1. QualityImprovementDeborah Naccarini, MSN,RN, CNESpring 2013

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 researcharticle. Journal of Specialists in Pediatric Nursing,(9)2, 70-72. 3. Terminology Quality The degree to which health services forindividuals and populations increase thelikelihood of desired health outcomes andare consistent with current professionalknowledge (IOM, 2001) Quality Management (QM) A preventative approach to addressproblems before they happen Quality Improvement (QI) The systematic processes used to measureoutcomes, identify hazards and errors, andimprove care. Blame-free 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. Six Aims for Improving theHealth Care System 6. National Initiatives National Database of Nursing QualityIndicators (NDNQI) https://www.nursingquality.org Patient Safety and Quality: An Evidence-Based Handbook for Nurses http://www.ahrq.gov National Patient Safety Goals http://www.jointcommission.org/standards_information/npsgs.aspx 7. Implementing QualityImprovement Quality improvement Moves from failed standards to proactiveapproach Involves everyone in organization 8. Sentinel Events Unexpected occurrence involving deathor serious physical or psychological injury,or the risk thereof. Joint Commission Specifically includes loss of limb orfunction Reviewable events http://www.jointcommission.org/sentinel_event.aspx 9. Root Cause Analysis (RCA) Identifiesfactors that led to sentinel event Focus on systems, processes Goal determine which organizationalimprovements are needed to decreaselikelihood of such events reoccurring RCA may also be done for non-sentinelevents 10. CauseEffectEquipment ProcessPeople Not enough nursesIncreasedProblem Falls Materials Environment Management 11. Breach of Care aka - Breach of duty Occurs when nurse deviates fromstandard of care Report problems in care delivery Chain of command 12. Components of QualityManagement Programs Basedon integrated system informationand accountability Comprehensive quality managementplan Multidisciplinary Critical paths Clinical pathways Focus on client outcomes Implementation continually evaluated 13. Benchmarking Methodof comparing standards toactual performance Three dimensions of quality care:StructureProcessOutcome Indicator 14. Intradisciplinary Assessmentand Improvement Peer review Outcomes management Audits Retrospective Concurrent 15. Interdisciplinary Assessmentand Improvement Utilization reviews Audits Peer reviews 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. PDSA CycleSource: Adapted from Schroeder, P. (1994). Improving quality performance. St. Louis, MO: Mosby. 18. Continuous QualityImprovement (CQI) Processto improve quality, performance Four major players Resource group Coordinator Team leader Team 19. Improving the Quality of Care Costs Nursestaffing Medication errors 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. Successful Risk Management Nurses play key role Patient perceptions Important factors once incident hasoccurred Recognition of the incident Quick follow-up and action Personal contact Immediate restitution 22. Blame-Free Environment Goals Reprisals Exceptions 23. Nursing Practice Allnurses must be involved in qualityimprovement Nursing students Commitment never to perform an act ifstudent uncertain how to perform Show accountability for actions Admit to errors if they occur