NURS FPX 6016 Assessment 3 Data Analysis and Quality Improvement Initiative Proposal

Among the typical traits of infants who are admitted to the NICU, there are low-weight infants, infants with blood infections, cardiac defects, respiratory disorders, and infants who were born prior to the completion of 37 weeks of gestation (Merewood et al., 2021). This weakness among such babies necessitate that they be given special care. Consequently, NICU units are regularly inspected by neonatal nurse practitioners and other interdisciplinary specialists regarding the data quality objectives, quality and safety outcomes.

Problem and Needs

Previous studies have shown that breast milk contains healthy value to babies. The role of breast milk in infants and the identification of the absorbable nutritional elements in the milk that makes it essential to the health of infants have also been established by the WHO and the American Academy of Pediatrics (Pelizzo et al., 2020). Among the advantages of breast milk, the milk enhances feeding sensitivity among preterm babies, sepsis and respiratory tract infections as well as early cognitive development. The experts have also reported that breast milk is capable of lowering the cases of necrotizing enterocolitis among the preterm babies (Wang et al., 2019). Considering the above knowledge regarding the role of breast milk to infants, the majority of hospitals have adjusted the human milk feeding rate over the last ten years. Nevertheless, the issue of favoritism to breast milk as the primary food offer to the infants has led to some human mistakes in feeding the infants. The errors have been reported by NICU to have escalated in the recent years with data analysis tools.

The current information of the quality management team at NICU which has already made a yearly evaluation of the quality outcomes at the organization in 2020 and 2021 showed almost and unfavorable misses in the administration of breast milk. The dashboard measures were reviewed following specific tests of variables,

including the evaluation of newborns younger than 34 weeks, Cytomegalovirus (CMV) inactive level and screening at the units of the organization and error rates in administering mother own milk in NICU units. According to the analysis of dashboard metrics, the quality management team found that, two of the quality indicators used in the organization were below the benchmarks of the hospital. CMV was the quality indicators in which screening level and inactivation at the NICU units and the error rate at the administering of mother own milk. Based on the analysis of the data at the NICU, NURS FPX 6016 Assessment 3 presents a quality improvement program that would be based on effective scanning of breast milk to minimize the human errors that have been cited as a result of mothers giving out milk to their babies.

Proposed Solution

The first priority of the segment in NURS FPX 6016 Assessment 3 is to analyze the relationship between the two quality indicators that failed to correspond to the benchmarks of the hospital and what this signifies to the delivery of quality healthcare in the institution. The report will then recommend quality improvement strategies which can help curb the error rates and improve the CWV inactivation and screening level within the hospital. The report will look at the patterns of relationships between information and the signals while creating the proposal since this will aid in the formulation of the hypotheses that influence nursing qualities and healthcare quality. In order to develop a plan and framework to improve the satisfactory results of the NICU units, the assessment will also assist in determining the cause of the quality issues.

The following table is a dashboard presentation of metrics of quality and safety of the NICU unit of the target hospital.

The statistics indicate that the number of babies taken to the NICU rose in 2021 compared to the results recorded in 2020. In 2021, there was also an increment in error rate when administering the breast milk by 10-percent. The other disclosure is the decrease in the degree of CMV inactivation and screening in 2021 in contrast with the amounts in 2020. Based on the information in the table above, the quality of patient care had dropped in 2021, and this is concerning to the hospital management. Among the stories based on the data, there are negative rating and perception regarding the hospital in terms of quality prenatal and postnatal care of infants. The alternate story is that the nurses and other medical practitioners at the hospital have been negligent in regards to proper administration of milk to babies. Another option is that the table’s margin of error could result in newborns being fed other mothers’ nursing milk, which could raise the risk of HIV transmission in the NICU. Also, low degree of scanning of the milk, prior to the milk being administered to the infants, may be a contributor in the administration of contaminated milk, which may have adverse patient consequences. Based on the above analysis of the NICU department

of the hospitals, the hospital facility is grappling with a quality problem in the management of infants.

Among the consequences of the analysis of the above dashboard metrics is the likelihood that the institution may undergo legal difficulties when faced with lawsuits brought by parents against the hospital (Lumbreras-Marquez et al., 2021). The other consequence is potential disciplinary measures and termination of the nursing practice license on the health practitioners deployed to the unit or discovered guilty of indiscipline in the handling of the infants. The babies might also be involved, particularly when they contract infections due to the absence of screening of the milk and mistakes in the process of giving mothers breast milk to the appropriate babies (Klotz et al., 2018). In the cases where the babies contract infections, they may spend longer periods at the NICU thus raising the medical expenses incurred by the parents.

Other than the above table, other factors in the quality assessment report within the NICU department of the hospital revealed other leadership issues. To demonstrate this point, the findings of the discussion between the unit’s nurses and managers of nurses revealed that the transactional leadership style employed at the unit may be a factor in the mistakes mentioned in the report analyzing the data. Transactional leadership employs punishment and rewards as a motivating factor, and subordinates should listen to the instructions of their seniors not to be punished or to receive rewards (Shlomai et al., 2021). The NICU branch exhibits the transactional leadership style since the majority of the subordinate workers lack skills and knowledge and have to be guided by their superiors. As a result, the absence of instructions regarding how to address the arising problems in the NICU department will automatically lead to the errors committed by the subordinate employees that will add up to the poor quality performance displayed in the table above.

Quality Improvement Initiative Proposal

The idea presented in as emphasized in NURS FPX 6016 Assessment 3 depends upon the main problem which led to the decline of the quality levels within the NICU department. Transactional style of leadership was not effective in ensuring that the facility could achieve higher quality healthcare to the infants. In this light, it is proposed to modify the leadership style of the NICU department and alter the transactional leadership to the transformational leadership. In comparison to the transactional leadership model, the transformational leadership model is proactive and leaders are adaptable and adopt new ideas capable of transforming the culture of a given organization (Wang et al., 2019). The culture within the NICU department needs to be transformed in case the hospital facility wants to experience a change in the level of care delivery to their infants.

The second facility-probably useful characteristic of the transformational type of leadership style is its motivation feature to the subordinates and the capacity to empower the employees to achieve the organizational objectives and goals by addressing the higher ideals and moral values (Merewood et al., 2021). With the implementation of the transformational leadership, the hospital facility will turn around its fortunes and the nurses will be dedicated to ensure that they provide better quality care to the infants, which in turn results in higher degrees of patient satisfaction.

NURS FPX 6016 Assessment 3 suggests that the plan-do-study-act model should be used in applying the transformational leadership style. This model is implemented by organizations and institutions to speed up the change, which is a pressing necessity and urgent requirement in the NICU department. The institution will need to implement the PDSA using some of the strategies as follows.

1. Plan:  An interdisciplinary team consisting of different stakeholders will be established and the team will use questionnaire survey to confirm the conclusion drawn above on the following issue as the leadership style employed in the NICU department. The survey will be conducted among nurses and other medical workers who work at the department. After reviewing the findings, the team will suggest that the change in the leadership behavior should be modified to transformational leadership to enhance the two quality indicators in the table above.
2. Do: Within the framework of this element, emphasis was laid upon the design of a strategic plan that may help in the realization of the intended NICU quality objectives. One such framework would be the training of the nurses in the department and empowering them with skills and knowledge to accomplish their duties.
3. Study: In this section, the plan would be to trace data of the Do part and see the difference and result in attaining the expected objectives at the NICU department.
4. Act: The aim of this aspect is to re-consider the objectives stipulated in the first step to ascertain the effectiveness of the transformational leadership in providing the quality expectations of the institution. The management will then perform data analysis in the quality indicators and check whether the data have increased or decreased. New strategies and goals can be embarked on the department and PDSA implemented on the goals depending on the available data.

Among the issues when implementing the PDSA model is the fact that a small number of quality indicators, as demonstrated in this case, will lead to a biased interpretation of the problem in the department (Lumbreras-Marquez et al., 2021).

NURS FPX 6016 Assessment 3 proposes that other quality indicators such as patient satisfaction, nurse-satisfaction, and mortality rate should be introduced in the department to further understand the factors that might be influencing quality achievements in the department. Theories, such as the foundation theory, have proposed that inefficiencies within one department might imply the presence of an organizational problem that impacts other departments negatively (Shlomai et al., 2021), and the management would be essential to investigate whether other departments within the facility have such quality problems as the NICU department.

Support for Quality Improvement through Integration of Interprofessional
Perspective

The assumptions that are made on quality improvement in a healthcare facility include the assumption that inefficiencies of one group of healthcare practitioners influences the quality outcomes of other healthcare practitioners. An example is where the nurses employed in the NICU department demonstrate a lack of professionalism in delivering their services, the doctors employed along will suffer inefficiency in their output due to receiving information provided by the incompetent nurses (Wang et al., 2019). At that, the quality aspects management in one group of professionals should be supported by other professionals working in the same area. Besides, the administration in the medical institution needs to improve resource delivery in order to support the provision of the targeted goals by all the professional teams working within the institution (Merewood et al., 2021). In this instance, the nurses must be enabled to effect the changes that they require in order to initiate improvement on quality levels within the NICU department although other strategies must be offered to improve interdisciplinary relationship within the department to

achieve cohesiveness and harmony in provision of healthcare services at the department.

According to the presumptions mentioned above in as emphasized in NURS FPX 6016 Assessment 3, leadership is the latent aspect. Although the recommended transformational leadership style may have an impact on the nurses’ relationships with different departments professionals, it will aid in the NICU department’s transition process, especially among the nurses. With this in mind, the interdisciplinary outlook in initiating the changes at the department can raise the likelihood that the proposed solutions can fulfill their intentions (Jawdeh et al., 2020). Moreover, the enhanced communication and interaction among the diverse professionals in the NICU department can be helpful to the infants, since it will reduce the number of days the infants spend at the facility.

Effective communication strategies to promote quality improvement

When leading an organization, it is essential that the leadership informs their subordinates on the strategies that they are employing in order to attain quality results. Lack of proper communication strategy will imply that subordinates fail to comprehend what the leadership wants, and this issue may influence the implementation of the change process (Agarwal et al., 2021). As depicted in the discussion above, inability of the nurse leadership to empower their subordinates to perform their duties without necessarily having to be ordered about by the seniors was one of the factors that led to the quality failure in the NICU department. There was no information that the subordinates knew on how to screen the milk, label the mothers milk and how to administer the milk to the infants. This resulted in an increase in the rate of errors in the department. The communication strategies failures by the nursing

leadership in the NICU department should not persist in the implementation of the proposed strategies to turn around the fortunes of the department.

The strategy that the facility should adopt is to institute correspondence systems in which there are clear communication lines between the nurse leadership, the subordinate nurses and other healthcare professionals who work in the same area as the nurses in the department. The verbal communication activities, the electric communication platforms, and approach to correspondence can intervene to augment the collective efforts of different healthcare professionals working at the NICU department (Jawdeh et al., 2020). The alternative idea is to access a system of shared information, where a doctor can learn what a nurse has done with a patient, and the former specifies the next action to be taken within the same document or platform on the treatment of a patient (Lumbreras-Marquez et al., 2021). The usual practice has been to have a file of a patient and record the treatment processes that could be assessed by other healthcare personnel to assess the treatment process to the patient. When it comes to infants, the strategy should incorporate diverse concerns such as the screening time and other developmental indicators that doctors need to make decisions on the infant.

Conclusion

Analyzing quality indicators within an organization is one among the methods of identifying the attainability of quality standards in an institution In the case of NICU department within the hospital to analyse quality indicators, the objective was to analyse higher levels of CMV screening and inactivation rates, the attainment of higher rates of feeding infants with breast milk, and labeling of milk correctly to avoid mistakes. The evaluation demonstrated a decline in the quality indicators in CMV levels of screening and inactivation, and in the administration of mothers milk.

The results of a meeting among nurses’ administration and the nurses themselves showed ineffective leadership. The report’s recommendation is that the department adopt a transformational leadership model, which would bring about changes within the division, empower nurses to carry out their objectives, and improve the relationships between the various healthcare professionals who work there. There would also be the need to better communication strategies to enhance coordination efforts between the nurses and other healthcare professionals. Together, the proposal will help the healthcare institution better its quality measures at the NICU department, as it will eradicate a portion of the inefficiencies and errors that helped to bring down the quality levels.

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