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Quality improvement


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Quality improvement

  1. 1. QualityImprovementDeborah Naccarini, MSN,RN, CNESpring 2013
  2. 2. Where to Begin… At the beginning, of course!  What is the relationship between Research and Quality Improvement (QI)?  To really understand the Quality Improvement process, you need to understand the research process and how research results are used in the QI process  Become one with research – it is now a part of your world as a nurse.  Be sure to read the article on Bb: Hudson-Barr, D. (2004). How to read a research article. Journal of Specialists in Pediatric Nursing, (9)2, 70-72.
  3. 3. Terminology Quality  “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (IOM, 2001) Quality Management (QM)  A preventative approach to address problems before they happen Quality Improvement (QI)  The systematic processes used to measure outcomes, identify hazards and errors, and improve care.  Blame-free
  4. 4. Why is there a need toimprove care? The2000 report by the Institute of Medicine (IOM) “To Err is Human: Building a Safer Health System” revealed  98,000 deaths in hospitals each year are PREVENTABLE!!!!  Current system is fragmented and poorly organized
  5. 5. Six Aims for Improving theHealth Care System
  6. 6. National Initiatives National Database of Nursing Quality Indicators (NDNQI)  Patient Safety and Quality: An Evidence- Based Handbook for Nurses  National Patient Safety Goals  nformation/npsgs.aspx
  7. 7. Implementing QualityImprovement Quality improvement  Moves from failed standards to proactive approach  Involves everyone in organization
  8. 8. Sentinel Events “Unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.” Joint Commission Specifically includes loss of limb or function Reviewable events event.aspx
  9. 9. Root Cause Analysis (RCA) Identifiesfactors that led to sentinel event Focus on systems, processes Goal  determine which organizational improvements are needed to decrease likelihood of such events reoccurring RCA may also be done for non-sentinel events
  10. 10. Cause EffectEquipment Process People Not enough nurses Increased Problem Falls Materials Environment Management
  11. 11. Breach of Care aka - Breach of duty Occurs when nurse deviates from standard of care Report problems in care delivery Chain of command
  12. 12. Components of QualityManagement Programs Basedon integrated system information and accountability Comprehensive quality management plan  Multidisciplinary  Critical paths  Clinical pathways  Focus on client outcomes  Implementation continually evaluated
  13. 13. Benchmarking Method of comparing standards to actual performance Three dimensions of quality care: Structure Process Outcome Indicator
  14. 14. Intradisciplinary Assessmentand Improvement Peer review Outcomes management Audits  Retrospective  Concurrent
  15. 15. Interdisciplinary Assessmentand Improvement Utilization reviews Audits Peer reviews
  16. 16. Measuring QI  Total Quality Management (TQM)  Four core characteristics  Customer or client focus  Total organizational involvement  Using quality tools and statistics for measurement  Identification of key processes for improvement
  17. 17. PDSA CycleSource: Adapted from Schroeder, P. (1994). Improving quality performance. St. Louis, MO: Mosby.
  18. 18. Continuous QualityImprovement (CQI) Processto improve quality, performance Four major players  Resource group  Coordinator  Team leader  Team
  19. 19. Improving the Quality of Care Costs Nursestaffing Medication errors
  20. 20. Risk Management Focus on problem Purpose  Identify, analyze, evaluate risks, and develop plan for reducing frequency and severity of accidents and injuries Functions
  21. 21. Successful Risk Management Nurses play key role Patient perceptions Important factors once incident has occurred  Recognition of the incident  Quick follow-up and action  Personal contact  Immediate restitution
  22. 22. Blame-Free Environment Goals Reprisals Exceptions
  23. 23. Nursing Practice All nurses must be involved in quality improvement Nursing students  Commitment never to perform an act if student uncertain how to perform  Show accountability for actions  Admit to errors if they occur