Running head: QUALITY AND SAFETY

An Examination of Quality and Safety at Bayfront Health

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Examination of Quality and Safety

This paper will examine how the Critical Care Unit (CCU) at Bayfront Health utilizes
quality and safety competencies to guide their patient care. A nurse manager was interviewed
using the questions provided and the answers will be discussed to determine if the care provided
is in accordance with the six quality and safety competencies chosen for this paper.
The first quality and safety competency is patient-centered care, which enables the
patient to receive care based on their values, preferences, and needs and empowers the patient to
be a full partner in the care they receive. The nurse manager for CCU explained that on his unit,
the nursing staff supports patients of different values, as long as it is not harmful to the patient.
He reported that his staff always strives to support the wishes of the patient and the family, and
that it helps when the patient has a living will. The nurse manager stated that gray areas are a
barrier to fully supporting patient-centered care, and that at times it is necessary to utilize staff
outside of nursing. The chaplain or ethics board have to be consulted in situations where there is
a difficult decision to make, and they can assist by making recommendations to the patient and
family. Working with interdisciplinary staff that supports one another ultimately allows the
nursing staff to do their best to support individuals and families with values that differ from their
own.
Teamwork and collaboration are also a part of the quality and safety competencies, and
encapsulate an interdisciplinary approach with open communication, mutual respect, and shared
decision-making. The CCU uses care-rounds on Tuesday and Thursday morning where an
interdisciplinary team makes rounds and discusses all of the patients on the unit. The team
consists of physical therapy, respiratory therapy, a clinical documentation specialist, a physician,

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pharmacy, case management, and a social worker. The physician is able to educate the nurses on
patient needs and answer any questions they might have, case management discusses patient
placement and family needs, and the social worker assists with home health or applicable
community resources. If the family is present, they are also able to ask any questions or voice
any concerns they might have while the team is present. This interdisciplinary approach to care
allows the patient and the family members to be more involved in their care, and also allows the
nurse to communicate relevant information to the health care team at one time. It also enables the
nurse to keep abreast with the plan of care for the patients and to be able to answer any further
questions the family might have.
Another quality and safety competency is the use of evidence based practice which
moves an organization from whats always been done to the use of research and best current
evidence to help lead their delivery of care. The Agency for Healthcare Research and Quality
(AHRQ) reports that research has proven when patients are engaged in their care, measurable
improvements in safety and quality can be seen. Because of this, the AHRQ has developed a
guide that focuses on four primary strategies to promote patient and family engagement, one of
which is the implementation of safe continuity of care by using nurse bedside change-of-shift
reports (AHRQ, 2013). Bayfront has followed this guideline given by the AHRQ, and one of the
major changes that has happened in the last year to reflect current best practice is the use of
bedside reporting. At shift change, the nurses are to give report to the next shift while at the
patients bedside. This change in practice gives greater autonomy to the patient in relation to
their care and also empowers them because they have a better understanding of the care they are
receiving. The use of change-of-shift reports keeps the patient and family members informed and
allows them to ask questions or voice any concerns they might have.

QUALITY AND SAFETY

Quality improvement utilizes data to monitor and measure outcomes of patient care and
then uses that information to design systematic processes to measurably improve health care
services in areas that are in need of better outcomes. One area that the CCU has analyzed and is
changing practice in is the use of foley catheters. Because there has been an increase in the
number of catheter associated urinary tract infections (CAUTI), Bayfront has formed a
committee to address this issue and has adopted the use of a maintenance bundle to decrease the
number of CAUTI incidents. The nurse manager communicated that the maintenance bundle
consists of the nurse evaluating the need for the foley catheter daily, prevention of dependent
loops in the tubing, placing the drainage bag below the level of the bladder, and daily perineal
care. The maintenance bundle has been proved through research that its use can prevent the
development of CAUTI. The committee has also developed a discontinuation protocol, and if the
patient meets the criteria for this protocol, the nurse can discontinue the catheter without a
physician order. These protocols not only reduce the number of CAUTI, but concurrently
improve patient outcomes and ensure the delivery of better healthcare services.
Safety is the fifth quality and safety competency and it focuses on reducing the risk of
harm to patients and providers. The nurse manager reported that six goals have been chosen from
the 2014 National Patient Safety Goals set forth by the Joint Commission and are being
implemented on the unit. The purpose of the National Patient Safety Goals is to improve patient
safety, identify problems in the delivery of safe healthcare, and implement solutions (Joint
Commission, 2014). The goals include: improve the accuracy of patient identification, improve
the effectiveness of communication among caregivers, improve the safety of medication use,
reduce the risk of healthcare associated infections, identify safety risks inherent to the patient
population, and follow universal protocol for preventing wrong site, wrong procedure, and

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wrong person surgery (Joint Commission, 2014). Protocols have been put in place to assist the
nurses with meeting these goals and increasing the safety of patient care. The nurse manager is
monitoring compliance with these goals and working one-on-one with staff members that need
further assistance in implementing these safety goals as part of their care.
Healthcare is increasingly moving towards informatics and the use of information
technology to help reduce error and complete tasks in a more efficient way. The nurse manager
reported that the two main issues with the Electronic Medical Records on CCU is the downtime
of the system and waiting for the provider to put in the orders. When the system is not operating
and the healthcare team is not able to access the Electronic Medical Records, they have to
transition to the use of paperwork and manually charting on the patient. The manager reported
that it is difficult to transition between the two and information can be lost in the transition. He
also reported that another difficult component is the provider not putting the orders into the
system in a timely manner. The provider may come to the floor, see all of the patients, and then
go to several other floors before they sit down to write their progress notes or add orders. This
causes the nurse to continuously check the computer for new orders to make sure they are
reviewing new orders in a timely manner so that patient care is not delayed.
Based upon the discussion with the nurse manager of CCU, it does appear that the unit
and Bayfront Health are striving to operate in accordance with the six quality and safety
competencies. Incorporating these competencies into the care that nurses and the other team
members are providing improves the overall healthcare system. All of these competencies are
designed to promote safe, high quality care for patients and their families and to design systems
that promote and encourage competent care.

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References
Agency for Healthcare Research and Quality (2013, June). Guide to patient and family
engagement in hospital quality and safety. Retrieved from
http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/
Joint Commission (2013, October 24). Hospital: 2014 national patient safety goals. Retrieved
from http://www.jointcommission.org/hap_2014_npsgs/