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  • ReferencesA.D.A.M. Medical Encyclopaedia. (2012). Diseases and conditions: Diarrhea. Retrieved April 18, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0003613/
  • ReferencesPath. (2010). Keeping a focus on diarrheal disease control in Viet Nam. Retrieved April 18, 2012, from http://healthmarketinnovations.org/sites/healthmarketinnovations.org/files/VAC_ddc_vietnam_fs[1].pdf
  • It is important to note that diarrhea is a major health problem following a disaster because more people will be susceptible to obtaining diseases rather than being physically injured. Also, because more than 70% of Viet Nam’s population live in rural areas, many hospitals are difficult to reach.ReferencesPath. (2010). Keeping a focus on diarrheal disease control in Viet Nam. Retrieved April 18, 2012, from http://healthmarketinnovations.org/sites/healthmarketinnovations.org/files/VAC_ddc_vietnam_fs[1].pdf
  • ReferencesMedicine Net. (2012). Disease & conditions: diarrhea. Retrieved April 19, 2011, from http://www.medicinenet.com/cholera/article.htm
  • ReferencesDuke Medical Center Department of Community and Family Medicine. (2005). Patient safety: Quality improvement. Retrieved April 19, 2012, from http://patientsafetyed.duhs.duke.edu/module_a/methods/fade.html
  • For example, a nurse comes onto her shift hours after the disaster to help, and most patients are acutely ill with medical type injuries. On the next day, she beings to see patients with nausea and diarrhea and supplements the patients with oral rehydration salts provided by the Center for Disease Control. On the third day, out of her 50 patients, 15 have mild diarrhea, and on the fourth day, more than 30 now have severe diarrhea and signs of cholera, such as liquid diarrhea with mucous present. The nurse realizes two important points based on the use of this model: 1. The rates of severe diarrhea seem to be increasing quickly 2. At least 3-4 have died from severe dehydrationThe nurse can use these two points to reflect over her care for her patients. For instance, should she be administering Ringers Lactate to her patients instead of oral rehydration therapy?
  • ReferencesWasson, J.H., Godfrey, M.M., Nelson, E.C., M, J.J., & Batalden, P.B. (2003). Microsystems in healthcare: Part 4. Planning patient-centered care. Joint Commission Journal on Quality and Safety, 29(5), 227-237
  • This example applies the theory to the health issue because the nurse’s action can have an impact on the spread of diseases, which is a form of quality improvement in the microsystem, or healthcare unit.
  • ReferencesWasson, J.H., Godfrey, M.M., Nelson, E.C., M, J.J., & Batalden, P.B. (2003). Microsystems in healthcare: Part 4. Planning patient-centered care. Joint Commission Journal on Quality and Safety, 29(5), 227-237
  • Six Sigma Model for quality improvement was discarded because of the focus on data acquisition and analysis as well as the need for baseline data before any analysis can occur. It is highly data driven, and while this can be highly beneficial, in a setting where disaster care is being provided and decisions are needed to be made quickly, it cannot be used as an initial tool for quality improvement. When focusing on the occurrence and subsequent treatment of post-disaster diseases such as cholera which leads to diarrhea in Vietnam, the focus is on how to efficiently and effectively treat patients while reducing inter-patient transmission in the face of hospital overcrowding. While benefit can be seen from the use of data tracking in situations such as this, the primary goal is qualitative and not quantitative especially in an underdeveloped medical system; thus Six sigma will not be effective in this situation. Total Quality Management (TQM) Model for quality improvement was discarded because it requires a developed medical system in order to be implemented. The goals are to provide acceptable, quality health services to patients that are affordable, error-free and timely. In order to meet the goals, reassessments need to occur to provide a base for continuous improvement which also requires total involvement of the entire health care organization. Unfortunately, in an under-developed system where treatment is based on wealth, bribery, and constrained by lack of health care staff and beds, this model is unable to be applied appropriately as there is not the leadership, nor the total involvement of the health care system to implement the TQM model.ReferencesDe Koning, H., Verver, J. P., Van den Heuvel, J., Bisgaard, S., & Does, R. J. (2006). Lean six sigma in healthcare. Journal for Healthcare Quality, 28(2), 4-11. doi:10.1111/j.1945-1474.2006.tb00596.xGeorge, M. L. (2003). Learn six sigma for service: How to use lean speed and six sigma quality to improve services and transactions. NY, NY: McGraw-Hill.Nelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission Resources.Ovretviet, J. (2000). Total quality management in European healthcare. International Journal of Health Care Quality Assurance, 13(2), 74-80.doi:10.1108/09526860010319523Patel, G. (Biomedical Engineer). (2012). Total quality management in health care [PDF]. Retrieved fromhttp://www.biomedicalprojects.com/files/TQM%20in%20Healthcare.pdfRaisinghani, M. S., Ette, H., Pierce, R., Cannon, D., & Daripaly, P. (2005). Six sigma: Concepts, tools, and applications. Industrial Management & Data Systems, 105(4), 491-505. doi:10.1108/02635570510592389
  • QI presentation

    1. 1. Thuy Trang Nguyen Thi Hloliphani Juta Jasmine Paul Lara KestelooQuality Improvement:Treatment of Post DisasterDiseases in Viet Nam
    2. 2. Health Issue: Treatment ofdiarrhea post disaster
    3. 3. What is diarrhea?• Occurrence of loose, watery, and frequent stools. Stool and vomit are highly contagious• Common causes: viral gastroenteritis (stomach flu), medical conditions, or by eating or drinking contaminated food or water (in Viet Nam during floods)• Treatment: – Fluids such as water and Pedialyte – Oral rehydration therapy – Intravenous fluid – Monitoring
    4. 4. How do nurses in Viet Nam treat diarrhea after adisaster? • Hanoi, Vietnam: 1 in 10 paediatric • Shortage of nursing staff and patients are hospitalised due to hospital beds due to inadequate complications of diarrhea and funding → diarrheal patients are during natural disasters the treated as outpatient and only a number increases few can be hospitalised. • Use of buckets under beds to catch stool. Buckets are then washed and disinfected with chlorine
    5. 5. Post disaster issue: Diarrhea• Despite strong improvements in key social indicators, water and sanitation and related diseases remain a major health problem following disasters in Vietnam. Polluted drinking water and swampy conditions substantially increase the risk of cholera, diarrhea, dengue fever, and malaria outbreaks. More than 70 percent of Vietnam’s 85 million people live in rural areas. While a large majority of rural communities have access to improved water sources, great disparities remain in access to clean water
    6. 6. Why focus on diarrhea as a health issue following a disaster?• “Although symptoms may be mild, approximately 5%-10% of previously healthy people will develop a copious diarrhea within about one to five days after ingesting bacteria from contaminated sources such as water and food”
    7. 7. QUALITY IMPROVEMENT THEORIES: FADE ModelMicrosystems Model
    8. 8. FADE model• → Focus• → Analyze• → Develop• → Execute/Evaluate
    9. 9. Relevance of the FADE model• The FADE model allows the nurse to focus on a concrete issue (diarrhea post disaster) and use baseline data (how many cases of cholera → diarrhea/ what are the rates of morbidity and mortality) to either: – Improve care/implement care – Reduce errors that are leading to high rates or morbidity or mortality – For example...
    10. 10. Microsystems model• Provides practical steps for designing/redesigningcomponents of the microsystem to perform optimally inalignment with guidelines and policies• Use of four “P’s” to guide patient-centered care: - Patients - People - Processes - Patterns
    11. 11. Relevance of the microsystems model• Places the patient at the forefrontE.g. Not placing patients with diarrhea beside those who are being treated for an open wound because doing so→ further spread of disease (based on evidence-based practice)
    12. 12. Drawback of the microsystems model• “Excellent planned care requires that the microsystem have services that match what really matters to a patient and family and protected time to reflect and plan. Patient self- management support, clinical decision support, delivery system design, and clinical information systems must be planned to be effective, timely, and efficient for each individual patient and for all patients”• Yes this is possible in a microsystem, but is it possible to achieve in one whose main concern is disaster management/care?
    13. 13. Six Sigma Model TQM Model
    14. 14. Discarded theories • Six Sigma • TQM Model Customer Define Focus Total PlanningControl Measure Participation Process Results Process Process Improvement Management Improve Analyze
    15. 15. ReferencesA.D.A.M. Medical Encyclopaedia. (2012). Diseases and conditions: Diarrhea. Retrieved April 18, 2012, fromhttp://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0003613/De Koning, H., Verver, J. P., Van den Heuvel, J., Bisgaard, S., & Does, R. J. (2006). Lean six sigma in healthcare. Journal for HealthcareQuality, 28(2), 4-11. doi:10.1111/j.1945-1474.2006.tb00596.xDuke Medical Center Department of Community and Family Medicine. (2005). Patient safety: Quality improvement. Retrieved April19, 2012, from http://patientsafetyed.duhs.duke.edu/module_a/methods/fade.htmlGeorge, M. L. (2003). Learn six sigma for service: How to use lean speed and six sigma quality to improve services and transactions. NY, NY:McGraw-Hill.Medicine Net. (2012). Disease & conditions: diarrhea. Retrieved April 19, 2011, from http://www.medicinenet.com/cholera/article.htmNelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.).Oakbrook Terrace, Illinois: Joint Commission Resources.Nguyen, H.N., Trung, K.V., & Niem, N.V. (2007). Fighting climate change: Human solidarity in a divided work. Flooding in Mekong RiverDelta, human development report 2007/2008Ovretviet, J. (2000). Total quality management in European healthcare. International Journal of Health Care Quality Assurance, 13(2), 74-80. doi:10.1108/09526860010319523Patel, G. (Biomedical Engineer). (2012). Total quality management in health care [PDF]. Retrieved fromhttp://www.biomedicalprojects.com/files/TQM%20in%20Healthcare.pdfPath. (2010). Keeping a focus on diarrheal disease control in Viet Nam. Retrieved April 18, 2012, fromhttp://healthmarketinnovations.org/sites/healthmarketinnovations.org/files/VAC_ddc_vietnam_fs[1].pdfRaisinghani, M. S., Ette, H., Pierce, R., Cannon, D., & Daripaly, P. (2005). Six sigma: Concepts, tools, and applications. IndustrialManagement & Data Systems, 105(4), 491-505. doi:10.1108/02635570510592389Wasson, J.H., Godfrey, M.M., Nelson, E.C., M, J.J., & Batalden, P.B. (2003). Microsystems in healthcare: Part 4. Planning patient-centeredcare. Joint Commission Journal on Quality and Safety, 29(5), 227-237
    16. 16. • We started by looking at our first presentation, which was a broad topic ofdisaster preparedness in Viet Nam, and individually researched specific issues thatoccur both in the acute phase, and the long term phase•Choosing the acute phase and attempting to find an issue in which nurses werethe focal point proved to be difficult; we then strategized and researched commonhealth issues post disaster that nurses encounter in Viet Nam•From here we found that Cholera was a common and specific healthissue, occurring both in rural and highly populated cities after disasters.However, we refined this to treatment of diarrhea, as this seemed to be a moreconcrete and specific health issue to link to the theories we chose• We used scholarly databases such as CINAHL, Pub Med, The World HealthOrganization, and other scholarly work from American and European accreditedjournals Search process
    17. 17. Collaboration• We initially collaborated as a group to researchand decide which topic would be appropriate. Weeach brainstormed one specific topic and came backto the group to discuss why we thought it would bea relevant topic. To choose one, we went back to theresearch to support each topic, which led to ourfinal decision•From here we worked individually but contactedeach other through e-mail and Facebook to gainnew ideas and knowledge•Each member of the group had the choice todecided which topic she wanted to focus on. Onegroup member was in charge of creating the PowerPoint after each member was done her slide(s)•Another member of the group read over the powerpoint for spelling errors and to ensure thereferences were scholarly and appropriately cited

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