Quality Improvement in Health Care

Quality Improvement in Health Care

“Using data to monitor the outcomes of care processes and using improvement methods to design and test changes to continuously improve the quality and safety of health care systems” is what quality improvement entails (QSEN, 2013).

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As hospitals across the country face increasing pressure to participate in a wide range of quality improvement activities, the role and influence of nurses in these efforts are growing. According to a new study published in 2014 by the Center for Studying Health System Change (HSC), hospital organizational cultures set the stage for quality improvement and the roles of nurses in those activities. For successful staff engagement in improvement activities, hospitals with a high-quality philosophy require everyone’s efforts, individual accountability, physician and nurse leadership, and effective feedback. (Debra A. Draper et al., HSC Research Brief No. 3 March 2008) The nurse is at the heart of the system and is best placed to assess the quality of health care services and to improve the processes by which these services are delivered to patients in the health care setting.

Hospitals face challenges related to nursing involvement, nursing resource shortages, difficulty engaging nurses at all levels, from bedside to management, and increasing demands to participate in more quality improvement activities, data collection, and reporting. Nurses are essential hospital caregivers and can significantly impact the quality of care, treatment, and patient outcomes. As hospitals face increasing pressure to participate in various quality improvement activities, they rely on nurses to help them meet these obligations.

We must gain a better understanding of the role of nurses in quality improvement and the challenges they face to provide valuable insights into how hospitals can optimize resources to improve patient care quality.

Hospitals have had quality improvement departments and employed related personnel for many years. Still, there is a new proliferation of these activities and increasing pressure on hospitals to participate in them. The goals of these quality initiatives mirror the three aims of the National Quality Strategy, which include Better Care, Healthy People/Healthy Communities, and Affordable Care (U.S. Department of Health and Human Services, 2012), and these objectives evolved from the Institute for Healthcare Improvement’s triple aim of improving patient care, improving population health, and reducing healthcare costs (Berwick et al., 2008)

To dig deeper into the quality improvement module’s objectives, I’ll look at: falls and injuries, pressure ulcers, ventilator-associated pneumonia, urinary catheter-associated infections, medication errors, handoffs, and nurse turnover.

Injuries and Falls:

While not every patient fall is avoidable, hospitals nationwide are implementing the right mix of technology, care processes, and focus to significantly reduce the number of falls and, more importantly, the injuries that patients sustain. According to the Joint Commission, the average increase in a hospital’s operational costs for a severe fall-related injury is more than $13,000, and the patient’s length of stay increases by 6.27 days on average. (Hospital and Health Networks).

Many factors contribute to falls, including the patient’s age, weak muscles, chronic conditions, and use of a cane or walker; environmental factors, such as beds not being positioned at an optimal height; and process of care factors, such as nurses failing to respond to call bells on time. No simple solution or practice has been shown to eliminate all falls. On the other hand, multifaceted fall prevention programs have been shown to reduce the risk of falls by up to 30%. (2014, Veterans Affairs Greater Los Angeles Healthcare System)

Isomi Miake & Lye and her colleagues at the Veterans Affairs Greater Los Angeles Healthcare System discovered several themes associated with successful fall prevention programs in a review of fall prevention programs: leadership support, front-line staff engaged in program design, a multidisciplinary committee to guide the program; pilot-testing interventions; use of information technology to provide data about falls; staff education and training; and convincing staff that f

Ulcers caused by pressure:

Critically ill patients are more likely to develop pressure ulcers, which increase morbidity and mortality. Pressure ulcers are becoming less common as a result of quality improvement projects.

Improving patient outcomes in an intensive care unit requires reducing the prevalence of pressure ulcers, identifying areas for improvement in pressure ulcer prevention, and increasing the adoption of preventive strategies. This quality improvement project used experimental methods to conduct 563 skin surveys on patients over 26 months. Bedside nurses received one-on-one clinical instruction during the surveys, and pressure ulcer data were displayed in the clinical area.

Pressure ulcers of all stages showed a general downward trend, with the prevalence falling from 50% to 8%. Pressure-relieving device appropriate allocation increased from 75% to 95% to 100%—National Institutes of Health Research, July 2008 (U.S. National Library of Medicine).

Quality improvement is a highly effective formula for improving patient outcomes that is simple to implement by leveraging clinical expertise and existing resources.

Pneumonia caused by a ventilator:

VAP is a common and potentially fatal complication of ventilator care. VAP is bacterial pneumonia in a patient on mechanical ventilation for 48 hours or more. Following the most recent CDC recommendations is the best defense to protect the patient. The critical point here is that nurses do not always follow these guidelines. The following interventions have been shown to have a clinical impact: I Non-invasive positive pressure ventilation for able patients with acute exacerbation of chronic obstructive pulmonary disease or pulmonary edema, (ii) Sedation and weaning protocols for those patients who do require mechanical ventilation, (iii) Mechanical ventilation protocols including head of the bed elevation above 30 degrees and oral care, and (iv) removal of subglottic secretions. (American Journal of Respiratory and Critical Care Medicine, 2011; 18)

Infections caused by urinary catheters

According to the Centers for Disease Control and Prevention, approximately 75% of UTIs acquired in the hospital are associated with a urinary catheter. 15-25% of hospitalized patients receive urinary catheters during their hospital stay. Prolonged urinary catheter use is the most critical risk factor for developing a catheter-associated UTI (CAUTI). A system of alerts or reminders for identifying all patients with urinary catheters and determining the need for ongoing catheterization.

The Health Infection Control Practices Advisory Committee’s most recent guidelines and protocols (2009) emphasize the importance of nurse-directed removal of unnecessary urinary catheters and education and performance feedback on appropriate use, hand hygiene, and catheter care. Procedure-specific guidelines for catheter placement and removal after surgery. Other protocols from the University of Pennsylvania Health System’s Center for Evidence-based Practice include postoperative urinary retention management, such as nurse-directed intermittent catheterization and bladder ultrasound scanners. (2009)

Medication mistakes:

Medication errors occur in all settings and may or may not result in an adverse drug event (ADE). Nurses are most involved during the medication administration phase but also play an essential role in detecting and preventing errors during the prescribing, transcribing, and dispensing stages.

ADE is associated with medications with complex dosing regimens and those administered in specialty areas such as intensive care units, emergency departments, and diagnostic and interventional areas. The Institute of Medicine National Academy in Washington, DC (2013) discovered that central nervous system agents, antineoplastics, and cardiovascular drugs were involved in deaths (the most severe ADE) caused by medication errors. The wrong dose (40.9 percent), the wrong drug (16 percent), and the wrong route of administration were the most common types of errors that resulted in patient death (9.5 percent). Oral and written miscommunication, name confusion (e.g., names that look or sound alike), similar or misleading container labeling, performance or knowledge deficits, and improper packaging or device were the causes of these deaths.

Conclusion

The healthcare system has the potential to transform its healthcare culture, but only if nurses are willing, better prepared, and capable of practicing and leading to the full extent of their education and training.

Nurses must be leaders to achieve significant change and work alongside and interdependently to improve processes. We must challenge existing rules that stifle open communication and work together to achieve a common goal. These characteristics exemplify transformational leadership, in which leaders and employees collaborate for the greater good. Nurse leaders fostering open communication and sharing information will lead to a cohesive, goal-directed team environment. Improvement can occur when nurses lead to facilitate teamwork and goal achievement by empowering the team rather than controlling it by seeking ongoing team member input and feedback.

Similar Post: Advanced health assessment of patients and populations

References:

Centers for Disease Control and Prevention. “Guidelines for preventing health-care-associated pneumonia, 2003: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC).” Epub.2014.

www.cdc.gov/ncidod/hip/pneumonia/default.htm (14 Jan. 2015).

Keyt H, Faverio P, Restrepo Preventing ventilator-associated pneumonia in the intensive care unit: A review of recent clinically relevant cent advancements. Indian J Med Res 2014;139:814-21 (http://www.cdc.gov/nhsn/library.html).

New Jersey Hospital Association Harrison T, Kindred J, Marks & Maran 2013 March 28.Epub.

OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 3 Pressure ulcer prevention: an evidence-based analysis Health Quality Ontario. ( Epub 2009 Apr ) Intensive Care Unit, North Shore Hospital, Sydney, Australia

Weston, M., Roberts (September 30, 2013) “The Influence of Quality Improvement Efforts on Patient Care “epub

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Nursing health quality improvement Assignment: Based on the information from one journal article.

This assignment is to write two pages of a single-spaced document with a 12-point font size in Times New Roman. That is about 500 words per page:

Page 1. •  Analyse the 10-step Clean Clinic Approach(CCA) in the article

• Compare the similarities and differences between the 10-step CC. Vs. PDSA (Plan-D0-Study-Act).

• Comment on the strengths and weaknesses of the Clean Clinic Approach

Page 2. • You are appointed as a leader to roll out the Clean Clinic Approach to another similarly sized region of Guatemala as part of the Ministry of Health plans for national implementation of the approach.

• Describe how you lead the roll-out, giving a high-level plan for the first three months. ( Notehigh-level keyword level plan, no details)