Patients at the community clinic range greatly. Overall, they have poor health status, and a very large percentage have diabetes. There are many lifestyle factors that are contributing to them having ulcers. It can be said that they are generally of lower socio-economic status, and we know that lower socio-economic status contributes to poorer health status. They are not proactive about their health- they are mostly over weight and many with diabetes do not manage their disease properly. They generally don’t practice good infection control themselves (miss appointments to get their wounds dressed, take bandages off early/ leave them on too long/ get them wet etc). They are not particularly involved in their own care- some have had their wounds for a long time and display little interest in their wound dressing.
There is always one nurse in the community wounds clinic- two on Friday. They work normal working hours- 7-4.30, 7 days a week. The nurses primary role is to care for the clients by dressing their wounds. The nurse is also responsible for the running of the clinic- this includes all paperwork and reception work. There are also cleaning staff who come after hours.
Qi tools in wound infection care finale
QI tools in wound infection care Rachel Duffy Phomolo Madome Eva van Swaaij
Fishbone-diagram People Prevention Nurses Knowledge nurses Assistants Lifestyle Wound infections Time Education material Hand washing DressingsProcedures Materials
Teach - back• Asking patients to repeat in their own words what they need to know or do.• Provides a chance to check for understanding and, if necessary, re-teach the information.
Project Planning Form• Useful tool for planning an entire improvement project• Includes:o List of changes the team is testingo All the PDSA cycles for each changeo Assigning individuals responsibility for each change
Microsystems and Infection Control- The Five P model• Purpose• Patients• Professionals• Processes• ƒPatterns
• Purpose: Why does your practice exist?• Culture, values, attitudes, beliefs and aspirations of the people who comprise the microsystem
• ƒ Patients: Who are your patients? What are their characteristics and demographics? What resources do they use? How do your patients view their care experience? How can you involve patients in your improvement work?
• Professionals: Who are the people on your team and when do they work? Who does what and when? Are roles optimized? How satisfied are members of your care team?
• Processes: What are the processes that your team uses every day? How long do these processes take? Where do delays occur? Where are you wasting time? Are these processes effective? What are your appointment types?
• Patterns: What are your typical interruptions? Do patients often call with similar concerns or questions? When do you meet as a team? What are your outcomes?
References• ASHP foundation. (2010). Clinical Microsystems- Transformational Framework for Lean Thinking. Retrieved from http://www.ashpfoundation.org/lean/CMS9.html• Meister, S (2011). QI tools root cause analysis. Iowa department of Public Health. Retrieved from: http://www.idph.state.ia.us/mphi/common/pdf/root_caus e_analysis.pdf• Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman A. Closing the Loop Physician Communication With Diabetic Patients Who Have Low Health Literacy. Arch Intern Med/Vol 163, Jan 13, 2003
Search strategies• Eva: I looked the fishbone diagram up on Google and read through various sources. With the information I’d gathered, I created the fishbone diagram of our problem.• Phomolo: searched in Google scholar and Pub med using key words PDSA tools and wound care• Rachel: used the same search strategy as every week- typed ‘5Ps of microsystems’ in to google scholar.
collaboration• We divided our selves according to the models we looked at on the previous presentation. Each of us did their part and we met an hour before claas to finalize our presentation. We choose who presents to the class looking at the number of presentations each did.