Magazine article American Nurse Today

Nurses Are Driving Quality in All Care Settings: Improving the Processes of Care Promotes Better Quality

Magazine article American Nurse Today

Nurses Are Driving Quality in All Care Settings: Improving the Processes of Care Promotes Better Quality

Article excerpt

Healthcare quality encompasses the structures of care, care-delivery processes, and patient outcomes. The Centers for Medicare & Medicaid Services (CMS), Office of the National Coordinator for Health Information Technology (ONC), and National Quality Forum (NQF) have each announced that quality measures should focus only on care outcomes. The easiest aspect of care to measure, care outcomes answer such questions as:

* Did the patient improve?

* Did treatments restore function?

* Is pain relieved or manageable?

The focus on outcomes leads some to believe care structures and processes aren't important. But nurses know that's not the case. For instance, having an adequate number of baccalaureate-prepared nurses with good support and administrative staff is integral to a structure that improves the chance of delivering excellent patient care. The processes of care--including addressing patients by name, ensuring documentation of accurate information, and working with patients to develop plans of care consistent with their needs and preferences--enhance patients' successful engagement in their care.

The structures and processes of care also improve outcomes. Because much of what nurses do is process oriented, we can work to ensure patients understand the processes while making certain that the work we do to manage quality in these processes is transparent to the nurses responsible for doing the work.

Improving the processes of care promotes better quality. The manufacturing industries focus on improving quality processes to ensure better outcomes. Kanban cards, used in lean production methods, are an example; these cards allow workers to stop processes when products don't meet quality requirements.

When the quality of care isn't adequate, nurses are in a unique position to stop processes, too. Suppose, for example, a nurse caring for a low-income patient in a rural hospital reviews his discharge instructions and discovers the physician prescribed dabigatran, a new-generation and costly anticoagulant medication, to treat atrial fibrillation. Instead of simply giving the prescription to the patient, knowing he can't afford to fill it each month, the nurse could speak to the physician about the relative value of this prescription compared to a less costly drug, such as warfarin. …

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