Quality Improvement Project for Patient Prescription Record

Quality Improvement Project for Patient Prescription Record The aim of this quality improvement project is to ensure that nurses record in the designated box on patients Prescription and administration record (to be referred to as: Kardex) if High Dose Antipsychotics Monitoring is Applicable YES or NO (to be referred as: applicable Y/N) and subsequently if yes, that the High Dose Antipsychotic Therapy monitoring form (to be referred to as: Monitoring form and the Early Warning Signs (EWS) Form have been activated for completion. The purpose of this is to secure patient safety from the side effects of the medication. There is widespread evidence which clearly links antipsychotic medication contributing to physical health problems such as cardiovascular problems, weight gain, endocrine problems, metabolic syndrome and sudden death (Gumber et al, 2010; Churchword et al, 2009; Tyson et al, 1999). Many premature deaths of people with serious mental illness are due to poor medical care that fails to monitor risk factors which may be due to side effects of medication (Cohen Hove, 2001). A council report by the Royal College of Psychiatrists (2006) revealed that past audits of high dose antipsychotic prescribing for in- patients showed poor adherence to monitoring recommendations. All patients on high dose antipsychotic treatment must be monitored. These guidelines attempt to clarify the identification of patients on high dose antipsychotics, factors to be taken into account before such prescribing and the documentation required when antipsychotics are prescribed in high dose; furthermore it is a polic y requirement of Forth Valley that this documentation is completed for these patients (Forth Valley, 2011). The charge nurse highlighted a concern when evaluating the patients Kardex audit, it showed 100% non-compliance for the completion of the Yes/No response for high dose antipsychotics monitoring. Subsequently when the patients are receiving high dose antipsychotics, there was inconsistency of the completion of the Therapy monitoring form and EWS form. A recent audit of patient Kardexes confirmed the charges nurse finding (see Pareto chart, Appendix B). To begin the process of the quality improvement project, a general ward meeting was held and attended by all staff in the ward that was on shift. During the meeting the charge nurse highlighted the recent findings of the Kardex audit. Concerns were raised that many areas on the Kardex were not being completed, and reminded staff nurses that this is not acceptable and needs to be improved. As a nurse it is extremely important to keep accurate documentation, good record keeping is an fundamental part of nursing practice, and is necessary to the delivery of safe and effective care (Nursing and Midwifery Council, (NMC) 2010). As an attempt to focus the quality improvement project more specifically the results of the audit were presented using a Pareto chart (Appendix B). The data confirmed the areas on the Kardex which were not being completed however, high dose antipsychotic monitoring Yes/No was the highest at 100% non-completion, therefore it was agreed that a new strategy would be implemented to improve this. McLaughlin and Kaluzny (2006) state that the defect focused on does not necessarily need to be the greatest frequency to be improved first, but attention should be given to that defect that may have a devastating result, such as an adverse event or even death. However the defect in this instance was the highest and potentially could cause an adverse event. Following the meeting a questionnaire (Appendix C) was devised and completed anonymously by the pharmacists, consultants and staff nurses to identify the root causes of why this area on the Kardex was not completed. A fishbone diagram was used to illustrate the findings (Appendix D). When populating the fishbone diagram with the data, it was clear to see that there were many reasons that each member of the multidisciplinary team had not completed the applicable area on the Kardex. Role confusion was a common theme from each member of the team. Hill-Smith et al (2012) claims that this is not unusual within multi-disciplinary teams and that respectful communication and clear instructions is of high importance in the delivery of high quality clinical care. Therefore based on these findings PDSA one was developed (Appendix G1). This tested whether the nurse attending the MDT meeting completes the Applicable Y/N on the patients’ Kardex following an email reminder and a verbal promp t from charge nurse before attending the meeting. The test confirmed there was a breakdown in communication, the nurse did not receive the email or a verbal reminder from the charge nurse prior to attending the MDT meeting therefore they were not aware of the procedure that had been discussed and as a consequence the applicable area on the form was not completed, this was confirmed by an audit of the Kardex (Appendix H). This informed the decision for PDSA two (Appendix G2). The nurse coordinating the shift should use the visual prompt situated on the shift coordinating sheet to remind the nurse attending the MDT meeting, to update applicable Y/N on the patients Kardex. The small change of a visual reminder on the shift coordinating sheet proved to be success. It reminded the coordinating nurse to verbally prompt the nurse attending the MDT meeting to complete the patient’s Kardex in the applicable area, which was shown by the Kardex audit after the shift; all patientsâ€℠¢ Kardexes were completed and as a consequently the Therapy form and EWS from were also initiated for completion. These findings are consistent with Simpson (2007) research, where teams have clear operating procedures in place, care coordinating is enhanced. The assumption was that the email and verbally prompt from the charge nurse would result in nurses completing the Applicable Y/N on all patients Kardexes, following the MDT meeting by 23rd February 2014 by 100%. Furthermore, if yes the Therapy form and the EWS form activated for completion. Audits were carried out on the dates shown to give a snapshot of the completion of Applicable Y/N on all patients Kardexes in the IPCU ward at that time. Initial findings of the first audit by the charge nurse on 01/02/2014 revealed that Applicable Y/N was completed 0%. The second audit carried out to confirm the previous results on 08/02/2014 which confirmed the charge nurses findings of 0% compliance of Applicable Y/N. PDSA one was carried out on 10/2/2014 the change revealed 0% improvement in the completion of Applicable Y/N. PDSA two was implemented on 21/2/2014 the change was successful, the results of the audit revealed that Applicable Y/N was completed on all patients Kardexes by 100% this in turn activated the completion of the Therapy form and EWS Form. Comparison of questions, predictions, and analysis of data: Engaging with the quality improvement (QI) project has required me to learn and apply new skills in practice. The process of plan, do, study, act (PDSA) cycles were a new technical skill which I had to not only learn myself, but teach fellow staff nurses on the ward, as this was also, a new process to them. I learnt that PDSA cycles provisionally test an idea by testing a change and assessing its impact. After implementing the first cycle, I learnt that it does not always get the results expected when making changes to your process; it taught me that it was better, and more effective to trial a small change to see if it made a difference, before implementing the change permanently. This also gave staff the opportunity to be involved and offer suggestions and see if the proposed changes would work. I also learnt that communication is an essential and fundamental process during the course of the QI. According to Adams (1999), to persuade others to make an improvement or change, the negotiator must be influential. The Charge nurse in this instance was the influential position to lead change. Unfortunately they were not able to fulfil their obligation in PDSA one, but they carried out the ward meeting and used this as a platform to discuss the Kardex audits with the staff which informed them of the need to make an improvement in practice. Once the need for the new process was established and its principles by the email from the charge nurse, informing the reasoning for a change in practice, this was used as a base for PDSA two. I learnt that it is just as important to define the risk of not making a change (Plummer, 2000) and in this circumstance, changing practice would not only enhance quality of care to patients, but it would promote the involvement between staff nurses and the MDT, building trust and confidence to make the change, whereas the risk of not making the change, could potentially cause an adverse event A final learning point I would like to include was how staff nurses initially were resistant to change. In my opinion from observing, the nurses were quite defensive as though they were being blamed for not doing their job correctly. The questionnaire used was an effective communication tool and successful resource for managing this resistance. It give staff the opportunity to anonymously feedback their reasons for not completing the applicable area on the Kardex, it also let them express their opinion without being condemned. Also, I feel that during this time, they were able to adjust and prepare for the change which minimised resistance (Bernhard and Walsh, 1995). I felt it was essential to take note of all their views as individuals and as team members, which provided further explanation of their reasoning for non-completion. Accountability was a consistent reason used by nurses for their reason for non-completion, as they felt it was a doctor or the pharmacist role and they did not want to be accountable for making the decision. When it was clarified that it was a team decision, by email from the charge nurse, the nursing staff felt supported. Mitchell (2001) states that accountability in nursing is a complex issue and acknowledged the importance of team support in the identification of roles and responsibilities. Frequent ideas and conversations with staff were held over the ten days, in advance of the change in PDSA two which I feel made the improvement successful and run smoother as nursing staff were aware of the new change. I have learnt that within nursing it is important to continually improve the way we work. Working at every level developing the knowledge, technical skills, including leadership, are vital for long-term improvement. Continually learning may be important not only to ensure that we have the skills needed to improve the quality of healthcare, but also to enhance the motivation to do so. Discuss the project’s significance on the local system and any findings that may be generalizable to other systems: Relocation to a new site change what been good practice and now a gap had appeared in the process of monitoring patient. The outcome of this project was a success. It was predicted that by 23rd February 2014 applicable Y/N would be completed by 100%. By establishing the success of the visual prompt in PDSA two on the co-ordinating sheet, was a very small but effective change. As a consequence, at the following staff meeting it was decided that the visual prompt would be a permanent fixture on the coordinating sheet, as it was a sustainable reminder to future shift coordinators, thus improving the initiation of therapy monitoring and EWS forms, and overall patient safety outcomes. Discuss the factors that promoted the success of the project and that were barriers to success. What did you learn from doing this project? What are your reflections on the role of the team? The factors which promoted success in the project were support and leadership from the charge nurse at the beginning of my placement. They helped identify areas in the ward which they felt needed improvement. Furthermore, as a student who had never been in a mental health ward, I felt overwhelmed with the task and this support and guidance helped me through the project. The use of the tools were a great way to involve staff on the ward to feel part of the project and broke down the barriers of pointing blame and focussed their attention in a systematic way, and explored the potential causes of the non-completions. I was amazed as how such a small change help facilitate and test change in a manageable way. I now understand that Quality improvement as a way of approaching change in healthcare that focuses on self-reflection, assessing needs and gaps, and considering how to improve in a multifaceted manner. I feel I have gained an enormous understanding in about quality improvement in that it aims to create an ethos of continuous reflection and a commitment to ongoing improvement. It provides nurses to gain an the skills and knowledge needed to assess the performance of healthcare and individual and population needs, to understand the gaps between current activities and best practice and to have the tools and confidence to develop activities to reduce these gaps Thus, the scan did not focus only on narrowly defined quality improvement models such as ‘plan, do, study, act’ (PDSA) cycles.

Arrival of Things from Another Culture in Hurricane hits England and Presents from my Aunts in Pakistan :: essays research papers

In ‘hurricane hits England’ (hurricane) by Grace Nichols the arrival of the hurricane challenges the thoughts of the poet, she is initially from the Caribbean but now live in Sussex, until the arrival of the hurricane she has not felt at home in England. This is similar to ‘presents from my Aunts in Pakistan’ (presents) by Moniza Alvi, she also has roots from another country and now lives in England. The arrival of presents from the Pakistan culture challenges her thinking, as does the hurricane to Nichols. The hurricane challenges her thinking by making her realise that it is possible to bring your roots anywhere. She comes to this realisation through the poem and at the end of it comes to the conclusion that ‘the earth is the earth is the earth’. She originally feels torn between her two cultures, it takes the arrival of the hurricane ‘to bring her closer’. Whereas in ‘presents’ it is the arrival of the presents from Pakistan that make her feel torn between cultures. The clothes are a symbol of culture, she feels ‘alien’ and awkward wearing them and much more comfortable in her English ‘denim and corduroy’. Nichols also uses symbolism in her poem, the hurricane is a symbol of her Caribbean culture. They are very irregular in England but a regular occurrence in her childhood in the Caribbean, this makes her feel comfortable and at home. The hurricane is used along with many other natural images, this is mainly because of the effect of the wind on the landscape, for example the 'trees / Falling heavy as whales' is an effective line because the huge trees become like whales when the torrential rain that accompanies a hurricane makes the land become almost like a sea. Another natural image is the ‘frozen lake in me’ which metaphorically is the poet being ‘frozen’ away from her county and now the hurricane has arrived to break the ice, so she can bring her roots anywhere. ‘Presents’ also uses natural images, the poet describes the sari that is sent as ‘apple-green’ and the salwar kameez as ‘peacock blue’ and the other ‘like an orange split open’. This vibrant simile and the repeated reference to colour draws her to the loveliness of the culture and emphasises the contrast to the boring English

Did William Pitt Bring About a National Revival?

Did William Pitt Bring About A National Revival? On one hand, it is easy to believe that Pitt did bring about national revival but on the other hand there are many factors that may lead one to believe otherwise. For example, the end of the American war and the Industrial Revolution both would have happened whether Pitt was in power or not. But many factors, such as Pitt’s natural skill and his reform ideas, helped him to contribute to the national revival. Pitt introduced the Eden Treaty and formed it with France.This helped to increased trade in Britain as, as a country, exports were vastly increased. Pitt also tightened the laws around smuggling items both into and out of Britain which also increased trade. He did this by introducing bonded warehouses, where goods could be stores free of tax until they were taken out of Britain for sale. The Sinking Fund was also introduced by Pitt and helped, again, to increase the amount of money in Britain. He did this by using Britainâ⠂¬â„¢s profits to pay off debts instead of spending money on other goods, but this was interrupted by the war against France.Pitt also made sure that all of the government’s money was collected and spent correctly in the right places. The streamlining of the Treasury’s financial management with the Consolidation Fund Act, where all 103 exchequer accounts were replaced by one, allowed proper national accounting. However, there were many factors that contributed to a national revival that Pitt was not responsible for. Pitt inherited the national deficit which was a huge advantage to him because it meant that the state of Britain and the government could only improve.The end of the war in America meant that overseas trade would increase and this helped Britain’s imports and exports to boom. This was also helped along by the Industrial Revolution, beginning in the North East, which increased trade in and out of Britain. To conclude, in many ways Pitt did contribute greatly to the national revival but he was helped by other factors that were out of his reach. The Sinking Fund helped Pitt along greatly but he was also assisted by the Industrial Revolution and booming trade from other nations.

The Pros and Cons of Parole - 2509 Words

Parole is a highly controversial issue in Australia and around the world. A likely cause for this controversy is the general publicÂ’s ignorance of the specifics where parole is concerned. Any casual observation of a local newspaper or current affairs program on TV will likely result in the discovery of a member of the publicÂ’s opinion of crime and criminals and the criminal justice system in general, and what they believe to be wrong with it and no doubt suggestions on how to fix it. These opinions will probably be biased in nature, and influenced by information supplied to them by various forms of media. This information does not necessarily reflect the reality of the situation regarding the parole system. Adding to this potential for†¦show more content†¦It was designed as a concession to the prisoner which was also expected to benefit the community as a whole, at the same time providing the environmental influences which would discourage the offender from committi ng further offences (Law Reform Commission NSW, 2001). Parole was originally designed in the mid-1800s as an alternative to incarceration when it became apparent that incarceration was unsatisfactorily effective at preventing further criminal behaviour by offenders (Travis, 1995). It was agreed that a system of reform would prove more effective than imprisonment when it came to producing law-abiding citizens. While parole has its origins in America, it underwent revision on Norfolk Island in a British penal colony operated by Alexander Maconochie, now referred to as the “father of parole”. This system, where prisoners were allowed increasing levels of freedom and other benefits in reward for good behaviour and productivity, laid the groundwork for the modern parole system in use today, though there have been modifications made in response to changing political and economic situations, as well as legal challenges. The parole system has had its criticisms in the years since its introduction into the Australian criminal justice system, with some questioning the procedures involved, and others calling for the abolition of parole altogether. Some of these criticisms come in the form of somewhat one-sided, subjectiveShow MoreRelatedPros and Cons of Parole Programs572 Words   |  2 Pagesoff, parole is â€Å"the conditional release of a prisoner, prior to completition of the imposed sentence, under the supervision of a parole officer† (Schmalleger Smykla, 2013). 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