reporting and associated factors among nurses: a cross-sectional study.BMC Nursing,17(1), 1-8.
Joshi, M., Ransom, E. R., Nash, D. B., & Ransom, S. B. (Eds.). (2014). The healthcare quality book: vision, strategy, and Tools. Chicago, IL, USA:: Health Administration Press.
Michel, J., Chimbindi, N., Mohlakoana, N., Orgill, M., Bärnighausen, T., Obrist, B., … & Tanner, M. (2019). How and why policy-practice gaps come about: a South African Universal Health Coverage context.Journal of Global Health Reports,3, e2019069.
Robinson, T., Bailey, C., Morris, H., Burns, P., Melder, A., Croft, C., … & Teede, H. (2020).Bridging the research-practice gap in healthcare: a rapid review of research translation centers in England and Australia.Health research policy and systems,181-17.
A Sample Answer 2 For the Assignment: NURS 8302 WEEK 3 Discussion Identifying Practice Gaps for Quality Improvement INSTRUCTIONS PLUS RUBRIC
Title: NURS 8302 WEEK 3 Discussion Identifying Practice Gaps for Quality Improvement INSTRUCTIONS PLUS RUBRIC
I commend you for wanting to tackle such a complex topic for your DNP project. Medication administration errors occur frequently but are seldom reported due to fear of punishment (Dirik et al., 2018). Medication administration errors are typically thought of as a failure in one of the five “rights” of medication administration (right patient, medication, time, dose, and route). Though some nurses follow the rights and use it thoroughly, mistakes in medication administration error still occur. Hence, four additional “rights” were proposed to include right documentation, action/reason, form, and response (MacDowell et al., 2021). You mentioned addressing issues such as systemic failures, like system misconfiguration, diversions, lengthy processes, and inadequate training of healthcare staff. I believe you are correct in referring to it as a systemic problem/ failure. MacDowell et al. (2021) states that the use of high-tech solutions such as the use of bar code medication administration and smart infusion pumps may assist in the reduction of medication administration errors. I can attest to the reduction in errors after the facility that I work for (HCA Florida Healthcare), recently decided to scan patient first and then the medication. It used to be that the bar code system would allow for the scanning of the medications first. I always believed it was backwards until it was finally fixed. Another problem with scanning bar codes is that nurses tend to use workarounds to solve issues when the patient’s arm band is not readable, the medication is not labeled or not in the system, increasing the risk of medication errors (MacDowell et al., 2021).
References
Dirik, H. F., Samur, M., Intepeler, S. S., & Hewison, A. (2018). Nurses’ identification and reporting of medication errors. Journal of Clinical Nursing, 28(5-6), 931-938. https://doi.org/10.111/jocn.14716Links to an external site.
MacDowell, P., Cabri, A., & Davis, M. (2021). Medication administration errors. Patient Safety Network. Retrieved from https://psnet.ahrq.gov/primer/medication-administration-errorsLinks to an external site.
A Sample Answer 3 For the Assignment: NURS 8302 WEEK 3 Discussion Identifying Practice Gaps for Quality Improvement INSTRUCTIONS PLUS RUBRIC
Title: NURS 8302 WEEK 3 Discussion Identifying Practice Gaps for Quality Improvement INSTRUCTIONS PLUS RUBRIC
Your detailed exploration of practice gaps and the potential quality improvement project focusing on medication administration errors is insightful. Medication errors are indeed a critical area that can significantly impact patient safety and overall healthcare outcomes. I appreciate your emphasis on addressing systemic issues, such as system misconfigurations, diversions, lengthy processes, and inadequate training, to prevent and mitigate these errors.
I would like to suggest an additional tool that you might find beneficial in addressing medication administration errors: the Failure Mode and Effects Analysis (FMEA). This systematic approach allows healthcare teams to proactively identify and prioritize potential failure modes in a process, assess their potential effects, and develop strategies to mitigate or eliminate these failures (Livingood et al., 2020). It can be a valuable complement to your proposed HFMEA tool, providing a comprehensive risk assessment and helping prioritize interventions.
Moreover, in the context of medication errors, barcode medication administration (BCMA) systems have proven effective in reducing errors. Implementing BCMA involves using barcodes on medications and patient wristbands, requiring nurses to scan both before administering medications (Dzidowska et al, 2020). This technology helps ensure that the right patient receives the right medication in the right dose at the right time, aligning with the five rights you mentioned. Integrating BCMA into your quality improvement project could be a practical step toward enhancing medication safety.
I’m interested to hear more about your thoughts on these additional tools and how you plan to integrate them into your quality improvement initiative. Your commitment to improving patient safety through addressing medication administration errors is commendable, and I look forward to hearing about the progress of your DNP project.
References
Dzidowska, M., Lee, K.S.K., Wylie, C. et al. A systematic review of approaches to improve practice, detection and treatment of unhealthy alcohol use in primary health care: a role for continuous quality improvement. BMC Fam Pract 21, 33 (2020). https://doi.org/10.1186/s12875-020-1101-x
Livingood WC, Bilello L, Lukens-Bull K, Smotherman C, Choe U. Implementation Research as Applied Science: Bridging the Research to Practice Gap. Health Promotion Practice. 2020;21(1):49-57. doi:10.1177/1524839919858082
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Content
Name: NURS_8302_Week3_Discussion_Rubric
| Excellent
90–100 |
Good
80–89 |
Fair
70–79 |
Poor
: 0–69 |
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| Main Posting:
Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. |
Points Range: 40 (40%) – 44 (44%)
Thoroughly responds to the Discussion question(s). Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources. |
Points Range: 35 (35%) – 39 (39%)
Responds to most of the Discussion question(s). Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of the post has exceptional depth and breadth. Supported by at least three credible references. |
Points Range: 31 (31%) – 34 (34%)
Responds to some of the Discussion question(s). One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Cited with fewer than two credible references. |
Points Range: 0 (0%) – 30 (30%)
Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references. |
|
| Main Posting:
Writing |
Points Range: 6 (6%) – 6 (6%)
Written clearly and concisely. Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style. |
Points Range: 5 (5%) – 5 (5%)
Written concisely. May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style. |
Points Range: 4 (4%) – 4 (4%)
Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors. |
Points Range: 0 (0%) – 3 (3%)
Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. |
|
| Main Posting:
Timely and full participation |
Points Range: 9 (9%) – 10 (10%)
Meets requirements for timely, full, and active participation. Posts main Discussion by due date. |
Points Range: 8 (8%) – 8 (8%)
Meets requirements for full participation. Posts main Discussion by due date. |
Points Range: 7 (7%) – 7 (7%)
Posts main Discussion by due date. |
Points Range: 0 (0%) – 6 (6%)
Does not meet requirements for full participation. Does not post main Discussion by due date. |
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| First Response:
Post to colleague’s main post that is reflective and justified with credible sources. |
Points Range: 9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. |
Points Range: 8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting. |
Points Range: 7 (7%) – 7 (7%)
Response is on topic and may have some depth. |
Points Range: 0 (0%) – 6 (6%)
Response may not be on topic and lacks depth. |
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| First Response: Writing |
Points Range: 6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. |
Points Range: 5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. |
Points Range: 4 (4%) – 4 (4%)
Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. |
Points Range: 0 (0%) – 3 (3%)
Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. |
|
| First Response: Timely and full participation |
Points Range: 5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation. Posts by due date. |
Points Range: 4 (4%) – 4 (4%)
Meets requirements for full participation. Posts by due date. |
Points Range: 3 (3%) – 3 (3%)
Posts by due date. |
Points Range: 0 (0%) – 2 (2%)
Does not meet requirements for full participation. Does not post by due date. |
|
| Second Response: Post to colleague’s main post that is reflective and justified with credible sources. |
Points Range: 9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. |
Points Range: 8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting. |
Points Range: 7 (7%) – 7 (7%)
Response is on topic and may have some depth. |
Points Range: 0 (0%) – 6 (6%)
Response may not be on topic and lacks depth. |
|
| Second Response: Writing |
Points Range: 6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. |
Points Range: 5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. |
Points Range: 4 (4%) – 4 (4%)
Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. |
Points Range: 0 (0%) – 3 (3%)
Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. |
|
| Second Response: Timely and full participation |
Points Range: 5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation. Posts by due date. |
Points Range: 4 (4%) – 4 (4%)
Meets requirements for full participation. Posts by due date. |
Points Range: 3 (3%) – 3 (3%)
Posts by due date. |
Points Range: 0 (0%) – 2 (2%)
Does not meet requirements for full participation. Does not post by due date. |
|
| Total Points: 100 | |||||
Name: NURS_8302_Week3_Discussion_Rubric
NURS 8302 WEEK 3 Discussion Identifying Practice Gaps for Quality Improvement INSTRUCTIONS PLUS RUBRIC Grading Rubric Guidelines
| Performance Category | 10 | 9 | 8 | 4 | 0 |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic decisions. |
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| Performance Category | 10 | 9 | 8 | 4 | 0 |
| Application of Course Knowledge –
Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations |
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| Performance Category | 5 | 4 | 3 | 2 | 0 |
| Interactive Dialogue
Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. (5 points possible per graded thread) |
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Summarizes what was learned from the lesson, readings, and other student posts for the week. |
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| Minus 1 Point | Minus 2 Point | Minus 3 Point | Minus 4 Point | Minus 5 Point | |
| Grammar, Syntax, APA
Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition |
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| 0 points lost | -5 points lost | ||||
| Total Participation Requirements
per discussion thread |
The student answers the threaded discussion question or topic on one day and posts a second response on another day. | The student does not meet the minimum requirement of two postings on two different days | |||
| Early Participation Requirement
per discussion thread |
The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week. | The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT. |