QI theories relevant to PPE compliance
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QI theories relevant to PPE compliance

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  • So what is the PDSA theory?Also called the Continuous Improvement cycleor Deming's cycle. It’s steps involve planning, doing, studying and acting. The theory is used for continuous improvement, and as it is a cycle it requires constant changes to the ongoing process.
  • American Society for Quality. (2011). Project Planning and Implementing Tools. Retrieved from: http://asq.org/learn-about-quality/project-planning-tools/overview/pdca-cycle.htmlThe Plan, Do, Study, Act cycle consists of:Plan: Recognising the need for change and plan it. Do: Testing the change initiative by carrying out a small-scale study. Study: Reviewing the study, the results and identify what you have found. Act: Taking action based on the above: If it was not successful, redo the cycle focusing on a different area. If it was successful, incorporate what you learned to plan new improvements, and begin the cycle again.
  • Adapted from:Van Tiela, F.H., Elenbaasb, T.W.O., Voskuilenc, B.M.A.M., Herczega, J., Verheggend, F.W., Mochtarb, B., & Stobberingh, E.E. (2006). Plan-do-study-act cycles as an instrument for improvement of compliance with infection control measures in care of patients after cardiothoracic surgery. Journal of Hospital Infection, 62,(1). Theaim of this study was to determine whether compliance with infection control measures for the care of hospital patients during and aftercardiothoracic surgery could be improved by using the PDSA cycle. The intervention consisted of instruction and training of nursing and medical staff on the use of PDSA cycles, feedback of the baseline measurements, and the use of posters in the proximity of the operating room.
  • Van Tiela, F.H., Elenbaasb, T.W.O., Voskuilenc, B.M.A.M., Herczega, J., Verheggend, F.W., Mochtarb, B., & Stobberingh, E.E. (2006). Plan-do-study-act cycles as an instrument for improvement of compliance with infection control measures in care of patients after cardiothoracic surgery. Journal of Hospital Infection, 62,(1). Throughout the study, monitoring took place and found that compliance levels fluctuated, however the last series of monitoring showed that compliance with general infection control measures in the OR had improved again, and that compliance had remained satisfactory on the ward and in the ICU, with the exception of patients recently transferred to the ICU from the OR. Therefore according to the study the results show that by using PDSA cycles, compliance with infection control measures can improve significantly. However, repeated monitoring is necessary to ensure continued compliance.
  • Van Tiela, F.H., Elenbaasb, T.W.O., Voskuilenc, B.M.A.M., Herczega, J., Verheggend, F.W., Mochtarb, B., & Stobberingh, E.E. (2006). Plan-do-study-act cycles as an instrument for improvement of compliance with infection control measures in care of patients after cardiothoracic surgery. Journal of Hospital Infection, 62,(1).The Study used the following PDSA cycle as part of its research and implementation of the program: Plan: 1. Identify potentially modifiable risk factors for wound infections in patients aftercardiothoracic surgery.2. Develop a pragmatic strategy to modify or prevent the occurrence of these risk factors.Do: 1. Collect baseline data, e.g. rates of compliance regarding the chosen indices ofcorrect procedure (baseline measurement).2. Carry out the planned interventionstrategy.3. Collect basic data, e.g. rates of complianceregarding the chosen indices of correct procedure (follow-up measurement).Study: 1. Analyse data.2. Summarize the results.3. Identify problems in the implementationof the designed intervention.Act:1. Determine the overall success or failure ofthe intervention.2. Identify potential modifications toimprove the intervention strategy.3. Update the intervention with solutions forthe identified problems.4. Prepare for the next PDSA cycle.
  • I think that this model could be useful in ensuring PPE compliance, in light of the study I found, as the model had been used efficiently. According to the study the results show that by using PDSA cycles, compliance with infection control measures can improve significantly. However, repeated monitoring is necessary to ensure continued compliance. Therefore if we were to implement a PDSA model to ensure PPE compliance, continuous monitoring would need to be implemented as well as perhaps further education, refresher or training days.
  • Many articles comment that the use of this theory is very useful to businesses and organisations, however they stress the need to continue the cycle, with many failing to complete the last steps – Study and Act. The study step is the most useful to ensure the success of the quality improvement project – by completing this step it ensures that the study is tested and re-evaluated to ensure that the project is on the right track.
  • Edwards, M. T. (2009). Peer Review: A New Tool for Quality Improvement. Physician Executive, 35(5), 54-59. Retrieved December 14, 2011, from Business Source Complete database.So What is Peer Review theory?Peer review is synonymous with, but not limited to, retrospective medical record review. It is also conducted in committees. Among other methods, cases are identified through generic screens for adverse events.
  • Hall, B.J. (2011). The Health Care Quality Improvement Act of 1986 and Physician Peer Reviews: Success or Failure? Retrieved from: http://www.usd.edu/elderlaw/student_papers_f2003/health_care_quality_improvement_act.htmA medical peer review committee is put in place in order to investigate conduct and care rendered of healthcare professionals. If it is found that the healthcare worker was negligent in any area of their work, they may face certain consequences. These consequences are dependent on the seriousness of the misconduct and according to each hospital’s policies. In Nursing, Peer Review plays a vital role in affecting the quality of work expected and maintaining professional autonomy.
  • Hall, B.J. (2011). The Health Care Quality Improvement Act of 1986 and Physician Peer Reviews: Success or Failure? Retrieved from: http://www.usd.edu/elderlaw/student_papers_f2003/health_care_quality_improvement_act.htmMany articles disagree with the use of the Peer review panel – with numerous claims that the panel can be used maliciously against physicians who don’t go with the status quo and speak their mind or try motivate people or institutions to change. Adapted from: Hall, B.J. (2011). The Health Care Quality Improvement Act of 1986 and Physician Peer Reviews: Success or Failure? Retrieved from: http://www.usd.edu/elderlaw/student_papers_f2003/health_care_quality_improvement_act.htmThe Health Care Quality Improvement Act (HCQIA) of 1986 was passed by Congress in the USA with the expectation that it would help protect hospitals and individual’s participating on medical peer review committees from potential libel. The Act has established standards for the hospital peer reviewcommittees, provides immunity for those involved in peer review, and has created the National Practitioner Data Bank, a system for reportingphysicians whose competency has been questioned or when the physician has been sanctioned.
  • Kinney, E.D. (2009). Hospital peer review of physicians: Does statutory immunity increase risk of unwarranted professional injury? Retrieved from http://indylaw.indiana.edu/instructors/kinney/articles/Mich_J_L&M_Peer_Review_2009.pdfAccording to Kinney, in her articleHospital Peer Review of Physicians... Issues with peer review are many and varied... “A major reason for due process inadequacies is no supervision exists for either the evidentiary and procedural aspects of the proceeding...The idea of the “reasonable belief” standard has been judicially interpreted to accord immunities when serious evidentiary or procedural irregularities are present. As judicially interpreted, the standard puts the targeted physician in a very difficult position. Unless the physician’s record and experience of clinical care in the hospital is virtually perfect, it is possible for other physicians and staff, including those with an ulterior agenda, to find and document some infraction of the standards for high quality clinical care that would be sufficient to support the “reasonable belief” standard.There is also no effective oversight of hospital peer review proceedings to protect the physician and ensure that peer review decisions are evidence based,fair and appropriately motivated. Without this oversight, no guarantee exists that decision makers and initiators do not have conflicts of interest or inappropriate personal motives for initiating peer review proceedings.
  • Kinney, E.D. (2009). Hospital peer review of physicians: Does statutory immunity increase risk of unwarranted professional injury? Retrieved from http://indylaw.indiana.edu/instructors/kinney/articles/Mich_J_L&M_Peer_Review_2009.pdfKinney also suggests four specific reforms in order to ensure that peer review works efficiently and fairly. These include:• More rigorous adherence to established principles of procedural due process in the design of peer review proceedings that are eligible for HCQIA immunity.• Establish higher standards for the evidence that must be demonstrated to meet the “reasonable belief” standard.• Ensure that hospitals’ conduct of inappropriate peer review proceedings are subject to consequences that are effective deterrents to the abuse of peer review.• Provide more effective oversight of hospital peer review proceedings to ensure more accountability from the hospital and participating physicians that peer review proceedings are fair and accurate.
  • I think that the use of peer review panels could be useful in ensuring that employees are following the correct procedures in regards to use of Personal Protective Equipment. Committees would need to be set up and peers would need to be assessed in an unbiased manner where ever possible, greater accountability would need to be taken by the hospital and the committee itself, and perhaps implement punishment for inappropriate reporting. External committees may be more useful in that they have the possibility of being less biased. Employees would also need further training before a peer review panel is introduced, and be made aware of the manner in which non-compliance will be dealt with.

QI theories relevant to PPE compliance QI theories relevant to PPE compliance Presentation Transcript

  • PDSA and Peer Review Theories
  •  Plan, Do, Study, Act  Used for continuous improvement  As it is a cycle it requires constant changes to the ongoing processDiagram taken fromhttp://www.iso9001consultant.com.au/PDCA.html
  •  Plan: Recognize the need for change and plan it. Do: Test the change initiative by carrying out a small-scale study. Study: Review the study, the results and identify what you have found. Act. Take action based on the above: If it was not successful, redo the cycle focusing on a different area. If it was successful, incorporate what you learned to plan new improvements, and begin the cycle again.Adapted from the American Society for Quality’s Project Planning and Implementing Tools paper.
  •  “Plan-do-study-act cycles as an instrument for improvement of compliance with infection control measures in care of patients after cardiothoracic surgery” Van Tiela, F.H., Elenbaasb, T.W.O., Voskuilenc, B.M.A. M., Herczega, J., Verheggend, F.W., Mochtarb, B., & Stobberingh, E.E. (2006). Journal of Hospital Infection, 62,(1).
  •  Plan: 1. Identify potentially modifiable risk factors for wound infections in patients after cardiothoracic surgery. 2. Develop a pragmatic strategy to modify or prevent the occurrence of these risk factors. Do: 1. Collect baseline data, e.g. rates of compliance regarding the chosen indices of correct procedure (baseline measurement). 2. Carry out the planned intervention strategy. 3. Collect basic data, e.g. rates of compliance regarding the chosen indices of correct procedure (follow-up measurement). Study: 1. Analyse data. 2. Summarize the results. 3. Identify problems in the implementation of the designed intervention. Act: 1. Determine the overall success or failure of the intervention. 2. Identify potential modifications to improve the intervention strategy. 3. Update the intervention with solutions for the identified problems. 4. Prepare for the next PDSA cycle.
  •  Theshort answer is “Yes”, although continuous monitoring would need to be implemented, possibly through peer reviews, and further education. Clipart taken from: http://www.istockphoto.com/stock- illustration-6514236-clipboard-list.php
  •  Failing to complete the STUDY and ACT step Failing to complete the whole cycle Completing the plan but not implementing it.
  •  Peer review is synonymous with, but not limited to, retrospective medical record review. Among other methods, cases are identified through generic screens for adverse events. Peer review is conducted in committees.
  •  Medical Peer Review: negligence and misconduct issues >Nursing peer review
  •  “The Health Care Quality Improvement Act of 1986 is, ostensibly, meant to protect the public from incompetent physicians by allowing those physicians on peer review committees to communicate in an open and honest environment and thus weed out incompetent physicians, without the specter of a retaliatory lawsuit by the reviewed physician. However, the consequences of the Act have instead helped promote an environment that protects those physicians on a peer review committee when they distort the review process for their own gain, by maliciously disciplining those physicians that may be in political or economic competition.” Hall, B.J. (2011). The Health Care Quality Improvement Act of 1986 and Physician Peer Reviews: Success or Failure? Retrieved from: http://www.usd.edu/elderlaw/student_papers_f2003/health_care_quality_improvement _act.htm
  •  No supervision “reasonable belief” standard No effective oversight of hospital peer review proceedings to protect the physician and ensure that peer review decisions are evidence based. Possible inappropriate personal motives
  • According to Kinney, E.D. (2009). Rigorous adherence to established principles of procedural due process in the design of peer review proceedings that are eligible for HCQIA immunity. Establish higher standards for the evidence that must be demonstrated to meet the “reasonable belief” standard. Ensure that hospitals’ conduct of inappropriate peer review proceedings are subject to consequences that are effective deterrents to the abuse of peer review. Provide more effective oversight of hospital peer review proceedings to ensure more accountability from the hospital and participating physicians that peer review proceedings are fair and accurate.
  •  Committees would need to be set up Greater accountability needs to be taken by the hospital and the committee External committees Further trainings Non-compliance issues dealt with