Running head: QUALITY AND SYNTHESIS PAPER

Quality and Synthesis Paper

Narjess Yazback
University of South Florida

QUALITY AND SYNTHESIS PAPER

Quality and Synthesis Paper

Based on an interview conducted on October 23rd, 2014 with a nurse manager (Mrs. S.) at
Bayfront Health Center, this paper will serve as a synopsis of the multiple questions covered. As
a new manager in a Florida hospital, Mr. S. answered some of the questions asked based on
previous managerial jobs in Wisconsin. The areas that were approached during the interview
include: (1) Patient-centered care, (2) teamwork and collaboration, (3) evidence Based Practice,
(4) Quality Improvement, (5) Safety, and (6) Informatics. The answers provided serve to show
the multidimensional adaptations and interdisciplinary practices needed in a hospital setting to
provide quality and safety in patient care.
On the topic of patient-centered care, Mr. S. explained that it is crucial to involve the
patient and the family in their care starting at admission. Mr. S. described that while conducting
admission databases, nurses ask the patient and their family about their beliefs and culture, and
how they usually care for themselves. Once this information is acquired, the nurses job is to be
culturally aware, and avoid ethnocentrism in order to support the patient and provide the best
care and education throughout their stay in the hospital. In some cases, barriers may be present
between the nurses values and that of the patient. If there is a significant clash between nurse
and patient that may affect quality of care in any way, it is important for the professional nurse to
approach the charge nurse or nurse manager in order to change shift assignments. To improve the
patient-nurse relationship on a culture and value standpoint Mr. S. suggested staff meetings
involving ongoing education.
The presence of inter-professional practice in the healthcare field is extremely important
because the care of just one patient involves the skills of multiple professionals that excel in their
particular domain. These professionals must be able to communicate efficiently together to

QUALITY AND SYNTHESIS PAPER

create a connected sphere of influence toward the patients care. Mr. S. at Bayfront health Center
described inter-professional practice as a daily occurrence on the unit. He stated that physicians,
physical therapists, and case managers make daily rounds to discuss plan of care and
communicate with the nurses face to face or via telephone. Consults can also be placed through
the electronic system if it is determined that the patient requires care from a specific healthcare
professional such as a nephrologist for instance. When asked if there are any daily around the
table inter professional meetings to bring together the different healthcare workers involved in
the patients care, Mr. S. explained that there were none, but he believes it would be beneficial to
implement in the future.
As another mean to improve quality and safety of patient care on the unit, Mr. S.
explained that computerized physician order entry (CPOE) has been implemented at his previous
position prior to Bayfront as evidence based practice. Medication errors are one of the most
common causes of preventable hospital injuries, but they can be reduced by up to 55% using
CPOE systems (Poon et al., 2004). During the interview Mr. S. mentioned that utilizing CPOE
instead of paper charts is more time efficient, and reduces the many mistakes that can occur
starting with human transcription from hand to paper, illegible handwriting, and wrong
interpretations by nurses. In regards to Bayfront, Mr. S. witnessed the implementation of interdisciplinary family and patient centered bedside rounds in the morning as a replacement to one
on one communication rounds. He states that this is a method of best practice because it
strengthens the patients independence and autonomy by directly involving them and their family
in their ongoing care. In support to Mr. S. statement, family centered rounds create an inclusive
environment for the patient and family, enhance education, and improve patients outcomes and
quality of care in the hospital (Sisterhen, L.L., Blaszak, R., Woods, B.M.,& Smith, E.C., 2007).

QUALITY AND SYNTHESIS PAPER

Following the ultimate goal of quality care, Mr. S. was asked about an unwanted
variation that had occurred on the unit and the measures that were utilized to resolve the
problem. The main issue discussed was the often unnecessary demand for sitters which resulted
in overtime hours amounting to twelve full time positions, and a total of $1.3 million extra
expenses for the hospital. In order to address the problem at hand, a multidisciplinary session
was held to formulate a plan of action. A new rating system was established to determine if the
patient needed a sitter, and the nurse manager was in charge of checking the professional nurses
assessment of the patient every shift to determine suitability. The sitters working were also held
more accountable in assisting the patient gain independence. Mr. S. stated that based on the data
collected after the new plan of action was initiated, overtime hours decreased, the hospital was
able to cut down costs by half a million, and lastly, the quality of patient care was improved due
to increased accountability of appointed sitters.
The last part of the interview involved the topic of safety in general. Safety composes a
large part of patient care because it is involved in many aspects of the health field. National
safety guidelines are implemented on the unit at hand in various different ways. They are posted
on the unit as a readily accessible visual guideline, and they are continuously reviewed in
mandatory monthly staff meetings. Safety is not only required in medication administration, and
direct practice between nurse and patient; it is also required during inter-professional
communication, and within the use of electronic resources. When approached about electronic
medical records in the hospital and the two main issues encountered, Mr. S. directly addressed
the patient privacy factor that is sometimes violated by leaving computer screens on. Two other
problems that were also addressed were: (1) the potential for error through telephone orders read
back (TORB) given by physicians, and (2) the human mistake of forgetting to chart. Overall,

QUALITY AND SYNTHESIS PAPER

quality and safety is an issue of priority in the professional nursing field, we must remain
attentive and diligent about the care we provide in order to maintain positive best outcomes.

QUALITY AND SYNTHESIS PAPER

Reference
Poon, G. E., Blumenthal, D., Jaggi, T., Honour, M. M., Bates, W. D. & Kaushal, R. (2004).
Overcoming barriers to adopting and implementing computerized physician order entry
systems in U.S. hospitals. Health Affairs, 23(4), 184-190
Sisterhen, L.L., Blaszak, R., Woods, B.M., & Smith, E.C. (2007). Defining family-centered
rounds. Teaching and learning in medicine: An International Journal, 19(3), 319-322.
doi: 10.1080/10401330701366812