reply to two peer responses of at least one paragraph (250 words each).
Post #1 
Quality Improvement
Quality improvement is a process that involves the ongoing team effort of healthcare professionals to make important changes within an organization that lead to measurable improvements in the delivery of care, increased patient safety, and  better patient outcomes.
Nurses spend a considerable amount of time with their patients. They are constantly monitoring vital signs and labs and assessing for critical changes. Using critical thinking and evidence-based practice, nurses are able to quickly identify problems that require intervention. Nurses are in the best position to influence quality care and patient outcome. According to Whiteman (2021), “the American Nurses Association and the American Association of Critical-Care Nurses identify participation in quality improvement (QI) efforts as part of a nurse’s role.”
Nurses take on many responsibilities in healthcare, including ensuring patient safety. Falls in hospitals are a major threat to patient Safety. It is reported that more than one million falls occur in hospitals each year in the US with 33% being preventable (Kowalski, 2018). A group of students conducted a quality improvement project to reduce the risk of falls. 10 patients were assessed for fall risk using the Morse Fall Scale. 70% of the patients we at risk for falls and 50% considered high risk. These results led to the implementation of a fall prevention plan to increase patient safety and decrease risk of injury. The plan included more frequent rounding, specifically late at night and  in the early morning. The study reported that 80% of falls occurred in the patients room at night and five were due to disorientation. It is recommended by the World Health Organization that nurses receive proper training to identify patients that are at risk for falls and do more frequent rounds with shorter intervals in between for high-risk patients.(Reyes et al, 2021). Implementing these changes leads increased patient safety and better outcome.
References:
Kowalski, S. L. (2018). Budgeting for a Video Monitoring System to Reduce Patient Falls and Sitter Costs: A Quality Improvement Project. Nursing Economic$, 36(6), 291–295.
Reyes, Laura, Drammeh, Amie, Paulino, Jennifer, Downer, Jodian, Mejia-Paulino, Rachel, Cabezas, Victoria, et al. (2021). A student-led quality improvement project on fall prevention. Nursing, 51, 15-17. https://doi.org/10.1097/01.NURSE.0000721800.82909.30
Whiteman, K., Yaglowski, J., & Stephens, K. (2021). Critical Thinking Tools for Quality Improvement Projects. Critical Care Nurse, 41(2), e1–e9. https://doi.org/10.4037/ccn2021914
Post #2      
                    ATI The Leader Case Study 4: 
     Quality improvement is used to help keep a facility or organization consistent and make sure that if they run into any problems they get closely evaluated and create plans to improve them and remain consistent with their goals. For example, it’s every hospital’s job to ensure patient safety and they have specific goals to achieve this but at times they don’t meet the goals then the quality improvement team steps in to evaluate the safety issue if needed. It is very important that nurses take part in the quality improvement team because of the nursing-sensitive outcomes that could be directly related to the problem they are observing, and they can take part in identifying these issues within the team and ways of improvement. Quality improvement interventions of facilities demonstrate various degrees of effectiveness (Desveaux, Halko, Marani, Feldman & Ivers, 2019).  
     I found an example of a quality improvement project to reduce the incidence and severity of pressure injuries in a residential aged facility. After performing a comprehensive audit at this facility, they realized that before implementation of new practices to ensure improvement that the staff’s knowledge was limited, and that skin inspections and assessments weren’t being performed on the residents (Waird & Monaro, 2021). As discussed in the ATI case study 4, they examined the structure, process, and evaluated the outcomes of their interventions on pressure injuries in their facility. The nurse-sensitive items that were found in their comprehensive audit was the fact that the staff was lacking knowledge and weren’t even completing assessments of the residents which directly lead to an increase and severity of the pressure related injuries that were occurring. After post-implementation of their interventions to include an education package for the staff it was found that their new knowledge was unable to be measured but skin inspections improved by the staff and pressure injury prevalence reduced to 33% and deep tissue injuries were eliminated (Waird & Monaro, 2021). The only thing that this audit was lacking compared to what was shown on the ATI case study was that they didn’t have good enough measurable outcomes of the staffing knowledge and could have been implemented to show more of a before and after comparison and proof of improvement. For example, they could have given the staff tests about completing an assessment or how it should be done before and after teaching and compare each of them to get a better idea of how much they learned and compared it to the quality improvement of pressure injuries by assessing their occurrence and severity. 
References 
Desveaux, L., Halko, R., Marani, H., Feldman, S., & Ivers, N. M. (2019). Importance of team functioning as a target of quality improvement initiatives in nursing homes: A qualitative process evaluation. Retrieved October 13, 2021, from https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=ccm&AN=139196414&site=ehost-live.  
Waird, A., & Monaro, S. (2021, June). Reducing the incidence and severity of pressure injuries in a high level care residential aged facility: a quality improvement project. . Retrieved October 13, 2021, from https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=ccm&AN=151253970&site=ehost-live. 

 

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