NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit

Name

Capella university

NURS-FPX 4020 Improving Quality of Care and Patient Safety

Prof. Name

Date

Improvement Plan Tool Kit

Diagnostic errors pose a significant healthcare issue. They cause harm to patients and delay appropriate care. These mistakes occur when diagnoses are ignored, incorrect, and delayed. Communication gaps, cognitive biases, poor clinical procedures, and system flaws are the causes of these errors. The National Academy of Medicine claimed that diagnostic errors account for 7-18% of harmful events in hospitals.

These errors underline the demand for action (Hall et al., 2020). This online assessment framework is an online repository to support a plan to decrease diagnostic mistakes. This resource center will propose healthcare workers annotated links to four key forms of resources that address these mistakes. Scholarly databases like PubMed, CINAHL, and MEDLINE will provide evidence-based data to support healthcare staff to improve diagnostic precision. It enhances communication and maintains safety initiatives.

Annotated Bibliography

Category 1: Cognitive and Human Factors in Diagnostic Errors

Kunitomo, K., Harada, T., & Watari, T. (2022). Cognitive biases encountered by physicians in the emergency room. BioMed Central Emergency Medicine, 22(1), 148. https://doi.org/10.1186/s12873-022-00708-3

This resource explores cognitive biases commonly encountered by doctors in emergency settings and endorses strategies that healthcare staff employ to improve diagnostic precision and patient safety. The article frameworks tendencies like availability bias, where recent and impactful events influence decision-making. It covers how preliminary statements cloud further analysis. As per the findings, 87% of respondents acknowledged experiencing cognitive biases in their practice, while 60% observed that these tendencies affected their therapeutic selections. Moreover, 72% of healthcare staff considered that empathy in these cognitive patterns improves treatment results. This understanding emphasizes the need for specialized training in emergency settings.

This resource supports methods like structured reexamination and diagnostic gaps. These approaches support nurses in rethinking early choices and reducing the need for primary impressions. Reflective practice is also suggested. Nurses must reexamine previous cases and evaluate decision outlines to build awareness of mental tricks. Team-based decision-making inspires a cooperative approach. It permits diverse views to spot ignored factors and reduces individual tendencies. Tools such as checklists and measures are directed to uphold organized and unbiased evaluations. Training that simulates high-pressure emergency room states permits practitioners to address biases in real time. These tactics empower nurses and healthcare staff to make more precise diagnoses. It nurtures better patient security in the high-speed emergency setting.

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit

Watari, T., Tokuda, Y., Amano, Y., Onigata, K., & Kanda, H. (2022). Cognitive bias and diagnostic errors among physicians in Japan: A self-reflection survey. International Journal of Environmental Research and Public Health, 19(8), 4645. https://doi.org/10.3390/ijerph19084645

This article investigates cognitive biases and diagnostic mistakes among physicians. It explains that healthcare experts are employed to expand diagnostic precision and patient security. The resource highlights the significance of self-reflection and mindfulness of common cognitive biases like anchoring, premature closure and confirmation bias. It leads to diagnostic mistakes. This resource is useful for nurses to integrate unvarying reflective practices to identify these biases in clinical decision-making. The article supports multidisciplinary teamwork and direct communication between medical staff to improve critical thinking and decrease the effects of individual bias. Nurses utilize these approaches by engaging in case appraisals. It nurtures open discussion in team meetings and dynamically contributes to differential diagnosis consultations.

The article discusses the advantages of organized decision-support tools and checklists. It can assist nurses methodically in assessing indications and lessening diagnostic errors produced by misunderstanding or misjudgment. This resource benefits healthcare teams by developing a culture of constant learning. It enables primary detection of diagnostic mistakes and encourages a safer patient care setting. The article underlines the value of a multidisciplinary approach in decreasing diagnostic errors and supporting cooperative decision-making among doctors and nurses. Nurses keenly participate in diagnostic discussions to help produce an inclusive environment. This approach enables healthcare teams to identify alternative diagnoses more efficiently, pose critical questions, and carefully assess patient data. 

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit

Webster, C. S., Taylor, S., & Weller, J. M. (2021). Cognitive biases in diagnosis and decision making during anesthesia and intensive care. British Journal of Anaesthesia Education, 21(11), 420–425. https://doi.org/10.1016/j.bjae.2021.07.004

This resource studies cognitive biases that impact decision-making and diagnosis in anesthesia and intensive care. Healthcare specialists and nurses should address the need to enhance diagnostic precision and patient safety. The paper states that 90% of anesthetists and intensivists undergo cognitive biases, with 50% acknowledging their influence on clinical judgments. Moreover, 70% met conditions where these biases led to diagnostic mistakes. It focuses on the demand for mindfulness and alleviation approaches. The article reviews policies like cognitive de-biasing, awareness training, and simulation-based education to assist doctors in identifying and responding to biases. Cognitive de-biasing includes using checklists, organized decision-making outlines, and reflective practices.

It permits nurses to classify potential bias sources such as confirmation bias or anchoring. This resource provides awareness training that inspires clinicians to comprehend common cognitive biases and mindfulness. It empowers an unbiased method for patient evaluations and prevents early decisions. Simulation-based training encourages nurses to practice real-life scenarios. It can expand their adaptive abilities under pressure and endorse more impartial clinical decisions. Furthermore, developing a cooperative setting where friendly discussions of diagnostic doubts are fortified can further support nurses in evading biased conclusions. It enhances patient safety and provides quality of care. This resource underlines that nurses can cultivate a culture of significant reflection and evidence-based practice by engaging in various approaches. It decreases diagnostic mistakes in multifaceted healthcare settings.

Category 2: Communication and Interprofessional Collaboration

Hansen, N., Precht, H., Larsen, P., & Jensen. (2023). Interprofessional diagnostic management teams: A scoping review protocol. Systematic Reviews, 12(1), 223. https://doi.org/10.1186/s13643-023-02391-2

This resource explores the role of interprofessional diagnostic management teams in enhancing accuracy in diagnosis and patient safety. This article recommends strategies healthcare professionals can apply to facilitate collaborative practice within the Interprofessional Diagnostic Management Teams (IDMTs). One of the most significant thrusts of the research is effective communication and teamwork among diverse healthcare professionals working in complex clinical scenarios. Nurses must be integral members of these teams and contribute their clinical expertise to advocating for patient-centered care, as all aspects must be considered when arriving at a diagnosis. This article points to the significance of established protocols and defined roles for IDMT members. It significantly reduces misunderstanding and hasten decision-making processes.

Furthermore, nurses should be able to contribute positively toward diagnostic errors and better patient safety, with nurtured mutual respect and shared accountability. In addition, training and reflective practice are suggested for improvement in teamwork and individual competencies over time. This resource underlines that nurses can contribute significantly to the effective development of interprofessional collaboration associated with better diagnostic outcomes and improved patient care. Nurses can apply these strategies by actively participating in team meetings. They utilize standardized communication tools during handoffs and engage in ongoing education and training to enhance their collaborative skills.

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit

Howick, J., Weston, A., Solomon, J., Nockels, K., Bostock, J., & Keshtkar, L. (2024). How does communication affect patient safety? Protocol for a systematic review and logic model. British Medical Journal Open, 14(5). https://doi.org/10.1136/bmjopen-2024-085312

This resource is an important link between communication and patient safety issues. A critical resource for health practitioners is assisting healthcare professionals in making necessary diagnoses and improving overall safety. The article discusses the protocol for a systematic review and the logic model, where a systematic review identifies the point that communication is the principal element affecting patient outcomes. This article will help improve their communication activities with patients, as well as the teams of interdisciplinary nurses, where they can use standardized tools and communication like SBAR – Situation, Background, Assessment, and Recommendation.

Nurses use critical information to report any situation to others to avoid diagnostics errors. The resource also emphasizes active listening and empathy in building trust with the patient, enabling them to share crucial information about their symptoms and concerns. Understanding the dimensions of communication and its impact on patient safety will allow nurses to advocate for training programs that enhance these skills within their teams. In the long term, this will help improve accuracy during diagnosis and reduce mistakes accordingly, thus making healthcare patients safer.

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit

Huynh, K., Brito, J. P., Bylund, C. L., Prokop, L. J., & Ospina, N. S. (2023). Understanding diagnostic conversations in clinical practice: A systematic review. Patient Education and Counseling, 116, 107949. https://doi.org/10.1016/j.pec.2023.107949

This article presents a source for understanding diagnostic conversations in clinical practice, significantly improving the accuracy of diagnosis and the safety of patients. This article will teach healthcare professionals, like nurses, strategies for enhancing patient communication. It emphasizes the importance of active listening and open-ended questions to gather a comprehensive history from the patient for the proper diagnosis. The article stresses the importance of shared decision-making in the diagnosis process. Nurses can establish an open setting where patients feel they have a say in their care through participation in discussions over symptoms and preferences.

This improves the result of diagnosis and increases the patient’s satisfaction level. This resource discusses contextual factors such as the healthcare setting and team dynamics influencing diagnostic conversations. Nurses can advocate for an environment that promotes effective communication between healthcare team members. Nurses can enhance their diagnostic conversations, enhance patient safety, reduce errors in diagnosis, and improve overall health outcomes.

Category 3: Technology-Related Interventions 

Scott, I. A. (2022). Using information technology to reduce diagnostic error: Still a bridge too far? Internal Medicine Journal, 52(6), 908–911. https://doi.org/10.1111/imj.15804

This resource explains the importance of information technology in lessening diagnostic errors for all healthcare professionals. The important aims outlined in this paper emphasize the integration of state-of-the-art Information Technology (IT) tools, including Electronic Health Records (EHR), with Clinical Decision Support Systems (CDSS) as part of the practice and work of a nurse into better management and information exchange.

The nurse can advocate for the friendly use of EHR systems, ensuring proper documentation and easy access to patient information. This article emphasizes adequate training and continuous support in using these technologies, reducing the risk of error through miscommunication or poor record-keeping. It describes the role of IT as enhancing collaborative care by permitting smooth information exchange between an interdisciplinary team. Better decision-making at the clinical level and better patient outcomes would be possible with the practice of a culture of collaboration if IT tools were exploited by nurses. These strategies reduce diagnostic error rates, improve safety outcomes, and enhance quality service delivery in the health sector.

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit

Sutton, R., Pincock, D., Baumgart, D., Sadowski, D., Fedorak, R., & Kroeker, K. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. NPJ Digital Medicine, 3(1), 1–10. https://doi.org/10.1038/s41746-020-0221-y

This article covers CDSS benefits, risks, and strategies for successful implementation. The authors reference over 150 studies and show that CDSS can reduce diagnostic errors by 10-30 % and improve adherence to clinical guidelines by 15%, with 50% of clinicians reporting alert fatigue. Healthcare professionals use strategies outlined within the article to improve the accuracy of diagnostics and patient safety. The article claims that CDSS can facilitate improvement in clinical decision-making due to evidence-based recommendations of alerts and reminders in response to the needs of nursing practice. Nurses are highly likely to benefit from integrating into the nursing process by using these systems when receiving real-time alerts and warnings regarding potential drug-to-drug interactions and adverse drug reactions, allergy profiles, and critical laboratory results.

This source emphasizes proper nursing staff education and training about CDSS to facilitate correct usage. This knowledge will protect against potential errors as the staff can interpret the outcome generated by the system correctly, providing better results to the patients. This also focuses on the dangers of CDSS, like alert fatigue and overdependency on technology. Nurses can use different techniques to minimize the risks outlined above by ensuring that CDSSs are designed so that minimal unnecessary alerts pop up and make them easier to use. The article helps nurses use CDSS to support their clinical judgment, leading to better diagnostic accuracy, patient safety, and overall health delivery.

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit

Zimolzak, A. J., Wei, L., Mir, U., Gupta, A., Vaghani, Subramanian, D., & Singh, H. (2024). Machine learning to enhance electronic detection of diagnostic errors. Journal of the American Medical Association Network Open, 7(9), e2431982. https://doi.org/10.1001/jamanetworkopen.2024.31982

This article discusses how Machine Learning (ML) can be integrated into the electronic detection of diagnostic errors. It is a useful read for healthcare professionals who want to improve the accuracy of diagnosis and enhance patient safety. The authors explain how ML algorithms analyze large amounts of patient data to identify patterns and anomalies that may signal potential diagnostic errors. This article provides useful strategies nurses adopt in their clinical practices using ML tools. These tools can help raise red flags for abnormal test results or inconsistencies in the patient’s record, hence further investigation and less possibility of misdiagnosis.

The article also emphasizes that continuous training and collaboration are essential for healthcare team members to effectively interpret and act on the insights generated by ML algorithms. This resource adds that ML should be implemented into existing EHR systems to make real-time alerts and decision support possible. Nurses improved their skills by offering timely and accurate patient care by implementing these high-tech technologies in their workflow. The strategies will improve diagnostic accuracy, reduce errors, and enhance patient safety in health care.

Category 4: Process Improvements and System-Based Strategies

Bell, S. K., Bourgeois, F., DesRoches, C. M., Dong, J., Harcourt, K., Liu, S. K., Lowe, E., McGaffigan, P., Ngo, L. H., Novack, S. A., Ralston, J. D., Salmi, L., Schrandt, S., Sheridan, S., Hessner, L., Thomas, G., & Thomas, E. J. (2021). Filling a gap in safety metrics: development of a patient-centred framework to identify and categorise patient-reported breakdowns related to the diagnostic process in ambulatory care. BMJ Quality & Safety, 31(7), 526–540. https://doi.org/10.1136/bmjqs-2021-013672

This article introduces a patient-centered outline that identifies and classifies patient-reported breakdowns in the diagnostic process of ambulatory care. Healthcare professionals can employ the strategies from this resource to improve diagnostic accuracy and patient safety by focusing on patient-reported insights as part of the diagnostic evaluation process. The article stresses that the patients’ feedback must be included in identifying common problems in care delivery. These issues involve lapses in communication and delays in diagnosis. Nurses systematically collect and analyze patient-reported data, which expose significant safety risks that otherwise go undetected. Nurses encouraging patients to share their experiences during diagnosis can better identify potential breakdowns in care and intervene quickly.

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit

This approach improves patient satisfaction and allows nurses to strengthen their communication skills. It leads to more accurate and compassionate care. Additionally, the resource advises that open communication channels enhance patient engagement. This critical point makes the relationship between the nurse and patient clearer and more trusting and further improves care quality. Nurses can proactively identify risk factors and advocate for improvements in clinical workflows. It ensures the patient’s voice informs the safety improvements. The results will include better diagnoses and fewer breakdowns in care. This approach fosters a stronger and patient-centered focus on safety in ambulatory settings.

 Lubin, I. M., Astles, J.  Rex, Shahangian, S., Madison, B., Parry, R., Schmidt, R. L., & Rubinstein, M. L. (2021). Bringing the clinical laboratory into the strategy to advance diagnostic excellence. Diagnosis, 8(3), 281–294. https://doi.org/10.1515/dx-2020-0119

This article focuses on the role of clinical laboratories in furthering excellence in diagnosis. It guides healthcare providers in improving the accuracy of diagnosis and patient safety. The article suggests laboratory data in clinical workflow and how prompt availability of accurate lab results significantly influences clinical decision-making. This resource suggests strategies for nurses that involve active collaboration between nursing and laboratory teams. This collaboration improves understanding of the significance of specific tests and leads to a deeper comprehension of their implications for patient care. This article emphasizes effective communication between the nurse and laboratory teams to deliver results promptly.

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit

Nurses ensure critical results are interpreted accurately and communicated efficiently for timely patient care. This resource encourages nurses to adopt continued education on laboratory procedures and diagnostic testing. Constant learning helps nurses stay updated on best practices and improve patient care. This article educates nurses on the continuous developments in laboratory technology and methodology that can make them effective patient supporters. It guides even more informed decisions while diagnosing and treating them. These measures culminate in enhanced cooperation among nurses and laboratory personnel, increased diagnostic accuracy, and care safety.

Poller, D. N., Johnson, S. J., & Bongiovanni, M. (2020). Measures to reduce diagnostic error and improve clinical decision making in thyroid FNA aspiration cytology: A proposed framework. Cancer Cytopathology, 128(12), 917–927. https://doi.org/10.1002/cncy.22309

This resource presents an extensive framework that helps reduce the incidence of diagnostic error in clinical decision-making for patients with thyroid fine needle aspiration cytology. This helps nurses employ various strategies provided in the resource for enhancing diagnostic accuracy and patient safety. The authors call attention to the role of standardized protocols in the FNA process. Nurses can use this to ensure consistency and reliability in sample collection and handling. This can be achieved by nurses’ active involvement in formulating and following these protocols and reducing variability that culminates in diagnostic errors. The article stresses that communication between the healthcare team members should be effective.

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit

It encourages the nurses to collaborate in a multidisciplinary manner to discuss cytology results and clarify any uncertainties quickly. This resource underlines the importance of education and training for nursing staff about cytopathology to enable them to recognize the pitfalls in the diagnostic process. Nurses can contribute significantly to better patient outcomes by keeping abreast of the latest developments and recommendations. Nurses use these practices in managing thyroid diseases to support high-quality diagnostics, decrease errors and improve patient safety. They can enhance patient education on managing thyroid conditions efficiently. 

Conclusion

Cognitive biases form an inclusive method of reducing diagnostic errors. This method enhances communication, incorporates technology, and fosters interprofessional teamwork. Resources can expand diagnostic precision and patient safety. The nurse utilizes reflective practices, organized decision-support tools, and current communication models. Integrating technological solutions into everyday practice, including EHRs and CDSS, ensures accurate records and informed medical decisions. Implementing these tools within a team-based environment promotes a culture of safety. It improves patient results while minimizing diagnostic errors in every healthcare setting.

References

Bell, S. K., Bourgeois, F., DesRoches, C. M., Dong, J., Harcourt, K., Liu, S. K., Lowe, E., McGaffigan, P., Ngo, L. H., Novack, S. A., Ralston, J. D., Salmi, L., Schrandt, S., Sheridan, S., Hessner, L., Thomas, G., & Thomas, E. J. (2021). Filling a gap in safety metrics: development of a patient-centred framework to identify and categorise patient-reported breakdowns related to the diagnostic process in ambulatory care. British Medical Journal, Quality & Safety, 31(7), 526–540. https://doi.org/10.1136/bmjqs-2021-013672

Hall, K. K., Hunt, S. S., Hoffman, L., Richard, S., Gall, E., Schoyer, E., Costar, D., Gale, B., Schiff, G., Miller, K., Earl, T., Katapodis, N., Sheedy, C., Wyant, B., Bacon, O., Hassol, A., Schneiderman, S., Woo, M., LeRoy, L., & Fitall, E. (2020). Diagnostic errors. Agency for Healthcare Research and Quality (US). https://www.ncbi.nlm.nih.gov/books/NBK555525/ 

Hansen, N., Precht, H., Larsen, P., & Jensen. (2023). Interprofessional diagnostic management teams: a scoping review protocol. Systematic Reviews, 12(1), 223. https://doi.org/10.1186/s13643-023-02391-2

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit

Howick, J., Weston, A., Solomon, J., Nockels, K., Bostock, J., & Keshtkar, L. (2024). How does communication affect patient safety? Protocol for a systematic review and logic model. British Medical Journal Open, 14(5). https://doi.org/10.1136/bmjopen-2024-085312

Huynh, K., Brito, J. P., Bylund, C. L., Prokop, L. J., & Ospina, N. S. (2023). Understanding diagnostic conversations in clinical practice: A systematic review. Patient Education and Counseling, 116, 107949. https://doi.org/10.1016/j.pec.2023.107949

Kunitomo, K., Harada, T., & Watari, T. (2022). Cognitive biases encountered by physicians in the emergency room. BioMed Central Emergency Medicine, 22(1), 148. https://doi.org/10.1186/s12873-022-00708-3

Lubin, I. M., Astles, J.  Rex, Shahangian, S., Madison, B., Parry, R., Schmidt, R. L., & Rubinstein, M. L. (2021). Bringing the clinical laboratory into the strategy to advance diagnostic excellence. Diagnosis, 8(3), 281–294. https://doi.org/10.1515/dx-2020-0119

Poller, D. N., Johnson, S. J., & Bongiovanni, M. (2020). Measures to reduce diagnostic error and improve clinical decision making in thyroid FNA aspiration cytology: A proposed framework. Cancer Cytopathology, 128(12), 917–927. https://doi.org/10.1002/cncy.22309

Scott, I. A. (2022). Using information technology to reduce diagnostic error: Still a bridge too far? Internal Medicine Journal, 52(6), 908–911. https://doi.org/10.1111/imj.15804

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit

Sutton, R., Pincock, D., Baumgart, D., Sadowski, D., Fedorak, R., & Kroeker, K. (2020). An overview of clinical decision support systems: benefits, risks, and strategies for success. Nature Partner Journals Digital Medicine, 3(1), 1–10. https://doi.org/10.1038/s41746-020-0221-y

Watari, T., Tokuda, Y., Amano, Y., Onigata, K., & Kanda, H. (2022). Cognitive bias and diagnostic errors among physicians in Japan: A self-reflection survey. International Journal of Environmental Research and Public Health, 19(8), 4645. https://doi.org/10.3390/ijerph19084645

Webster, C. S., Taylor, S., & Weller, J. M. (2021). Cognitive biases in diagnosis and decision making during anaesthesia and intensive care. British Journal of Anaesthesia Education, 21(11), 420–425. https://doi.org/10.1016/j.bjae.2021.07.004

Zimolzak, A. J., Wei, L., Mir, U., Gupta, A., Vaghani, Subramanian, D., & Singh, H. (2024). Machine learning to enhance electronic detection of diagnostic errors. Journal of the American Medical Association Network Open, 7(9), e2431982. https://doi.org/10.1001/jamanetworkopen.2024.31982