NURS FPX 6212 Assessment 1 Quality and Safety Gap Analysis

NURS FPX 6212 Assessment 1


Capella University


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25, March 2024

NURS FPX 6212 Assessment 1: Quality and Safety Gap Analysis

The research looked at how six sizable, publically financed surgical trials in England were implementing effective results. It sought to explain how and why, in light of the data from these studies, surgical practices changed (or remained the same examined if changes in surgical procedures financed by the NHS in England between 2001 and 2020 were consistent with the trial results. To ascertain the causes of the noted practice changes—or lack thereof—25 participants—trial authors, surgeons, and medical staff—were interviewed online. Exercise After a stroke, percutaneous vs. nasogastric tube feeding (changed after ten years). Resurfacing of the patella (modification expected based on trial results). Repair an abdominal aortic aneurysm (modifications followed by changing evidence) (Kelly Ann Schmidtke et al., 2022). Nasogastric tube feeding following a stroke during three trials (change took ten years).Resurfacing of the patella (modification expected based on trial results). Two studies on varicose veins (one of which was replaced by another).A single study on reflux disease (fewer surgical referrals as a result of more accessible medical care). Causes of Not Adopting: Surgeons took into account material from several sources outside of the particular trial under consideration, according to interviews. This explains why several trials had no discernible effect on practice.

Results from a single experiment taken out of context are not usually applied to surgical practice. The entirety of the information, including current studies and other treatment choices, is taken into account by decision-makers. The study indicates that over time, healthcare practitioners do consider the data from clinical trials, even if not all studies result in rapid changes to practice. A&F therapies have been demonstrated to be successful in enhancing adherence to medical guidelines in randomized controlled trials (RCTs). Still, not much was known about their cost-effectiveness.

The purpose of this study is to determine whether or not A&F interventions are more cost-effective than either deploying fewer or less extensive treatments. Methods: Up till December 2021, studies published were analyzed in a systematic review. Major economic and medical databases were combed for research assessing the financial viability of A&F treatments for healthcare practitioners. The research examined the effects of A&F interventions in comparison to “usual care” or treatments that lacked certain A&F elements. 35 studies (out of 13,221 examined) satisfied the requirements for inclusion. Seven research revealed that A&F therapies were, Dominant (more cost-effective and effective). In 26 investigations, potentially cost-effective. dominated (more expensive and less effective) in two investigations. monitoring health results (rather than only following recommendations). weighing the costs of interventions as well as medical care. research works released after 2010. According to this study, A&F treatments may be a cost-effective way to raise the standard of care. However, the real cost-effectiveness may be overestimated due to publication bias, which occurs when research with good results is more likely to be published (Moore et al., 2022).


NURS FPX 6212 Assessment 1: Identifying Systemic Challenges in Organizational Quality and Safety Outcomes

The cost-effectiveness of Audit and Feedback (A&F) interventions for healthcare professionals was investigated in a systematic study. The goal of these treatments is to increase adherence to suggested practices. Although RCTs have demonstrated the effectiveness of A&F, less is known about its financial advantages. Using searches of important medical and economic databases, researchers examined papers released up until December 2021. They contrasted A&F interventions with less thorough methods or standard treatment. Results showed encouraging trends. A&F interventions were often more prevalent, more cost-effective, and/or potentially cost-effective. Nevertheless, some research revealed that they were more costly and less effective. It’s interesting to note that elements like taking into account all pertinent expenditures and evaluating health outcomes (rather than merely following guidelines) appeared to be linked to a better potential for cost-effectiveness (Dowd et al., 2023). Furthermore, research conducted after 2010 and with excellent reporting quality tends to provide better economic results for A&F interventions. According to the review, A&F treatments may be practical and cost-effective methods for raising the standard of healthcare. It does, however, recognize the possibility of publication bias, in which research showing promise is more likely to be published, thereby inflating the actual cost-effectiveness of A&F. Analgesics, which are drugs used to treat pain, might be dangerous for senior citizens living in residential care homes. To the 2021 criteria established by the Society for Post-Acute and Long-Term Care Medicine (AMDA), the purpose of this study was to identify residents who would require a review of their existing pain management strategy (Jung et al., 2022).


NURS FPX 6212 Assessment 1: Proposing Practice Changes to Enhance Quality and Safety Outcomes in Organizations

Investigated the discrepancy between the utilization of ERPs in the real world and their proven advantages. Researchers looked at tried-and-true implementation techniques, suggested a fresh adoption paradigm, and noted typical implementation challenges with ERP. The evaluation emphasizes that following best practices alone is not enough for an ERP deployment to be effective. It highlights how crucial “soft skills” like team dynamics, leadership, and emotional intelligence are to developing an environment that supports and encourages the use of ERP. According to the study’s findings, surgeons must acquire new abilities and tactics to guide their teams toward attaining broad and long-lasting adherence to ERP best practices. This research was conducted in a sizable Irish university teaching hospital. According to a risk assessment, the way critically sick children are now transported between hospitals does not adhere to national and international best practices. The initiative offered a complete solution to close this gap and raise the standard of service.

The project’s main goal was to give newborn nurses access to a universal Paediatric Advanced Life Support Programme (PALS). The goal of this educational program was to guarantee that nurses had the necessary clinical competencies for safe and efficient pediatric transport, as well as to upskill them. The initiative recognized the significance of implementing change management concepts and cultivating a supportive hospital culture. This pediatric quality improvement program shows how education may greatly enhance the safety and quality of critically sick child transportation by setting benchmarks against best practices. To ensure constant improvement in patient outcomes, the initiative also suggests continuing observation and evaluation of clinical standards in pediatric transport. Maternal-child care, which includes preconception, pregnancy, delivery, postpartum recuperation, and the years spent raising children, is an essential element of primary healthcare. In this field, registered nurses are essential since they need to possess the knowledge and abilities to offer families evidence-based treatment in a variety of settings. Nonetheless, there are difficulties in training nurses in this area.

There is a dearth of perinatal and child health care professionals, and the rivalry for clinical placements, falling birth rates, shifting choices for birthing, and greater outpatient treatment are making it harder to offer these services. Many recent grads feel unprepared for mother-child care as a result. Simulation-based learning shows itself to be a viable remedy. It adds practical skills to theoretical information in a secure setting where students may practice and get feedback. This method provides practice opportunities and consistent experiences. This method provides regular experiences and facilitates the practice of a variety of abilities, including delegation, teamwork, and communication. It may also emphasize safety and quality capabilities. More study is required since no systematic studies that examine the qualitative experiences of educators and students using mother-child simulation have been done before. The purpose of this study is to determine whether or not incorporating simulation into nursing education programs is suitable and relevant (Aloia et al., 2019). 

NURS FPX 6212 Assessment 1: Prioritizing Proposed Practice Changes for Enhanced Quality and Safety Outcomes

A “simulation-based learning exercise” is defined by the International Nursing Association for Clinical Simulation and Learning as the particular educational strategy that will be the subject of this review. Studies that employ simulation for instruction in undergraduate nursing programs, pre-registration, pre-licensure, or other pertinent programs for healthcare professionals will be examined by researchers. It establishes maternal-child nursing, which covers care given to a child throughout the first five years of life as well as during pregnancy and delivery. This includes the settings of prenatal, neonatal, and pediatric care. Research on older kids, teenagers, or young people won’t be included. This speaks to the aspects that make simulation an appropriate teaching tool and the degree to which it may be included in undergraduate nursing education programs. Here, we’re talking about the perspectives and experiences of students who take part in simulation-based. The goal of the research was to comprehend the benefits of SBL for teachers and students alike. They concentrated on how instructors may successfully incorporate it into the curriculum and how well it prepares pupils. Participants or instructors in undergraduate nursing programs, pre-nursing programs, or healthcare professional programs. Methods of qualitative research concentrated on simulated experiences in mother-child care education. Research done and published between 2000 and 2016 in North America, Europe, Australia, and New Zealand. After taking part in SBL, students said they felt more equipped for situations they would face in the real world. However, when simulation was employed as a means of assessment, some people felt anxious. Realistic scenarios, a secure learning environment, continuous assistance, and curriculum alignment were all components of effective SBL techniques. Faculty training, technological access, and budget constraints were obstacles to SBL integration. such as developing relationships that cannot entirely be replicated. Particularly for less frequent cases, simulation-based learning can boost students’ confidence in managing mother-child healthcare issues. Careful preparation and attention to educational factors are necessary for effective implementation. Although there may be obstacles due to a lack of resources, there might be substantial learning gains for students. 

Fostering a Culture of Quality and Safety Through Proposed Practice Changes

The healthcare environment requires more qualified medical personnel who can handle issues related to both cost and quality. Programs for graduate medical education (GME) must change to give residents, or housestaff, the abilities and information to spearhead quality improvement (QI) projects. The existing QI curriculum in GME is frequently ineffectual, despite the potential advantages for both trainees and institutions. people’s demands and origins are diverse. inadequate backing for learning through systems-based and real-world experience. Rethinking how institutions handle QI education is necessary for meaningful GME change, particularly in terms of improving resident learning environments.

Here are various methods to make this happen Create an institutional QI curriculum that is standardized for all training levels and specializations to guarantee that all residents are held to the same standards. The healthcare environment requires more qualified medical personnel who can handle issues related to both cost and quality. Programs for graduate medical education (GME) must change to give residents, or housestaff, the abilities and information to spearhead quality improvement (QI) projects. General surgery residencies will need to exhibit success in both clinical outcomes and quality improvement (QI) teaching to be eligible for new certification from the Certification Council for Graduate Medical Teaching. The present status of the QI curriculum in surgical training programs was examined in this research conducted by the American College of Surgeons. Researchers used databases including Embase, PubMed, and Google Scholar to perform a systematic evaluation of material published between January 2000 and March 2013. A surgical QI curriculum, according to their definition, is an organized course of study that includes certain teaching strategies, material, and evaluation resources for residents.

Two unbiased reviewers evaluated the indicated surgical curricula’s quality. Just 50 of the 1155 evaluated references made reference to QI in graduate medical education. Nearly half of the studies examined QI instruction in non-surgical disciplines. Out of the 31 curriculum designs that were found, only 6 were specifically for surgical training. Few programs provide QI instruction to all residents; most curricula target residents past their second year of training. The most popular instructional strategies included talks and slideshows. Although several curricula incorporated quality improvement methods such as Plan-Do-Study-Act (PDSA) and Root Cause Analysis, fewer than 25% of the program made use of proven evaluation techniques. The study found that surgical education already has certain components of a QI curriculum, but there is a dearth of complete and consistent information. The authors suggest creating a data-driven national QI curriculum for surgical residency programs by expanding on the strengths found in this research (Medbery et al., 2021).

NURS FPX 6212 Assessment 1: Impact of Organizational Culture and Hierarchy on Quality and Safety Outcomes

Employees were trained in safe behaviours, root cause analysis, and safety concepts. Clinical teams and risk management worked together to recognize and mitigate potential hazards. Accurate tracking was assured by standardized labelling and classification of major safety occurrences. Various safety indicators were implemented to track advancements and pinpoint opportunities for enhancement. A new hierarchy of command was established to support safety programs. Details of data and safety incidents were shared freely throughout the facility. An estimated 68% fewer significant safety occurrences occurred. Compliance rates rose significantly for many quality metrics, including asthma management procedures and the avoidance of pneumonia associated with ventilator use (Groene et al., 2020). Throughout the campaign, there were only two pharmaceutical mistakes that resulted in significant injury. If this initiative is successful, other pediatric hospitals may use it as a model, which would raise the bar for children’s safety across the country. Because of the program’s success, a comparable patient safety effort is currently being implemented throughout the Spectrum Health system, which employs over 16,000 people.

Using a multi-level approach, the research will look at hospitals, hospital departments, and individual patients. A variety of techniques, including questionnaires, patient surveys, standard hospital data analysis, and audits of patient records, will be used to gather data. Using a cross-sectional methodology, researchers will collect data all at once. Hospitals from eight European nations will be chosen at random. To provide for a more thorough investigation, the study will concentrate on four distinct medical conditions: hip fracture, heart attack, stroke, and delivery. In addition, skilled outside evaluators will visit hospitals to provide an initial assessment of their quality improvement frameworks. A range of statistical techniques will be employed to examine the gathered information. Whereas data reduction techniques handle massive datasets for better interpretation, descriptive statistics will provide an overview of the material.

NURS FPX 6212 Assessment 1:

By using psychometric analysis, the validity and reliability of the measuring instruments will be guaranteed. Relationships between various variables will be investigated by bi- and multivariate analysis. You may learn more about how different factors affect patient outcomes by using causal diagrams and outcome models. To reduce the influence of any potential biases in the research, bias analysis will be done in the end. The project’s two main deliverables are to be produced. Initially, a quality improvement toolkit will be created, providing hospitals with an assortment of materials and instruments to construct their own safety and quality initiatives. Second, a system for evaluating maturity will be developed. This will make it possible for medical facilities and healthcare buyers to assess how well a hospital’s quality improvement program is working  (Peterson et al., 2022).

Justifying Necessary Organizational Changes to Correct or Mitigate Adverse Quality and Safety Outcomes

The goal of biomedical research is to make people healthier. Scientists have historically ranked topics that require research and critiqued one other’s work. However, some businesses use the following tactics in industry-funded health research. Steering clear of conventional scientific analysis dominates the objectives of research. There is proof that these strategies frequently benefit industrial items. This problem is exacerbated by public policies that support business interests. A brand-new idea called structural conflict of interest (COI) is put forth to comprehend the influence on research goals. This describes circumstances, such as intellectual monopolies, in which commercial entities wield excessive power. These agreements may result in monetary resources putting industry priorities first excluding other areas of interest in research insufficient public return on investment There are currently no systems in place for Taking note of popular issues Taking up ethical concerns Keeping societal and private interests in balance Research-only approaches to product clearance can also Ignore aspects of environmental and social health, Reduce regulatory safeguards by hiding advantages and hazards (Greco & Diniz., 2020). Real-world data from five hospitals in the same healthcare system were examined in this study. Hospital-acquired bleeding complications rates of heparin-induced thrombocytopenia (a complication of a specific anticoagulant), physician-reported medication reactions, and abnormal test results related to medication toxicity were the four key metrics that researchers compared one year prior and one year later EMR implementation.

The study found that after the use of EMRs, hospital-acquired bleeding problems significantly decreased. This implies that EMR systems have the potential to enhance patient outcomes for those undergoing anticoagulant treatment. Nevertheless, the eMMS’s design is really important. According to the examination of HACs following EMR adoption, furthermore, eMMS design advancements may be able to reduce difficulties even more. Potentially useful areas for development were highlighted by the researchers as automated clinical decision assistance and improved integration of pathology test data. It is noteworthy that the average monthly rate of medication events reported by clinicians and abnormal test findings associated with drug toxicity did not significantly alter. The study also found that the use of EMR led to a 62.5% decrease in occurrences of heparin-induced thrombocytopenia. To sum up, the use of electronic medical record systems can help patients undergoing anticoagulant medication achieve better results. However, improving these systems’ designs is crucial to maximizing safety and care quality (Redman., 2023).

Effective Communication of Analytical Data and Information with Correct Grammar and Mechanics

For scientists researching the chronology of events in the history of life, chronograms, also known as evolutionary time trees, are essential resources. The branch lengths in these representations signify the passage of time and show the links between different species. Chronograms are essential to many scientific fields, from understanding extinction events to guiding conservation efforts. Nevertheless, creating a chronogram of superior quality requires a great deal of effort and time. A new software application called DateLife takes on this problem. DateLife provides several essential functions. A user-friendly web application and an R package are also available (Román-Palacios et al, 2018). Conveniently retrieves, condenses, and reanalyses previously collected chronogram data from a carefully selected collection of publicly accessible, expert-reviewed sources. Users input one or more species’ scientific names. DateLife finds pertinent chronograms with at least two of the requested species and standardizes the names before searching its database. The user is shown extracted chronograms along with their associated information. DateLife maps node ages (evolutionary divergence periods) from matched chronograms onto a user-supplied or pre-constructed reference tree using a congruency algorithm. Although deeper nodes could show larger fluctuations, cross-validation studies verify that DateLife’s node time estimations are in line with those from the original chronograms. The calibre of the input chronograms determines the calibre of DateLife’s output. Users ought to take into account the data’s possible biases as well as the source (Sánchez et al., 2024).

NURS FPX 6212 Assessment 1: Conclusion

The papers included in this compilation show several facets of healthcare quality and safety improvement. Better patient outcomes are the common objective of these initiatives, which range from examining the efficacy of educational treatments to assessing the influence of corporate culture. Although studies on Audit and Feedback (A&F) treatments show promise in enhancing adherence to best practices, they also highlight the importance of thorough cost-effectiveness analysis and taking publication bias into account. Similar to this, research on simulation-based learning for nurses and residents emphasizes how it may improve safety and practical abilities while also pointing out the need for more study before using it more widely. Research examining the discrepancy in quality between surgical trial outcomes and actual clinical practices emphasizes how crucial it is to take into account all pertinent data and promote an ongoing learning environment (Mollentze et al., 2022). Furthermore, studies on how structural conflicts of interest affect research objectives highlight the necessity of strong protections to guarantee that public health agendas are given top priority. All things considered, these studies offer insightful information to educators, legislators, and healthcare professionals who want to raise the standard and safety of healthcare delivery. To achieve the best possible patient results, they emphasize the significance of evidence-based practices, a dedication to lifelong learning, and a collaborative culture(Arturo Torres Ortiz et al., 2023).

NURS FPX 6212 Assessment 1: References

Tao, R., Cheng, X., Gu, L., Zhou, J., Zhu, X., Zhang, X., Guo, R., Wang, W., & Li, B. (2024). Lipidomics reveals the significance and mechanism of the cellular ceramide metabolism for rotavirus replication. Journal of Virology.


Sánchez, L. L., Emily Jane McTavish, & O’Meara, B. (2024). DateLife: leveraging databases and analytical tools to reveal the dated Tree of Life. Systematic Biology. https://doi.org/10.1093/sysbio/syae015

Dowd, L. A., Cross, A. J., Liau, S. J., Jadczak, A. D., Renuka Visvanathan, Veal, F. C., & J Simon Bell. (2023). Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services. Drugs & Aging, 40(5), 449–459. https://doi.org/10.1007/s40266-023-01025-5

Arturo Torres Ortiz, Kendall, M., Storey, N., Hatcher, J., Dunn, H., Roy, S., Williams, R. C., Williams, C. A., Goldstein, R. A., Didelot, X., Harris, K., Breuer, J., & Grandjean, L. (2023). Within-host diversity improves phylogenetic and transmission reconstruction of SARS-CoV-2 outbreaks. ELife, 12. https://doi.org/10.7554/elife.84384

Redman, B. K. (2023). Rebalancing commercial and public interests in prioritizing biomedical, social, and environmental aspects of health through defining and managing conflicts of interest. Frontiers in Medicine, 10. https://doi.org/10.3389/fmed.2023.1247258

Kelly Ann Schmidtke, Evison, F., Grove, A., Kudrna, L., Tucker, O., Metcalfe, A. J., Bradbury, A. W., Bhangu, A., & Lilford, R. (2022a). Surgical implementation gap: an interrupted time series analysis with interviews examining the impact of surgical trials on surgical practice in England. BMJ Quality & Safety, 32(6), 341–356. https://doi.org/10.1136/bmjqs-2022-015077

Jung, M., Cangadis‐Douglass, H., Nielsen, S., Lalic, S., Dobbin, M., Russell, G., Prathivadi, P., Wood, P., Manias, E., Lee, C. Y., Arnold, C., Kuleas, M., Schumann, J. L., Ilomäki, J., & Bell, J. S. (2022). What are the research priorities for optimizing the safe and effective use of opioids in Australian general practice? Drug and Alcohol Review, 42(3), 604–613. https://doi.org/10.1111/dar.13539

Moore, L., Guertin, J. R., Tardif, P.-A., Ivers, N. M., Hoch, J., Conombo, B., Antony, J., Stelfox, H. T., Berthelot, S., Archambault, P., Turgeon, A., Gandhi, R., & Grimshaw, J. (2022). Economic evaluations of audit and feedback interventions: a systematic review. BMJ Quality & Safety, 31(10), 754–767. https://doi.org/10.1136/bmjqs-2022-014727

Amimo, J. O., Raev, S. A., Chepngeno, J., Mainga, A. O., Guo, Y., Saif, L., & Vlasova, A. N. (2021). Rotavirus Interactions With Host Intestinal Epithelial Cells. Frontiers in Immunology, 12https://doi.org/10.3389/fimmu.2021.793841

Aloia, T. A., Keller, D. S., Kowalski, R. B., Lin, H., Luciano, M. M., Myers, J. A., Sinha, P., Spaniolas, K., & Young-Fadok, T. M. (2019). Enhanced recovery program implementation: an evidence-based review of the art and the science. Surgical Endoscopy, 33(11), 3833–3841. https://doi.org/10.1007/s00464-019-07065-6


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