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Assessment Description
In this assignment, you will propose a quality improvement initiative from your place of employment that could easily be implemented if approved. Assume you are presenting this program to the board for approval of funding. Write an executive summary (750-1,000 words) to present to the board, from which the board will make its decision to fund your program or project. Include the following:

The purpose of the quality improvement initiative.
The target population or audience.
The benefits of the quality improvement initiative.
Interprofessional collaboration that would be required to implement the quality improvement initiative.
The cost or budget justification.
The basis upon which the quality improvement initiative will be evaluated.
You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

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Solution

A Quality Improvement Initiative Proposition: Installation of a Clinical Decision Support (CDS) System

A computerized clinical decision support system (CCDSS) is a technological solution to the practice quality problem of care fragmentation and medical errors. It is a system that is integrated with the organization’s electronic health record (EHR) system to help providers in decision making about treatment. For instance, the CDS will alert the clinician to a patient’s allergies if they attempt to prescribe a medication such as penicillin to which the patient is allergic and the data is available in the EHR system. The CDS can also give suggestions on the best possible medication combinations for treating a particular ailment based on the algorithms already fed into the system following clinical guidelines and recommendations (AHRQ, 2019; Taber et al., 2021). The purpose of this executive summary is to present a proposition for the installation of a CDS system to reduce care fragmentation and facilitate care coordination at a healthcare setting.

Purpose of the Quality Improvement (QI) Initiative

The main purpose of the QI initiative is to facilitate care coordination, prevent care fragmentation, and also prevent errors in prescription. Care fragmentation occurs for instance when a clinician orders for a laboratory or radiologic investigation that had already been done by the patient. With no system to alert the provider that this test had already been done, the patient will go ahead and do it again. The implications of this are far-reaching. First, the patient will incur unnecessary extra healthcare costs. Second, the test may involve exposure to radiation (or example) and so the patient may receive unnecessarily high doses of harmful radiation. Clearly, this goes against the bioethical principle of nonmaleficence as espoused by Beauchamp and Childress (Haswell, 2019).

The Target Audience for the QI Initiative

The targeted audience or population for the QI initiative is clinicians who are the prescribers and decision makers on treatments and interventions. In this particular healthcare setting, this includes advanced practice registered nurses (APRNs) such as family nurse practitioners or FNPs, physicians, and physician assistants (PAs). These are the providers that will use the EHR system to prescribe treatments to the patient based on subjective information, objective findings, investigations and tests, and previous records.

As a matter of course, the above prescription has to take place in the organization’s EHR. This is made possible by the Computerized Provider Order Entry or CPOE interface that facilitates the prescription (Alotaibi & Federico, 2017). According to the law and regulatory requirements, there is no other way that the provider can legally prescribe treatment except this way. The law that mandates the use of EHRs in all healthcare settings is the Health Information and Technology for Economic and Clinical Health or HITECH Act (Sweeney, 2017).

Benefits of the Quality Improvement Initiative

The benefits of the quality improvement initiative are many and very critical. They can be enumerated as follows:

  1. Prevention of never events such as medication-induced anaphylactic shock because the clinician did not know that the patient was allergic to the medication.
  2. Prevention of drug interactions by reminding the clinician of the medications the patient is already on that may interact with the one being prescribed.
  • Prevention of adverse reactions of medications from the prescription of the same or similar medications with the same mode of action.
  1. Prevention of duplicate laboratory and radiologic tests and examinations.
  2. Reduction of healthcare costs for the patient as well as the length of hospital stay.
  3. Improvement of patient safety and overall patient outcomes.

Required Interprofessional Collaboration for the Implementation of the Initiative

In order for this quality initiative to be successfully implemented, there will have to be close interprofessional collaboration among a number of professionals. These professionals will be under the leadership of the project manager who will by default be the organization’s nurse informaticist (Sipes, 2016). She will collaborate closely interprofessionally with the application analyst, the software engineer, the quality assurance test engineer, the various nurse leaders, departmental heads, physicians, nurse practitioners, physician assistants, the pharmacist, and nurses (Vant, 2017; Vivian & Edward, 2019).

The Cost Justification

The implementation of any technological solution that involves innovative healthcare technologies is an expensive affair. However, in the case of this CDS system, this cost is justified completely. This can be appreciated from the perspective of what the organization would spend were the errors it will prevent to occur. For instance, a breach of patient safety through any of the never (sentinel) events such as severe drug interactions may result in a malpractice suit for the tort of negligence (Buppert, 2021). This can cost the organization tens of thousands of dollars in remedial compensation from court rulings.

Basis for Evaluation of the QI Initiative

This quality improvement initiative of the CDS system will be evaluated on the basis of data relating to a number of EHR dashboard performance indicators or outcome measures (McGonigle & Mastrian, 2017). These will include:

  • The length of hospital stay.
  • The rate of readmissions within 30 days of discharge.
  • The number of prescription errors.
  • The number of reported sentinel events.

Conclusion

QI initiatives are fundamental for the provision of quality healthcare. This has a direct effect on the organization’s bottom line and reputation. The integration of a CCDSS in this organization’s EHR system will go a long way in safeguarding the reputation of the institution and preventing it from incurring losses due to lawsuits stemming from the tort of negligence.

References

Agency for Healthcare Research and Quality [AHRQ] (2019). Clinical Decision Support. https://www.ahrq.gov/cpi/about/otherwebsites/clinical-decision-support/index.html

Alotaibi, Y., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631

Buppert, C. (2021). Nurse practitioner’s business practice and legal guide, 7th ed. Jones & Bartlett Learning.

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

McGonigle, D., & Mastrian, K.G. (2017). Nursing informatics and the foundation of knowledge, 4th ed. Jones & Bartlett Learning.

Sipes, C. (2016). Project management: Essential skill of nurse informaticists. Nurse Informatics, 252-256. https://doi.org/10.3233/978-1-61499-658-3-252

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics (OJNI), 21(1). https://www.himss.org/library/healthcare-informatics

Taber, P., Radloff, C., Del Fiol, G., Staes, C., & Kawamoto, K. (2021). New standards for clinical decision support: A survey of the state of implementation. Yearbook of Medical Informatics, 159-171. http://dx.doi.org/10.1055/s-0041-1726502

Vant, A. (2017). Four crucial members of an EHR implementation team. EHR In Practice. https://www.ehrinpractice.com/four-crucial-members-of-an-ehr-implementation-team-154.html 

Vivian, S., & Edward, B. (2019). Building informatics-savvy health departments: The systems development life cycle. Journal of Public Health Management and Practice, 25(6), 610-611. https://doi.org/10.1097/PHH.0000000000001086

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