Nursing: A Concept-Based Approach to Learning, 2nd Edition

Module 50 Quality Improvement  The Concept of Quality Improvement Definitions Quality ( defined by Institute of Medicine (IOM) the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge Quality management ( preventive approach to address problems before they become crises Quality improvement ( systematic processes used to Measure client outcomes Identify hazards and errors Improve client care See CONCEPTS RELATED TO QUALITY IMPROVEMENT, p. 2682 Improving the quality of health care Institute of Medicine (IOM) 2000 reportTo Err Is Human Building a Safer Health System 98,000 deaths in hospitals each year resulted from preventable medical mistakes Report stimulated by Presidential Advisory Commission on Consumer Protection and Quality in the Health Care Industry Current system fragmented and poorly organized Committee on the Quality of Health Care in America 2001 reportCrossing the Quality Chasm Focused on developing new healthcare system that improves health Healthcare providers unable to keep up with rapid changes in technology Chronic diseases now leading cause of illness, disability, health problems Affect almost half of U.S. population Current system is complex, fragmented, disorganized Six aims for improvement Safe Effective Client-centered Timely Efficient Equitable See Figure 501, SIX AIMS FOR IMPROVING THE HEALTHCARE SYSTEM, p. 2683 Recommended changes Need for evidence-based care Reorganization of practices to meet needs of clients who require More time Broad array of resources Closer follow-up Systematic attention to clients need for information Ready access to necessary clinical expertise Use of supportive information systems National initiatives Federal initiatives Nationwide focus on developing indicators of quality care measures to document quality care National Database of Nursing Quality Indicators Developed by American Nurses Association (ANA) in 1998 Provides important statistically valid and reliable data Data may be used by organizations to improve client care Data may also be used to identify relationships between nursing staffing levels and client outcomes Patient Safety and Quality An Evidence-Based Handbook for Nurses Agency for Healthcare Research and Quality (AHRQ) Recognizes that nurses uniquely positioned to participate in quality surveillance measures Examines number of critical issues Need for evidence-based practice in nursing Client-centered care issues Need to reduce declining function among hospitalized older adults Pediatric safety Nursing work environments National Patient Safety Goals The Joint Commission Revised annually Requires all accredited healthcare organizations to meet goals designed for their specific type of facilities Critical care hospitals Long-term care facilities Home care agencies Patient Protection and Affordable Care Act (PPACA or ACA) To be implemented from 2010 2020 Encourages individuals and small businesses to obtain insurance Insurance must cover preventive services Insurance companies can no longer deny coverage for pre-existing conditions Medicare and Medicaid are expanded and reformed DHHS has developed National Strategy for Quality Improvement in Health Care Better care Health people/healthy community Affordable care See Box 50-1 SIX PRIORITIES FOR HIGH QUALITY CARE, p. 2684 State and local initiatives States use federal and state funds to provide insurance to low-income individuals Funding sources often tied to taxes on specific items such as tobacco or alcohol Community health centers (CHCs) ( state or federally funded facilities that provide health care to the uninsured and underinsured populations The quality improvement process Quality improvement ( a continuous multistep, multilevel process that identifies areas for improvement based on performance and industry standards Moves health care from failed standards and problems to proactive approach Involves everyone in organization Analysis of current protocols and outcomes To begin QI, an individual, unit, or facility must understand its baseline performance Intradisciplinary assessment ( occurs within a group of individuals who have similar positions Peer review ( used to professionally critique a colleagues work based on predetermined standards Audits ( an examination of records to verify accuracy and proper use Retrospective audit ( performed after a clients discharge Concurrent audit ( performed while client is still undergoing care Outcomes management ( uses client experience to guide improvement in all areas of health care Interdisciplinary assessment ( assessment of collaboration among multiple disciplines Includes all assessments done for intradisciplinary assessments, plus utilization review Utilization review ( analyzes the use of resources to identify areas of overuse, misuse, and underuse Case Study A ( Ruth Davison is a 74-year-old woman who has been admitted to the same-day surgery center for elective right carpal tunnel repair, p. 2685 Benchmarking ( method used to compare performance of an individual or organization to industry standards Standards( standards of care are based on established models of high quality performance Structure standards ( relate to material resources, human resources, and general organizational structure Process standards ( focus on the steps used to lead to a particular outcome Outcome standards ( focus on the performance of the process Indicators ( statistics that reflect the organizations performance in a specific area Targeting areas for improvement Sentinel events ( an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof Breach of care ( occurs when a nurse deviates from the standard of care Risk management ( the process by which vulnerabilities are identified and changes are made to minimize the consequences of adverse patient outcomes and liability Case Study B ( At an extended care facility, Reuben Meyers, an 84-year-old man with Alzheimer disease, p. 2687 Identifying factors that promote better outcomes Root cause analysis Reducing medication errors Staffing practices in nursing Resource utilization Blame-free environment Personal responsibility Implementation of new protocols When a problem has been identified and a plan put in place to improve the quality of care, that plan must be implemented Most important step is educating nurses and other clinicians Evaluation of efficacy of new protocols Implemented changes must be evaluated Quality assurance ( data related to the original problem must be collected and analyzed based on benchmark standards Components of quality management programs Based on integrated system of information and accountability Programs differ depending on needs of healthcare organization and types of client care provided Comprehensive quality management Quality management plan ( systematic method to design, measure, assess, improve organizational performance Uses multidisciplinary approach Critical paths are example of quality management plan Identify expected outcomes within a specific time frame Allows staff to tract and account for variances form expected outcomes Decision-making processes guided by collected data Focus is on client outcomes, expectations, satisfaction Implementation of plan or change continually evaluated using client satisfaction survey Total quality management (TQM) one common program Emphasizes commitment to excellence throughout organization Created by Dr. W. Edward Deming Four core characteristics Customer or client focus Important to address needs of both internal and external customers Internal customers ( employees, departments within organization External customers ( clients, visitors, physicians, insurance companies Puts the customer first Total organizational involvement Goal ( involve and empower all employees to make a difference in quality of service Departments work together as team Using quality tools and statistics for measurement Many tool formats, designs available Deming developed the Plan-Do-Study-Act (PDSA) cycle One method to test effectiveness of a change Plan to test change is developed (plan) Plan put into action (do) Consequences of changed process collected (study) Determine what modifications needed (act) Identification of key processes for improvement Systems-related Clinical Managerial Continuous quality improvement (CQI) Process used to improve quality and performance Often used synonymously with TQM Never-ending process Involves evaluation, actions, mindset to strive constantly for excellence Four major players Resource group Made up of senior management Establishes overall CQI policy, vision, values Coordinator Often appointed by CEO to provide day-to-day management of CQI Team Teams designated to evaluate and improve selected processes Formally established Range in size from 5 to 10 people Team leader Has familiarity with process being evaluated Organizes meetings, sets agendas, guides group Case Study C ( An unidentified middle-age female is transported to the ED by two law enforcement officers , p. 2691 Six Sigma Uses quantitative data Six Sigma is A measure How much performance varies from a standard A goal A management system Involves management to a greater extent that other quality management systems Uses DMAIC system to improve outcomes Define the problem Measure Analyze Improve Control Lean Six Sigma Focuses on improving process flow and eliminating waste Provides tools that can be used with a Six Sigma management system Review The Concept of Quality Improvement Relate Link the Concepts and Exemplars Refer Go to Nursing Student Resources Reflect Case Study 2015 by Education, Inc. 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