Quality improvement response

Quality improvement response Order Description   I need to respond to 3 of my classmates discussion post with at least 250 words. I need to add on to the discussion to further the discussion by adding information.. maybe state what you thought was interesting and add information to further discussion. Original Post: "Nursing 330 Discussion 3 Quality Improvement Hello everyone and welcome to discussion 4. This time we are going to focus on nursing quality improvement initiatives. For this discussion I would like you to go to the NDNQI or the national database for nursing quality indicators and look at the clinical quality/nursing quality improvement under the resources and research tab. You can also just follow this link: http://www.pressganey.com/resources#?t=Select all/none?t=Clinical Quality?t=Nursing Quality: NDNQI?t=Core Quality Measures?t=Patient-Reported Outcomes (PROMS)? t=Engagement?t=Caregiver Burnout?t=General?t=Patient Experience?t=CAHPS Programs?t=Transparency?t=Nursing?t=Safety?m=Select all/none?m=Articles?m=Knowledge Brief? m=Program Summary?m=White Papers?m=Research Notes?m=Blog?m=Video?m=Webinar?m=Case Study?m=Partners Magazine?m=Report?s=Select all/none?s=ACO/Cross-Continuum?s=Acute? s=Acute Care?s=Ambulatory Surgery?s=Behavioral Health?s=Dialysis/ICH?s=Emergency Department?s=General?s=Home Health?s=ICU?s=Medical Practice?s=NDNQI?s=Nursing? s=Pediatrics?s=Post-Acute Care?s=Process and Performance Improvement?s=Safety?s=Specialty Services?s=Transparency There are hundreds of articles, webinars, and resources on this website. Please spend some time and find a project/presentation that interests you. Then come back to this discussion and share what the project was, how it involved nursing, the goals of the project, and what the outcome was. Once you have done that, I want you to come up with an improvement project based on a current or previous clinical experience (student or professional). Please do not name hospitals, clinics, or people in your proposal. This is a place for you to think about how you as a nurse would want to improve the field you work in. Your proposal should have all 4 areas of the P-D-S-A cycle in it but remember this is just an idea so you will not actually “do” anything but plan for what you would do, what you would expect, and what you would anticipate from your actions. An example is: Plan- Have RN do a chart review of each client in a long term care center weekly to ensure all testing and follow up appointments are up to date. Do- The RN reviewed all files weekly for 1 month Study- was the number of missed tests and follow up visit reduced? Did the nursing staff report feeling more informed about the needs of the clients? Were there any unexpected results? Act- Should weekly chart reviews of client be continued? Do any adjustments need to be made to the process? Another example from my clinical experience is when my place of employment started doing the CCHD or critical congenital heart defect screening. We knew that we were doing them but did not have a way to track and document our results officially. My PDSA cycle looked like this: Plan: I found a state created tracking document for the CCHD screening. It was decided that I could present this at a staff meeting and then all nurses would document the CCHD screenings on these forms when completed. These would then be filed in the office. Do: All the RN’s used the form after they completed the CCHD screening and filed them. Study: After a few weeks we reviewed and all babies born at the birth center had received this screening. The nursing staff also reported feeling more confident in who had received the screening because we could go back and verify at anytime. Act: After this review it was decided that we would continue to use this document to record and track this important data. These projects can be seemingly simple but can have a large impact on nursing satisfaction and client care! Remember, you are just sharing ideas to get us all thinking about how important nursing is in the quality improvement of healthcare! Thank you all and I can’t wait to hear your ideas!" Post 1: The article that I thought was really interesting was about improving the pediatric experience. Pediatric patients I would imagine are difficult; they come in to the hospitals or clinics not feeling good and also in fear of nurses or doctors. Sometimes the expectations of the nurses or aids from the family’s expectations are unmeasurable. Which this can vary on every patient, educating and finding out what their different needs are can improve their experience. No patient is the same, so I always like to have an open mind and to not assume they like ice in their water or they don’t like butter with their toast. The goals of this project were to improve the experience, and with the studies it has improved. When we take a little more time to listen and educate the patient, patients feel that we care and that we are here to help. Making sure that the patient knows and understands their goals and plan, the result of the patients stay or expectations will be a better experience for the patient and everyone that has participated in their care. A situation I have come across throughout my clinical experience, at one of my previous jobs, we had instruments that we auto claved. Every week and every month we had to do cleanings and every month we had to send in a test strip to make sure our autoclave was heating up to the right temperature. Charting of these weekly runs weren’t being documented and so there was no way to go back to see who ran the test every week or sent in every month. At one point this became a problem. Plan - Plan to document in a binder each time the auto cycle being run, date, time, and who is performing the run. Do - I observed that everyone charted every time they ran the auto clave. It decreased the unknown of who did what each week or month. Study - Everyone was compliant in this goal. We measured it by having a binder and if any problems or tests came back failed, the RN supervisor went straight to this binder instead of going to everyone on the team, to ask “who ran this test?” It was effective. Act - Concluding from this cycle – I felt very comfortable when charting after each auto clave cycle. It was a great way to communicate with other staff. “If it’s not charted, it wasn’t done” post2: The project was exploring the benefits of hospice as it has been historically an overlooked medical service. A study was done the presented positive results for the patients and their families, which makes this a holistic plan of care for everyone involved. The study concluded that less money was spent, less invasive procedures were done, less hospital admissions, and less ICU admissions. All of these results did not impact life advantage and families reported that their loved one was given what they truly needed in the end cycle of life. The goal of the project was to ensure hospice was working efficiently with other collaborative care teams, it proved to be more than affective and has now gained more freedom from CMS regulations and the federal government. My personal PDSA goes back to widespread error in lab draws and medications with coagulation management. Plan: Identified patients that had missed lab draws for PT/INR monitoring. Identified patients that had errors in medications, either the Coumadin dosage was incorrect and nurses were unknowingly committing med errors and increasing risk for DVTS, CVAs, hemorrhage, etc. Identified source of errors in Coumadin orders in MAR – Coumadin management was widespread and each nurse may process orders slightly different, potential for errors in transcription. Do: Nurse Manager ran report of each and every patient who was taking Coumadin, reviewed their MAR for accuracy with Coumadin Log that had previous orders, lab draw dates, etc. Identified current errors, prevented further errors by conducting review, notified MD and families of affected patients. Changed plan for Coumadin Management to be done by managerial oversight in this skilled nursing facility. In morning meeting for patient review, the team will review Coumadin results, orders, and that day’s scheduled coumadin lab draws via whiteboard tracking system. Study: Reports were reviewed of medication and treatment errors weekly, monthly, and then quarterly of system to monitor effectiveness. Audits were also done of Coumadin Log in comparison to MAR and lab orders to ensure accuracy. Act: This proved to be an effective oversight of Coumadin management and decreased the medication, treatment, lab, and transcription errors by simple review. Continued review and updating of whiteboard daily in morning meetings by nurse managers. post3: The article that I chose to discuss from the NDNQI website was “The Influence of Nurse Work Environment on Patient, Payment and Nurse Outcomes in Acute Care Settings.” The article’s focus was on the impact of the nursing environment and staffing on the ability of the nurses to provide high quality patient care. Research has shown that hospitals with better RN staffing and nursing work environments have better nurse outcomes including burnout rate, less job dissatisfaction, and lower intent to leave rates. Patient outcomes also improve with better nursing work environments and staffing. The findings in the article showed that in the best work environments, RN staffing had less of an impact than the quality of the work environment and the cohesiveness of the team that’s providing care. Some main points and goals of this article were focusing on the data on the correlation among structure and outcome measures, specifically in relation to patient falls and hospital-acquired pressure ulcers. There was also a strong correlation between RN staffing and the patient’s perception of discharge process and overall experience of their stay, as well as their perception of the nurses. Analyses performance was tested in 2 categories, one was staffing above the median (50th percentile) and below, and the other was work environment from least favorable to most favorable. Organizations with above median staffing outperformed those with below, however organizations with the lowest staffing and the highest level of work environments outperformed others in all areas. The outcome of the article is to point out the importance of staffing and nurse environments. There is a direct connection between adequate RN staffing and nurse outcomes, being that nurses are more satisfied with their jobs and are more likely to stay in their jobs when their units are well staffed. I work in a clinic setting and something I noticed this last year that was compromising patient safety was the specific “extra” jobs that needed to be done throughout the day, such as: autoclaving surgical instruments, checking expiration dates and counting narcotic drugs. This was a quality improvement project that I tried to do this year in my clinic. Plan: I observed how often these extra tasks around the clinic were being done. Often times, the autoclave would go days without being ran. This meant that instruments were sitting out waiting to be sterilized when the providers needed them for procedures. Sometimes this would cause patients to have to reschedule procedures. When I would go into the drug closet to pull out a narcotic, the drugs would often times be uncounted from the morning. Another task that that was being overlooked was checking expiration dates. A couple of times I pulled out medications for patients that were expired, and if I hadn’t double checked they may have been administered. I decided to implement something similar to a chore chart so all of these assignments were assigned to specific people. Do: I created a template that allowed all of the MA’s in the clinic to have a job every month, and it rotated at the beginning of the month so everyone had a turn to do the jobs that were unfavorable like quality controls on point of care machines and daily autoclaving. Study: I sent the new chore chart to all of the MA’s in the clinic and told them we would do a trial run to test how often these tasks were being ignored, compared to before the chore chart was implemented. It was explained to everyone that it was now their responsibility to ensure their assignment was being completed. The MA’s were all optimistic about this, because it would make someone accountable for each chore, and hopefully that meant they would be done daily. Act: After this was implemented, we noticed that when employees were out of the office for the day, their assignment wasn’t being done. I was able to plan a new system that ensured that tasks were still being done when someone was out for the day. The effectiveness of this is still being evaluated, but we have all noticed significant improvement.