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Quality improvement in nursing
- 1. Quality Improvement in Nursing Astrid Grgurich
- 2. Role of Nurses in Quality Improvement
- 3. Role of Nurses in Quality Improvement • Monitor for early recognition of adverse events, complications and errors. • Initiating deployment of appropriate and timely care to aid patients in these situations (Varkey, 2008) ▫ CRITICAL FACTOR: available level of nurse staffing ▫ Do nurses feel they are included in the quality improvement process?
- 4. Quality Improvement in Nursing Review data Improve patient care Evaluate nursing and work performance environment Identify areas Formulate for goals improvement (American Nurses Association, 2011)
- 5. Tools for Quality Improvement Data Collection Patient Analytic safety Retrospective Safety Event surveys Analysis Prospective Error Event reporting Analysiss Record review (Varkey, 2010)
- 6. Nursing Quality Indicators Structure Process Outcome (American Nurses Association, 2011)
- 7. Nursing Quality Indicators • Falls/Injury • Pressure ulcers • Pain assessment Patient • Physical restraint • Infection (health-care related) • Safety • Staff mix • Nurse : patient • Nursing care hours per Staff patient per day • OSH • Nursing education (American Nurses Association, 2011)
- 8. References • American Nurses Association. (2011). National database of nursing quality indicators. Retrieved from https://www.nursingquality.org/FAQPage.aspx • Varkey, P. (Ed.). (2010). Medical quality management: Theory and practice. Sudbury, MA: Jones and Bartlett Publishers.
- 9. The Process – How did we get here? Brainstorming Isolation and Orientation and delegation of search organisation of topics for information further research
Notas do Editor
- Nightingale pioneered data collection for quality improvement in nursing. She used data collected to support her efforts to reduce the incidence and spread of infections in her patient wards. This process brought about change to culture of ward; beliefs, behaviours and material objects used.
- The nurse’s role in quality improvement is to be vigilant and recognise those events which undermine quality, such as complication and error.In response, it is the responsibility of the nurse to initiate appropriate care to these situations.While these are specific goals, they are heavily influenced by the availability of staff to implement these actions.Another contributing factor is whether or not nurses feel they are included in the QI process. A study conducted in the US found that nurses felt they contributed to, but were rarely involved in the planning and implementation of quality improvement processes.
- How does quality improvement in nursing work?Data is reviewed and from this data, the performance of nurses can be judged.The quality improvement team pinpoints warning signs and from here identifies areas that require improvement. Once these areas have been identified, goals for their rectification can be set. The ultimate outcome of these goals are to improve patient care and work environment.
- How are areas for quality improvement in nursing identified?Patient safety tools:Safety surveys - the report presents statistics (averages, standard deviations, minimum and maximum scores, and percentiles) on the patient safety culture composites and items from the survey.Error reporting – organises errors into preventable adverse events, near misses and non-preventable for the identification of appropriate areas for improvementRecord review – identifies contributing factors to morbidity and mortality statistics Analytic tools:Retrospective event analysis – problem solving tool used to define problems, identify causes and create solutionsPareto charts – identify dominant causes of errorsProspective Event Analysis – uses exploration of potential failures to reduce their risk of occurrence.
- Nursing quality indicators are those areas of nursing that have been identified as contributing to patient care and work environment and which require frequent quality improvement. The identified quality indicators can be organised into three categories. Structure of nursing care is indicated by the supply of nursing staff, the skill level of the nursing staff, and the education/certification of nursing staff. Process indicators measure aspects of nursing care such as assessment, intervention, and RN job satisfaction. Patient outcomes that are determined to be nursing sensitive are those that improve if there is a greater quantity or quality of nursing care (e.g., pressure ulcers, falls, IV infiltrations)
- What are the universal nursing quality indicators?Patient safety: eg. Falls, medication errorsPressure ulcersPhysical/sexual assaultPain assessment/intervention/reassessment cyclePeripheral IV infiltrationPhysical restraints Healthcare-associated infections: Catheter-associated UTICentral line-associated blood stream infectionVentilator-associated pneumoniaStaff mix : Registered Nurses (RNs)Licensed Practical/Vocational Nurses (LPN/LVNs)Unlicensed assistive personnel (UAP)Nursing care hours provided per patient day Nurse Turnover, job satisfaction, work environmentRN education/certification
- Initial broad spectrum orientation search