Transcript: Market your change Train everyone involved Make changes to job descriptions, policies, procedures, forms Addressing supply and equipment issues Assigning day-to-day ownership for the maintenance of the new process Have senior leaders remove any barriers Modules of Quality Improvement “Every system is perfectly designed to get the results it gets” Three questions + PDCA cycle DMAIC Process of “Normalization” People have a tendency to fall into old habits People have a tendency to resist change People may feel threatened by a change What is Quality Improvement??? Challenges Of Change Quality Improvement 1. The Aim: What are we trying to accomplish? (How good do we want to get and by when?) 2. The Measures: How will we know a change is an improvement? 3. The Changes: What change can we make that will result in improvement? Best Practice How can you improve a system to achieve better results in the all aspects of quality? A formal approach to the analysis of performance and systematic efforts to improve it
Transcript: Lynch, D. (2012). Achieving Zero Central Line-Associated Bloodstream Infections: Connector Design Combined with Practice in the Long-Term Acute Care Setting. Journal of the Association for Vascular Access, 17(2), 75-77. Menyhay, S. Z., & Maki, D. G. (2008). Preventing central venous catheter-associated bloodstream infections: development of an antiseptic barrier cap for needleless connectors. American journal of infection control, 36(10), S174-e1. Perry, M., & Goss, L. (2013). IV Connector’s Role in an Initiative to Reduce Bloodstream Infections among Vulnerable Oncology Patients. American Journal of Infection Control, 41(6), S129. Rymed Neutral Advance Technology. (n.d.). In Rymed Technologies Online. Retrieved from http://rymedtech.com/solutions/ Smooth, swabbable septum surfaces Double microbial barrier Zero deadspace No priming necessary No blood reflux No biofilm adhesion Thank You! NURSING CONCERNS Jane Leung alteration in breathing pattern alteration in peripheral vascular circulation alteration in electrolyte imbalance alteration in fluid balance (retention & deficit) impairment in skin integrity Bariatric and Transplant surgery Pre-op & Post-op patients Kidney Liver Roux-en-Y gastric bypass Whipple complications Nursing Diagnosis Rhoads 4 Quality Improvement Measures Quality Improvement Risk for infection!!! Pressure ulcers Wound complications (ie. dehiscence, evisceration) Pain, N/V Activity level Pt. satisfaction Caregiver support Concerns RyMed Invision Plus Connector 62 ECG bpm
Transcript: 1. Form a list of all chronic diabetic and hypertensive medication. 2. Give the list to the Pharmacist. 3. Pharmacist to make a list of trade names available for each medication. 4. Take photos of each medication that is on the list. 5. Print photos and create A2 poster. 1. Dugdale DC, Epstein R, Pantilat SZ. Time allocation in primary care office visits. Physician and patient behavior. 2006;14(Suppl 1):S34-S40. doi:10.1046/j.1525-1497. 2006.00263. 2. Goold SD, Lipkin M. Medication errors the importance of an acurate drug history. British Journal of clinical pharmacology. 2009;14(Suppl 1):S26-S33. doi:10.1046/j.1525-1497.2009.00267.x. 3. Williams MV, Baker DW, Parker RM, Nurss JR. Medication errors problems and recommendations from a consensus meeting. British Journal of clinical pharmacology. 2009;158(2):166-172. 4. http://www.statssa.gov.za/?page_id=993&id=drakenstein-municipality. Date accessed: 04/11/2016 The cycle was carried out from the 4th Nov 2016, by Dr Marinescu. It was easy to implement and explain to patients. A total of 35 patients. 18 were diabetic and/or hypertensive of which 1 knew the name of their medication. The poster was shown to a total of 17 patients. Process Measure - The chart was thus used on 94% of patients with diabetes and/or hypertension. Outcome Measure - The average time taken by patients to identify their medication from the poster was 40 seconds. Balance Measure - The average time of a consultation was 14 minutes. By placing the poster in front of the patient eliminated the time wastage. At Wellington CDC we aim to decrease the time spent by patients physically identifying their chronic anti-diabetic and anti-hypertensive medication during a consultation from 4 minutes, 20 seconds to 1 minute, by the 2 November 2016. Plan for the Cycle: Creating the Poster: • WHO o Medical students o Medical doctors o Patient o Pharmacists • WHAT o The time taken by the patient to identify the medication which they are currently on. • WHEN o It will be done during the consultation of a patient which is on anti-diabetic and anti-hypertensive medication, 4th November, 2016. • WHERE o In the consultation rooms of the health care practitioners, at Wellington CDC. • HOW o Health professional to place poster in front of patient for selection, instead of having the poster on the wall Need Identification and Problem: PDSA Cycle 1. Form a list of all chronic diabetic and hypertensive medication. 2. Give the list to the Pharmacist. 3. Pharmacist to make a list of trade names available for each medication. 4. Take photos of each medication that is on the list. 5. Print photos and create A2 poster. Predictions: • WHO o Medical students o Medical doctors o Patient o Pharmacists • WHAT o The time taken by the patient to identify the medication which they are currently on. • WHEN o It will be done during the consultation of a patient which is on anti-diabetic and anti-hypertensive medication, 4th November, 2016. • WHERE o In the consultation rooms of the health care practitioners, at Wellington CDC. • HOW o Health professional to place poster in front of patient for selection, instead of having the poster on the wall Plan for data collection: Objectives: Quality Improvement Shorter waiting times for patients. Doctors now have more time available to do health promotion and patient education. Poster used for patient education. Improving patient education - will result in better adherence and control of chronic disease. All resulting in an improved quality of care provided to patients. Dr's at Wellington CDC: - assisted us in making the list of medication - utilised poster during consultation - collected data Pharmacist: - made list of trade names - allowed us to take photos of the medication Dillon and Umr: - made list of medication - took photos of medication - made the poster - followed up on progress by Dr's - analysed data - made conclusions Patients Plan: Predictions: • Outcome measure: o The time taken by patients to identify the medication from the poster. o The consulting HCP will time this process using the stopwatch on his/her computer and record the time on the daily stats sheet • Process measure: o The percentage of patients attending the clinic who the HCP showed the poster to. i.e Amount of patients the HCP showed the poster to for the day Total number of diabetic and hypertensive patients seen by the HCP for the day o This will be calculated using the daily stats sheets. • Balance measure: o The total time of the consultation o The consulting HCP will time this process using the stopwatch on his/her computer and record it on the daily stats sheet. All data was recorded during consultations at Wellington CDC. The daily stats sheets were collected at the end of each day. A2 As our goal time of 1 minute was achieved we’ve decided to ADOPT our change. We will apply our change at full scale, by involving the other 3 Health-care Practitioners. Make photocopies of posters and distribute it.
Transcript: Study - Consider the system that relates to the aim i.e. what processes will be affected by the improvement efforts - Involve members familiar with all different parts of processes - Effective teams require three kinds of expertise System leadership Clinical -Technical expertise Day to day leadership - Project leader Team Leader : Medical Director Plan Once you have chosen your team, review and modify the aim based on their input Priority Setting Criteria: Problem assessment and clarification of current situation Act - The problem (opportunity for improvement) - Form a team - Three Questions: The Aim, The Measures, The changes - Test changes - PDSA Cycle - Implement changes that work - Spread the changes to other areas High Level Flow Chart Choose your team - It helps to clarify complex processes - It helps team members gain a shared understanding of the process and use this knowledge to collect data, identify problems, focus discussions, and identify resources. - It serves as a basis for designing new processes. - It identifies steps that do not add value to the internal or external customer, including: Delays Needless storage and transportation Unnecessary work, duplication, and added expense Breakdowns in communication "All improvement will require change, but not all change will result in improvement." - Objectives - Questions and predictions - Plan to carry out the cycle (who, what, where,when) - Plan for data collection "Every system is perfectly designed to get the results it gets" Select the improvement (a change) Understand the sources of the problem and the process variation Implementation Readmission to the hospital within three days of discharge from pediatric ward You need to understand where it is failing - Identify what is wrong - Make sure it is the step that needs fixing Source of data: Quality Improvement Models Reference: Introduction to Quality Improvement Author: Nazanin Meshkat MD, FRCPC, MHSc, Assistant Professor, University of Toronto (Date Created: September 2011) Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco, CA: Jossey-Bass Publishers; 1996;60. Lloyd R. Quality Health Care: A Guide to Developing and Using Indicators. Sudbury, MA: Jones and Bartlett Publishers; 2004. F - O - C - U - S In this topic we have presented an introduction to: - Quality Improvement - The Model of Improvement - 3 questions (What is your aim, measures, change) and PDSA cycle - Types of Measures - Change and Implementation To implement a reduction strategy in order to improve the quality and safety of patient care and reduce the high cost of readmission to the hospital by reducing the readmission by 50% (from 7.8% to 4%) over a period of three (3) months Reducing the Rate of Absconded Patient from ER Problem assessment and clarification of current situation Patient makes a follow-up appointment Measurement Analysis of data have shown that rate of readmission of patients who have been discharge within three (3) days, has increased up to 7.8% of the total patient discharge. Review of the patient’s medical records was done to assess the cause of readmission. The analysis shows that 39% of all readmission have been judged to be preventable because they were associated with indicators of substandard care Flow Chart/Diagram Executing the Model for Improvement Team Members Quality Director Consultant & Chief of Pediatrics Department Pediatrics Quality Representative Head nurse of Pediatrics Ward II Head nurse of Pediatrics Ward I Health Educator Social Worker Patient Affairs Patient leaves clinic - Enables rapid testing and learning - Allows for incremental testing - Instead of spending weeks or months planning out a comprehensive change, then putting it into practice only to find that it is fundamentally flawed - Can aid you in: Developing a change Testing a change Implementing a change Plan a change Do the change Study the results Act on the results How can you improve a system to achieve a better results in Quality? To gain an understanding of what quality improvement is To present the Model for Improvement and PDSA cycle To introduce flowcharts To introduce measurement in quality improvement Revisit the Aim Clarify the current process P-D-S-A CYCLE Objectives The Change QUALITY IMPROVEMENT P-D-S-A by Quality Management & Patient Safety Objective: Latest Readmission Rate from Pediatric Ward in MCHN is 1.6% - How will we know that a change is an improvement? - Measurement is critical for testing and implementing changes - Gather just enough data to learn and complete another cycle - Short duration - 3 types of measures for quality improvement Outcome measures Process measures Structure Measures - For any improvement project you want to identify a family of measures Quality Improvement Quality Assurance What can we do to improve? What went wrong? - Proactive - Reactive - Avoids blame - Often punitive - Foster
Transcript: January - March ( charting compliance for nursing intervention) 30 random charting audit was done and 70% compliance April 2015 - 30 random charting audit was done - May 2015 - 30 random charting audit was done - Documentation Documentation is any written or electronically generated information about a patient that describes the care or service to the patient. Nursing Intervention chart documentation Quality Improvement Purpose of documentation 1. Professional accountability 2.Professional responsibility 3.Quality assurance 4.Patient teaching/Education 5.Assesment 6. Monitoring 7.Auditing 8.Legal record and practice standard 9.Prevention of nursing practice error 10.Financial billing Quality Improvement
Transcript: Risk factors for cardiovascular disease and type 2 diabetes are obesity, poor diet, smoking and lack of excersise which are highly prevalent amongst people with SMI (White et al, 2009). Implementing the HIP The HIP includes a comprehensive list of sections such as pulse, blood pressure, BMI, caffeine intake and dental health to ensure that a person's needs are identified and what follow up action is appropriate (White et al, 2009). People with SMI are more likely to suffer from chronic physical conditions such as cardiovascular disease and diabetes (White et al, 2009). Quality improvement The side effects of medication used to treat SMI such as anti psychotics can affect a person's physical health. These include increased appetite, increased weight gain, metabolic effects and sedative effects which may affect co- ordination and decrease motivation to participate in physical activity (Cunningham et al,2013). Quality improvement is the concept of developing new or existing strategies to improve patient care (McCormack et al, 2013). It is important in nursing because nurses must ensure that they are delivering efficient, evidence based care to service users whilst ensuring care is individualized.By developing skills and knowledge, nurses can improve care outcomes for individuals (McCormack et al, 2013). What is Quality improvement? It is estimated that people with serious mental illness (SMI) die 10-15 years earlier than the general population (White et al, 2009). The HIP was developed as a tool to help mental health nurses assess a person's physical health. The aim of the HIP is to improve physical health monitoring in mental health care and to flag up any risk factors which may effect their physical health (White et al, 2009). Cunningham C, Peters K, Mannix J (2013)- Physical health inequities in people with severe mental illness: identifying initiatives for practice change, Issues in mental health nursing, 34 (12), 855-862. McCormack B, Manley K, Titchen A (2013)-Practice development in nursing and healthcare. White J, Gray R, Jones M (2009)-The devlopment of the serioss mental illness physical health improvement profile, Journal of psychiatric and mental health nursing, 16 (5), 493-498. White J, Gray R, Swift L, Barton G, Jones M (2011)-The serious mental illness health improvement profile (HIP):study protocol for a cluster randomized controlled trial, trails journal, 12:167. References Health improvement profile (HIP) Shuel et al (2010) conducted a study of the effectiveness of the HIP in an outpatient clinic in Scotland. The study found that mental health nurses and service users participating in the study found the assessment useful and it improved physical risk detection rates. A randomized controlled trial by White el al (2011) found that in the initial piloting stage, mental health nurses, service users, psychiatrists and G.P's found the HIP improves the detection of physical conditions and improves physical care planning. Why is physical health a big issue in mental health care? The HIP was implemented by training mental health nurses to deliver workshops to colleagues on the use of the HIP. There are barriers to implementing this on a larger scale.Mental health nurses may find there is no one in their area that is trained to teach them to use the HIP (White et al, 2009).
Transcript: Example of a Jeopardy Template By: Laken Feeser and Rachel Chapman When creating without a template... http://www.edtechnetwork.com/powerpoint.html https://www.thebalance.com/free-family-feud-powerpoint-templates-1358184 Example of a Deal or No Deal Template PowerPoint Game Templates There are free templates for games such as jeopardy, wheel of fortune, and cash cab that can be downloaded online. However, some templates may cost more money depending on the complexity of the game. Classroom Games that Make Test Review and Memorization Fun! (n.d.). Retrieved February 17, 2017, from http://people.uncw.edu/ertzbergerj/msgames.htm Fisher, S. (n.d.). Customize a PowerPoint Game for Your Class with These Free Templates. Retrieved February 17, 2017, from https://www.thebalance.com/free-powerpoint-games-for-teachers-1358169 1. Users will begin with a lot of slides all with the same basic graphic design. 2. The, decide and create a series of questions that are to be asked during the game. 3. By hyper linking certain answers to different slides, the game jumps from slide to slide while playing the game. 4. This kind of setup is normally seen as a simple quiz show game. Example of a Wheel of Fortune Template https://www.teacherspayteachers.com/Product/Wheel-of-Riches-PowerPoint-Template-Plays-Just-Like-Wheel-of-Fortune-383606 Games can be made in order to make a fun and easy way to learn. Popular game templates include: Family Feud Millionaire Jeopardy and other quiz shows. http://www.free-power-point-templates.com/deal-powerpoint-template/ Quick video on template "Millionaire" PowerPoint Games Some games are easier to make compared to others If users are unsure whether or not downloading certain templates is safe, you can actually make your own game by just simply using PowerPoint. add logo here References Example of a Family Feud Template PowerPoint Games are a great way to introduce new concepts and ideas You can create a fun, competitive atmosphere with the use of different templates You can change and rearrange information to correlate with the topic or idea being discussed. Great with students, workers, family, etc. For example: With games like Jeopardy and Family Feud, players can pick practically any answers. The person who is running the game will have to have all of the answers in order to determine if players are correct or not. However, with a game like Who Wants to be a Millionaire, the players only have a choice between answers, A, B, C, or D. Therefore, when the player decides their answer, the person running the game clicks it, and the game will tell them whether they are right or wrong.
Transcript: "Buzz" words & terminology CQI (Continuous Quality Improvement) TQM (Total Quality Management) Six Sigma LEAN Improve Quality of Care? Improve Quality of Life? Improve Facility Outcomes? Achieve/maintain Accreditation Standards? Other?????????? Using evidence based & analytical decision making for driving Quality Improvement Quality Improvement Objectives Identify factors requiring evaluation before initiating changes in delivery systems Apply Quality Improvement (QI) principles Empower others to participate in CQI programs For class..... Improvements in.... What analytical steps have you used for decision making in Nursing Practice before this? Processes Products Outcomes Can you think of examples of each??? Continuous Quality Improvement Quality Improvements "Bigger Goals" QI Paper Assessment: Description of Change Rationale Strategies for Implementing Change Stabilizing Changes & Evaluation Primary Objective of QI
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