A nurse is caring for a client diagnosed with pneumonia and assesses labored breathing and copious tracheobronchial secretions. What priority action should the nurse encourage with the client?

A. Conduct a study about the time and money costs of implementing the change. While analyzing costs and time efficiency is important for evaluating resource utilization, it does not directly measure the effectiveness of the changes in reducing medication errors. The primary goal of quality improvement is to assess patient safety outcomes rather than financial impact alone.
B. Establish a benchmark to identify a standard of performance. Setting benchmarks is a useful strategy for quality control, but it is a preliminary step in the evaluation process. Benchmarks provide a target for improvement, but they do not measure whether the specific changes implemented have led to a reduction in medication errors.
C. Compare the number of medication errors before and after the action was implemented. The most effective way to evaluate the success of the changes is to analyze pre- and post-intervention data. Comparing the frequency of medication errors before and after the quality improvement measures allows for an objective assessment of whether the interventions have led to a meaningful reduction in errors.
D. Provide the staff with a questionnaire to quantify staff satisfaction with the changes. Staff feedback is valuable for assessing workflow and morale, but it does not directly measure the effectiveness of the intervention in reducing medication errors. A reduction in actual error rates provides a more concrete evaluation of the intervention’s success.

A. Client develops ecchymosis at the venipuncture site. Minor bruising at venipuncture sites is a common and expected side effect of heparin therapy due to its anticoagulant effect. While the nurse should monitor for increased bruising, isolated ecchymosis at an IV site does not necessarily indicate excessive anticoagulation or require immediate provider notification.
B. PTT 70 seconds (control 25-40). Heparin therapy is adjusted based on the activated partial thromboplastin time (aPTT). The therapeutic range is typically 1.5 to 2.5 times the control value, which in this case would be approximately 60-100 seconds. A PTT of 70 seconds is within the therapeutic range, so it does not require urgent intervention.
C. Client develops hematuria. Hematuria is a sign of potential excessive anticoagulation or internal bleeding, which can be a serious complication of heparin therapy. This finding suggests that the client's coagulation status may need immediate reassessment, and the heparin infusion may require adjustment or reversal with protamine sulfate if necessary. The healthcare provider should be notified promptly.
D. Order for Coumadin 2.5 mg to begin today. It is common practice to start warfarin (Coumadin) while a client is on heparin therapy because warfarin takes several days to reach therapeutic levels. Heparin is typically continued until the INR reaches a therapeutic range. Therefore, this order does not require provider notification.