Quality Improvement Case Study

In October 2005 the Quality and Safety Education for Nursing program was established. This program is funded by the Robert Wood Johnson Foundation. QSEN was developed specifically for future nurses to understand and be aware of key challenges such as the knowledge, skills, and attitudes that are essential to constantly advance the quality and safety of the way healthcare systems work. The goal for QSEN is to reshape the identity of nursing so it includes the recommendations by the Institute of Medicine so there is a commitment to the quality and safety proficiency (Dycus, 2009).

In the United States alone there are 98,000 deaths per year caused by low quality health care (Ignatavicius & Workman, 2013, pg. 2). This statistic is disturbing because the errors that resulted in death were errors that were preventable. The intent of this chapter is to bring awareness to health care providers that are able to make a change in the quality of health care. In current practice patients are subjected to medication errors, preventable hospitalizations, premature death, and poor care provided due to racial, ethical, or low-income factors.

Crossing the Quality Chasm defines safe as, “avoiding injuries to patients from the care that is intended to help them” (p. 5). Ideally, this aim is to help protect patients from harm, improve on safe patient-care practices, and utilize the most up to date evidence-based medicine for better outcomes.

Quality improvement is a systematic and continuous process which leads to improvements in healthcare services. The health services are then a reflection of the improving health status of a patient population (Health Resources & Services Administration, n.d.). Quality improvement strategies are the actions which a team will take to accomplish the goals of process improvement. The Institute of Medicine (2001) has developed a vision of six aims for improvement in healthcare which include, safe, effective, patient-centered, timely, efficient, and equitable care. Making improvements in these areas will better meet the needs of patients.

Patient safety and quality of care are vital outcomes in the healthcare system. As professionals dealing with human lives, we consider these topics as core to our practice. In 2005, the Quality and Safety Education (QSEN) project was created in response to the challenges recognized in preparing nurses with the knowledge, skills, and attitude (KSAs) essential in providing safe and high-quality care to every patient (QSEN, 2012). This QSEN collaboration was the product of the strategies developed by the Institute of Medicine (IOM) report Crossing the Quality Chasm in 2001 and Health Professions Education: A Bridge to Quality in 2003 (Armstrong, G. & Barton, J., 2014). There were six competencies identified in the QSEN curriculum that includes patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, informatics, and safety. In this paper, the QSEN competency, evidence-based practice will be discussed in relation to achieving quality and safety to the nursing process.

Patient safety one of the driving forces of healthcare. Patient safety is defined as, “ the absence of preventable harm to a patient during the process of healthcare or as the prevention of errors and adverse events caused by the provision of healthcare rather than the patient’s underlying disease process. (Kangasniemi, Vaismoradi, Jasper, &Turunen, 2013)”. It was just as important in the past as it is day. Our healthcare field continues to strive to make improvement toward safer care for patients across the country.

Quality Improvement can be defined as the combined effort of health care professionals including, doctors, nurses, healthcare managers who ensure better patients outcome such as quality care, safety, better system performance and better professional development. Healthcare system always goes through changes, whether its implementation of new systems or diagnosis of new disease. Therefore, health organizations are always in need of some improvement and advancement. In order to achieve improvement, systems have to go through a series of change; however, not all changes can be called an improvement. To ensure the improvement in these systems, some powerful strategies are planned, designed and implemented. These formal strategies analyze the systemic efforts and measure performance in order to improve the entire system and is called quality improvement or QI program.

The requirement for quality and safety improvement initiatives influences the health care system. Quality health care is health services for individuals and populations that increase the likelihood of desired health outcomes and are consistent with current professional knowledge (Hughes, 2008).

To improve the quality, safety, efficiency, and effectiveness of patient care, applying research and evidence-based practice is necessary. In the Institute of Medicine’s report, Keeping Patient Safe: Transforming the Work Environment of Nurses, there is an emphasis on adequate nurse staffing (Hickey & Brosnan, 2012). Therefore, the quality improvement initiative is to focus on closing the gap between the core staffing and actual staffing in a six-week schedule.

Quality improvement in health care has been and will continue to be a beneficial process in helping with many problems faced in healthcare. According to U.S Department of Health and Human Services (2011) “quality improvement consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups” (p.1). These systematic and continuous actions have indeed led to many health care improvements throughout the years including reductions in infection rates, medication errors, and health care costs. One major current concern in the health care field is the presence of catheter associated bloodstream infections (CABSI’s). Provonost, Marsteller, and Goeschel (2011)

Pearl, you mentioned in your post that quality improvement (QI) performance measures are tied to financial reimbursement. The Centers for Medicare & Medicaid Service (CMS) certainly apply quality improvement to providers’ reimbursement. CMS sets rules to follow to keep health care costs down and make sure the program is not paying for treatment that is unnecessary or harmful. Private insurers are implementing restrictions as well. A patient asked yesterday about how the Affordable Care Act had affected a family practice. The provider answered that it had certainly made there more rules to follow to ensure full reimbursement of expenses. This is part of CMS’ initiative to save taxpayer money. CMS states that its programs measure data

Safe practice played a great role in addressing patient safety. The safe practice that endorsed by the National Quality forum and supported by the Agency for Healthcare research and quality had address few critical aspect to improve patient safety 6; by creating culture of safety, matching health care need with service delivery capability, facilitating information transfer and clear communication, safety in specific setting or process of care and increasing safe medication use.6, 7

Rapid changes requiring staff training across multiple disciplines is listed as another top 5 problem with quality assurance in this particular facility. Frequent regulatory changes requiring repeated in-services are costly, impair employee satisfaction, and impact quality of care given. It is difficult at times for clinical employees to feel confident with quality improvement when aspects of their roles are so frequently

Quality measures are strategies that gauge, evaluate or compute health care processes, results, discernments, patient insight, and administrative structure. In addition, quality measures are frameworks that are connected with the capacity to deliver first-class health care and/or that are able to identify with one or more quality objectives for medicinal services. These objectives include: compelling, protected, effective, quiet focused, impartial, and opportune consideration. Quality measures can be used to measure quality improvement, public reporting, and pay-for-reporting programs specific for health care providers (CMS.gov, 2016). There are an assortment of quality measures in which health care organizations can use to determine the status of the care they are delivering. Many are appropriate, but few are chosen for this research paper. Among them are: National Health Care Surveys, Hospital IQR Programs, Scorecards, and Political, Power, and Perception/Data for Decision-making tools.

Health care systems are reporting and monitoring quality of care indicator data with increasing regularity.