HQS-610 Foundations of Quality Improvement and Patient Safety Course Assignments & Examples Study Guide

HQS-610 Foundations of Quality Improvement and Patient Safety Course Assignments & Examples Study GuideHQS-610 Foundations of Quality Improvement and Patient Safety Course Description

This course provides foundational knowledge that will equip learners to make decisions regarding quality improvement and patient safety. Learners explore the quality improvement process and examine the most commonly used models and tools for improving health care quality. Learners will also evaluate methods to track, assess, analyze, and review data relating to patient safety issues. Prerequisite: NUR-590 & NUR-630 or HCA-540.

GCU HQS-610 Foundations of Quality Improvement and Patient Safety Course Week 1- 8 Syllabus

Foundations of Quality Improvement and Patient Safety


Credit Hours 6.0

PreRequisites NUR-590 & NUR-630 or HCA-540.

coRequisites None

Course Add-Ons Additional Material

Most RN-BSN student at the Grand Canyon University find this course very tough and confusing. Being the climax of their program, many lose the opportunity to finish with a 4.0 GPA just because they messed up with this course.

You can also read another study guide on nursing assignments for students from another post on HQS-620 Project Management in Health Care Course Assignments & Examples.

HQS-610 Foundations of Quality Improvement and Patient Safety Course Discussions

Topic 1 DQ 1

Describe ethical issues that are commonly associated with continuous quality improvement. As the Christian worldview promotes ethical behavior, explain how ethical principles informed by a Christian perspective might be beneficial for Christians and non-Christians alike regarding continuous quality improvement.

Using a minimum of two scholarly resources, compare and contrast two different methods of quality improvement used in health care.

Topic 4 DQ 1

Discuss the value of complete and accurate documentation. Provide an example from the news or from your professional experience when documentation has proven to be the key aspect in a legal case review. What laws and policies govern proper documentation practices and who establishes these practices?

Clinical nursing documentation is essential in letting nurses continuously reflect on their choice of interventions for patients and the effects of their interventions. Therefore, it is vital to the quality and continuity of nursing care (De Groot et al., 2022). Nursing documentation can be described as a reflection of the entire process of providing direct nursing care to patients. Complete and accurate documentation is crucial in various fields, including healthcare, legal, and business. It records events, actions, and decisions, clearly showing what transpired. This documentation can be used as evidence in legal cases, to track progress, and to ensure compliance with laws and regulations. Consequently, there is international consensus that clinical nursing documentation must reflect the phases of the nursing process, namely assessment, diagnosis, care planning, implementation of interventions, and evaluation of care or – if relevant, handover of care (De Groot et al.,2022).

In healthcare settings, for example, accurate documentation is essential for providing quality patient care, ensuring proper billing, and protecting healthcare providers from legal liability. In a legal case review, medical records are crucial in determining the standard of care provided to a patient and whether any negligence occurred. For example, if a patient sues a healthcare provider for medical malpractice, detailed and accurate documentation of the patient’s treatment and the provider’s actions can be critical in determining liability. There are various laws and regulations that govern proper documentation practices in different industries. The Health Insurance Portability and Accountability Act (HIPAA) sets standards for protecting patient health information, including requirements for maintaining accurate and confidential medical records. In the legal field, rules of evidence dictate what types of documentation can be admitted in court and how they should be authenticated. The Privacy Rule also contains standards for individuals’ rights to understand and control how their health information is used (HIPAA, 2022). A primary goal of the Privacy Rule is to ensure that an individual’s health information is adequately protected while allowing the flow of health information needed to provide and promote high-quality healthcare and protect the public’s health and well-being. The Privacy Rule permits important uses of information while protecting the privacy of people who seek care and healing (HIPAA, 2022).

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Topic 4 DQ 2

Explain variance and its common causes in patient care process and outcomes, including costs. Analyze the effects of linking quality improvement measures to payment structures. Discuss the effect that various payment structures have on quality outcomes.

Variance in patient care process and outcomes relies on the differences or deviations from the standard of expected or desired. It goes beyond such simple issues as making an intended departure from a guideline or recognizing a meaningful change in the care outcome (Neuhauser et al., 2011). There are more than excellent or lousy variations (meeting a target). Everything observed or measured varies. Some variation in healthcare is desirable, even essential, since each patient is different and should be cared for uniquely (Neuhauser et al., 2011). New and better treatments and improvements in care processes result in beneficial variation. Special-cause variation should lead to learning. The ‘Plan–Do–Study’ portion of the Shewhart PDSA cycle can promote valuable change (Neuhauser et al., 2011).

This can occur at various stages of the healthcare delivery process, including diagnosis, treatment, and follow-up care. Common causes of variance in patient care include:

Inadequate or no standardized protocols: When healthcare providers do not follow standardized protocols or guidelines for patient care, there can be inconsistencies in the quality of care delivered.

Breakdown of Communication: lack of communication between healthcare team members or healthcare providers and patients can lead to treatment and follow-up care errors.

Resource constraints: poor resources, such as staffing, equipment, or funding, can impact the quality of care that patients receive.

Factors that are related to patients. Variance in patient outcomes can also be influenced by factors such as patient compliance with treatment plans, underlying health conditions, and socioeconomic status.

Lack of training or education: When clinicians are not adequately trained or educated in best practices, they may deliver suboptimal patient care. For instance, a particular hospital is in a region participating in the CMS Comprehensive Care for Joint Replacement payment model. The hospital’s Outcomes Improvement Team is working to improve the quality of care for patients with total hip or knee replacement surgery (Ferguson, 2021a). They are currently focusing on a process to ensure that patients with diabetes have a preoperative hemoglobin A1C result to confirm that their diabetes is being controlled (otherwise, surgery should be postponed) (Ferguson, 2021a).

Different payment structures, such as fee-for-service, bundled, and value-based payments, can also influence the quality of care delivered. Fee-for-service payment models may incentivize providers to provide more services, regardless of necessity or effectiveness. In contrast, value-based payment models reward providers for achieving quality outcomes and cost savings. By aligning payment structures with quality improvement measures, healthcare systems can encourage providers to focus on delivering high-quality, cost-effective care.

In addition, variance in patient care processes and outcomes can significantly impact healthcare quality and costs. By linking quality improvement measures to payment structures and implementing value-based payment models, healthcare systems can incentivize providers to deliver high-quality care, reduce variance in care processes, and improve patient outcomes. This can ultimately lead to better patient healthcare outcomes and more efficient use of healthcare resources.

In general, payment methods based on the budget for a range of care are better at controlling the total costs of that care, but they can create concerns regarding underuse. They may also require more excellent institutional investment in information and management systems so the provider organization can monitor care and costs. Payment on a per unit basis has the opposite effect: it is often easier for providers to manage but is usually less amenable to controlling total costs (Institute of Medicine (US) Committee, 2001).

The payment methods used most commonly today are based on payment for some unit of care as it is used. Physicians are typically paid through fee-for-service methods, and hospitals through billed (discounted) per diem or case charges. The use of capitation for hospitals may also be declining in favor of per diem, perhaps influenced by reductions in length of stay so that health plans prefer to “rent beds” on an as-needed basis. Information on the frequency of use of budget approaches is not available. It is noteworthy, hence, that most providers receive payment from a variety of payers that may rely on different methods. Therefore, any given provider….

Topic 5 DQ 1

Evaluate three different tools developed to manage patient safety issues and educate health care providers. Describe one strength and one limitation of each.

Washington Manual of Patient Safety and Quality Improvement

Fondahn, E., Lane, M., & Vannucci, A. (2016). Washington manual of patient safety and quality improvement. Wolters Kluwer. ISBN-13: 9781451193558

Root-cause analysis helped assess reported errors/incidents and differentiate between active and latent errors, identifying the need for changes to policies and procedures and serving as a basis to suggest system changes, including improving risk communication (Hughes,2008).

RCA is a systematic process for identifying the underlying causes of adverse events or near misses in healthcare to implement corrective actions to prevent future occurrences.

Strength: RCA provides a structured approach to investigating patient safety incidents, allowing healthcare providers to identify the root causes of errors and develop targeted interventions to prevent similar incidents from happening in the future.

Limitation: RCA can be time-consuming and resource-intensive, requiring a significant investment of time and effort from healthcare providers to analyze patient safety incidents thoroughly. There are specific steps for an RCA that involve understanding the event in chronological order and identifying the steps of the care process in a way that identifies the latent and active errors (Hampe et al., 2023). Human factors are considered universal concerns about human error, rather than attribution to an individual for blame or punishment, and can be mitigated through process improvements (Hampe et al., 2023).

Plan-Do-Study-Act (PDSA) was used by most initiatives included in this analysis to implement initiatives gradually while improving them as needed. (Hughes,2008). The rapid-cycle aspect of PDSA began with piloting a single new process, followed by examining results and responding to what was learned by problem-solving and making adjustments, after which the next PDSA cycle would be initiated (Hughes,2008).

Strengths: The majority of quality improvement efforts using PDSA found tremendous success using a series of small and rapid cycles to achieve the goals of the intervention because implementing the initiative gradually allowed the team to make changes early in the process and not get distracted or sidetracked by every detail and too many unknowns (Hughes,2008). The ability of the team to successfully use the PDSA process was improved by providing instruction and training on the use of PDSA cycles, using feedback on the results of the baseline measurements, meeting regularly, and increasing the team’s effectiveness by collaborating with others, including patients and families, to achieve a common goal.

Limitations: Some teams experienced difficulty using rapid-cycle change, collecting data, and constructing run charts. One team reported that applying simple rules in PDSA cycles may have been more successful in a complex system (Hughes,2008).

Failure modes and effects analysis (FMEA) was used to avoid events and improve or maintain the quality of care (Hughes,2008). FMEA was used prospectively to identify potential areas of failure where experimental characterization of the process at the desired speed of change could be assessed and retrospectively to characterize the safety of a process by identifying potential areas of failure, learning about the process from the staff’s point of view (Hughes, 2008). Using a flow chart of the process before beginning the analysis got the team to focus and work from the same document. Information learned from FMEA was used to provide data for prioritizing improvement strategies, serve as a benchmark for improvement efforts, educate and provide a rationale for the diffusion of these practice changes to other settings, and increase the ability of the team to facilitate change across all services and departments within the hospital (Hughes, 2008).

Strength: Using FMEA facilitated systematic error management, which was essential to good clinical care in complex processes and complex settings and was dependent upon a multidisciplinary approach, integrated incident and error reporting, decision support, terminology standardization, and caregivers’ education (Hughes, 2008). FMEA is easy to use and an efficient tool for identifying potential failures to increase the reliability and safety of complex systems. This technique also helps gather data for decision-making and proactive risk control. FMEA can help avoid or reduce medical errors that cause patient harm in a healthcare setting (El-Awady, 2023).

Discussion Question Topic 5 DQ 2

Using personal experience or research, describe best practices that are in place that promote patient, community, and provider safety in the practice setting. In doing so, be sure to include methods to identify and prevent verbal, physical, and psychological harm to patients and staff.

By using evidence-based practices, health care providers can prevent clinical errors which will improve upon patient safety. Garnering the latest research evidence, following guidelines, and establishing protocols will ensure effectiveness as well as safety. Additionally, regularly investing in staff training and development can enhance the skills and knowledge of staff by enabling them to provide top notch care. Healthcare is always changing, so practices change as well. While it has been established that health is not just the absence of diseases, it is a term that is often thrown around and therefore, has been diluted. We need to establish quality care. At a nursing home, rehab facility, or a critical care hospital, it’s harder to envision establishing that quality of care because the patients’ health is already in a compromised state. This is why we need to think broadly and implement strategies that will prevent health-care associated infections and illness. This can be done through proper hygiene, PPE, and other infection control guidelines. While these strategies stay in mind, we need to, above all, prevent patient harm. Learning what early detection is and how to promptly act can prevent a deterioration of health and can reduce the risk of on the road harm. Promoting a safe environment that eliminates verbal, physical, and physiological use such as having security cameras with-in and outside the facility, using de-escalation techniques, and using pre- approved language.


Chien L. Y. (2019). Evidence-Based Practice and Nursing Research. The journal of nursing research : JNR, 27(4), e29. doi/10.1097/jnr.

Topic 6 DQ 1

Discuss what other methods are used beyond root cause analysis to analyze and classify medical errors. How do these methods compare to root cause analysis? Which one would you be more likely to choose if you needed to investigate a medical error made on your unit? Why?

In addition to root cause analysis, other methods are used to analyze and classify medical errors. This includes Failure Mode and Effects Analysis (FMEA), Cause-and-Effect Analysis, Incident Reporting Systems, and Human Factors Analysis.

FMEA is a proactive risk assessment tool that identifies potential failure modes in a process and evaluates the possible effects of each failure. The cause-and-effect analysis focuses on identifying an error’s immediate and underlying causes. Incident reporting systems collect and analyze mistakes and near-miss data to identify patterns and trends. Human factors analysis looks at how human factors, such as communication, workload, and fatigue, contribute to errors.

FMEA can be an excellent and practical starting point for scientists to begin to consider earlier general causes of failures, preventing waste of time and money and, even better, to implement the management and the control of procedures, equipment, and staff training of the laboratory. Moreover, such a quality tool, combined with a quantitative approach that measures errors and uncertainty, accustoms the researcher to pay attention to the margins for error in any laboratory operation (Mascia et al.,2020). These methods differ from root cause analysis in their focus and approach. Root cause analysis typically aims to identify the underlying systemic issues that contributed to an error. At the same time, other methods may focus on different aspects of the error, such as individual actions or process failures.

When I need to investigate a medical error on my unit, I would likely choose a combination of root cause analysis and FMEA. Root cause analysis would help me identify the systemic factors contributing to the error. In contrast, FMEA would help me proactively identify potential failure modes and prevent similar errors in the future. By combining these approaches, I would have a detailed understanding of the error and be better equipped to implement practical solutions to prevent future occurrences. An example of how FMEA has been used to avoid medical errors or reduce risk is reported. The study comprised two independent teams of pharmacistsat a teaching hospital in Sri Lanka who conducted the FMEA over two months (El-Awady,2023). Human factors are considered universal concerns about human error, rather than attribution to an individual for blame or punishment, and can be mitigated through process improvements  (Hampe et al., 2023).


Mascia, A., Cirafici, A.M., Bongiovanni, A., et al. A failure mode and effect analysis (FMEA)-based approach for risk assessment of scientific processes in non-regulated research laboratories. Accred Qual Assur 25, 311–321 (2020). https://doi.org/10.1007/s00769-020-01441-9

El-Awady S. M. M. (2023). Overview of Failure Mode and Effects Analysis (FMEA): A Patient Safety Tool. Global journal on quality and safety in healthcare, 6(1), 24–26. https://doi.org/10.36401/JQSH-23-X2

Hampe, H., Frndak, D., & Kydonaki, C. (2023). Global Collaboration in Teaching Root Cause Analysis with Healthcare Professional Students. Higher Education, Skills and Work-Based Learning, 13(4), 772–785. https://doi-org.lopes.idm.oclc.org/10.1108/HESWBL-02-2022-0041

Topic 6 DQ 2

Describe the difference between a medical error and a good catch. Use a personal example or find a current example in the news to illustrate your point. Discuss which evidence-based practices are used when evaluating errors and good catches

Sample Answer:

A medical error is a mistake or oversight made by a healthcare provider that results in harm or potential harm to a patient. This could include prescribing the wrong medication, misdiagnosing a condition, or performing a procedure incorrectly. On the other hand, a good catch is when a healthcare provider identifies and prevents a potential error before it reaches the patient, thus preventing harm. Implementing a good catch safety program will provide your team with the meaningful data necessary to reveal process and system vulnerabilities. This allows them to develop and implement timely, proactive, data-driven improvement activities.

Furthermore, an incentive-driven good catch program can transform the hospital’s culture and attitude surrounding near miss events. Even the language surrounding “good catch” is a positive shift that can transform a practitioner’s mindset. When administrators reward a good catch with a desirable incentive, it helps shift the cultural attitude toward event reporting

When staff feel empowered and responsible for patient safety, they are more likely to be vigilant and attentive to potential issues. As a result, you’ll improve both workplace satisfaction for staff and long-term safety outcomes for your patients (Iorio, 2023).

For example, a recent news article reported a case where a nurse caught a potential medical error when a patient’s medication dosage was about to be administered at a higher than prescribed amount. The nurse double-checked the order, realized the mistake, and prevented the patient from receiving the incorrect dosage. This would be considered a good catch, as the nurse was able to prevent potential harm to the patient.

When evaluating errors and good catches, evidence-based practices are used to determine the root cause of the issue and to implement measures to prevent future occurrences. This may include conducting a root cause analysis, reviewing policies and procedures, implementing checklists or protocols, and providing additional training to staff. By using evidence-based practices, healthcare providers can learn from mistakes and improve patient safety. According to WHO  a near miss event is “an error that has the potential to cause an adverse event (patient harm) but fails to do so because of chance or because it is intercepted.” (Iorio, 2023).

Examples of good catches in healthcare are:

Preventing near falls: due to meal tray placement, failure to issue no-skid socks.

Noticing medication errors before administration: incorrect medication, expired medication (Iorio, 2023).

Correcting inaccurate labeling: smudged specimen labels, missing dietary alerts, etc)

Addressing privacy errors (patient information left visible. (Iorio, 2023).

As the science of translating research into practice is fairly new, there is some guiding evidence of what implementation interventions to use in promoting patient safety practices (Titler, n.d.). Hence, there is no magic bullet for translating what is known from research into practice. To move evidence-based interventions into practice, several strategies may be needed. Additionally, what works in one context of care may or may not work in another setting, thereby suggesting that context variables matter in implementation (Titler, n.d.).


Iorio, S. (2023, January 30). How to Implement a Hospital Good Catch Program. American Data Network. Retrieved May 17, 2024, from https://www.americandatanetwork.com/patient-safety/how-to-implement-a-hospital-good-catch-program/#:~:text=A%20Good%20Catch%20campaign%20is,before%20a%20patient%20is%20harmed

Titler, M. G. (n.d.). The evidence for evidence-based practice implementation. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. https://www.ncbi.nlm.nih.gov/books/NBK2659/

Topic 7 DQ 1

Describe what is meant by the term human factors. Take a minute to think critically about your own strengths, limitations, and values. Now think about your team members. How do these areas have an impact on clinical decision making in relation to patient safety? Be specific. Provide an example of flawed clinical decision-making and potential legal ramifications.

Human factors study how humans interact with systems, equipment, and environments to optimize performance, safety, and well-being. This includes understanding human behavior, capabilities, limitations, and how these factors can influence decision-making. (Health and Safety Executive, 2018).

“Human factors refer to environmental, organizational and job factors, and human and individual characteristics, which influence behavior at work in a way which can affect health and safety”(Health and Safety Executive, 2018).

This definition includes three interrelated aspects that must be considered: the job, the individual, and the organization.

Job includes areas such as the nature of the task, workload, the working environment, the design of displays and controls, and the role of procedures. Tasks should be designed by ergonomic principles to account for human limitations and strengths. This includes matching the job to people’s physical and mental strengths and limitations (Health and Safety Executive, 2018). Mental aspects would consist of perceptual, attentional, and decision-making requirements—the individual, including their competence, skills, personality, attitude, and risk perception. Individual characteristics influence behavior in complex ways. Some factors, such as personality, are fixed; others, such as skills and attitudes, may be changed or enhanced.

The organization includes work patterns, the culture of the workplace, resources, communications, leadership, and so on. Such factors are often overlooked during the design of jobs but significantly influence individual and group behavior(Health and Safety Executive,2018).

Studies suggest that many healthcare practices can affect autonomy by their effects not only on patients’ treatment preferences and choices but also on their self-identities, self-evaluations, and capabilities for autonomy (Entwistle et al.,2010 Relational understandings de-emphasize independence and facilitate well-nuanced.

Considering my strengths, limitations, and values, I recognize that l will have strong attention to detail and critical thinking skills. Notwithstanding, I may also have biases or blind spots that could impact my decision-making. My staff members may have different strengths and limitations, and it is essential to consider how these differences can contribute to a more well-rounded decision-making process.

Those factors can significantly impact patient safety when making decisions in clinical settings. For example, if a team member is overly confident in their abilities and dismisses input from others, this could lead to errors in diagnosis or treatment. On the other hand, if a team member is too hesitant to speak up or lacks assertiveness, important information may be missed.

One example of flawed clinical decision-making and potential legal ramifications could involve a team member misinterpreting a patient’s medical history or symptoms, leading to a misdiagnosis or incorrect treatment plan. The healthcare provider could be held accountable for medical malpractice if this error harms the patient. This highlights the importance of effective communication, collaboration, and consideration of human factors in clinical decision-making to ensure patient safety and minimize the risk of errors. Human factors is an established body of science that is positioned to assist with the challenge of improving healthcare delivery and safety for patients. Human factors and healthcare professionals can work together to identify problems and solutions that may not be apparent by traditional means (Russ et al., 2013).

While human factors do not promise instant solutions for healthcare improvement, they can provide a wealth of scientific resources for sustainable progress. Human factors’ goals pave the way for interdisciplinary collaborations that may yield new, sustainable solutions for healthcare quality and patient safety (Russ et al.,2013).


Health and Safety Executive. (2018). Introduction to human factors. Human factors/ergonomics – Introduction to human factors. https://www.hse.gov.uk/humanfactors/introduction.htm

Entwistle, V. A., Carter, S. M., Cribb, A., & McCaffery, K. (2010). Supporting patient autonomy: the importance of clinician-patient relationships. Journal of General Internal Medicine, 25(7), 741–745. https://doi.org/10.1007/s11606-010-1292-2

Russ, A. L., Fairbanks, R. J., Karsh, B. T., Militello, L. G., Saleem, J. J., & Wears, R. L. (2013). The science of human factors: separating fact from fiction. BMJ quality & safety, 22(10), 802–808. https://doi.org/10.1136/bmjqs-2012-001450

Topic 7 DQ 2

Interprofessional teamwork and communication affect patient safety. Provide an example from your professional life of ineffective communication. Next, describe appropriate handoff communication practices. Discuss how proper communication and teamwork made a difference.

Healthcare systems are seeking assistance from other well-known industries for a solution to issues related to handoff communication, the system for relaying patient information from one caregiver to another. The handoff should provide accurate information about a patient’s care, treatment, services, and condition; communication inconsistencies exist among practitioners (Ardoin & Broussard, 2011). This lack of consistent messages prompted staff development nurses in a community hospital to introduce the SBAR process (situation, background, assessment, and recommendation) as the standard for handoff communication to reduce errors and improve patient safety (Ardoin & Broussard, 2011).

As a nurse, I have encountered several ineffective communications that have affected patient safety. One example that comes to mind is when a patient was transferred from the emergency department to the medical-surgical floor without proper handoff communication between the two teams. The patient had a complex medical history and required close monitoring, but crucial information about their condition, medications, and treatment plan was not adequately conveyed to the receiving team.

In this case, the lack of proper handoff communication creates confusion and delays in providing appropriate care to the patient. The relay of the message to the team was not well received. Patient’s needs and requirements could have put the patient at risk for medication errors, complications, or adverse effects.

We must follow appropriate handoff communication practices to prevent such incidents. This includes using standardized tools like SBAR (Situation, Background, Assessment, Recommendation), which conveys the critical information clearly and in a structured way. It is also essential to involve all relevant team members in the handoff process, including nurses, physicians, and other healthcare providers. Moreover, ensuring two-way communication is crucial, allowing for questions, clarifications, and feedback from the receiving team.

In a healthcare setting, patient care involves necessary interactions between several healthcare professionals over successive shifts and across different departments. Adequate and effective communication and handoff of information between healthcare professionals have been recognized as an essential factor in healthcare quality and patient safety (Adam et al., 2022). However, with each handoff, loss of information and miscommunication are expected due to a large amount of information, high frequency of exchange, and differences in perception ofwhat is important and worth mentioning in the handoff process (Adam et al., 2022).

In addition, the stress and exhausting nature of the job renders healthcare professionals more prone to making mistakes, which may lead to delays in management, prolonged hospitalization, and medication errors, compromising patient safety (Adam et al., 2022). Communication errors have been reported to be one of the major factors leading to sentinel events. A sentinel event is a patient’s harm or death not caused by a natural disease process. To reduce the magnitude of this problem, many hospitals use standardized handoff communication “as a process in which patient’s information is communicated from one healthcare giver to another in a consistent manner (Adam et al., 2022).

Proper communication and teamwork can make a significant difference in patient safety. When healthcare providers effectively communicate and work together, they can prevent errors, improve coordination of care, and enhance patient outcomes (Adam et al., 2022). By establishing a culture of open communication, mutual respect, and collaboration, healthcare teams can ensure that patients receive safe and high-quality care throughout their healthcare journey. The SBAR form is a simple and effective tool for improving communication; it helps doctors capture all relevant patient information. Most importantly, most doctors were satisfied with using this tool for handoff communication (Adam et al., 2022).   


Ardoin KB, Broussard L. Implementing handoff communication. J Nurses Staff Dev. 2011 May-Jun;27(3):128-35. doi: 10.1097/NND.0b013e318217b3dd. PMID: 21602630. 

Adam MH, Ali HA, Koko A, Ibrahim MF, Omar RS, Mahmoud DS, Mohammed SOA, Ahmed RA, Habib KR, Ali DY. The Use of the Situation, Background, Assessment, and Recommendation (SBAR) Form as a Tool for Handoff Communication in the Pediatrics Department in a Sudanese Teaching Hospital. Cureus. 2022 Nov 29;14(11):e31998. Doi: 10.7759/cureus.31998. PMID: 36589181; PMCID: PMC9798145.

Topic 8 DQ 1

Discuss the link between national trends in health information technology (HIT) initiatives and quality improvement. How does this affect patient safety? Provide two specific examples.

Computer Provider Order Entry (CPOE) has revolutionized how physicians and other providers direct patient care in multiple settings. CPOE has both benefits and disadvantages. CPOE has been shown to reduce the number of medication errors in hospitalized patients  (Connelly,2019). It is associated with increased time for completion of some physician workflow. The quantity and quality of clinical data are rapidly expanding, including electronic health records (EHRs), disease registries, patient surveys, and information exchanges. HIT initiatives can improve patient safety through electronic health records (EHRs). EHRs allow healthcare providers to comprehensively view patients’ medical histories, medications, allergies, and test results in one centralized system. This can help prevent medication errors, identify potential drug interactions, and ensure that all care team members know a patient’s health status (Connelly, 2019).

Numerous studies have shown that only implementing an EHR and computerized physician order entry (CPOE) has rapidly decreased the incidence of specific errors, introducing however many more. This means that high-quality clinical decision support is essential for healthcare organizations to achieve the full benefits of electronic health records and CPOE. In the current healthcare setting, when facing a decision, healthcare providers often do not know that specific patient data are available in the EHR, do not always know how to access the data, do not have the time to search for the data, or are not fully informed on the most current medical insights (Connelly, 2019).

Moreover, decisions by healthcare professionals are often made during direct patient contact, ward rounds, or multidisciplinary meetings. This shows that decisions are made in seconds or minutes, depending on the healthcare provider having all patient parameters and medical knowledge readily available at the time of the decision. A computer also considers all data available, making it possible to notice changes outside the scope of the professional and notice changes specific to a particular patient within normal limits (Clinical Decision Support Systems, n.d).

In conclusion, healthcare practitioners frequently put clinical and laboratory data into the system as a record in an electronic system for the care of patients.

Database information sources may be different. For example, data comes from the hospital discharge abstracts, completed patient respondents’ self-questionnaires, insurance submission claims, files of employees, and computerized records from the pharmacy. Identified personal data contains information or documents that have a patient’s referral, allowing for the identification of the patient.

EMRs contain medical information and data relevant to patient health care.

Some opportunities may arise from nurses’ and physicians’ ability to use data from EHRs to improve effective decisions when a framework such as Clinical Decision Support (CDS) is used. CPOE and CDSS are beneficial in providing safe patient care. CPOE makes it easier to manage patient orders electronically, thereby making it faster to reduce the risk of making errors when orders are handwritten (Clinical Decision Support Systems, n.d).  


Connelly, T. P., & Korvek, S. J. (2019, July 29). Computer Provider Order Entry (CPOE).Nih.gov; StatPearls Publishing.  https://www.ncbi.nlm.nih.gov/books/NBK470273/

[PDF] Clinical Decision Support Systems | Semantic scholar. (n.d.). https://www.semanticscholar.org/paper/Clinical-Decision-Support-Systems-Wasylewicz-Hoeks/1383d1ab6fa5ba132a17dcde947fcbdc6a7932c9

Topic 8 DQ 2

Explain how clinical decision support systems (CDSS) impact quality improvement and patient safety. Discuss both the strengths and opportunities for improvement ofa CDSS that you are familiar with from your professional setting or research.

Clinical decision support systems (CDSS) significantly impact quality improvement and patient safety in healthcare settings. These systems utilize patient data and evidence-based guidelines to assist healthcare providers in making informed decisions about patient care. CDSS can help reduce medical errors, improve adherence to best practices, and ultimately enhance patient outcomes by providing real-time information and recommendations. CDSS provides practitioners with evidence-based suggestions for clinical decision-making (Sutton et al., 2020). This assists in reducing the risk of error that would compromise patient safety. CDSS has shown to have a rapid evolution as they are now commonly administered through electronic medical records and other computerized clinical workflows, which has been enhanced by increasing global adoption of electronic medical records with advanced capabilities (Sutton et al., 2020).

There remain unknowns regarding the effect CDSS have regardless on the providers who use them, patient outcomes, and costs care (Sutton et al., 2020).One strength of CDSS is its ability to standardize care by providing clinicians with evidence-based guidelines and best practices. This can help ensure that all patients receive high-quality, consistent care, regardless of the provider they see. CDSS can also help clinicians identify potential medication errors, drug interactions, and allergies, reducing the risk of adverse events.

Another strength of CDSS is its ability to improve efficiency and workflow. By automating specific tasks and providing real-time decision support, CDSS can help streamline the clinical decision-making process and reduce the cognitive burden on healthcare providers. This can lead to quicker, more accurate decision-making and ultimately improve patient outcomes.

However, there are also opportunities for improvement in CDSS. One common challenge is the integration of CDSS into existing electronic health record systems. Some CDSS may not seamlessly integrate with electronic health records, leading to usability issues and potential errors in data transfer. Additionally, the quality and relevance of the clinical guidelines and evidence used by CDSS can vary, leading to potential inaccuracies and inconsistencies in recommendations.

In my professional setting, I have encountered a CDSS that could benefit from improvements in its user interface and customization options. The system provides valuable decision support, but the interface is complex and challenging to navigate, leading to potential errors and inefficiencies in workflow. Additionally, the system does not allow for easy customization based on individual providers’ specific needs and preferences, limiting its effectiveness in supporting clinical decision-making. Due to the increased use of electronic medical records in physicians’ offices, broader implementation of computer-aided clinical decision support systems (CDSS) is possible and offers an opportunity to reduce this gap between knowledge and performance (Holstiege et al., 2015). These systems directly aid in clinical decision-making by providing specific clinical recommendations by matching patient characteristics with rules in a computerized knowledge base (Holstiege et al.,2015).

CDSSs are effective in improving provider performance across various clinical settings. Nevertheless, there is relevant variability among properties and methods of implementation of CDSS and resulting effectiveness. In addition, achieving large-scale adoption rates remains a challenge (Holstiege et al.,2015).

Overall, while CDSS has the potential to significantly impact quality improvement and patient safety in healthcare settings, there are opportunities for improvement in areas such as integration, usability, and customization. By addressing these challenges, healthcare organizations can maximize the benefits of CDSS and enhance patient care outcomes.

An advanced CDSS includes, for example, checking drug-disease interactions, individualized dosing support during renal impairment, or recommendations on laboratory testing during drug usage (Clinical Decision Support Systems, n.d).


[PDF] Clinical Decision Support Systems | Semantic scholar. (n.d.). https://www.semanticscholar.org/paper/Clinical-Decision-Support-Systems-Wasylewicz-Hoeks/1383d1ab6fa5ba132a17dcde947fcbdc6a7932c9

Clinical Decision Support Systems [Internet].

U.S. National Library of Medicine. [cited 2021Feb

Holstiege, J., Mathes, T., & Pieper, D. (2015, January). Effects of computer-aidedclinical decision support systems in improving antibiotic prescribing by primary careproviders: A systematic review. Journal of the American Medical Informatics Association : JAMIA. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4433375/

HQS-610 Foundations of Quality Improvement and Patient Safety Course Assignments

HQS 610 Grand Canyon University Continuous Quality Improvement Process Assignment Paper

The purpose of this assignment is to discuss the purpose and use of the continuous quality improvement (CQI) process.

In a 1,000-1,250 word paper, address the following:

  1. Explain the need for CQI in health care.
  2. Describe methods of CQI used in health care.
  3. Describe factors that have an effect on the CQI process.  
  4. Describe the overall impact that the CQI process has on staff.
  5. Describe the overall impact that CQI initiatives have on patient outcomes.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

This assignment requires a minimum of three scholarly resources.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

HQS 610 GCU Week 5 Just Culture and Culture of Safety Assignment


The purpose of this assignment is to examine factors that contribute to a just culture and a culture of safety and how they are implemented within a health care organization. Identify a health care organization that uses a just culture and culture of safety. Research how a just culture and culture of safety are implemented within that organization.

In a 1,000-1,250 word paper, analyze the factors that create a just culture and culture of safety within your selected organization. Include the following in your paper:

  1. A description of the health care organization you selected.
  2. An analysis of the factors that create a just culture and culture of safety within the selected health care organization.
  3. An evaluation of how the mission and vision of your identified organization align with the factors that create a just culture and culture of safety, including two or three examples.

This assignment requires a minimum of two scholarly sources. If the necessary information is not readily available on the organization’s website, you may need to set up an interview with someone at the organization.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

HQS 610 Grand Canyon University W7 National Patient Safety Initiatives Essay

The purpose of this assignment is to analyze national patient safety initiatives. Review the National Patient Safety Goals, and select any initiative that you are familiar with (u can pick anyone of them). In a 750word paper, analyze the national patient safety initiative you have selected. Include the following in your paper:

Will attach the link to the national patient safety goals

  1. A description of the national patient safety initiative you have selected that you are familiar with or have seen in practice and what the setting would be for that initiative.
  2. A description of how this initiative is supported by evidence.
  3. An analysis of how the nation is trending toward this goal and its importance for improving patient outcomes in health care. Provide one or two examples to support your position.    

An abstract is not required

Apa 7th edition

Only 2 sources needed

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