Reference no: EM133399723

Quality Improvement and Patient Safety: Assignment Instructions

1) Introduction
This assignment provides the students with an opportunity to demonstrate the interrelationship between Quality Improvement and Patient Safety and practice in nursing.

The student will undertake a cortical evaluation of an aspect of their practice from the quality improvement and patient safety perspectives.

Thinking about quality in healthcare
You might find it helpful to think about what good quality care looks like and where your care could be better. The Institute of Medicine in the US published a report back in 2001 that identified six dimensions of quality care: safe, timely, effective, efficient, equitable, and patient-centered (STEEEP).

Problem
Once you have identified the topic of your assignment, you need to decide what the scope of your assignment will be and set your assignment aims by asking the question, "What are we trying to accomplish?" Writing your aims statement is important as it allows you to agree on clear, defined goals. These can help keep your work focused as you go through your assignment and help you work out how you will make your improvement happen.
You could use the Institute of Medicine STEEEP domains to inform your aims. Another approach to setting practical aims is to make them "SMART":
• Specific - what are you trying to achieve and for who?
• Measurable - by how much will things have improved? Compared to what?
• Achievable - is this aim within your power to achieve with the resources that you have available? Sustainable assignments start small and then grow and spread.
• Relevant - what is the point of this goal? How does it improve outcomes, processes, or structure?
• Timely - by when will you achieve it? Remember, this can be a short time.
A good aims statement might be: "To reduce the number of missed doses of medication for all patients on six elderly care wards within our hospital by greater than 50% compared to current practice. This will reduce medication error by ensuring patients get medications in the prescribed doses and thus aim to improve the effectiveness of their medication".

Measurement
Having now identified the problem and carried out relevant background research, it is important to measure the problem. This enables you to answer the second question from the Model for Improvement, "How will we know change is an improvement?" by allowing comparison to what currently exists. It will also help build your case for change alongside your background research by outlining the scale of the existing problem within your local context.
Decide what your structure, process, or outcome measures will be. It would help to consider these when setting your aims statement. Some examples of measures might be:
• Evidence of local arrangements to monitor creatinine levels and urine outputs for those at risk of acute kidney injury (structure)
• The number of patients on your post-surgical ward who have their creatinine level and urine output checked within four hours of surgery (process)
• The number of patients on your post-surgical ward who develop acute kidney injury - i.e., the incidence (outcome).
You are likely to collect more than one type of measure during your assignment, but this may not include structure measures. Try to consider how you can capture outcomes as these ultimately matter most to patients. However, healthcare must have reliable processes to deliver the proper care to the right patient every time. You will also need to decide how to express and communicate these measures most effectively, such as a whole number or percentage change.
Do not forget that you will be collecting these measures continuously - or frequently - throughout your assignment. Therefore, you may wish to start thinking about how you will obtain continuous measurement throughout your assignment. At the very least, we would expect data collection at baseline, during every PDSA cycle, and after your final PDSA cycle.
How does the care you provide measure up?
Alternatively, think about what works well and what frustrates you during your work. You can then brainstorm with you whether this is related to:
• Structures - infrastructure that impacts on quality or outcomes of care, e.g., staffing ratios on a labor ward
• Process - an activity that occurs for patients or populations, e.g., every patient with a stroke has a brain scan within 24 hours, or every patient with diabetes in a population receives structured diabetes education
• Outcomes - the result of healthcare, e.g., mortality from sepsis. Patient-related outcome measures (PROMS) and patient experience are important outcomes to consider.