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Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups. Quality is directly linked to an organization’s service delivery approach or underlying systems of care. While each QI program may appear different, a successful program always incorporates the following four key principles: QI work as systems and processes, focus on patients, focus on being part of the team, and focus on use of the data (

Workplace quality improvement project

Like every other organization, my job is confronting the issue of nurse retention. Because of this shortage, the full-time staff have been coerced into working mandatory overtime which has led to increase in medication errors and staff injury (needle stick). The nurses are over worked and fatigued. Since the incidents, more time is allocated to focus on nurse fatigue and its’ role in medication error, and injury. With evidence demonstrating a strong association between fatigue and work hours; Ferris 2015, in her research concluded the incidence of medication error and needle stick injury increases when nurses work extended shifts and hours. Those chances are significantly increased when working overtime and night shifts.

A second study which was very interesting, addressed the various levels of fatigue and its implications for both patient and provider safety. Thethree dimensions of fatigue are mental, physical and total, which can be acute or chronic. Mental fatigue is a state that arises in response to increasing mental task demands and stresses (mental workload), and results in a perceived sense of weariness, reduced motivation, reduced alertness, and reduced mental performance in workers. Physical fatigue in contrast is a state that develops throughout the body in response to increasing physical task demands and stresses (physical work-load), as well as expectancy of work demands, and can lead to physical discomfort and a decreased capacity to generate force or power. Total fatigue can be defined as a state that arises in healthcare workers who are exposed to excessive mental, physical, and emotional demands through their work tasks and schedules, and over time can result in these workers not being able to function at their normal capacity leading to an increased risk for injury or error (Pasupathy & Barker 2012).

How the published reliable database guideline gathered its data

On my quest to gather the data, a thorough literature search using multiple data bases was conducted.  There are several established published guidelines addressing medication errors and prevention. The oncology nursing society has recently updated its Administration Safety Standards for the Safe Administration and Management of Oral Chemotherapy. Methodology:  the development process was led by a Steering Group from ASCO and ONS. Steering group members and ASCO staff performed a structured literature search to identify relevant literature. After reviewing the literature, the groups met via conference calls to draft the guidelines. In total 38 people participated, including oncologists, nurses, pharmacists, social workers, practice administrators, and patient advocates. Standards were discussed, reviewed, and revised by the workshop participants. My job is using the same process to develop new guidelines to help with decreasing medication errors and promote staff safety. An outside consulting firm was hired. Nursing questionnaires were given to staff and patients. Individualized interviews with management and staff was conducted. Some of the guidelines mentioned in the ONS document can be implemented at my job. 


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