Feb 23, 2024 NURS 8302 Week 8 Discussion: Quality Improvement Models
NURS 8302 Week 8 Discussion: Quality Improvement Models
NURS 8302 Week 8 Discussion: Quality Improvement Models
Health care delivery is complex and faces numerous challenges. An adequate response to these challenges and ensuring that health care remains optimal requires continuous improvement of processes and outcomes. As a result, quality improvement initiatives to address a performance gap should be part of everyday practice. Quality improvement (QI) models should be applied to ensure that the process is systematic and procedural. NURS 8302 Week 8 Discussion: Quality Improvement Models
The Root Cause Analysis (RCA) Model
The RCA model is among the commonly applied models when the cause of an adverse problem needs to be explicit. RCA is founded on the premise that issues causing errors must be identified, and health care providers should avoid focusing on individual mistakes (Martin-Delgado et al., 2020). In this case, there is more to errors and other adverse events than what is generally seen. Karkhanis and Thompson (2020) explained that RCA has three main components: data, a multidisciplinary team, and error prevention. NURS 8302 Week 8 Discussion: Quality Improvement Models
When a problem occurs, health care providers should collect relevant data through records’ analysis and participants’ interviews, among other strategies. The multidisciplinary team helps to analyze the problem in-depth from a team approach. Eventually, the identified error is eliminated, and appropriate measures to prevent future harm are implemented (Agency for Healthcare Research and Quality, 2019). The method identifies errors, responds effectively, and guides interventions to prevent future harm.
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RCA Implementation in Response to an Adverse Event NURS 8302 Week 8 Discussion: Quality Improvement Models
The RCA model can be highly effective when responding to a medication error problem. A suitable example would be when a patient receives the wrong prescription. Implementing RCA in this situation would commence with data collection from the health care providers involved in the process. Next, a multidisciplinary team would analyze the problem to examine whether it was individual or administrative. The problem would then be fixed through technology adoption or training health care professionals to prevent recurrence. NURS 8302 Week 8 Discussion: Quality Improvement Models
Health care organizations should be committed to continuous quality improvement. For better outcomes, they should apply QI models to ensure that QI is systematic and procedural. The RCA model is highly effective in problem identification, analysis, and solution. It can be used in health care organizations and the broader nursing practice to guide quality improvement. NURS 8302 Week 8 Discussion: Quality Improvement Models
References
Agency for Healthcare Research and Quality. (2019). Root cause analysis. https://psnet.ahrq.gov/primer/root-cause-analysis NURS 8302 Week 8 Discussion: Quality Improvement Models
Karkhanis, A. J., & Thompson, J. M. (2020). Improving the effectiveness of Root Cause Analysis in hospitals. Hospital Topics, 99(1), 1-14. https://doi.org/10.1080/00185868.2020.1824137
Martin-Delgado, J., Martínez-García, A., Aranaz, J. M., Valencia-Martín, J. L., & Mira, J. J. (2020). How much of Root Cause Analysis translates into improved patient safety: A systematic review. Medical Principles and Practice, 29(6), 524-531. https://doi.org/10.1159/000508677 NURS 8302 Week 8 Discussion: Quality Improvement Models
Discussion: Quality Improvement Models
Breakdown of QI Models NURS 8302 Week 8 Discussion: Quality Improvement Models
In order to determine which QI model should be used for an adverse event. I had to review the following QI models several times to really determine which model would serve the team best for an adverse event.
Root cause analysis (RCA) is a structured method used to analyze serious adverse events. It is a model that identifies and analyze those factors that contributes to a specific outcome or problem (Knox, et al., 2015). It is an essential tool for quality improvement. The following QI tools can be used within a healthcare setting or practice to identify the different factors that are at play with a given performance issues: 5 Whys, fishbone diagrams, and fall-out ((Knox, et al., 2015). NURS 8302 Week 8 Discussion: Quality Improvement Models
The Plan-Do-Study-Act (PDSA) Worksheet is a useful tool for documenting a test of change (IHI, 2021). The PDSA cycle is shorthand for testing a change by developing a plan to test the change (Plan), carrying out the test (Do), observing and learning from the consequences (Study), and determining what modifications should be made to the test (Act) (IHI, 2021). PDSA & Plan-Do-Check-Study (PDCA) are used interchangeably.
NURS 8302 Week 8 Discussion: Quality Improvement Models However, “checking” in PDCA involves comparing the results to the expected results, followed by thee question, “How do the results compare to what was expected?” As far as “study” in PDSA, it is the deeper introspection of results, followed by the question, “What can we learn based on the results?” PDSA involves an in-depth analysis of results, rather than just comparing with the expected results.
The Lean concept, according to Nash et al., (2017), is a way to specify the meaning of value, to align steps, processes in the best sequence, to conduct activities without interruption whenever someone requests them, and to perform the activities more effectively (Nash, et al., 2017). Lean is a process that helps to avoid the following types of waste: overproduction, waiting, unnecessary transport, overprocessing, excess inventory, unnecessary movement, and defects (Nash, et al., 2017). NURS 8302 Week 8 Discussion: Quality Improvement Models
A3 is a structured problem solving and continuous improvement approach, first employed at Toyota and typically used by lean manufacturing practitioners (Sobek, n.d.). A3 provides a simple and strict approach systematically leading towards problem solving over structured approaches. There are ten steps to the A3 process, according to UNC School of Medicine (2021): NURS 8302 Week 8 Discussion: Quality Improvement Models
Step 0: Identify a problem or need
Step 1: Conduct research to understand the current situation
Step 2: Conduct root cause analysis
Step 3: Devise countermeasures to address root causes
Step 4: Develop a target state
Step 5: Create an implementation plan
Step 6: Develop a follow-up plan with predicted outcomes
Step 7: Discuss plans with all affected parties
Step 8: Obtain approval for implementation
Step 9: Implement plans
Step 10: Evaluate the results
In summary, the A3 process is rooted in the basic PDCA cycle. However, I found this model somewhat challenging. Steps 1-8 are the Plan step (with step 5 planning the Do step and step 6 planning the Check step). Step 9 is the Do step, and step 10 is the Check step. Based on the evaluation, another problem may be identified and the A3 process starts again (Act) (UNC School of Medicine, 2021). NURS 8302 Week 8 Discussion: Quality Improvement Models
Quality Improvement Model Selected
The quality improvement model that might be implemented in my HCO or nursing practice in response to an adverse event requiring quality improvement would be “Root Cause Analysis. For example, if a patient was given the wrong blood transfusion and suffered a severe blood reaction, a root cause analysis supported by QI tools, 5 Whys and the cause and effect or fishbone diagrams would be the best model/QI tool combination that should be implemented by the QI team to visually diagram the possible cause of this medication error. The team will be able to truly diagnose the problem rather than focusing on symptoms or the patient’s reaction to her blood transfusion. NURS 8302 Week 8 Discussion: Quality Improvement Models
References
Agency for Healthcare Research and Quality (AHRQ). (2020). Health literacy universal precautions toolkit, 2nd Edition. Plan-Do-Study-Act (PDSA) Directions and Examples. Retrieved from https://www.ahrq.gov/health-literacy/improve/precautions/tool2b.html NURS 8302 Week 8 Discussion: Quality Improvement Models
Institute of Healthcare Improvement (IHI). (2021). Plan-Do-Study-Act (PDSA) worksheet. Institute for Healthcare Improvement, Cambridge, Massachusetts, USA NURS 8302 Week 8 Discussion: Quality Improvement Models
Knox, L., Levine, J., Sommers, B., Michaels, L., & Fries, E. (2015). Module 11: Using root cause analysis to help practices understand and improve their performance and outcomes. Agency for Healthcare Research and Quality. NURS 8302 Week 8 Discussion: Quality Improvement Models
Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press. NURS 8302 Week 8 Discussion: Quality Improvement Models
Sobek, D. K. (n.d.). Steps of the A3 process. Montana State University. Retrieved from https://www.montana.edu/dsobek/a3/steps.html NURS 8302 Week 8 Discussion: Quality Improvement Models
UNC School of Medicine. (2021). A3. Institute for Healthcare Quality Improvement. Retrieved from https://www.med.unc.edu/ihqi/resources/a3/ NURS 8302 Week 8 Discussion: Quality Improvement Models
What is the most effective method for implementing quality improvement? When creating a plan, what specific strategies and/or models should be used? You have spent the last seven weeks researching quality improvement in healthcare and nursing practice, and you will continue your research by examining specific quality improvement models. What models would be most effective in your nursing practice or healthcare organization? NURS 8302 Week 8 Discussion: Quality Improvement Models
Because healthcare is complex and diverse, quality improvement cannot be a one-size-fits-all approach. There are numerous strategies and methods for implementing quality improvement to meet an organization’s complex and diverse needs. NURS 8302 Week 8 Discussion: Quality Improvement Models
Choose one quality improvement model to investigate and analyze for this Discussion. Consider how the chosen model might be implemented in your healthcare organization or nursing practice. Examine the effectiveness of this model and consider how it might be used to address the consequences of adverse events in nursing practice. NURS 8302 Week 8 Discussion: Quality Improvement Models
To Prepare:
Review the Learning Resources for this week, and reflect on the different quality improvement models presented.
Select one quality improvement model from the following to focus on for this Discussion:
Root Cause Analysis (RCA)
A3
Lean
Plan, Do, Study, Act (PDSA)
Reflect on the quality improvement model you selected, and consider how it might be implemented in your healthcare organization or nursing practice. NURS 8302 Week 8 Discussion: Quality Improvement Models
By Day 3 of Week 8
Post a brief explanation of the quality improvement model you selected, including a description of the components that make up this model. Be specific. Then, explain how this quality improvement model might be implemented in you healthcare organization or nursing practice in response to an adverse event requiring quality improvement. Be specific and provide examples. NURS 8302 Week 8 Discussion: Quality Improvement Models
By Day 6 of Week 8
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different quality improvement model than you. Suggest an additional strategy on how your colleague may implement the quality improvement model they selected in their healthcare organization or nursing practice. NURS 8302 Week 8 Discussion: Quality Improvement Models
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your NURS 8302 Week 8 Discussion: Quality Improvement Models
NURS 8302 Week 8 Discussion Quality Improvement Models
colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS 8302 Week 8 Discussion: Quality Improvement Models
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Read Also: NURS 8302 Week 6 Assignment 1: Organizational Culture Assessment Tool
Choose a QI initiative which has been the subject of focus in any healthcare setting. Explain the rationale that your senior leaders used in selecting this initiative for attention and focus.
Hospital acquired infections (HAI) is a serious concern in healthcare and has been the focus of quality improvement in recent years. Infections that occur after hospitalization significantly increase hospital costs. HAI and the extra costs that are incurred are absorbed by the hospital or healthcare system. Patients who acquire these infections require more days of care in the hospital and in turn develop feelings of anger for providers and increases the chance of patients pursuing legal action. The increased costs that hospitals incur secondary to HAI is a good reason for senior leaders to place HAI on the top of the QI initiative list. These costs can be incurred in several ways described above.
Explain how adverse events are handled in your organization from the public’s perspective and well as internally.
The organization that I currently work for places great priority in a culture of safety. In Air Medical Transports, errors can mean life or death of the patient as well as the crew. Many years ago, one of our helicopters crashed after picking up a patient and departing to the hospital with the patient and crew on board. The helicopter got caught in power lines that were not visualized and no one on board survived. Every year we “stand down”, shut down our transport services on the anniversary of the crash to honor the victims but to also refocus our attention on safety. After thorough investigation, the public was made aware of the cause of the accident and internal staff utilized this information to improve safety processes within our transport team. Punitive actions are not taken when adverse events occur but instead education occurs for all staff to learn from the event. Discussion in staff meetings and process improvement efforts occur. The goal is to eliminate the possibility of the same event happening again. “Acknowledging that errors and adverse events are systems problems and not people problems is a crucial first step, but follow-through on that acknowledgement- with appropriate response when something happens – is critical” (Joshi, Ransom, E., Nash, Ransom, S., 2014, p. 277).
Find a scholarly article or one from the public press, published within the last 5 years which recounts a serious error. Relate this error to any organization with which you have some familiarity.
In the news article “Nurse charged in fatal drug-swap error pleads not guilty” a nurse was charged with reckless homicide after a medication error resulted in death of the patient (Loller, 2019). The nurse administered the paralytic agent of Vecuronium instead of the ordered agent of Versed which is a sedative. The report from the Centers for Medicare and Medicaid Services communicated that the nurse overrode the medication automatic dispensing cabinet and typed “VE” and chose the first medication that appeared. A medication error can occur in any organization where medications are given. The risk of an error is inevitable but efforts to improve the process of administering medications with safety stops in place have improved medication errors. One of the 6 key dimensions identified by the second IOM report Crossing the Quality Chasm is to avoid injury to patients from the care that is intended to help them (IOM, 2001). Medication errors can happen in any health care facility or setting in which medications are administered. Medication errors can result in differing outcomes for patients and for providers which can range from mild to severe. A medication time out, like a surgical time out which has been shown to prevent surgical errors, has proven to be an effective strategy to decrease mediation errors with utilizing few resources (Santos et al., 2021).
References
Institute of Medicine (U.S.) Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press.
Joshi, M. S., Ransom, E. R., Nash, D. B., & Ransom, S. B., (Eds.). (2014). The Healthcare Quality Book (3rd ed.). Chicago, IL: Health Administration Press
Santos1, L. L., Camerini, F. G., Fassarella, C., de Almeida, L. F., Setta, D. X. d. B., & Radighieri, A. R. (2021). Medication time out as a strategy for patient safety: Reducing medication errors. Revista Brasileira De Enfermagem, 74(1), 1-7. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1590/0034-7167-2020-0136
there are different quality improvement strategies that can be employed to enhance effective patient outcomes. These approaches/strategies ought to adhere to the organizational objectives and the operational standards. The Plan-Do-Study-Act Cycle is considered one of the best quality improvement model used by different healthcare institutions (Nash et al., 2019). The model involves the application of the systematic processes for gaining valuable learning and knowledge for the continual improvement of the clinical processes, service delivery, and the products used in enhancing the treatment processes (Shaw et al., 2018). This model has been successfully used to facilitate processes undertaken by different healthcare providers. Under this phase of the quality improvement model, we seek to understand the problem and where a gap in practice exists as well as establish an objective laying out what we are trying to accomplish (McNicholas et al., 2019). Through the use of The Plan-Do-Study-Act Cycle, healthcare providers have been able to integrate all the elements required in the treatment processes and to determine the possible outcomes before undertaking the actual quality improvement program.
References
McNicholas, C., Lennox, L., Woodcock, T., Bell, D., & Reed, J. E. (2019). Evolving quality improvement support strategies to improve Plan–Do–Study–Act cycle fidelity: a retrospective mixed-methods study. BMJ quality & safety, 28(5), 356-365. http://dx.doi.org/10.1136/bmjqs-2017-007605
Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press
Shaw, S. C., Devgan, A., Anila, S., Anushree, N., & Debnath, H. (2018). Use of Plan-Do-Study-Act cycles to decrease incidence of neonatal hypothermia in the labor room. Medical Journal Armed Forces India, 74(2), 126–132. https://doi-org.ezp.waldenulibrary.org/10.1016/j.mjafi.2017.05.005
Research refers to the systematic review as well as the creative approach of promoting the standardized knowledge on a given topic or healthcare processes. Research processes are important in establishing new knowledge that can be used to enhance healthcare operational activities. Research process may involve different factors and resources. The entire process of research often involves the collection and analysis of data to determine effective outcomes. In the healthcare processes, research studies are always conducted to determine possible solutions on a given process of healthcare activity (Peden et al., 2019). The research can also be done to enhance knowledge and increase the understanding of a given area of knowledge. The process of research may also involve the expansion of a given area of knowledge. For instance, it may extend the process of the study from what had already been established.
Quality improvement, on the other hand, refers to the direct relationship that is often experienced at various levels of the improved services and the anticipated healthcare outcomes for the given population under the study. Quality improvements involves the application of the already established knowledge or information to promote the overall quality outcomes in the healthcare processes (Dahrouge et al., 2019). Establishing quality improvements in the healthcare processes involves safe, efficient, timely, and the customer centered practices. Adherence to the quality improvement processes often leads to effective and quality healthcare outcomes in most of the organizations or clinical settings.
In the emergency room where I currently work, quantitative and qualitative research processes are used to determine the best approaches in enhancing quality practices for effective healthcare outcomes. Both the research approaches are also used to enhance already established knowledge to ensure effective healthcare delivery.
References
Dahrou
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