Quality Improvement In Healthcare

Quality improvement in healthcare is to improve patient outcomes by standardizing evidenced-based patient-centered care (Centers for Medicare and Medicaid Services [CMS], 2017). To accomplish improvement of the quality of care one must be able to measure the improvements, which is quality measurement (CMS, 2017). Quality improvement and quality measurement are essential components of a quality improvement initiatives to assist a healthcare organization to acquire and transform patient-centered care interventions to improve quality of care, patient safety, and patient satisfaction (Institute for Healthcare Improvement [IHI], 2018).

Healthcare Concern

The Labor and Delivery Unit (LDU), is a small rural hospital specialty unit in Northeastern

The nationwide shortage is due to unexpected demand for the medication and manufacturing interruptions related to factory upgrades, repairs, and rebuilding from last year’s hurricane season (American Society of Health-System Pharmacists [ASHP], 2018). The shortage of Fentanyl has negatively affected the healthcare industry’s ability to provide adequate labor patient pain control and other patient pain that requires Fentanyl (ASHP, 2018; Daniel S. Orlovich, 2014; U.S. Food and Drug Administration [FDA], 2018) The healthcare organizations understand the shortage and rationing of the medication. However, the patient does not always comprehend or appreciate the limited supply of medication and just wants to have their pain controlled (Daniel S. Orlovich, 2014). This is true for the LDU patients. Many patients have expressed their dissatisfaction with not receiving an epidural early in labor. This can adversely affect future patronage to the LDU, which would affect the healthcare organization’s

• 28% of the nurses have less than two years’ experience in labor and delivery.

• 40% of the nurses have one or fewer years’ experience in labor and delivery (Integris Miami Hospital, 2018). The data indicates that 68% of the LDU’s nursing staff has two years or less of labor and delivery experience. This inexperience may have contributed to the increase in patient pain levels of 7-10 for over three hours. For instance, an inexperienced nurse may not be conversant in the alternative forms of labor pain control such as the utilization of a birthing ball, position changes, Lamaze breathing techniques, massage, and warm showers (Gayeski, Brüggemann, Monticelli, & dos Santos, 2015). Another area of the data to explore is the 39% decrease in inadequate pain relief of the laboring patients. This may be due to an experienced nurse laboring the patient, or the patient experienced pain for less than three hours then delivered. Another possible reason for the decrease is the retirement of a nurse anesthetist in the second month of the studied data. The LDU nursing staff noticed that more patients experienced poor labor pain relief was from epidurals placed by this particular nurse antitheist in comparison to the other nurse anesthetists. However, this is just speculation and research may be indicated to understand why this trend is occurring and is the trend real or just