-An Article published by the American College of Physicians-Outlines 8 principles for successfully measuring change in Quality Improvement in Medical practiceNelson, E., Splaine, M., Batalden, P., & Plume, S. (1998). Building measurement & Data Collection into Medical Practice. Annals of Internal Medicine, 128(6). 460-466. Retrieved from http://edocs.library.curtin.edu.au/eres_display.cgi?url=DC60262746.pdf&copyright=1
Nelson, E., Splaine, M., Batalden, P., & Plume, S. (1998). Building measurement & Data Collection into Medical Practice. Annals of Internal Medicine, 128(6). 460-466. Retrieved from http://edocs.library.curtin.edu.au/eres_display.cgi?url=DC60262746.pdf&copyright=1
Measurement ofhand washing inwound infectionsRachel DuffyPhomolo MadomeEva van Swaaij
Measurement: Process and OutcomeIndicatorsMeasuresThere are 3 types of measures used in quality work: Structure: Physical equipment and facilities Process: How the system works Outcome: The final product, resultsStructure and process are easier to measure; outcome is more important.Difference between Process and outcome: Process: How Healthcare is provided How the system works Outcome: Health status Does it make a difference?
Building Measurement and DataCollection into Medical Practice Aim: What are we trying to accomplish? Measures: How will we know that a change is an improvement? Changes: What changes can we make that we think will lead to an improvement?
Principles1. Seek usefulness, not perfection, in the measurements- Helps to begin with a small, useful data set that fits your work environment, time limitations and costs constraints2. Use a balanced set of process, outcome and cost measures3. Keep measurement simple; think big, but small- focus on a limited, manageable, meaningful set of starter measures4. Use qualitative and quantitative data- quantative measures are better at capturing the objective world; qualitative measures are better at reflecting subjective issues
5. Write down the operational definitions of measures-provides a clear method for scoring or measuring avariable in a reproductive manner6. Measure small, representative samples- emphasis onusefulness, not perfection7. Build measures into daily work- help the personcapture the right information at the right time8. Develop a measurement team- success inmeasurement requires time and technical expertise.Team up to lighten the workload, add knowledge andboost moral
Fishbone-diagram People Prevention Nurses Knowledge Patients nurses Assistants Lifestyle Wound infections Appointments Time Education material Dressingprocedure Hand washing Dressings Procedures Materials
What? Compliance with hand washing procedures in a community health care center
Why hand hygiene• One of the most important factor in cross infections• Adherence to hand hygiene recommendations remains poor, and improvement efforts frequently lack sustainability.• To assess the performance of individual staff members and educate them by intervening in real time• To assess the impact of a quality improvement intervention to increase adherence to hand hygiene guidelines
How?Ask patients to register whether their nurse is washing her hands Positive Negative Patients are likely to register correctly A lot of work to inform the patients about their task Cheap Possible bias: Nurse can wash her hands when the patients is out of sight Raise patients awareness about Does not register the quality of infection control washing Does not compromise patient privacy
How?Observer looking if the nurse washes her hands Record hand hygiene compliancePositive NegativeVery little to no bias ExpensiveCount both opportunities for hand Not very appropriate in an understaffedhygiene and the action of hand settinghygiene.Can verify when hand hygiene was Compromising patient privacypracticedHand hygiene quality can be assessed Staff members can change their behaviours
How?Ask staff to register when they forgot to wash their hands Positive Negative Easy Bias e.g. due to time constraints , expectancy Cheap Time consuming for a busy nurse Does not compromise patient privacy
Consequences• Better adherence to hand washing• Raise awareness• Better knowledge of infection control in community centres • Specific actions for infection control in a community centre• Less potential for infection transmission