Quality Management In Healthcare Industry

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Understanding the importance of quality management in healthcare is crucial for growth in the industry. The reason this management concept was chosen from the rest is due to the recurrent incidences among staff nurse and student nurses where the quality of nursing skills has been compromised in the clinical setting due to various reasons. One of which will be elaborated in this essay.

During an afternoon shift, a student was under the supervision of a staff nurse who was covering a cubicle of 6 patient. Due to shortage of staff, there was no enrolled nurse to help-out. There was a female patient with diabetes who was under their care. She was due for in insulin injection pre-meal via an insulin pen. The staff nurse in charge was preparing to administer the insulin, and because she was swamped with a lot of work at that time, the student asked if she could administer the injection subcutaneously to lighten her workload. The staff nurse immediately allowed the student, since the student’s performance had been exemplary, and she was already competent in administering insulin at that time. The student promptly went to administer the insulin as ordered. Following the proper method of medication administration, she injected the insulin dialled to the prescribed amount of insulin units. She also properly inserted the needle into the skin. She pushed the button of the pen, and unknowingly pushed it back to zero units. She assumed that was the correct method and went on to document her work. What she did not realise was that the patient did not receive any insulin at all. It was few hours after that the staff nurse measured the patient’s blood glucose reading, did she realise that it had increased drastically. This medication error led the patient to suffer from hyperglycemia. She then asked the student how she administered and found that she used a wrong method of administering.

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A few issues regarding this problem was that the student clearly had knowledge deficit on how the to use the insulin pen, also the staff in charge did not supervise the student as she was administering the drug. To understand what went wrong and how to improve this situation, one suitable solution would be to incorporate quality management as one of the strategies to rectify this problem. Quality management is basically used to help develop ones’ performance, and ultimately saving cost. There are three components to total quality management which comprises of quality control, quality assurance and quality improvement. Based on the scenario stated above quality improvement is most suitable to aid in finding the main root cause of the problem. These four strategies include the Deming cycle, SixSigma, Focus and Benchmark. Deming cycle as known as PDCA cycle, is a cyclic four stage method to promote constant enhancement, increase quality within the business. This cycle has four components, plan, do check and act. To begin, in the planning phase, first the problem needs to be brought forth and then to ensure that all pertinent information is collected to search for the origin of the main issue. In this case it would be medication error due to lack of supervision and insufficient training for the student. In the second phase, it is to search for an effective solution based on a tool to eventually use to evaluate its effectiveness. Following this, to check, it is important to use the relevant information and verify the end results by comparing the older results with it. Lastly, utilizing the new data, propose the new idea of how to improve to be shared during the following PDCA cycle, updating on the efficiency and progress. The other strategies like Sixsigma, focus and benchmark is also inter-related, all of which also are key improvement approaches to find the best method to prevent future incidences leading to medication error. Finding the root cause of a problem may be a long and time-consuming, hence it is crucial to rectify each situation as effectively in the shortest possible time as possible.

In quality improvement, there are also various tools to use to recognise the problem. Tools such as Ishikawa diagram, pareto diagram, control chart as well as the run chart were designed to help organizations reduce and improve the number of challenges faced. According to Dr. Kaoru Ishikawa, a quality and control expert, the ishikawa diagram also known as the fishbone diagram, is used widely to search for numerous possible root causes causing the problem. The main issue identified was medication error, which in the fishbone diagram would be the head of the fish. Connecting to the head, is the backbone containing a minimum of four attributes based on the main issue. Some examples such as lack of training for the student to be competent in using new products in the ward, further training for the staff nurse to realise the importance in supervising students no matter how busy they are and also double- checking their work to ensure proper flow and prevent mistakes causing harm to the patient. To add on, other factors like shortage of manpower causing the staff nurse to be overwhelmed with work could be a reason to rule out. Communication would also be an additional factor that would have caused the medication error. Communication breakdown between the staff nurse and the student could have led the patient to suffer serious consequences. Some approaches to maintaining good communication would be to have good body language.

Nursing is not the easiest job. One has to be diligent, kind, quick thinking and most of all meticulous. Staff nurses obey the doctor’s instructions and administer medication that can heal or harm the patient at any given time. Student nurses progress the most during their clinical posting as that is the one time their can practice their skills

In my opinion, nursing is a multi-tasking job. To ensure that medication errors are prevented, one has to learn the technique of multi- tasking to as to be capable to do multiple things at one time. If that is not possible due to overwhelming workload, the staff nurse needs to be able to get assistance to get the job done. According to Singapore Nursing Board (2018), “Nurses/midwives have to maintain a safe environment, through the use of, quality assurance and risk management strategies.”, it is important to, “Delegate, monitor and supervise work performed by the EN and other ancillary staff”. With that being said, nurses have the responsibility to ensure that all their work is done dutifully with integrity. To ensure that the nurses provide a safe operational setting, by supervising, overseer and assess every situation and procedure is done correctly following the hospital’s protocol. I have gained knowledge from this assignment to understand the importance of correct practice and to know that clarifying doubts about every decision i make when dealing with patients is vital as mistakes can lead to severe consequences and harm to the patient. It could also be life threatening. As a student, we should never be over-confident, and claim to know our skills without proper supervision.

To conclude, quality management is a significant process that enables healthcare personal to overcome hinderances in the hospitals. Using the various strategies can aid in conquering the issues in a systematic manner. Staff nurses and student need to be educated on their specific roles and to know what should and should not be done in the hospital that could endanger the lives of the patients they care for.    


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