Discussion: Safety Goals in Area of Work and Lewins Theory of Change Research

Patient safety is always of the utmost importance when providing care. Patients and their family members trust healthcare workers to provide safe, effective, quality care. The care provided extends beyond the immediate issue they came in for and extends to active management of potential problems. Nurses are responsible for assessing, monitoring, critically thinking, and advocating for the patients. I work on a cardiovascular progressive care unit. Most of our patients have atrial fibrillation or a cardiovascular issue that makes them candidates for anticoagulant therapy. Patients continue to develop DVTs despite intervention or in many cases, refuse treatment or do not comply with continued care. For this reason, I believe this is an area we could improve on.  The 2018 patient safety goal I would like to focus on is NPSG.03.05.01, reduce the likelihood of patient harm associated with the use of anticoagulant therapy.

Anticoagulation therapy is used for several reasons including atrial fibrillation, deep vein thrombosis, pulmonary embolism, elevated troponin with chest pain, and valve replacements. The Joint Commission (2018) notes “anticoagulation medications are more likely than others to cause harm due to complex dosing, insufficient monitoring, and inconsistent patient compliance.” The importance of this safety goal is to improve patient outcomes by identifying individuals who may be candidates for anticoagulation therapy, actively monitoring for therapeutic range, ensuring safety for both bleeding risk and DVT risk, and educating the patient to ensure patient compliance. Discussion: Safety Goals in Area of Work and Lewins Theory of Change Research

My organization could improve by providing additional education regarding anticoagulant therapy to prescribers, staff, patients, and families per The Joint Commission (2018) safety standards. In an observational study performed by Olaiya, Lurie, Watt, McDonald, & Greaves (2016), found patients to be at a significant risk for harm related to lack of knowledge by their providers in using anticoagulant drugs. In fact, their study found that some of the providers were unable to differentiate between rivaroxaban, dabigatran, and apixaban’s benefits, risks, and different indications. It was concluded that education for providers and patients is necessary. Discussion: Safety Goals in Area of Work and Lewins Theory of Change Research

In my facility, nurses would benefit from additional knowledge to better assist in assessing for potential candidates for anticoagulation therapy. Nurses would also have a better understanding so they may educate patients for improved compliance with treatment. Verbal and written educational material would reinforce the importance of monitoring and educate the patient on food-drug interactions, what potential reactions to look for, and improve safety outcomes. Each patient should receive these handouts specific to their illness and medication being used.

There are multiple internal and external factors that may influence this change. Finkelman (2016), major barriers to quality healthcare include access to care, how the patient processes information, and how they manage their illness. Finkelman (2016) states health literacy impacts patient-provider communication both verbal and written communication; therefore, it is important to assess for vulnerable population and ensure adequate understanding. The provider or nurse may need to modify teaching to allow for adequate understanding. Verbal and written communication allows for reinforcement of material so the patient may review the material at their leisure. This change will affect all patients currently on anticoagulants so it is important to be well educated on anticoagulant therapy, culturally competent and respectful of diversity. Discussion: Safety Goals in Area of Work and Lewins Theory of Change Research

Nursing Theory (2016) Lewin’s theory involves three stages: unfreezing, change, and refreezing. Essentially, the idea of unfreezing is to identify and stop the patient from doing something that is counterproductive. The second step is change, the implementation for their greater health, and finally, refreezing is when the patient accepts, adapts, and implements the change for themselves because they understand the necessity. 

Lewin’s Theory of Change

Discussion: Safety Goals in Area of Work and Lewins Theory of Change Research References

• Finkelman, A. W. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). New York, NY: Pearson Education, Inc.
• The Joint Commission. (2018, January). National Patient Safety Goals. Retrieved from https://www.jointcommission.org/assets/1/6/NPSG_Chapter_HAP_Jan2018.pdf
• Nursing Theory. (2016). Lewin’s Change Theory. Retrieved from http://www.nursing-theory.org/theories-and-models/Lewin-Change-Theory.php
• Olaiya, A., Lurie, B., Watt, B., McDonald, L., & Greaves, M. (2016). An observational study of direct oral anticoagulant awareness indicating inadequate recognition with potential for patient harm. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26865203