quality & performance improvement for emergency department nurses
TRANSCRIPT
QUALITY & QUALITY & PERFORMANCE PERFORMANCE IMPROVEMENTIMPROVEMENT
For Emergency Department Nurses
Definition Quality & Performance Improvement
are… Continuous cycles of improvement Driven by our mission and vision That stimulate individuals and teams to look
at the way they deliver care and services In order to identify the root causes of
problems in our systems and processes And encourage innovation to make changes
that improve them.
The Goal of Improvement
To become a “highly reliable” health care organization Delivering the right care to the right patient, at
right time, every time (Sec. Michael Leavitt, HHS, 2007)
Humans are error-prone, not highly reliable Systems and processes can be highly reliable The goal of process and systems
improvement is to make it hard for staff to make an error, thus making the care & services provided highly reliable
Quality Control (QC)Quality Control (QC)
Routine checks are in place that ensure your service or output is safe, accurate and effective
QC is required by licensing agencies, routinely documented and generally easily shared among staff
Examples: temp checks, routine preventive maintenance, running test controls
Quality Assurance (QA)Quality Assurance (QA) Shows where we are in
relation to where we want to be
Compares measured performance to a predetermined benchmark or threshold
Examples: complete medical record documentation; compliance with care guidelines for AMI, HF, pneumonia, stroke patients
0
20
40
60
80
100
Nov Dec Jan Feb
Percent ED Patients Immunized
Influenzae vaccinations
Quality & Performance Quality & Performance ImprovementImprovement
Use collected data intentionally, to make changes for the better
Opportunities for improvement are identified and prioritized
Specific improvement goals are established
Changes are tested to see if they achieve the established goals
QI/PI rely on measuring progress routinely
Quality Improvement focuses on improving clinical quality
Performance Improvement focus is organization-wide
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20
40
60
80
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Nov Dec Jan Feb
Percent ED Patients Immunized
AB
C
D
A: opportunity identified & vaccination status added to admission assessment
B: standing orders implemented
C: protocol for nurse admin prior to discharge implemented
D: goal achieved
But we already give good care …
PROVE IT!
Health care systems as “pillars”
Service: consistently exceeding customer expectations results in increased satisfaction
Clinical Quality: patient-centered care that is safe, effectively, timely, efficient, equitable
People: well-trained, recognized, and rewarded staff bring commitment and dedication to the workplace
Finance: solid planning and management results in a positive margin to sustain current ops and provide future needs
Growth: a well-researched, methodical approach involving key stakeholders results in steady growth
The pillars work together, synergistically, to achieve mission
Quint Studer, Hardwiring Excellence, © 2003
Centers for Medicare Centers for Medicare and Medicaid and Medicaid Services (CMS)Services (CMS)
An effective QA/PI program is a condition of participation (required for Medicare/Mcaid payment)
Involves all patient care and other services affecting patient health and safety
Includes nosocomial infections and medication therapy
Includes an annual evaluation of the CAH program
More Conditions of Participation
QI/PI program must include the quality and appropriateness of diagnosis and treatment
AMI, HF, pneumonia, surgical site infection prevention
Considers the findings and recommendations from the state Quality Improvement Organization (QIO) and takes corrective action
Takes appropriate remedial action to address deficiencies found through the program, including regulatory survey deficiencies
National Patient Safety Goals
Improve medication safety Reduce healthcare-acquired
infections Reduce the number of patient falls Use at least two patient identifiers (2) Improve communication among
caregivers Reduce preventable deaths
IHI 5 Million Lives Campaign
Prevent harm from high-alert medications
Reduce surgical complications Prevent pressure ulcers Reduce MRSA infection Deliver evidence-based CHF care Get boards on board the quality
program
Department QI/PI Everyone gets to demonstrate how they
are… Exceeding customer expectations Improving the quality of care and/or services Developing staff Managing finances Growing their service
Department managers & staff will… Decide how they will measure their performance Decide what processes need improvement and
how to improve them
Data Collection “What gets measured gets managed.”
We pay attention to what we are measuring
“BUT … not everything that can be measured is worth managing…” Measure the most important things
“…and everything that should be managed can’t always be easily measured.” Use QI/PI to improve things you can actually
measure
Some ED Nursing Measures
Service: Patient satisfaction survey results Clinical Quality: All vital signs recorded on
arrival, at discharge, and at least every one hour throughout the ED stay
People: all ED nursing staff are BLS or ACLS certified
Finance: reduce utilization of per diem ED staff
Growth: facility works to achieve state trauma receiving center designation
The PDCA Improvement Cycle
Understanding the ProcessTo Be Improved - Flowchart
Create a step by step picture of a work process
Identify and add missing steps
Streamline areas of overlapping efforts & eliminate unnecessary steps
Standardize the process or system- this means everyone does it the same way
Reporting Data with Run Charts
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100
“The ED Nurse explained my discharge instructions in a way I could understand.”
Target
Facility performance
Reporting Data with Run Charts
0
1
2
3
4
5
Chest Pain ED Patients: Number of Opportunities Missed to Complete
12-lead EKG within 10 minutes of Arrival
Goal = 0 missed opportunities
Reporting Data with Histograms
0
500
1000
1500
2000
2500
3000
3500
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Per Diem ED Nurse Staff Dollars
Target = < $1000/mo
Tips for SuccessTips for Success
Start Somewhere““If you put off everything till you’re sure of it, you’ll never get anything done.”If you put off everything till you’re sure of it, you’ll never get anything done.”
Norman Vincent PealeNorman Vincent Peale
Keep after it – your perseverance benefits the patients, the hospital, the community & you personally Keep quality reporting on your monthly staff meeting
agenda
Share data collection and reporting responsibilities It helps build competence, teams, and cooperation
Tips for SuccessTips for Success
Don’t Bite off More than You Can Chew Make your projects worthwhile but not Make your projects worthwhile but not
overwhelmingoverwhelming One major improvement project at a time is often One major improvement project at a time is often
enoughenough
Don’t Reinvent the Wheel Research best practices; borrow from other facilities
Align Projects with the Department’s Priorities We all have plenty to do; don’t make stuff up
Tips for SuccessTips for Success
Use the Quality Coord/Director as a resource For ideas about data collection, reporting, displayFor ideas about data collection, reporting, display
Be Prepared when it is your turn to report ““Excellence is a habit, not an event.” AristotleExcellence is a habit, not an event.” Aristotle
Attitude is Everything! This doesn’t have to be a mindless paper-pushing
exercise YOU have the power to make it meaningful
Tips for SuccessTips for Success
““Celebrate, celebrate!!Celebrate, celebrate!!Dance to the music!” Dance to the music!”
Three Dog NightThree Dog Night
Celebrate each success, no matter Celebrate each success, no matter how smallhow small
Reward the entire teamReward the entire team
Finally…..Finally…..
Find joy in your work; if you don’t, what’s the point?