Paper details

Create a quality improvement project plan, which will likely be 8 pages in length.

Introduction

For this assessment, you will apply everything that you have learned so far to create your quality improvement plan. Quality improvement is a critical piece of all health care practice and the DNP-prepared nurse is critical in leading and implementing quality improvement initiatives across all types of organizations. By completing this assessment you will demonstrate your competence towards DNP Essential IV: Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care and how you will be able to apply it in your current and future practice.

Instructions

All of your previous assessments have been built up to complete this one. Now, it is time to create a quality improvement project plan, using data to create a sense of urgency. You should include depictions of pre- and post-implementation workflows and the risk management mitigation plan you developed. Use the Quality Improvement Project Plan Template [DOCX] to complete this assessment. Remember to use evidence-based practice to support your plan.

Overall, your assessment will be assessed on the following criteria:

• Explain the problem, its significance, and its impact on the chosen health care environment.
  • Make sure you use appropriate data from sources like Leapfrog and Medicare Compare to support your explanation.
• Outline proposed technology/informatics solutions and the plan to implement them within the chosen health care environment.
  • Make sure you address why your plan is relevant to your problem.
• Explain potential implementation challenges related to the proposed plan.
  • Think about the logistical, personnel, and resources that might be part of the challenges or that could help overcome the challenges.
• Explain the role of leaders in change management related to the proposed plan.
  • Think about who the relevant leaders would be for implementing your plan and what type of communication plan they should be using to help with implementation.
• Analyze the workflow related to the technology/informatics, providing visual depictions of the workflow before and after implementing the proposed plan.
  • Make sure to address both pre- and post- implementation workflows, as well as create depictions of each workflow.
• Convey purpose in a well-organized text, incorporating appropriate evidence and tone in grammatically sound sentences.
• Apply APA style and formatting to scholarly writing.

Additional Requirements

Your assessment should also meet the following requirements:

• Length: Submit a completed Quality Improvement Project Plan Template [DOCX], which will likely be 10 double-spaced pages, plus your reference list.
• References: 5–8 scholarly or professional resources, no more than five years old.
• APA format: Submission should follow current APA style and formatting. Review the Evidence and APA section of the Writing Center for guidance.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Defend the selection of a technology to meet the needs of a health care organization.
  • Explain potential implementation challenges related to the proposed plan.
  • Explain the role of leaders in change management related to the proposed plan.
• Competency 2: Evaluate technology and its effect within a health care organization.
  • Outline proposed technology/informatics solutions and the plan to implement them within the chosen health care environment.
  • Analyze the workflow related to the technology/informatics, providing visual depictions of the workflow before and after implementing the proposed plan.
• Competency 3: Evaluate and solve ethical and legal issues relating to health care technology.
  • Explain the problem, its significance, and its impact on the chosen health care environment.
• Competency 4: Address assessment purpose in a well organized text, incorporating appropriate evidence and tone in grammatically sound sentences.
  • Convey purpose in a well-organized text, incorporating appropriate evidence and tone in grammatically sound sentences.
  • Apply APA style and formatting to scholarly writing.

RESOURCES

• Society for Participatory Medicine. (n.d.). https://participatorymedicine.org/
  • This website provides many resources related to defining participatory medicine, its benefits, and how patients and professionals can work together.
• Centers for Medicare & Medicaid Services. (n.d.). Hospital CAHPS (HCAHPS). https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/HCAHPS1
  • This website presents information about the meaning and interpretation of HCAHPS.
• HCAHPS. (2022). CAHPS hospital survey. https://hcahpsonline.org/
  • This website provides information about how HCAHPS scores are or can be used to measure consumer satisfaction.
• Leapfrog Group. (n.d.). Leapfrog hospital safety grade. https://www.hospitalsafetygrade.org/
  • This web page describes the mission and purpose of the Leap Frog organization. Hospital safety grades based upon multiple indicators are presented and can be shared. You can use such data to identify opportunities for improvement via evidence-based practice changes using informatics.
• Medicare.gov. (n.d.). Medicare compare. https://www.medicare.gov/care-compare/
  • This website provides users with an opportunity to compare organization and provider quality and patient safety scores. You can use such data to identify opportunities for improvement via evidence-based practice changes using informatics.
• Montalvo, I. (2007). The National Database of Nursing Quality Indicators (NDNQI). OJIN: The Online Journal of Issues in Nursing, 12(3). https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingQualityIndicators.aspx
  • This web page presents information about the National Database of Nursing Quality Indicators. The content will help you understand how these data are used to monitor patient safety and quality of care.
• Akareem, H. S., Ferdous, A. S., & Todd, M. (2021). Impact of patient portal behavioral engagement on subsistence consumers\\\’ wellbeing. International Journal of Research in Marketing, 38(2), 501–517.
  • This study examines the relationship between patient portal use and wellbeing in a select population. The results indicate positive associations between subsistence consumers\\\’ individual resource integration, patient portal behavioral engagement, and wellbeing.
• Carini, E., Villani, L., Pezzullo, A. M., Gentili, A., Barbara, A., Ricciardi, W., & Boccia, S. (2021). The impact of digital patient portals on health outcomes, system efficiency, and patient attitudes: Updated systematic literature review. Journal of Medical Internet Research, 23(9).
  • This study reveals that evidence regarding health outcomes is generally favorable, and patient portals have the potential to enhance the doctor-patient relationship, improve health status awareness, and increase adherence to therapy. It is still unclear whether the use of patient portals improves health service utilization and efficiency.
• Dendere, R., Slade, C., Burton-Jones, A., Sullivan, C., Staib, A., & Janda, M. (2019). Patient portals facilitating engagement with inpatient electronic medical records: A systematic review. Journal of Medical Internet Research, 21(4). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482406/
  • This study concludes that while the evidence is currently immature, patient portals have demonstrated benefit by enabling the discovery of medical errors, improving adherence to medications, and providing patient-provider communication.
• Fareed, N., MacEwan, S. R., Vink, S., Jonnalagadda, P., & McAlearney, A. S. (2022). Relationships between patient portal activation and patient satisfaction scores among CG-CAHPS and HCAHPS respondents. The American Journal of Managed Care, 28(1), 25–31. https://www.ajmc.com/view/relationships-between-patient-portal-activation-and-patient-satisfaction-scores-among-cg-cahps-and-hcahps-respondents
  • The results of this study suggest the potential for patient portals to enhance patient satisfaction, especially in areas such as care coordination and care transitions. In both inpatient and outpatient settings, portal use may improve the patient-centeredness of care.
• Kachroo, N., Fedrigon, D., Li, J., & Sivalingam, S. (2020). Does \\\”MyChart\\\” benefit \\\”my\\\” surgery? A look at the impact of electronic patient portals on patient experience. The Journal of Urology, 204(4), 760–768. https://www.auajournals.org/doi/10.1097/JU.0000000000001090
  • Based upon a retrospective chart review, the authors concluded that patients undergoing endourology procedures who use MyChart make fewer telephone calls and are significantly less likely to have an unscheduled clinic or emergency department visit or a complication.
• Kallmerten, P. S., Chia, L. R., Jakub, K., & Turk, M. T. (2021). Patient portal use by adults with heart failure: An integrative review. Computers, Informatics, Nursing, 39(8), 418–431.
  • The purpose of this integrative review is to synthesize what is known about patient portal use by adults with heart failure to identify contributing factors for use and areas for future research. It concludes that the patient perceptions of the patient portal can lead to the acceptance and use of the technology that can enhance self-management. Health care providers should partner with adults with heart failure to maximize the features of the patient portal to support self-management.
• Kinney, A. P., & Sankaranarayanan, B. (2021). Effects of patient portal use on patient satisfaction: Survey and partial least squares analysis. Journal of Medical Internet Research, 23(8). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8433860/
  • The authors contend that their model shows that patient portal use can influence patient satisfaction through the mediating effects of gratification, health self-awareness, and health perception. Patient satisfaction is an important outcome for health care organizations. Therefore, by promoting effective patient portal use and fostering patient perceptions, health care organizations can improve patient satisfaction.
• McAlearney, A. S., Hefner, J. L., MacEwan, S. R., Gaughan, A., DePuccio, M., Walker, D. M., Hogan, C. T., Fareed, N., Sieck, C. J., & Huerta, T. R. (2021). Care team perspectives about an inpatient portal: Benefits and challenges of patients’ portal use during hospitalization. Medical Care Research and Review, 78(5), 537–547.
  • This study presents findings about the care team\\\’s reports of the benefits and challenges associated with the use of patient portals.
• Santos, A. D., Caine, V., Robson, P. J., Watson, L., Easaw, J. C., & Petrovskaya, O. (2021). Oncology patients\\\’ experiences with novel electronic patient portals to support care and treatment: Qualitative study with early users and nonusers of portals in Alberta, Canada. JMIR Cancer, 7(4).
  • This study concludes that although people diagnosed with cancer and their family caregivers considered an online patient portal as beneficial, they identified several areas that limit how portals support their oncology care. Providers of health care portals are encouraged to recognize these limitations and work toward addressing them.
• American Association of Colleges of Nursing. (n.d.). DNP essentials. https://www.aacnnursing.org/DNP/DNP-Essentials
  • This web page presents a list and description of the AACN DNP Essentials. Pay particular attention to DNP Essential IV.
• Hammersla, M., Belcher, A., Ruccio, L. R., Martin, J., & Bingham, D. (2021). Practice and quality improvement leaders survey of expectations of DNP graduates\\\’ quality improvement expertise. Nurse Educator,46(6), 361–365.
  • The results of this study support the need for nurses pursuing a DNP in advanced nursing practice to have education and training beyond their area of specialization, specifically in quality improvement methods and tools.
• Haupeltshofer, A., Egerer, V., & Seeling, S. (2020). Promoting health literacy: What potential does nursing informatics offer to support older adults in the use of technology? A scoping review. Health Informatics Journal, 26(4), 2707–2721.
  • In this study, the researchers inquire what characterizes nursing informatics as an expanding field in relation to the roles and competencies of nurses in technical appropriation processes of older adults. They conducted a scoping review based on a systematic literature search and identified 23 relevant studies and developed a modular system to characterize the potential of nursing informatics: nursing informatics as a profession, competencies of nurses and nursing informatics, assessments, and eHealth literacy.

SAFER Guides and Evaluating Technology Usage

As healthcare continues to embrace technological advancements, healthcare professionals must thoroughly understand the potential risks of implementing these technologies. This is especially critical for Doctor of Nursing Practice (DNP) nurses who may find themselves leading large-scale informatics implementation projects. Identifying and mitigating potential risks is critical to ensuring the safety and integrity of patient data in healthcare settings (Scantlebury et al., 2021).

We will examine the use of these guides to evaluate the implementation of an electronic health record (EHR) system as a solution for addressing safety, process, or quality issues in a chosen healthcare context, i.e., Allen hospital (Aguirre et al., 2019). The findings from this evaluation will inform the development of a risk mitigation plan in a later assessment. Using the SAFER guides, DNP nurses can comprehensively understand the potential risks of implementing informatics solutions in healthcare (Flaubert et al., 2021). This knowledge is critical for ensuring patient safety and data integrity and for the success of informatics implementation projects. This paper will explore using the SAFER guides to identify performance and risk issues in healthcare settings.

EHR as a Practice Change to Drive Improvements

An electronic health record (EHR) is a proposed informatics solution implemented as part of a practice change to drive improvements in the chosen healthcare environment (Tsai et al., 2020). The EHR system will replace the paper-based record-keeping system with a digital platform enabling healthcare providers to access patient information from a centralized location. The EHR system will capture and store patient information such as medical history, diagnoses, medications, allergies, laboratory test results, and radiology reports.

The primary goal of implementing an EHR system is to improve patient care and outcomes by providing healthcare providers with easy access to accurate, up-to-date patient information (Adane et al., 2019). This will help to ensure that healthcare providers can make well-informed decisions about patient care, reducing the likelihood of errors and improving patient safety. Additionally, the EHR system will streamline administrative processes such as billing and scheduling, reducing the time and resources required for these tasks. Other improvement goals include increasing efficiency, reducing costs, enhancing communication, and improving patient satisfaction.

SAFER Guide Findings Related to Good Performance 

The SAFER Guides evaluation of Allen Hospital’s EHR implementation has identified several areas where the hospital performs well. One of the areas where Allen Hospital is performing well is in the Hardware and Software Dependability domain. The hospital has implemented robust hardware, and software systems that are dependable, stable, and secure, which helps to ensure that patient data is protected and available when needed (Szarfman et al., 2022). The hospital has also implemented several measures to ensure the reliability of hardware and software systems, such as regular system backups and failover systems.

Another area where Allen Hospital is performing well is in the Contingency Planning domain. The hospital has established robust contingency plans to ensure that patient data is protected and available during a disaster or system failure (Melnychuk et al., 2022). The hospital has also established procedures for regular data backups and recovery to ensure that patient data is not lost during a system failure (Melnychuk et al., 2022).

In addition, the hospital is performing well in the Clinical Process Improvement domain. The hospital has implemented several measures to improve clinical processes, such as using clinical decision-support tools and integrating clinical guidelines into the EHR system (Enticott et al., 2021). This has helped improve the quality of patient care, reduce errors, and improve patient outcomes.

Examples

For example, during the SAFER Guides evaluation, it was found that Allen Hospital has implemented several measures to ensure that the EHR system is dependable and secure. For instance, the hospital has implemented a robust backup system, ensuring that patient data is backed up regularly and available in case of a system failure. The hospital has also implemented a failover system that ensures that the EHR system remains available in case of a hardware or software failure. Furthermore, the hospital has implemented clinical decision support tools, such as alerts and reminders, which have helped improve patient care quality. For instance, the EHR system alerts clinicians when patients are due for preventive services, such as cancer screenings and immunizations, which has helped to improve patient outcomes (Huffstetler et al., 2022).

SAFER Guide Findings related to risks

Based on the SAFER Guides evaluation of Allen Hospital’s proposed implementation of an EHR, several risks were identified that could potentially impact the project’s success. These risks are categorized under various SAFER components, including Hardware & Software Resilience, Contingency Planning, System Interfaces, Patient Identification, Clinical Workflow, and Communications. Below are examples of specific risks identified in each of these components.

Examples

The SAFER Guides used to evaluate the proposed Electronic Health Record (EHR) system at Allen Hospital highlighted several risks that must be addressed for successful implementation. The first area of concern identified by the SAFER Guides was the hospital’s IT infrastructure’s ability to support the new EHR system, which could lead to system downtime and data loss (Keshta & Odeh, 2020). The EHR system may also require significant hardware upgrades to meet the system requirements. Another risk identified by the SAFER Guides was the need for a robust contingency plan in case of system failure or data loss (McGowan et al., 2022). The hospital may need to invest in a backup and recovery system to ensure that data is not lost in case of a disaster.

The SAFER Guides also revealed that the new EHR system might need to interface better with other systems used by the hospital, such as the laboratory information system or the pharmacy system. This could lead to data consistency and errors (Khubone et al., 2020). In addition, the Guides highlighted the need for a reliable patient identification system to avoid patient data being assigned to the wrong record. The new EHR system may require significant changes to the clinical workflow at Allen Hospital, requiring staff training on new workflows and ensuring that the EHR system runs smoothly with existing clinical workflows. Finally, the SAFER Guides identified the need for new communication channels between clinicians, staff, and patients, which should be reliable and secure to avoid data breaches and communication errors (Das et al., 2020). These findings reveal that Allen Hospital needs to develop robust hardware and software resilience, contingency planning, patient identification systems, and communication channels to support the successful implementation of the proposed EHR system.

Using the SAFER Guide to Discover Areas of Risk and Improvements

Using the SAFER Guides to evaluate the risks associated with implementing an EHR system at Allen Hospital was an enlightening experience. It helped me understand the importance of identifying potential risks and addressing them proactively to ensure the success of an informatics project. By identifying risks associated with implementing an EHR system at Allen Hospital, I focused on developing a risk mitigation plan that addresses each identified risk.

This experience taught me the importance of working collaboratively with stakeholders and subject matter experts to develop a comprehensive risk mitigation plan. Identifying risks and developing a mitigation plan requires input from various stakeholders, including IT staff, clinicians, and administrators, to ensure all potential risks are identified and adequately addressed (Bhagat et al., 2020). This experience will be helpful in my future practice as a DNP nurse, where I will be responsible for leading large-scale informatics projects. I now understand the importance of utilizing SAFER Guides to identify potential risks associated with implementing new technology in healthcare settings. I will use this experience to guide my future practice, emphasizing the importance of collaboration and proactive risk management to implement informatics projects in healthcare settings successfully.

In short, the experience of using SAFER Guides to discover areas of risk and focus improvement efforts has provided me with valuable insights and skills that will be useful in my future practice. I now understand the importance of proactive risk management and collaboration to implement informatics projects in healthcare settings successfully.

Conclusions

The SAFER Guides were an invaluable tool in identifying potential risks and areas for improvement related to implementing an Electronic Health Record system at Allen Hospital. Using the SAFER Guides, we better understood the hospital’s current IT infrastructure, contingency planning, system interfaces, patient identification, clinical workflow, and communications (Dash et al., 2019). With this knowledge, we can now develop a comprehensive risk mitigation plan that addresses these areas and ensures the successful implementation of the EHR system. As a DNP nurse, the experience of using the SAFER Guides has been beneficial in preparing for future informatics/technology implementation projects and enhanced my understanding of the importance of risk assessment and mitigation in healthcare technology.

References

Adane, K., Gizachew, M., & Kendie, S. (2019). The role of medical data in efficient patient care delivery: A review. Risk Management and Healthcare Policy, Volume 12(12), 67–73.

https://doi.org/10.2147/rmhp.s179259

Aguirre, R. R., Suarez, O., Fuentes, M., & Sanchez-Gonzalez, M. A. (2019). Electronic health record implementation: A review of resources and tools. Cureus, 11(9).

https://doi.org/10.7759/cureus.5649

Bhagat, S., Kapatkar, V. K., Mane, A., Pinto, C., Parikh, D., Mittal, G., & Jain, R. (2020). An industry perspective on risks and mitigation strategies associated with post conduct phase of clinical trial. Reviews on Recent Clinical Trials, 15(1), 28–33.

https://doi.org/10.2174/1574887114666191016103332

Das, S., Siroky, G. P., Lee, S., Mehta, D., & Suri, R. (2020). Cybersecurity: The need for data and patient safety with cardiac implantable electronic devices. Heart Rhythm, 3(7).

https://doi.org/10.1016/j.hrthm.2020.10.009

Dash, S., Shakyawar, S. K., Sharma, M., & Kaushik, S. (2019). Big data in healthcare: Management, analysis and future prospects. Journal of Big Data, 6(1), 1–25.

https://doi.org/10.1186/s40537-019-0217-0

Enticott, J., Johnson, A., & Teede, H. (2021). Learning health systems using data to drive healthcare improvement and impact: A systematic review. BMC Health Services Research, 21(1).

https://doi.org/10.1186/s12913-021-06215-8

Flaubert, J. L., Menestrel, S. L., Williams, D. R., & Wakefield, M. K. (2021). Educating nurses for the future. In www.ncbi.nlm.nih.gov. National Academies Press (US).

https://www.ncbi.nlm.nih.gov/books/NBK573912/

Huffstetler, A. N., Epling, J., & Krist, A. H. (2022). The need for electronic health records to support delivery of behavioral health preventive services. JAMA, 5(3).

https://doi.org/10.1001/jama.2022.13391

Keshta, I., & Odeh, A. (2020). Security and privacy of electronic health records: Concerns and challenges. Egyptian Informatics Journal, 22(2), 177–183.

https://doi.org/10.1016/j.eij.2020.07.003

Khubone, T., Tlou, B., & Mashamba-Thompson, T. P. (2020). Electronic health information systems to improve disease diagnosis and management at point-of-care in low and middle income countries: A narrative review. Diagnostics, 10(5), 327.

https://doi.org/10.3390/diagnostics10050327

McGowan, J., Wojahn, A., & Nicolini, J. R. (2022, February 10). Risk Management Event Evaluation and Responsibilities. PubMed; StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK559326/

Melnychuk, E., Sallade, T. D., & Kraus, C. K. (2022). Hospitals as disaster victims: Lessons not learned? Journal of the American College of Emergency Physicians Open, 3(1), e12632.

https://doi.org/10.1002/emp2.12632

Scantlebury, A., Sheard, L., Fedell, C., & Wright, J. (2021). What are the implications for patient safety and experience of a major healthcare IT breakdown? A qualitative study. DIGITAL HEALTH, 7(3), 205520762110100.

https://doi.org/10.1177/20552076211010033

Szarfman, A., Levine, J. G., Tonning, J. M., Weichold, F., Bloom, J. C., Soreth, J. M., Geanacopoulos, M., Callahan, L., Spotnitz, M., Ryan, Q., Pease-Fye, M., Brownstein, J. S., Ed Hammond, W., Reich, C., & Altman, R. B. (2022). Recommendations for achieving interoperable and shareable medical data in the USA. Communications Medicine, 2(1).

https://doi.org/10.1038/s43856-022-00148-x

Tsai, C. H., Eghdam, A., Davoody, N., Wright, G., Flowerday, S., & Koch, S. (2020). Effects of electronic health record implementation and barriers to adoption and use: A scoping review and qualitative analysis of the content. Life, 10(12), 327.

https://doi.org/10.3390/life10120327