NRS 451 Provide an example of how you would apply CQI in your current or past position

Continuous quality improvement (CQI) is an ongoing procedure to always find a better way of doing things. A quality improvement plan is described as any action targeted at lowering the quality gap for a group of patients’ representatives of those seen in ordinary practice (Helbig, 2018). This is something we know all so well in the healthcare field as well as other professions. Quality improvement teams are organized when data need to be collected and analyzed to find new and innovative ways to make improvements (Helbig, 2018). When an organization uses pre existing issues or dilemmas to come up with a more productive of handling or doing something it benefits the facility in the long run. It makes the work environment and patient experiences easier and better all around. The organization must embrace the need for change to actively pursue institutionalizing a culture of safety and quality improvement (Hughes, 2008). My previous hospital could have benefited from using more CQI, there were multiple situations that were overlooked even though employees were voicing them. Having multiple people in a workplace come together with the same issue should tell the organization, this is something to look into. We had an issue with breaks and lunches not being taken because lack of staff. This caused nurses to be overworked, stressed and tired. Staffing is a very big contribution to how the facility functions, not having enough causes a lot of unsafe and delayed care. This unfortunately wasn’t a priority and continued to happen till a group of employees got together and took matters into their own hands taking legal action. I have moved to another hospital and am having a completely different experience in regards to this issue so I know it is possible to take care of your staff so they can do their job to the fullest with no issues.

References

Helbig, J. (2018). Reengineering Health Care Management. Nursing Leadership & Management: Leading and serving. Retrieved from https://lc.gcumedia.com/nrs451vn/nursing-leadership-and-management-leading-and-serving/v2.1/#/chapter/5

Hughes, R. G. (2008). Chapter 44: Tools and strategies for quality improvement and patient safety. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2682/

The incidences of catheter-associated urinary tract infection (CAUTI) have steadily increased among the pediatric patient population (Schiessler et al., 2019). The utilization of the Children’s Hospitals’ Solutions for Patient Safety bundle and the sterile insertion of the indwelling catheter device continues to result in steady increases in catheter-associated urinary tract infections among the pediatric intensive care unit patient population (Schiessler et al., 2019). The quality improvement committee reviewed the bundle elements for patient safety and found that the utilization for indwelling catheterization was not specified clearly for indications for use and to discontinue (Schiessler et al., 2019). The multi-disciplinary team developed a quality improvement protocol based on evidence-based practices and safety measures that healthcare providers would be allowed to immediately remove the indwelling catheter from the patient if it was no longer deemed necessary (Schiessler et al., 2019). This quality improvement protocol would empower clinical nurses with more independence as healthcare providers to immediately remove an indwelling catheter from patients when it is no longer indicated (Schiessler et al., 2019).

The incidences of catheter-associated urinary tract infections (CAUTI) are preventable with the utilization of quality improvement protocol (Schiessler et al., 2019). The implementation of this new protocol resulted in a 28% decrease in the length of time of indwelling catheters when this quality improvement was evaluated after six months (Schiessler et al., 2019). The quality improvement protocol was reevaluated within a year and the catheter-associated urinary tract infection rate decreased from 4.8 in 2017 to 0.8 in 2018 (Schiessler et al., 2019).

Reference:

Schiessler, M., Darwin, L.M., Phipps, A.R., Hegemann, L.R., Heybrock, B.S., & Macfadyen, A. (2019). Don’t Have a Doubt, Get the Catheter Out: A Nurse-Driven CAUTI Prevention Protocol. Pediatric Quality and Safety. 2019, July/August. Volume 4, Issue 4, p. e183. https://doi.org/10.1097/pq9.000000000000183

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Continuous Quality Improvement (CQI) is a deliberate, defined process which is focused on activities that are responsive to community needs and improving population health (CQI, 2022). Continuous Quality Improvement constantly drives the organization management and staff to strive a more efficient patient outcome. I am personally addressing the challenge of the healthcare industry by finally advancing my degree and achieving my BSN. I already have a mentor that is involved in assisting me in pursuing my MSN. I recently switched from working in surgery for fourteen years to working from home as a Prior Authorization Nurse. Now I have increased my technology skills, learning Microsoft Word, Excel and Powerpoint all over again to advance my technical knowledge needed for my new position. I haven’t use those skills since I graduated from nursing school in 2003. It has been a complete change communicating with patients entirely remote assisting them surgical procedures, receiving their medication and coordinating needed appointments. It has been great delivering quality care and achieving patient satisfaction from home.

NRS 451 Provide an example of how you would apply CQI in your current or past position

Reference:

Continuous Quality Improvement (CQI). (2022). The Minnesota Department of Health.

https://www.health.state.mn.us/communities/fhv/cqi.html.

Continuous Quality Improvement (CQI) is also described as Performance and Quality Improvement (PQI). It is a process of creating an environment where both organization’s management and employees endeavor to improve current processes and continue those efforts at quality improvements. Many of the examples of quality improvement in healthcare are developed according to the guidelines proposed by the Institute of medicine. There were 6 primary goals identified for patient care. As per the proposed guidelines, patient care should be: Safe: patients should not be harmed while receiving care, care provided should be effective, avoiding treatments which practitioners know will not be effective. Care should be provided in a timely and efficient manner. Care provided should not vary because of patients’ gender, ethnicity socioeconomic status or other personal differences but equitable and patient centered, respecting patient preferences and values relating to their healthcare. With these guidelines healthcare providers can significantly improve patient outcomes and patient experience (NCBI, 2022)

Quality improvement efforts have become common in healthcare organizations with varying approaches used, including Continuous Quality Improvement process. “This is a quality management process that encourages all health care team members to continuously ask the questions, “How are we doing?” and “Can we do it better”(BMC, 2021). For healthcare, the goal of continuous quality improvement is to consistently meet and go beyond the expectations for patients and caregivers, service providers and the community on a whole. Improvement efforts look at processes and outcomes, it is data driven and allows for feedback, has a long term approach and shared success. Many quality initiatives focus on decreasing costs also increasing patient and staff safety and satisfaction (NCBI, 2022)

An example of a quality improvement initiative that I would apply in my previous place of employment is revising the patient care plan for the nursing assistants who visit patients to provide personal care. I would ensure that in the electronic medical record where details of care provided by the CNAs, would reflect clearly details of bowel movements. The layout of the care plan would ensure that this information be entered in order to move forward through the record to close, rather than depending on a narrative note which may or may not include this information if the note is written at all. A frequent occurrence is patients seen in homes or ALF’s where this information is often not available to visiting nurses and the result is many days passing without anyone being aware of the patient’s last bowel movement. The availability of this pertinent information to healthcare providers is important in promoting health and patient safety by avoiding the complications from avoidable occurrences of constipation and bowel obstructions which impact patient well being along with increased hospitalizations and resulting facility costs and feedback reflecting poor patient experience.

O’Donnell B, Gupta V. Continuous Quality Improvement. [Updated 2022 Apr 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559239/

Hill, J.E., Stephani, AM., Sapple, P. et al. The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review. Implementation Sci 15, 23 (2020). https://doi.org/10.1186/s13012-020-0975-2

Continual Quality Improvement (CQI) is a continuous process in which healthcare professionals analyze current medical concerns and deliberate on the best method to address them. A quality improvement plan is described as any action targeted at lowering the quality gap for a group of patients’ representatives of those seen in ordinary practice (Helbig, 2018). As a result, the CQI process entails monitoring all nursing procedures, identifying any problems, and implementing any required modifications. As a consequence, both patients and personnel may feel secure while at healthcare facilities. Also, quality assurance, problem resolution, and quality enhancement are all components of the concept of continuous quality improvement (McCalman et al., 2018). Nurses understand the importance of continuous quality improvement (CQI) in enhancing efficiency and patient outcomes (Helbig, 2018).

As a staff nurse, one example of continuous quality improvement that I would use or practice is ensuring that I am up to date on the various practices and managements in taking care of patients in various circumstances in order to deliver excellent services. I will also offer input on effective and ineffective services. In addition, I will work with my colleagues and supervisor to improve the procedures and outcomes of our services. Some interventions that may be used to enhance compliance with hand hygiene include education, performance audits with health promotion, and changes in the availability of hand hygiene products.

Reference:

McCalman, J., Bailie, R., Bainbridge, R., McPhail-Bell, K., Percival, N., Askew, D., Fagan, R., & Tsey, K. (2018, March 22). Continuous quality improvement and Comprehensive Primary Health Care: A Systems Framework to improve service quality and health outcomes. Frontiers in public health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874897/

Continuous quality improvement (CQI) approaches in primary health care have enabled adherence to best practice clinical guidelines and improved regularity of client attendance. According to the U.S. Department of Health and Human Services (HHS). First, organizations identify, describe and assess strengths and issues. Then, they test, implement, learn from, and adjust solutions to the problems uncovered in the first stages. In practice, this continuous cycle may result in minor corrections rather than large-scale transformations, but over time, the organization adapts to issues revealed through data collection and review.

CQI lowered hospital admissions for patients with chronic conditions and reduced the number of visits older patients had to emergency departments. Resources can be used more effectively when real-time data enables organizations to manage availability better (Matthews, 2014)

I would ask continuously, “Can we do this better?” By cultivating a culture centered on continuous improvement, the organization ensures every player begins to look for ways to boost efficiency, increase timeliness and improve effectiveness.

Matthews V, Schierhout G, McBroom J, Connors C, Kennedy C, Kwedza R, et al. Duration of participation in continuous quality improvement: a key factor explaining improved delivery of type 2 diabetes services. BMC Health Serv Res (2014)

https://www.hhs.gov/sites/default/files/NVAC-White-Paper-Vaccine-Safety-System.pdf https://www.healthit.gov/sites/default/files/tools/nlc_continuousqualityimprovementprimer.pdf

NRS 451 Provide an example of how you would apply CQI in your current or past position