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Measurement edited
- 1. Measurement of hand washingin wound infections Rachel Duffy Phomolo Madome Eva van Swaaij
- 2. Measurement: Process andOutcome Indicators Measures There are 3 types of measures used in quality work: Structure: Physical equipment and facilities Process: How the system works Outcome: The final product, results Structure and process are easier to measure; outcome is more important. Difference between Process and outcome: Process: How Healthcare is provided How the system works Outcome: Health status Does it make a difference?
- 3. Building Measurement andData Collection into Medical Practice Aim: What are we trying to accomplish? Measures: How will we know that a change is an improvement? Changes: What changes can we make that we think will lead to an improvement?
- 4. Principles 1. Seek usefulness,not perfection, in the measurements- Helps to begin with a small, useful data set that fits your work environment, time limitations and costs constraints 2. Use a balanced set of process, outcome and cost measures 3. Keep measurement simple; think big, but small- focus on a limited, manageable, meaningful set of starter measures 4. Use qualitative and quantitative data- quantative measures are better at capturing the objective world; qualitative measures are better at reflecting subjective issues
- 5. 5. Write downthe operational definitions of measures- provides a clear method for scoring or measuring a variable in a reproductive manner 6. Measure small, representative samples- emphasis on usefulness, not perfection 7. Build measures into daily work- help the person capture the right information at the right time 8. Develop a measurement team- success in measurement requires time and technical expertise. Team up to lighten the workload, add knowledge and boost moral
- 6. Fishbone-diagram People Prevention Nurses Knowledge Patients nurses Assistants Lifestyle Wound infections Appointments Time Education material Dressing procedure Hand washing Dressings Procedures Materials
- 7. What? Compliance withhand washing procedures in a community health care center
- 8. Why hand hygiene •One of the most important factor in cross infections • Adherence to hand hygiene recommendations remains poor, and improvement efforts frequently lack sustainability. • To assess the performance of individual staff members and educate them by intervening in real time • To assess the impact of a quality improvement intervention to increase adherence to hand hygiene guidelines
- 9. How? Ask patients toregister whether their nurse is washing her hands Positive Negative Patients are likely to register correctly A lot of work to inform the patients about their task Cheap Possible bias: Nurse can wash her hands when the patients is out of sight Raise patients awareness about Does not register the quality of infection control washing Does not compromise patient privacy
- 10. How? Observer looking ifthe nurse washes her hands Record hand hygiene compliance Positive Negative Very little to no bias Expensive Count both opportunities for hand Not very appropriate in an understaffed hygiene and the action of hand setting hygiene. Can verify when hand hygiene was Compromising patient privacy practiced Hand hygiene quality can be assessed Staff members can change their behaviours
- 11. How? Ask staff toregister when they forgot to wash their hands Positive Negative Easy Bias e.g. due to time constraints , expectancy Cheap Time consuming for a busy nurse Does not compromise patient privacy
- 12. Consequences • Better adherenceto hand washing • Raise awareness • Better knowledge of infection control in community centres • Specific actions for infection control in a community centre • Less potential for infection transmission
- 13. Desirable Characteristics • Relevance • Evidence-based • Reliability • Reproducibility • Validity • Feasibility
- 14. Reasons against implementation •Financial • Observer costs money • Bias • Positive or negative • Time • Nurse already has time constraints with patients
- 15. References • 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_cause_a nalysis.pdf • Varkley, P (2010). Medical Quality and Management. Theory and practice. American College of Medical Quality. Jones and Bartlett Publishers. Sudbury, Massachusetts. Pg. 37. • Nelson, E., Splaine, M., Batalden, P., & Plume, S. (1998). Building measurement & Data Collection into Medical Practice. Annals of Internal Medicine, 128(6). 460-466. Retrieved from http://edocs.library.curtin.edu.au/eres_display.cgi?url=DC602 62746.pdf©right=1
Editor's Notes
- #3 http://patientsafetyed.duhs.duke.edu/module_a/measurement/measurement.html
- #4 -An Article published by the American College of Physicians-Outlines 8 principles for successfully measuring change in Quality Improvement in Medical practiceNelson, E., Splaine, M., Batalden, P., & Plume, S. (1998). Building measurement & Data Collection into Medical Practice. Annals of Internal Medicine, 128(6). 460-466. Retrieved from http://edocs.library.curtin.edu.au/eres_display.cgi?url=DC60262746.pdf&copyright=1
- #5 Nelson, E., Splaine, M., Batalden, P., & Plume, S. (1998). Building measurement & Data Collection into Medical Practice. Annals of Internal Medicine, 128(6). 460-466. Retrieved from http://edocs.library.curtin.edu.au/eres_display.cgi?url=DC60262746.pdf&copyright=1