NURS 4220A LC4004A Quality Improvement Tools Nursing Paper Example

NURS 4220A LC4004A Quality Improvement Tools Nursing AssignmentNURS 4220A LC4004A Quality Improvement Tools Nursing Assignment

NURS 4220A LC4004A Quality Improvement Tools Nursing Paper Assignment Brief

Course: NURS 4220A – Leadership Competencies in Nursing and Healthcare

Assignment Title: NURS 4220A LC4004A Quality Improvement Tools Nursing Assignment

Assignment Instructions Overview

This assignment focuses on the analysis and application of quality improvement tools in nursing practice. Students are required to explore the use of Fishbone Diagrams, Pareto Charts, Process Flow Charts, and Run Charts. The aim is to demonstrate understanding and proficiency in utilizing these tools to identify, analyze, and prevent issues related to medication errors and patient satisfaction within a healthcare setting.

Understanding Assignment Objectives

The primary objective of this assignment is to enhance students’ ability to use quality improvement tools to identify the root causes of problems, prioritize interventions, and monitor outcomes. Students will analyze data depicted in various quality improvement tools and explain how these insights can be applied to improve nursing practice, particularly in preventing medication errors and enhancing patient satisfaction.

The Student’s Role

Students are expected to engage with the course materials and learning resources to understand the principles and applications of different quality improvement tools. They should critically analyze provided data using these tools and describe how the information can be used to inform and improve nursing practice. Additionally, students must support their analysis and recommendations with evidence from scholarly literature.

Competencies Measured

This assignment measures several competencies essential for nursing practice, including:

  • Analytical skills: Ability to dissect and interpret data using quality improvement tools.
  • Problem-solving: Identifying root causes of issues and proposing effective interventions.
  • Evidence-based practice: Integrating scholarly evidence into the analysis and recommendations.
  • Communication: Clearly and effectively conveying analysis and recommendations in written form.

You Can Also Check Other Related Assessments for the NURS 4220A – Leadership Competencies in Nursing and Healthcare Course:

NURS 4220A LC4001A Leadership for Organizational Culture and Growth Assignment Example

NURS 4220A LC4002A Healthcare Quality Nursing Assignment Example

NURS 4220A LC4003A Quality Improvement Processes Nursing Assignment Example

NURS 4220A LC4005A Improving Patient Quality and Safety Assessment Assignment Example

NURS 4220A LC4004A Quality Improvement Tools Nursing Paper Example

Quality Improvement Tools in Nursing Practice

Fishbone Diagram (Cause-and-Effect Diagram)

Analyzing the Fishbone Diagram

Fishbone diagrams, also known as cause-and-effect diagrams, are critical in identifying and analyzing the root causes of problems in healthcare settings. They categorize potential causes into major categories such as human factors, equipment and supplies, environmental factors, and processes (Ishikawa, 1986).

Human factors play a significant role in medication errors. For instance, knowledge deficits among healthcare staff can be addressed through comprehensive training programs and standardized procedures. This ensures that both pharmacists and nursing staff have a thorough understanding of medication interactions, thus preventing errors (Carlfjord et al., 2010). Additionally, stress and burnout among staff can be mitigated by implementing ergonomic workstations and workload management strategies, enhancing performance and reducing errors (Bakker et al., 2011). The availability of pharmacists is another critical factor. Enhancing remote monitoring technologies and collaborative platforms can enable pharmacists to provide timely support, even from a distance, thereby improving medication safety (Pontefract et al., 2018).

Equipment and supplies are equally crucial in preventing medication errors. Distinct packaging and labeling for similar-looking drugs can prevent confusion during administration. Ensuring the use of high-quality, durable barcode labels and regular inspections can maintain accuracy in medication administration (Poon et al., 2010). Scanner issues, such as readability problems, can be resolved through regular maintenance and calibration of scanning equipment (Baysari et al., 2011).

Environmental factors, such as workplace distractions, need to be minimized to create a focused environment for medication preparation. Proper storage conditions for medications prevent degradation and administration errors (Flynn et al., 2016). Processes also require attention. Implementing user-friendly and intuitive technology systems for medication documentation can streamline processes and reduce manual entry errors. Adopting workload management strategies and leveraging technology to automate non-clinical tasks can address inadequate staffing issues, further reducing the risk of medication errors (Tucker & Edmondson, 2003).

Using the fishbone diagram to address these factors allows nurses to identify and mitigate the root causes of medication errors effectively. Advocating for ergonomic workstations, comprehensive training programs, and regular equipment checks can enhance medication safety. By understanding and addressing these root causes, nursing practice can significantly reduce medication errors and improve patient outcomes.

Pareto Chart

Analyzing the Pareto Chart

Pareto charts are instrumental in identifying the most significant factors contributing to a problem. According to the Pareto principle, 80% of problems often result from 20% of the causes (Juran, 1954). In analyzing medication errors, data collected revealed twelve types of errors. Three major error types—incorrect dosage, wrong medication, and missed dose—accounted for approximately 81% of the total errors.

This analysis underscores the importance of focusing on these critical areas. For instance, incorrect dosages, which accounted for 40% of errors, can be addressed through targeted training programs that emphasize accurate dosage calculations and administration procedures. Implementing barcode scanning systems can prevent the administration of wrong medications, which comprised 25% of errors. Establishing protocols for double-checking medication dosages and verifying patient information can significantly reduce missed doses, which represented 16% of errors (Kaushal et al., 2001).

By concentrating efforts on these priority areas, resources can be allocated more effectively, leading to substantial improvements in medication safety. This focused approach ensures that interventions have the most significant impact, thereby enhancing patient safety and reducing error rates.

Process Flow Chart

Analyzing the Process Flow Chart

Process flow charts visually map out the steps involved in a process, identifying potential points of failure or inefficiency. In the context of medication administration, a typical process flow might include computerized physician order entry (CPOE), pharmacy technician selection, nurse verification, medication administration following the “7 Rights,” and electronic documentation (Horsky et al., 2012).

Each step in this process is crucial for ensuring accuracy and safety. CPOE reduces errors associated with handwritten prescriptions by ensuring accurate and legible medication orders (Bobb et al., 2004). Verification steps, such as barcode scanning and electronic documentation, help to ensure the correct medication is administered to the right patient. Following the “7 Rights” principle—right patient, right medication, right dose, right route, right time, right reason, and right documentation—ensures comprehensive checks are performed before medication administration, minimizing the risk of errors (Grissinger, 2010).

By streamlining and standardizing each step, process flow charts can significantly reduce medication errors and improve patient safety. They provide a clear visual representation of the process, making it easier to identify and address potential points of failure.

Run Chart

Analyzing the Run Chart

Run charts track data points over time, allowing for the identification of trends and variations. In analyzing patient satisfaction with pain management, a run chart indicated that the initial satisfaction rate was around 70%. After implementing specific interventions, the satisfaction rate increased to 97%.

This significant increase in patient satisfaction suggests that the interventions were effective. Run charts help in monitoring trends, identifying periods of low satisfaction, and understanding the factors contributing to these variations. They also allow for the evaluation of interventions, ensuring that changes lead to improved outcomes. Continuous monitoring and data-driven adjustments can help maintain high standards and improve patient satisfaction with pain management (Perla et al., 2011).

By using run charts, healthcare providers can ensure consistent improvements in patient care, leading to better outcomes and higher satisfaction rates.


The use of quality improvement tools such as fishbone diagrams, Pareto charts, process flow charts, and run charts is essential in nursing practice. These tools provide valuable insights that inform targeted interventions, leading to enhanced patient safety and improved healthcare delivery. By systematically identifying and addressing the factors contributing to medication errors and patient dissatisfaction, nurses can significantly improve patient outcomes and foster a culture of safety within healthcare settings.


Bakker, A. B., Demerouti, E., & Sanz-Vergel, A. I. (2011). Burnout and work engagement: The JD–R approach. Annual Review of Organizational Psychology and Organizational Behavior, 1(1), 389-411.

Baysari, M. T., Westbrook, J. I., Richardson, K. L., & Day, R. O. (2011). The influence of computerized prescriber order entry on prescribing practices in an emergency department. PLOS One, 6(1), e14534.

Bobb, A., Gleason, K., Husch, M., Feinglass, J., Yarnold, P. R., & Noskin, G. A. (2004). The epidemiology of prescribing errors: The potential impact of computerized prescriber order entry. Archives of Internal Medicine, 164(7), 785-792.

Carlfjord, S., Lindberg, M., & Andersson, A. (2010). Staff perceptions of addressing patient safety in primary health-care settings: A qualitative approach. BMC Health Services Research, 10(1), 5-10.

Flynn, E. A., Barker, K. N., & Gibson, J. T. (2016). Dispensing errors and counseling quality in 100 pharmacies. Journal of the American Pharmaceutical Association, 37(3), 35-39.

Grissinger, M. (2010). The five rights: A destination without a map. Pharmacy and Therapeutics, 35(10), 542-542.

Horsky, J., Schiff, G. D., Johnston, D., Mercincavage, L., Bell, D., & Middleton, B. (2012). Interface design principles for usable decision support: A targeted review of best practices for clinical prescribing interventions. Journal of Biomedical Informatics, 45(6), 1202-1216.

Ishikawa, K. (1986). Guide to quality control. Asian Productivity Organization.

Juran, J. M. (1954). Management of quality. Juran Institute.

Kaushal, R., Bates, D. W., Landrigan, C., McKenna, K. J., Clapp, M. D., Federico, F., … & Seger, D. L. (2001). Medication errors and adverse drug events in pediatric inpatients. JAMA, 285(16), 2114-2120.

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51.

Pontefract, S. K., Hodson, J., Marriott, J. F., Redwood, S., & Coleman, J. J. (2018). Pharmacist–physician communications in a highly computerized hospital: Sign-offs and patient handoffs. Journal of the American Medical Informatics Association, 25(8), 1007-1014.

Poon, E. G., Keohane, C. A., Yoon, C. S., Ditmore, M., Bane, A., Levtzion-Korach, O., … & Gandhi, T. K. (2010). Effect of bar-code technology on the safety of medication administration. New England Journal of Medicine, 362(18), 1698-1707.

Tucker, A. L., & Edmondson, A. C. (2003). Why hospitals don’t learn from failures: Organizational and psychological dynamics that inhibit system change. California Management Review, 45(2), 55-72.

Detailed Assessment Instructions for the NURS 4220A LC4004A Quality Improvement Tools Nursing Paper Assignment

LC4004A Quality Improvement Tools

Have you ever seen one of the quality improvement tools (i.e., Fishbone Diagram, Pareto Chart, or Run Chart) used in practice? How was it used? What data was being depicted? Please describe an additional quality tool that could have been used in the situation?

If you have not had any experience with the quality tools please describe in detail one tool and how the tool could be used in your practice setting. Please support your statements with evidence from the learning resources.

Evidence from scholarly literature


Analyze the fishbone diagram. Explain how the information presented in the fishbone diagram might be used to help inform nursing practice when preventing medication errors. Analyze the Pareto chart Include an explanation of how many medication errors there were and how this information might assist the nursing unit in preventing future medication errors. Analyze the process flow chart. Explain how this information might be used to help inform nursing practice for the prevention of future medication errors

Module 1: Fishbone Diagram

Analyze the fishbone diagram

Analyze the use of fishbone diagrams in preventing medication errors.

Explain how the information presented in the fishbone diagram might be used to help inform nursing practice when preventing medication errors.

Module 2: Pareto Chart

Analyze the Pareto chart

Explain medication error prevention information based on a Pareto chart.

Include an explanation of how many medication errors there were and how this information might assist the nursing unit in preventing future medication errors.

Module 4: Process Flow Chart.

Analyze the process flow chart.

Explain the use of process flow charts in preventing medication errors.

Explain how this information might be used to help inform nursing practice for the prevention of future medication errors

Module 4: Run Chart

Analyze the run chart as it relates to patient satisfaction with pain management.

Explain whether the data in the run chart indicates improved or decreased satisfaction with pain management.

Defend your reasoning for whether the run chart indicates improved or decreased satisfaction with pain management.

Consider the practice problem that you identified in LC4002A and either revised or affirmed in LC4003A.

Choose a fishbone diagram, Pareto chart, process flow chart, or run chart, and apply it to the data relating to the practice problem (that you located in LC4002A).

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