2. Topic for Quality Improvement
Disasters
Polluted Drinking Water
Staffing Shortages
3. Theories for Quality Improvement
• Focus on a concrete issue and use
baseline data
FADE Model
• Provides practical steps for
Microsystems designing/redesigning components
of the microsystem to perform
Model optimally in alignment with
guidelines and policies
4. Tools for Quality Improvement
Plan
Act Do
Study
People
Purpose Patients Patterns
Processes
5. Measurement for Quality Improvement
• What: hand washing
• How:
quantitative (numerical based e.g. amount of hand washing done,
effectiveness of hand washing and compliance from the staff
qualitative ( data that approximates and characterise)e.g
providing feedback based on the quantitative research
• Why; Know Impact on Diarrhea Incidence and Prevalence, to know if
Change Needed, Know Effect of Hand Washing Programs, Know Staff
Habit changes
• Impact; breached patient confidentiality, measuring techniques
questionable , perceived trust and temporary compliance
Measurement can tell us whether or not the hand washing
programs have increased the amount and quality of employee
hand washing and if the incidence and prevalence of diarrhea
cases in the hospital has decreased.
6. Exploitation Low level of risk if
Informed Consent proper measures taken
Breach of Simple measures
Confidentiality Potential for program
expansion and
modification
Duty to protect
patients from harm
dictates that action
must be taken
Cons Pros
7. Bartter, K.( 2001). Ethical Issues in advanced nursing practice. Edinburgh: Elsevier science limited.
Cleary, B. A. (1995). Supporting empowerment with Deming′s PDSA cycle. Empowerment in
Organizations, 3(2), 34-39. doi:10.1108/09684899510089310
The Canadian Encyclopedia. (2012). Medical ethics. Retrieved April 25, 2012, from
http://www.thecanadianencyclopedia.com/articles/medical-ethics
Duke 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
Harris, J. L., & Roussel, L. (2010). Initiating and sustaining the clinical nurse leader role: A practical guide.
Sudbury, MA: Jones and Bartlett.
Ludwick, R., & Silva, M.C. (2006). Ethics: What would you do? Ethics and infection control. Online Journal of
Issues in Nursing, 12(1), doi 10.3912/OJIN.Vol12No01EthCol01
Malm, H., May, T., Francis, L.P., Omer, S.B., Salmon, D.A., & Hood, R. (2008). Ethics, pandemics, and the duty to
treat. American Journal of Bioethics, 8(8), 4-19
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.
Oxford University Press. (2008). A framework for ethical analysis. Retrieved April 25, 2012, from
http://fds.oup.com/www.oup.com/pdf/13/9780199214303.pdf
Oxford University Press. (2012). Oxford dictionary. Retrieved April 25, 2012, from
http://oxforddictionaries.com/definition/utilitarianism
Path. (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
Rumbold, G.( 1999). Ethics in Nursing Practice. 3rd edition. Philadelphia: Elsevier limited
Stanford Encyclopedia of Philosophy. (2012). Virtue ethics. Retrieved April 25, 2012, from
http://plato.stanford.edu/entries/ethics-virtue/
To, K. G., Graves, N., Huynh, V. N., & Le, A. T. (2011). Structure of infection control and prevention in Cho Ray
hospital: An analysis of the current situation. International Journal of Infection Control, 8(1), 14-20.
doi:10.3396/ijic.v8i1.004.12
Wasson, 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
Weber, J. R., & Kelley, J. (2011). Health assessment in nursing (4th ed.). Philadelphia: Lippincott Williams &
Wilkins.
8. Reviewed previous presentations and
summarized each
Utilized appropriate references from previous
presentations
9. Split the presentations between group
members
Combined each member’s summary into a
final presentation
Supported presenting member in preparation
Editor's Notes
The problem we chose to study was diarrhea outbreaks in Viet Nam with a specific focus on the post-disaster outbreaks where the medical system is extremely over-taxed. Diarrhea is an issue because of common and recurrent disasters such as typhoons and floods which lead to contaminated water suppliesPolluted drinking water and swampy conditions substantially increase the risk of cholera, diarrhea, dengue fever, and malaria outbreaks in Viet NamShortages of nursing staff and hospital beds due to inadequate funding in Viet Nam -> diarrheal patients being treated as outpatients and only a few can be hospitalised. 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
We chose two models to apply to the problem of controlling diarrhea outbreak in a Viet Nam hospital.FADE ModelMicrosystems ModelFADE ModelThe FADE model allows forfocus 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 careReduce errors that are leading to high rates or morbidity or mortalityMicrosystems ModelProvides practical steps for designing/redesigning components of the microsystem to perform optimally in alignment with guidelines and policies Places patient at the forefront using the four P’s: patients, people, processes, patternsReferencesDuke 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.htmlWasson, 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
We looked at both the PDSA and the 5 ‘s Microsystems tools to implement the hand washing program for quality improvement in Veitnam Hospitals in order to reduce the transmission of diarrhea. These tools were chosen as they best accounted for the patient focus and was appropriate for implementation in an under-developed medical system where statistical data will most likely not be available and trying to get such information may be too demanding on the current system. These two tools allowed for the primary use of qualitative data rather than a strict focus on quantitative data. The PDSA tool is very appropriate for staging the hand washing plan from development to review while the 5 P’s microsystem’s tool was more appropriate in the actual plan development process as it ensures that the many microsystems involved in a quality improvement program are engaged and accounted for. PDSAPlan:Increase ease, education and incentive to wash handsWhat is needed to accomplish this?Do:Staff education days, place hand wash stations at each bed, initiate infection control monitoring, implement incentive programStudy:Was an improvement seen? Were there less hospital acquired cases? Has the staff all received training?Act:Positive results = carry on with current action or add/tweak small portionsNegative results = new plan to attain goal5 P’s microsystem ToolPeople: NursesPatterns: Lack of compliance, lack of ease, incentive and monitoringProcesses: Hand washing, Staff monitoring, incentive measuresPurpose: Reduction of disease transmissionPatients: All under nurses’ care in hospitalReferencesCleary, B. A. (1995). Supporting empowerment with Deming′s PDSA cycle. Empowerment in Organizations, 3(2), 34-39. doi:10.1108/09684899510089310Nelson, 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.Cleary, B. A. (1995). Supporting empowerment with Deming′s PDSA cycle. Empowerment in Organizations, 3(2), 34-39. doi:10.1108/09684899510089310Nelson, 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.Harris, J. L., & Roussel, L. (2010). Initiating and sustaining the clinical nurse leader role: A practical guide. Sudbury, MA: Jones and Bartlett.PATH. (2010). Keeping a focus on diarrhea disease control in Viet Nam [PDF]. Retrieved from http://healthmarketinnovations.org/sites/healthmarketinnovations.org/files/VAC_ddc_vietnam_fs[1].pdfTo, K. G., Graves, N., Huynh, V. N., & Le, A. T. (2011). Structure of infection control and prevention in Cho Ray hospital: An analysis of the current situation. International Journal of Infection Control, 8(1), 14-20. doi:10.3396/ijic.v8i1.004.12Weber, J. R., & Kelley, J. (2011). Health assessment in nursing (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
Our ethical conclusion was that our program had the capacity to adapt to the current situation of the Vietnamese hospitals in question and to take into account ethical issues or questions while still having a positive impact on the occurrence of hand washing and the incidence/prevalence of diarrhea.Some of the possible ethical issues we identified are exploitation, informed consent, confidentiality and appropriate to system. In all cases we were able to find ways to minimize the risks and thus rendering the program ethical to be implemented. Despite a constant level of risk existing, as is with all programs, there is also the duty of the health care community to keep patients safe and to do no harm. One way to fulfil this duty is to reduce the transmission of diarrhea through hand washing.ReferencesBartter, K.( 2001). Ethical Issues in advanced nursing practice. Edinburgh: Elsevier science limited.The Canadian Encyclopedia. (2012). Medical ethics. Retrieved April 25, 2012, from http://www.thecanadianencyclopedia.com/articles/medical-ethicsLudwick, R., & Silva, M.C. (2006). Ethics: What would you do? Ethics and infection control. Online Journal of Issues in Nursing, 12(1), doi 10.3912/OJIN.Vol12No01EthCol01Malm, H., May, T., Francis, L.P., Omer, S.B., Salmon, D.A., & Hood, R. (2008). Ethics, pandemics, and the duty to treat. American Journal of Bioethics, 8(8), 4-19Oxford University Press. (2008). A framework for ethical analysis. Retrieved April 25, 2012, from http://fds.oup.com/www.oup.com/pdf/13/9780199214303.pdfOxford University Press. (2012). Oxford dictionary. Retrieved April 25, 2012, from http://oxforddictionaries.com/definition/utilitarianismRumbold, G.( 1999). Ethics in Nursing Practice. 3rd edition. Philadelphia: Elsevier limitedStanford Encyclopedia of Philosophy. (2012). Virtue ethics. Retrieved April 25, 2012, from http://plato.stanford.edu/entries/ethics-virtue/
