Describe the need for quality improvement activities.

Describe the need for quality improvement activities.
Assignment: Quality Improvement

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This program generously funded by the Robert Wood Johnson Foundation

Quality Improvement

Jean Johnson, PhD, RN, FAAN

Quality Improvement: As Used in this Module Use data to monitor the outcomes of care process and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems.

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Key Message The key message of this module is: Improving patient care requires a systematic process of defining problems in order to identify potential causes and develop strategies to improve care. This process requires the ability to measure care. We can only improve care if we can measure how well we are doing and compare our performance against others.

Learner Objectives By the end of this module, the learner will be able to:

1.  Describe the need for quality improvement activities.

2.  Describe strategies for learning about the outcomes of care including the use of measures, Plan Do Study Act (PDSA), and other commonly used approaches to identify problems and factors that contribute to the problems.

3.  Seek information about outcomes of care through the use of publicly reported measures as well as unit and institution level measures.

4.  Seek information about quality improvement projects in care settings.

5.  Recognize that nursing and other health professions students are part of systems of care.

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Helen Haskell and her husband agreed to have their 15- year-old son have cosmetic surgery to correct pectus excavatum. He entered the hospital as a healthy, robust young man, but he died 4 days after his surgery. The cause of death was a dysfunctional health system. The failure of nursing care as well as other providers led to his death. No one would listen seriously to the family’s concerns about the deteriorating state of their son. He had complained of severe stomach pain but was told it was gas and to walk it off. He had been given an overdose of Toradol, which likely contributed to a large bleeding duodenal ulcer, which was the physiologic cause of his death. His death was preventable.

Nurses and Quality Improvement

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Nurses and Quality Improvement

Numbering over 3 million, nurses are the central nervous system of health care in America, comprising the largest portion of the healthcare workforce. Nurses are the mainstay of quality improvement departments in healthcare institutions and systems, are frequently the ones to implement change as needed, and have always played a major advocacy role for ensuring safe and appropriate care to our patients. Nurses have the opportunity and responsibility to lead the efforts in quality improvement in all settings.

Florence Nightingale and Quality Improvement Florence Nightingale holds the distinction of being one of the first healthcare professionals to systematically collect data and improve care through the use of data. Nightingale’s bedside data collection and subsequent hygiene improvement interventions at a military hospital during the Crimean War led to a dramatic reduction in patient mortality. From its inception, nursing has been rooted firmly in quality improvement.

NUR 329

Quality Improvement

Quality improvement in health care has evolved from processes that looked at physical plant, staff qualifications, and policies and procedures to processes that focus on the actual care and outcomes that patients experience.

Quality Improvement

Quality and Safety Education for Nurses (QSEN) defines quality improvement as:

Use of data to monitor the outcomes of care processes and use of improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems (Cronenwett et al., 2007).

NUR 329

Improving Care

Improving patient care requires a systematic process of defining problems in order to identify potential causes of those problems with the main goal of developing strategies to improve care. This process requires being able to measure care.

Improving Care

We can only improve care if we can measure how well we are currently providing it.

NUR 329

Improving Care

It is important for nurses to understand that we are part of a system of care and that quality improvement is a process that involves nurses, physicians, and everyone involved in patient care. In order to improve care, the entire team has to be committed to that goal.

Background

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To Err is Human

The Institute of Medicine released a series of reports that brought attention to the issues of quality. The first, To Err is Human brought startling statistics to light about the number of needless deaths and injuries caused by medical errors.

It was estimated that 100,000 people a year died as the result of poor care and millions suffered ill effects.

Crossing the Quality Chasm

The second, Crossing the Quality Chasm, provided a definition and aimed to improve quality of care. In this report, the Institute of Medicine defined quality as:

The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

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Crossing the Quality Chasm

Crossing the Quality Chasm established six aims that have formed a framework for moving forward with improving quality. The aims are that care should be

Safe: Care should be as safe for patients in healthcare facilities as in their homes.

Effective The sciences and evidence behind healthcare should be applied and serve as the standard in the delivery of care.

Efficient Care and service should be cost-effective, and waste should be removed from the system.

Timely Patients should experience no waits or delays in receiving care and service.

Patient centered The system of care should revolve around the patient, respect patient preferences, and put the patient in control.

Equitable Unequal treatment should be a fact of the past; disparities in care should be eradicated

Value

Value is also an important concept in quality improvement. Value takes into consideration the cost of care as well as the quality of the outcome of care. High- value care would be low cost with a great deal of benefit. An example of high-value care is a nurse recognizing that a newborn is having an increased respiratory rate and immediately starts the protocol to manage this problem before the baby gets into significant distress.

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Quality and “Never Events”

All nurses should be aware of information available from regularly collected data. For instance, all hospitals collect data related to falls, infections, pressure ulcers, and other events. Recent rules established by the Centers for Medicare and Medicaid have identified “never events,” which are serious and costly events that should never occur in a hospital if appropriate care is provided.

“Never Events” Include . . . •  Objects left in after surgery •  Air embolisms •  Blood incompatibility •  Pressure ulcers •  Falls in the hospital •  Catheter-associated urinary

tract infections •  Catheter-associated vascular

infections •  Mediastinitis after CABG •  Inadequate glycemic control •  Surgical site infections Assignment: Quality Improvement

•  Deep vein thrombosis and pulmonary embolism

•  Drug-induced delirium •  Wrong surgical or other

invasive procedures performed on a patient

•  Surgical or other invasive procedures performed on the wrong body part

Describe the need for quality improvement activities.

Describe the need for quality improvement activities.

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