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Quality and Safety in Nursing. Группа авторов
Читать онлайн.Название Quality and Safety in Nursing
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isbn 9781119684459
Автор произведения Группа авторов
Жанр Медицина
Издательство John Wiley & Sons Limited
Textbox 1.1 Summary: The Institute of Medicine Quality Chasm Series
To Err Is Human: Building a Safer Health System (2000)This first IOM report presented the first aggregate data on the depth and breadth of quality and safety issues in US hospitals. Analysis of outcomes from hospitals in Colorado and Utah reported that 44,000 people die each year because of medical errors, while in New York hospitals there are 98,000 deaths. More people die annually from medical error than from motor vehicle accidents, breast cancer, or AIDS. Medical errors are the leading cause of unexpected deaths in health care settings. Communication is the root cause of 65% of sentinel events. The report presents a strategy for reducing preventable medical errors with a goal of a 50% reduction over five years.
Crossing the Quality Chasm: A New Health System for the 21st Century (2001)Recognizing health care organizations as complex systems, the report offers system recommendations to achieve sweeping reform of the American healthcare system: quality problems are pervasive and costly; problems are embedded in the systems themselves, not workers; and major system redesigns hold the most potential for improvement. A set of six health care performance expectations measure patient care outcomes in the STEEEP model (Figure 1.1). Measures of these six aims align incentives for payment and accountability based on quality outcomes.
Health Professions Education: A Bridge to Quality (2003)Education is declared as the bridge to quality based on five competencies identified as essential for health professionals of the twenty‐first century: patient‐centered care, teamwork and collaboration, evidence‐based practice, quality improvement (and safety, later added as a sixth competency), and informatics. Recommendations include developing a common language to use across disciplines, integrating learning experiences, developing evidence‐based curricula and teaching approaches, initiating faculty development to model the core competencies, and implementing plans to monitor continued proficiency in the competencies.
Keeping Patients Safe: Transforming the Work Environment of Nurses (2004)The 2004 IOM report links nurses’ work environment with patient care safety and quality. Key recommendations helped shaped nurses’ roles in quality and safety, including the importance of creating a satisfying and rewarding work environment, a learning environment, adequate staffing, support from organizational governing boards, and trust between nurses and organizational leaders. Nurses want a voice in shaping the guidelines and policies for their work to incorporate evidence‐based best practices, effective leadership, and interdisciplinary collaboration.
Identifying and Preventing Medication Errors (2006)Medication errors make up the largest category of error, with as many as 3–4% of US patients experiencing a serious medical error while hospitalized, representing huge economic consequences. A national agenda for reducing medication errors would require collaboration from doctors, nurses, pharmacists, the Food and Drug Administration and other government agencies, hospitals and other health care organizations, and patients.
The second report, Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001), issued recommendations for sweeping changes in health care systems and proposed the STEEEP model for system changes (Figure 1.1). Goals for system changes are outlined in four recommendations that have spurred many initiatives but few broad overarching improvements and still no national leadership group:
Create a national focus through leadership, research, tool kits, and protocols to enhance knowledge about safety.
Identify and learn from errors by establishing a vigorous error‐reporting system to ensure a safer health care system.
Increase standards and expectations for safety improvements through oversight groups, professional organizations, and health care purchasers.
Improve the safety system within health care organizations to ensure that care improves.
The STEEEP model provides a roadmap for care that is safe, timely, effective, efficient, equitable, and patient centered. Still a relevant performance model, these aims provide the measures of quality and accountability that continue to elude health care, particularly considering the impact of social determinants of health inherent in these measures that continue to present inequalities across health care. Measures from the STEEEP model illustrate how health care system fragmentation and decentralization are barriers to safe quality care. Although the United States spends more than any other country on health care, the system has significant shortcomings, across measures of efficiency, quality, access, safety, and affordability (Kurani and Cox, 2020). For example, patients may see multiple providers who may not be able to share critical patient information due to a lack of technology infrastructure, or providers have a feeling of ownership that precludes sharing information or seeking consultation. Although most data are based on acute care in patient settings, errors in physician offices, outpatient settings, nursing homes, and patient homes are even more troubling due to less oversight, fewer reporting structures, and lack of accountability.
Figure 1.1 2018 Global update on 2001 IOM STEEEP model of health care quality.
Sources: National Academy of Medicine, 2018, Institute of Medicine, 2001, Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC.
Education was recognized as the necessary intervention for improving systems of care in the 2003 IOM report, Health Professions Education: A Bridge to Quality. The report outlined a radical redesign for all health professional education to emphasize six core competencies essential for improving twenty‐first‐century health care: patient‐centered care, teamwork and collaboration, evidence‐based practice, quality improvement, safety, and informatics. To integrate the six competencies into nursing, the Robert Wood Johnson Foundation funded the QSEN project, described later in this chapter and more fully in Chapter 3.
Two additional IOM reports, Keeping Patients Safe: Transforming the Work Environment of Nurses (IOM, 2004) and Identifying and Preventing Medication Errors (Aspen et al., 2007), examined the impact of the work environment on quality safe nursing care and the magnitude of medication safety. Nurses are key to improving quality and safety: they are the largest segment of the health care workforce and spend the most time with patients. The 2004 report illustrated how working conditions, environment, leadership support, human factors, roles in decision‐making, and workforce influence safe quality care and stimulated further study on the link between working conditions and relationships on quality and safety outcomes discussed later in the chapter.
Nurses have a central role in medication safety, a complex intervention examined in the fifth book in the series (Aspen et al., 2007). Medication errors are the single largest category of mistakes and often result from interruptions, distractions, poor processes, staffing, and lack of team collaboration of those involved in the medication administration trajectory. On average, inpatients may experience at least one medication error per day. Medication errors account for over 7,000 deaths annually. The US Food and Drug Administration (FDA) investigates more than 100,000 US reports each year of suspected medication errors (https://www.fda.gov/drugs/information‐consumers‐and‐patients‐drugs/working‐reduce‐medication‐errors).