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Quality Improvement & Patient Safety

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 Why the Focus on Patient Safety?

Between 44,000 and 98,000 Americans die from medical errorsannually (Institute of Medicine [IOM], 2000 !"omas et al, 2000!"omas et al, #999$

Medication%related errors for "os&itali'ed &atients cost rou"ly )2 *illion annually (IOM, 2000 Bates et al, #99+$

4# million uninsured Americans e-"i*it consistently worse clinicaloutcomes t"an t"e insured and are at increased ris. for dyin&rematurely (IOM, 2002 IOM, 200/a$

!"e la *etween t"e discoery of more effectie forms of treatmentand t"eir incor&oration into routine &atient care aeraes #+ years(Balas, 200# IOM, 200/*$

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IOM’s Six Aims to ui!eImprovements

 Safe1 aoidin inuries to &atients caused *y t"e care t"at isintended to "el& t"em

Timely1 reducin waits and sometimes "armful delays for *ot"

t"ose w"o receie and t"ose w"o ie care  Effective1 &roidin serices *ased on scientific .nowlede to all

 w"o could *enefit, and refrainin from &roidin serices tot"ose not li.ely to *enefit

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IOM’s Six Aims to ui!eImprovements

 Efficient: aoidin waste, includin waste of e3ui&ment,su&&lies, ideas, and enery 

 Equitable: &roidin care t"at does not ary in 3uality *ecause

of &ersonal c"aracteristics suc" as ender, et"nicity, eora&"iclocation, and socioeconomic status  Patient-centered: &roidin care t"at is res&ectful of and

res&onsie to indiidual &atient &references, needs, and alues,and ensurin t"at &atient alues uide all clinical decisions

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Simple "ules to ui!e Improvements

are is customi'ed accordin to &atient needs and alues 5nowlede is s"ared, and information flows freely  6ecision ma.in is eidence *ased

7afety is a system &ro&erty  !rans&arency is necessary  eeds are antici&ated  aste is continuously decreased oo&eration amon clinicians is a &riority

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#ornerstones of Quality Mana$ement

ustomer defines 3uality  Orani'ational su&&ort for all em&loyees to deelo& 3uality

.nowlede and s.ills

Belief in t"e &eo&le w"o are wor.in to sere t"e customer

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Quality Mana$ement in

%ealth #are

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Quality Assurance

Ins&ection oriented

:eactie to &ro*lems

orrected s&ecial &ro*lems and did not addressoerall &rocess im&roement

:es&onsi*ility *eloned to only a few &eo&le

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Quality Improvement

;lannin and &reention oriented

;ro*lem solin *y em&loyees at all leels

orrection of common cause &ro*lems andim&roement in wor. &rocesses

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 "e$ulatory an! Accre!itation A$encies

:eulatory orani'ations

enters for Medicare and Medicaid 7erices Administers t"e Medicare &roram

:e3uires 3uality manaement in

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 "e$ulatory an! Accre!itation A$encies

ational ommittee for >uality Assurance (>A$?&rimary oluntary accreditation aency for manaedcare orani'ations

!"e @oint ommission?first reulatory aency toem*race 3uality im&roement &rinci&les in "os&ital% *ased settins

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 "e$ulatory an! Accre!itation A$encies

ursins role in reulatory and accreditation standards

na*les "ealt" care orani'ations to successfully meetreulatory standards

7u&&orts t"e oerall manaement of &atient care and wor.in colla*oratiely wit" ot"er &rofessionals to dot"e followin1

Identify &rocess im&roements needs

Initiate c"ane

Monitor onoin effectieness of &atient care

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#linical In!icators an!Process Improvementools 

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#linical In!icators

7ere as a *asic foundation for 3uality monitorin and ealuation Measura*le as&ects of care t"at s"ow t"e deree to w"ic" clinical

care is or is not carried out (e, administer correct IC solution at&rescri*ed rate$

Dsed as an assessment of clinical care to identify areas in w"ic"3uality im&roement issues may *e &resent

Eel& to identify t"e oals of 3uality im&roement

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Process Improvement ools

7u&&ort t"e understandin of .ey wor. &rocesses1  Analy'in and clearly understandin t"e wor. &rocess 7electin t"e .ey as&ects of t"e &rocess to im&roe sta*lis"in

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Process Improvement ools

Flowc"art Ma&s out w"at actually occurs in a wor. &rocess

Bar c"art :eflects fre3uency at w"ic" eents occur, or t"e im&act eents

"ae on a &rocess ause%and%effect diaram Eel&s to identify &otential causes of a &ro*lem

:un c"art Gra&" of data &oints as t"ey occur oer time

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Institute for %ealthcareImprovement 'I%I(

 Coluntary orani'ation formed to assist "ealt" care leaders toim&roe 3uality 

Hed deelo&ment of c"ane conce&ts for s&ecific areas

:educin &atient delays :educin cesarean delieries

:educin aderse dru eents

:educin entilator%related &neumonia

:educin "os&ital%ac3uired &ressure ulcers

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)o*Part Mo!el for Improvin$%ealth #are 'I%I(

 As. t"ree fundamental 3uestions1

 "at are we tryin to accom&lis"

Eow will we .now t"at a c"ane is an im&roement

 "at c"anes can we ma.e t"at will result in im&roement

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)o*Part Mo!el for Improvin$%ealth #are 'I%I(

 Action ste&s1 ;lanJ6oJ"ec.JAct cycle (

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Process Improvement an!Patient Safety  

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"oles of Accre!itin$ an!"e$ulatory A$encies

ational &atient safety oals esta*lis"ed *y !"e @ointommission1

Im&roe t"e accuracy of &atient identification

Im&roe t"e effectieness of communication amoncareiers

Im&roe t"e safety of medication use

:educe t"e ris. of "ealt" careJassociated infections

 Accurately and com&letely reconcile medications across t"e

continuum of care

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"oles of Accre!itin$ an!"e$ulatory A$encies

ational &atient safety oals esta*lis"ed *y !"e @ointommission (continued$1 :educe t"e ris. of &atient "arm resultin from falls ncourae &atients actie inolement in t"eir own care as

a &atient safety stratey  !"e orani'ation identifies safety ris.s in"erent in its &atient

&o&ulation Dniersal ;rotocol1 !"e orani'ation fulfills t"e e-&ectations

set fort" in t"e Dniersal ;rotocol (for eliminatin wron

site, wron &rocedure, wron &erson surery$

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he Professional +urse an! PatientSafety 

ational 6ata*ase of ursin >uality Indicators (6>I$ ollects desinated indicators t"at stronly affect clinical

outcomes !wo maor &ur&oses

;roide com&aratie data to "ealt" careorani'ations to "el& su&&ort 3ualityim&roement actiities

 Ac3uire national data to ain a *etterunderstandin of t"e lin. *etween nurse staffin

and &atient outcomes

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he Professional +urse an! PatientSafety 

>uality indicators ursin Eours &er ;atient 6ay  7taff Mi- (:s, H;s, Dnlicensed Assistie ;ersonnel$

Eos&ital%Ac3uired ;ressure Dlcers FallsKInury :esultin From Falls urse 7taff 7atisfactionK: surey ;ediatricKeonatal only1 ;ain Assessment and ;eri&"eral IC

Infiltration ;syc"iatric only1 ;"ysicalK7e-ual Assault

+ ’ " l i Q li

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+urses’ "ole in QualityImprovement

urses s"ould enter &ractice wit" t"e .nowlede and s.ills toma.e 3uality im&roement &art of t"eir reular wor. 

>uality im&roement s"ould not *e considered a se&aratefunction wit"in t"e nursin role *ut rat"er an onoin &art oft"e &rofessional role

!wo sinificant nursin functions closely influence &atientsafety and 3uality1 Monitorin for early reconition of aderse eents,

com&lications, and errors Initiatin de&loyment of a&&ro&riate care &roiders for

timely interention and res&onseKrescue of &atients in t"esesituations