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1. NURS FPX 8020 Assessment 3 Quality Improvement Proposal
Student Name
Capella University
NURS-FPX8020
Instructor Name
Due Date
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NURS FPX 8020 Assessment 3

2. Introduction
Quality improvement (QI) is a central philosophical foundation of the Doctor of Nursing Practice (DNP)
role, as nurse leaders must utilize technology and evidence-based interventions to enhance patient
safety, improve care outcomes, and strengthen organizational performance. In NURS FPX 8020 at
Capella University, students are expected to design quality improvement proposals that align with
organizational goals and evidence-based practices.
This assessment demonstrates the learner’s ability to identify a significant clinical or organizational
issue, propose evidence-based solutions, engage stakeholders, and develop a structured plan for
implementation and evaluation. The proposed QI initiative focuses on preventing medication
reconciliation discrepancies during patient transitions from hospital to home care. These discrepancies
are a leading cause of avoidable readmissions, medication-related harm, and inefficiencies in care
coordination.
Identifying the Quality Issue
Safe discharge processes are essential for patients leaving acute care facilities. Medication reconciliation
is a critical component of these processes. However, evidence shows that 18% of discharged patients
experience medication errors, including duplications, omissions, or toxicities. These errors are especially
common among geriatric patients with chronic conditions requiring multiple medications.
Organizational data reveals that nearly one-third of all 30-day hospital readmissions are medication-
related. Such errors jeopardize patient safety, diminish trust in healthcare, and result in significant
financial penalties due to avoidable admissions. In response, this Quality Improvement Proposal
introduces a nurse-led medication reconciliation initiative designed to strengthen discharge accuracy,
improve communication, and enhance patients’ understanding of their treatment regimens during the
transition to home care.
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Evidence-Based Intervention Plan
The proposed intervention is a nurse-initiated medication reconciliation process that begins 24 hours
before discharge and includes a follow-up on day 7 post-discharge. Transitional care nurses, advanced

3. practice nurses, or registered nurses will compare the patient’s active medication profile with the
discharge treatment plan to identify discrepancies.
Key components of this intervention include:
Reviewing in-hospital medications using the electronic health record (EHR).
Conducting patient-caregiver consultations for clarification and education.
Making follow-up phone calls after discharge to assess adherence and address issues.
This structured approach ensures continuity of care, reduces errors, and supports patients in managing
their medications effectively at home.
Evidence Supporting the Intervention
Evidence strongly supports medication reconciliation as an effective strategy to reduce errors and
readmissions. The Institute for Healthcare Improvement (IHI) reports that adherence to standardized
reconciliation practices can reduce adverse drug interactions by up to 50% and lower readmission rates
significantly.
Studies published in the Journal of Patient Safety and BMJ Quality & Safety further confirm that direct
communication between nurses and patients during discharge planning improves understanding and
minimizes discrepancies. Guided by these models, this intervention is tailored to meet both
organizational infrastructure capabilities and patient needs, making it a practical and evidence-based
solution.
Stakeholder Engagement Strategy
Successful QI implementation depends on the active participation of stakeholders. For this initiative, key
stakeholders include hospitalists, bedside nurses, advanced practice nurses, pharmacists, IT specialists,
quality improvement teams, patients, and caregivers.
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Stakeholder engagement will begin with interprofessional workshops to share project goals, review
evidence, and discuss anticipated outcomes. Ongoing feedback will be collected to refine the process and
foster a sense of ownership. Interprofessional staff training will strengthen both medication
reconciliation skills and patient communication competencies.

4. Regular meetings will provide opportunities to review progress, address challenges, and celebrate
successes. This collaborative approach fosters transparency, accountability, and trust, all of which are
vital to driving sustainable healthcare change.
Implementation and Resource Planning
The intervention will be rolled out in three phases over 12 weeks:
1.Phase One: Staff training, reconciliation template development, and integration into the EHR.
2.Phase Two: Pilot testing on two medical-surgical units using iterative Plan-Do-Study-Act (PDSA)
cycles.
3.Phase Three: Expansion to all inpatient units based on pilot outcomes.
Resource needs include nurse time, educator facilitation, modest EHR modifications, and patient
education materials. These requirements are manageable within the organization’s capacity.
Cost and Resource Planning
The intervention requires modest short-term investments in training, documentation updates, and
educational resources. These costs are expected to be offset by long-term savings achieved through
reduced readmissions and fewer adverse drug events. By reallocating existing human resources and
leveraging available technology, the organization can implement the intervention cost-effectively while
maintaining sustainability.
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Evaluation and Outcome Measurement
Evaluation will focus on both primary and secondary outcomes.
Primary Outcome: Reduction in medication discrepancies at discharge and during follow-up
calls.
Secondary Outcomes: Patient self-reported adherence, 30-day readmission rates, and incidence
of adverse drug reactions.

5. Data will be collected through EHR audits, incident reports, and patient surveys. Weekly measurements
will be taken during the pilot phase, followed by monthly reviews to track trends. Qualitative feedback
from staff and patients will be analyzed to ensure the intervention remains patient-centered and
adaptable.
Alignment with DNP Essentials
This proposal aligns with multiple AACN DNP Essentials:
Essential II: Organizational and systems leadership for quality improvement.
Essential III: Use of evidence-based practice in healthcare improvement initiatives.
Essential IV: Integration of information systems and patient care technology.
Essential VI: Interprofessional collaboration for improving outcomes.
By addressing these essentials, the proposal highlights systems-level leadership, evidence-based
decision-making, and collaborative practice—hallmarks of DNP education and practice.
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Conclusion
Medication reconciliation errors pose a significant threat to patient safety and organizational
performance. This Quality Improvement Proposal offers a structured, nurse-led intervention to enhance
discharge accuracy, reduce readmissions, and improve patient outcomes. Grounded in evidence-based
practices and interprofessional collaboration, the initiative demonstrates the leadership capacity of
DNP-prepared nurses to implement meaningful change.
As healthcare continues to evolve, interventions like this one represent essential steps toward safer,
more effective, and patient-centered care.
References

6. Institute for Healthcare Improvement. (n.d.). How-to Guide: Prevent Adverse Drug Events.
https://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventAdverseDrugEvents.aspx
Mueller, S. K., et al. (2019). Medication discrepancies at hospital discharge and adverse events.
Journal of Patient Safety, 15(2), 123–129.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474281/
Agency for Healthcare Research and Quality. (n.d.). Medications at Transitions and Clinical
Handoffs (MATCH) Toolkit for Medication Reconciliation. https://www.ahrq.gov/patient-
safety/reports/engage/interventions/medrecon.html
Centers for Medicare & Medicaid Services. (n.d.). PDSA Cycle Guide.
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/
Downloads/PDSA-Cycle-Guide.pdf
American Association of Colleges of Nursing. (2006). The Essentials of Doctoral Education for
Advanced Nursing Practice. https://www.aacnnursing.org/DNP/DNP-Essentials
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