Donabedian's Quality Improvement Model

Risk management is commonly used by the organization, which involves the process of identifying risk, analyzing risk and implementing strategies for eliminating and copying with liabilities. As a result of the risk management in health care delivery, there are many activities and actions in health care delivery which can be reduced to expose to the possible errors and the negative incidents to patients.

In practice, according to hospital authority annual report, medication safety is always being highly prioritized among the identified risk that it is mainly being closely monitored in the three aspects of prescribing, dispensing and administering drugs to patients. Getting a thorough understanding on the medication safety in the three aspects of prescribing, dispensing and administering drugs by the proactive risk identification and analysis, the possible errors and the potential negative incidents to patients can be minimized and reduced.
Analyzing the clinical scenario of medication safety, Donabedian’s quality improvement model is adopted to analyze the process for proactive identification and management of risk as well as promote the healthcare quality and minimize the errors. It includes the three sequential components, namely structure, process and outcome.
Structure is the resources available to provide
adequate health care, such as facilities, equipment, and trained personnel; Process is the activities or actions of healthcare practitioners giving care to patient as well as the activities of the patients receiving help and care. Outcomes seek to capture the quality of care based on the indicator related to health-status, cost of care or patient’s satisfaction.

In terms of structure, training and environment are identified as the possible contributing factors throughout the process of prescribing, dispensing and administering drugs to the increased risk of medication incident to patient.
Throughout the process, adequate training available to provide for the staffs involved in, include pharmacist, physician and nurses, is a key to reach the minimization of the medical incidents and the qualified care to the patients. The type of possible errors as known drug allergy and misidentification will expose the patients to the possible morbidity and even mortality if it can not be stopped before reaching the
patients.
Not being alert to the possible errors of known drug allergy, patients may be prescribed, dispensed and administered with the different drugs of the same class which is allergic to the patients. As well as the patient misidentification leading to the wrong drug, such as selecting wrong patients from the Clinical Management System and the subsequent incident of printing wrong drug list from the electronic patient record, patients are dispensed and administered with the wrong drugs afterwards.
Therefore, training available for the involved staffs in the identified possible type of errors and known drug allergy and misidentification is crucial for increasing their risk alertness and hence minimizing potential risk of the medical incidents throughout the process of prescribing, dispensing and administering drugs.

Besides, environment of storage and security of medicines is identified as the possible contributing factors to the medical errors and incidents.