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Quality is a key concern for all healthcare providers and organizations. Absolutely no one wants adverse patient outcomes! Examples of adverse patient outcomes include the following:

  • Wrong-site surgeries

  • Wrong medication

  • Prescribing errors

  • Transcribing errors

  • Poor communication (both written and verbal)

  • Healthcare-associated infections (HAIs)

Adverse outcomes aren't just bad for patients; they're also bad for healthcare organizations. This is because adverse outcomes often bring with them increased costs and lower reimbursements. While it used to be that healthcare organizations were reimbursed per individual for healthcare services provided, that's no longer the case. Today, insurers generally do not reimburse healthcare organizations for treatment needed due to iatrogenic events—that is, illnesses or other medical problems caused by the healthcare system itself, which often result in prolonged and costly hospital stays.

Iatrogenic Events

The 2001 Institute of Medicine (IOM) report Crossing the Quality Chasm highlighted the tens of thousands of iatrogenic events and deaths that occur in US healthcare systems on an annual basis (IOM, 2001). More recently, a 2013 study in the Journal of Patient Safety reported that between 210,000 and 440,000 patients die each year from iatrogenic effects after presenting themselves in a healthcare setting (James, 2013).

Generally speaking, the lower the quality of care provided, the higher the potential risk to the healthcare organization, which often results in higher costs. For example, consider the costs involved with a patient who develops a stage IV pressure ulcer while in the hospital! Improving quality, then, is imperative for any healthcare organization. That's what this chapter is about.

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One major force behind quality-improvement initiatives in hospitals is the IOM (now called the National Academy of Medicine). The IOM's report To Err Is Human (1999), which laid out in graphic numbers the shocking scale of iatrogenic events, has been a key driver of quality improvement in hospitals.

Quality and Safety Education for Nurses (QSEN)

In 2005, in response to adverse patient outcomes and public perceptions of the quality of healthcare in the US, the University of North Carolina at Chapel Hill launched a multiphase ongoing project called Quality and Safety Education for Nurses (QSEN). As its name suggests, this project focuses on quality and safety—and nursing's contributions to both—in a healthcare setting. The goal of QSEN is to improve the quality and safety of healthcare delivered to patients.

QSEN has outlined core competencies consisting of knowledge, skills, and attitudes (KSAs) that all prelicensure nursing students should master. (QSEN competencies have also been developed for graduate nursing students.) These are based on competencies identified by the IOM (2003). The six core competencies, or KSAs, are as follows:

  • Patient-centered care: This KSA recognizes that the patient is a full partner in the provision of compassionate and coordinated care. This competency addresses ...

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