APA format. MUST BE  1 SEPERATE RESPONSE TO EACH QUESTION. 1 paragraph per response. Use only scholar authors only. References needed Discussion 1: This week we discuss the hurdles implementing the quality improvement plan. At first I thought this would be difficult but looking back to my previous posts I have already touched on the many hurdles in implementation. One that I have not discussed is lack of providers. With Washington being 45th in the nation for mental health it goes to reason that one of the reasons we rank so poorly is lack of access and in that we lack providers (Mental Health America, 2020). My facility is currently trying to hire two new mental health providers, we are already facing understaffing in this area of practice. Attempting to have an existing provider attend rounds when they are already understaffed is unlikely, however, if we fill those position it would become more feasible. This means availability of physical staff available is my largest hurdle to overcome. The cost of having a dedicated mental health practitioner could be argued as cost prohibitive. When just looking at patients with delirium we find increased cost of stay and increased mortality rates (Blair et al., 2018). If we look at the cost of extended stays for patients with mental health disturbances, including delirium, we could argue the savings from shortened stays and lowering mortality rates more than offsets the cost of the dedicated practitioner. Many of our mental health patients present with being underinsured, if they have medical insurance at all and have chosen to not seek treatment until it is life threatening do to cost prohibitive appointments (Mental Health America, 2020). If patients could be extubated earlier and leave the hospital sooner, the overall cost could be a net positive by having more patients survive the ICU and leave quicker. If given the opportunity to implement the addition of mental health into the ICU it would be done in a 6-12-week period to adapt the culture to this addition. I would first have them participate in daily rounds with the unit to facilitate conversation and see if they could add input to manage those suffering with delirium or difficult to wean from sedation patients. After two weeks I would implement a more intimate relationship with the staff and have them round alone, not just with daily rounds, to see if nursing or physicians had more in-depth concerns for certain patients. After two to three weeks doing more personal rounds giving physicians the ability to consult the specialist early for concerns about medications or response to daily awakening trials would be implemented. This is the point that the new team member would be fully integrated. Discussion 2: In a utopian world, the implementation of all proposed action steps would be utilized to prevent adverse drug events (ADEs).  Unfortunately, the absolute amount of resources required to facilitate solving all healthcare problems is not a reality.  A proposed action step to improve practice would be to have a pharmacist within each department to monitor and adjust medication orders quickly, mix various medications, and be a resource for provider and nursing staff.  A pharmacist who is available as a resource to collaborate with and educate those seeking assistance is a vital component to patient safety.  According to Grill et al. (2019), the implementation of on floor pharmacists in the emergency department saved physicians 75 minutes per shift and spared physicians from distractions, reducing a myriad of prescribing errors.              Additionally, the implementation of bar code scanning monitoring and providing routine education to those who fall below a specific scanning threshold.  For those who consistently above the threshold, incentives and praise should be incorporated into the organizational infrastructure to improve colleague morale and job satisfaction.  It is important not to implement punitive measures, as Battard (2017) explains that punitive measures undermine the overall goal of improved patient safety and diminishes morale.              Regrettably, the implementation of departmental pharmacists is limited financially.  Justifying to administration powers the costs and benefit ratio in a reasonably small community hospital would be challenging.  One could argue for on-floor pharmacists who assist critical care floors such as the emergency department and intensive care unit due to the acuity of patients in those domains.  However, justifying pharmacists for multiple departments would not be cost-effective.              Bar code scanning monitoring, education, and performance incentives are potential cost-effective methods for reducing ADEs.  Still, a barrier could be resistance from directors and managers who must develop and conduct the educational meetings in addition to their existing workload.  This application appears to be the most practical method for improving ADEs in a small community hospital setting.

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