Introduction
The advanced nursing practice patient safety concern to be addressed in this paper is medication reconciliation issues during face-to-face patient care. In this context, medical reconciliation refers to the procedure carried out when comparing the medications taken by a patient before and after the change in care. It assists in the prevention of medical errors, which helps to ensure that a patient is given the drug that is most suited for their condition.
Challenges in Patient Care
Poor Communication
During face-to-face patient treatment, one of the challenges associated with medical record reconciliation is a lack of appropriate communication. This can lead to a breakdown in communication between the medical professionals and the patients, which in turn raises the risk of patients receiving the incorrect medication.
Lack of Time
Another issue faced during the process is time constraints as a nurse, which enhances the possibility of discrepancies and errors. In such a scenario, nurses do not have enough time to interact with their patients to share more information about their health. Patients who don’t follow their doctors’ orders or take the steps they’ve been advised to do may be doing so because they don’t have access to sufficient information.
Documentation Problems
Another issue that arises throughout the reconciliation process that impacts the delivery of care is inadequate documentation. Inadequate documentation of changes, non-compliance, and missed doses are all potential outcomes. Improper documentation can hurt the transition process and continuity of care. Because of this issue, there is a greater chance that the medical industry may be impacted by errors and medication that is not taken as prescribed. To eliminate the damaging effects of medical reconciliation problems, the healthcare industry needs to undergo significant transformation.
Description of Selected Change Model for Quality Improvement Proposal
The change model for quality improvement proposal that can be useful for the identified patient safety concern is the transtheoretical model of behavior change. Because the model views change as a process, its primary emphasis is on analyzing individuals’ perspectives, behaviors, and intentions to determine whether they are prepared for change (Keshmiri et al., 2017). The application of the model in nursing will assist in the promotion of change, which is essential in order to get rid of the adverse effects that are connected with problems with medical reconciliation. Proper implementation of the model also helps to ensure that there is an understanding of processes that contribute to change.
Model Stages
Pre-Contemplation
The model outlines five stages that a person must undergo to achieve the desired change. The first stage of the model is pre-contemplation, characterized by a person showcasing problem denial, which is influenced by a lack of knowledge about the issue affecting them. In this scenario, an individual is either unaware of the potential outcomes that could result from their behavior or is under the impression that their actions will not cause any problems.
When this stage is applied to the problems with medical reconciliation encountered during face-to-face care, the medical providers or patients may be oblivious to their behavior, which negatively impacts the situation. People in this situation are not likely to be open to change, and as a result, they are likely to continue their conduct for a considerable amount of time.
Contemplation
The second stage of the transtheoretical model is contemplation, which is characterized by negative behavior and thus starts with considering the need for change. However, individuals in this stage remain unsure whether or not they should do the action. When this stage is applied to patient safety problems, nurses and patients are aware that their actions are likely to have a detrimental effect on the patient’s well-being and the quality of care they receive. A nurse is likely to discover that a lack of communication with other providers or patients is leading to non-compliance issues and errors in the care they give.
Preparation
Another stage of the transtheoretical model is preparation, which requires a person to be ready and intend to change. In such a situation, a person must demonstrate their commitment to altering their behaviors (Ekberg et al., 2016). This can be accomplished by creating action plans and soliciting support from other individuals during the transformation process. Nurses who have difficulties with medical reconciliation when giving face-to-face care but who are still in the preparation stage of their shift have the responsibility of identifying methods that will assist them in changing undesirable behaviors. It is essential for one to know what steps they need to take to accomplish their goals and succeed.
Action
The model’s fourth stage is action, characterized by overt behavior modification. An individual who has reached this stage is actively working to modify their behavior and is using a variety of tactics to increase the likelihood that positive results will be obtained. At this point, the individual will need to engage in self-monitoring, the establishment of goals, and the addressing of available problems in order for change to be achieved.
When giving face-to-face treatment, a nurse who is frequently confronted with medical reconciliation challenges can rely on the stage to adopt the measures necessary to eradicate the issues and behaviors that cause them. In this scenario, a nurse can begin implementing strategies for enhanced communication and allocating extra time to patient visits to resolve the many reconciliation concerns. The goal of the action stage is to guarantee that a person takes the steps necessary to bring about the desired improvements in their lives.
Maintenance
The last stage of the transtheoretical model of behavior change is maintenance, which is focused on ensuring that change is sustained for an extended period. Previous behavior must have been successfully altered, and methods must be put into place to ensure the new behavior is maintained. This is accomplished through consistent self-monitoring to locate areas where improvements can be made. If a nurse has reached this stage of the model, there is a good chance that any problems with medical reconciliation have been resolved; as a result, there is a greater possibility of obtaining ideal patient outcomes.
Presentation of Selected Change Model for Quality Improvement Analysis
Better Patient Safety
One expected outcome after successfully implementing the change model is enhanced patient safety. The many challenges associated with medical reconciliation that arise during the provision of face-to-face care pose considerable risks to the safety of the patient population. The realization of the intended change will ensure that nurses perform the appropriate medical reconciliation, which is essential for achieving the desired outcomes for patients (Redmond et al., 2018). Promoting increased health and quality of life will be significantly aided by improved patient safety.
Reduced Medical Errors
Another effect that is to be anticipated from the procedure is that it will assist in reducing the number of medical errors that occur during transitions. Correct medication reconciliation ensures that a patient’s medications are listed and that any modifications to the list are documented in an accurate and complete manner.
The Role of a DNP-Nursing Leader in Change Management
A DNP-prepared nursing leader has a significant role in evaluating the outcomes and sustainability of the proposed change. In the process of outcomes evaluation, a nurse leader who holds a doctorate in nursing practice can use the knowledge and skills they possess to evaluate the efficiency of the proposed change (Tenhunen et al., 2020). They are able to determine whether the change has resulted in the expected outcomes and pinpoint any areas that require improvement. They also have the ability to apply evidence-based practice to determine the most effective practices and interventions, which can be employed to enhance results.
A DNP-nursing leader can also make use of their leadership talents to guarantee that the suggested change is sustainable over time by ensuring that the change is sustained over time. They can collaborate with others who have a stake in the outcome to devise a strategy for maintaining the change over time. This strategy should incorporate regular review and monitoring to ensure that the change remains beneficial. They are also able to cooperate with other healthcare professionals and community organizations in order to establish a culture of sustainability and to support the use of the most effective methods.
A nurse leader also has the ability to argue for policy changes and allot resources to support the change that has been presented. They can use their expertise in healthcare policy to recognize opportunities for funding and assistance, and they may collaborate with policymakers and stakeholders to acquire the resources required to maintain the change by using their knowledge. Some of the DNP essentials explored within the assignment are helping to minimize medical errors and adverse outcomes through improved patient safety.
Conclusion
In conclusion, there is a need for change in the health sector to ensure nurses engage in appropriate medical reconciliation. The process of medical reconciliation poses a significant threat to the health and safety of the patient. This will significantly improve patient safety by lowering the risk of medication errors and reducing the possibility of patients not complying with their treatment plans.
The transtheoretical model of behavior modification will be utilized in the process of putting the change into effect. The paradigm can be broken down into five stages: pre-contemplation, contemplation, preparation, action, and maintenance. The correct use of the model will encourage a shift in behavior while providing direct patient care, increasing patient safety. A DNP-prepared nursing leader will play a significant role in outcome evaluation and change sustainability. This will involve identifying whether desired outcomes have been achieved and the need for improvement strategies.
References
Ekberg, K., Grenness, C., & Hickson, L. (2016). Application of the transtheoretical model of behaviour change for identifying older clients’ readiness for hearing rehabilitation during history-taking in audiology appointments. International Journal of Audiology, 55(sup3), S42-S51. Web.
Keshmiri, F., Rezai, M., Mosaddegh, R., Moradi, K., Hafezimoghadam, P., Zare, M. A.,… & Shirazi, M. (2017). Effectiveness of an interprofessional education model based on the transtheoretical model of behaviour change to improve interprofessional collaboration. Journal of interprofessional care, 31(3), 307-316. Web.
Redmond, P., Grimes, T. C., McDonnell, R., Boland, F., Hughes, C., & Fahey, T. (2018). Impact of medication reconciliation for improving transitions of care. Cochrane database of systematic reviews, (8). Web.
Tenhunen, M. L., Heinonen, S., Buchko, B. L., & Frumenti, J. (2019). The expert role of the DNP prepared nurse impacting healthcare systems: Bench to bedside, classroom to boardroom. Web.