NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation

NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation

Student Name

Capella University

NURS-FPX 6016 Quality Improvement of Inter-professional Care

Prof. Name

Date

Analyze a Current Quality Improvement Initiative

Healthcare facilities worldwide encounter various challenges which require the implementation of Quality Improvement (QI) initiatives so that positive patient outcomes are obtained. Similarly, a QI initiative for preventing patient falls is implemented at Miami Valley (MV) Hospital. Globally, patient falls are a very common issue in hospitals. Annually around 70,000 to 1 million patients face falling events in hospitals which results in approximately 250,000 injuries and up to 11,000 causalities (LeLaurin & Shorr, 2019). Most of these falls are prevalent in the elderly population.

In a study falls in older people resulted in 26.5% of prevalence. Oceania has the highest rate of falls 34.4% in the older population and America, it is 27.9% (Salari et al., 2022). Countrywide benchmarks depict a ratio of 3.44 falls out of 1000 days in medical and surgical units. Approximately, 1/4th of these inpatient falls are injurious and roughly cost $7000 per case. Out of the 14 hospital-acquired public health issues, injurious falls are one of them for which hospitals are not refunded the costs hence this is a burden on healthcare facilities (Venema et al., 2019). These statistics and the increasing trend of patient falls within the hospital prompted the administration to establish quality improvement initiatives to prevent these adverse events hence improving quality and ensuring patients’ safety. 

NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation

The quality improvement plan initiated in MV hospital is based on two approaches. 

1. Immediate response to the patients who fall –whenever a fall event occurs, immediate evaluation and analysis of the risk factors and triggering elements to prevent future incidences of falls. 
2. Long-term management – identification of the risk factors at the time of admission, after three months, yearly, and upon the changing of condition to categorize the patients at high risks of falls and continuous interventions are taken to ensure their safety.  

These approaches help the hospital to create a comprehensive fall assessment that assists in developing interventions that are continuously revised according to the individual patients’ needs. However, the initiative has negatives as well for example it does not address the fall events that occur due to mishandling of the patients by healthcare professionals. Additionally, another drawback of this initiative is the increased burden on the nursing staff in terms of increased time consumption and excessive documentation.

Evaluation of the Success of the Quality Improvement Initiative

There is a basic principle for every QI initiative which is “if you can’t measure it, you can’t improve it”. It is essential to identify the key indicators on which the improvement plan is evaluated so that success can be identified and the need for changes can be fulfilled. The Agency for Healthcare Research and Quality (AHRQ), mentions fall rates and fall prevention practices as benchmarks for evaluating the success of quality improvement programs.

Measuring these will help in deciding whether the care is improving, static, or worsening after the implementation of QI initiatives. AHRQ recommends regular monitoring of a) an outcome (no of falls per 1000 occupied beds), b) care processes (fall risk factors and actions to reduce these risks), c) structure to assist best practices (inter-professional collaboration in the team) (Taylor et al., 2017). The measurement system used for this purpose is The Tracking Record for Improving Patient Safety (TRIPS).

Key indicators for the fall management program are 

• Number of falls every month.
• Number of patients who fall every month
• Number of patients with more than one fall each month
• Number of falls causing serious injuries each month

NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation

To evaluate the success of the QI initiative implemented by Miami Valley hospital above mentioned metrics are utilized. According to the TRIPS key indicators, the number of fall events every month reduced to 15 from 27. Moreover, it was identified that only 10 patients had suffered these falls and out of them only 3 patients had more than one event and surprisingly only one patient suffered from a fatal injury. Approximately 100 fall events were reduced half-yearly and the costs associated with these adverse events decreased by 50% as compared to the usual cost.

This data analyzed that the two QI initiative approaches mentioned earlier have positive impacts on improving patient safety in terms of early identification of the risk factors, effective planning and implementation of the interventions which resulted in a reduced number of fall events and fewer injuries. The assumptions on which this analysis is based are the number of beds occupied in the hospital, the number of inpatient falls, and the implementation team that is involved in the process of the quality improvement program. 

Inter-professional Perspectives and Actions 

Successful implementation of any QI initiative requires inter-professional collaboration. The research identified that inter-professional collaboration improves quality patient care, patient safety, and health outcomes. Moreover, this can positively impact the success of QI programs. Out of many ways to encourage this collaboration, one is to empower frontline staff especially nurses to collaborate effectively with colleagues from different disciplines so that effective implementation of QI initiatives can take place (Brugman et al., 2022). Nurses, nurse educators, quality control, finance, and administrative personnel effectively collaborated in the Miami Valley hospital to implement the initiative.

Although nurses played a vital role in the identification of risk factors using patients biographical and medical history and implementing prevention strategies, nurse educators planned a curriculum for nurses and other healthcare professionals to educate them on the importance of risk prevention and encourage them to incorporate strategies for quality improvement. On the other hand, the finance department analyzed the costs associated and kept a record of the reduced number of cases and the reduced costs with them. The quality control department and administration frequently checked the records, audited the clinical areas, and improved patient outcomes using the clinical data. This analysis misses the information on what initiatives were taken within the hospital to reduce nurses’ workload and time consumption due to this extra responsibility because excessive workload can lead to burnout eventually decreasing the workforce.

Additional Recommendations

To further improve the outcomes of the quality initiative, it is recommended to use these two approaches: microsystems and PDSA cycle. 

Microsystems approach: 

The clinical microsystem is described as a small group of people constantly working together to provide the best care to patients for achieving smaller goals. The study suggests that smaller goals/projects with achievable and clear parameters are more successful than those with bigger perspectives in an organization (Abrahamson et al., 2020). The objective of the microsystem approach is to promote stress on small, replicable, and achievable services. This approach is recommended in this case of the fall prevention QI initiative at Miami Valley Hospital as well so that every individual team member is tasked with minimum extra responsibilities hence effective implementation is achieved and outcomes are easily measurable. With larger interventions, comes greater responsibilities and bigger data which take efforts to get resolved and there are more chances of missing important aspects whereas microsystems are beneficial in these circumstances. 

PDSA cycle: 

The concept of the PDSA cycle is recommended in healthcare quality improvement initiatives. The purpose of using this model is based on continuous improvement. Key features of the PDSA cycle are continuous data collection, intervening on small scale, and the use of theoretical reasons to resolve them (Knudsen et al., 2019). 

To further explain the PDSA cycle in quality improvement initiatives let’s break down the steps of this cycle:

1. PLAN: Identification of the problem, formulation of an intervention, creating of an implementation team, and discussion of the strategic plan. 
2. DO: Implementation phase. 
3. STUDY: Monitoring outcomes, test results (small-scale tests are helpful so that microsystems can learn from the outcomes before implementing at a broader level), and reassessment and revisions of the interventions. 
4. ACT: Although this step closes the individual cycle but initiates the next cycle of continuous improvement through the steps mentioned above. Quality improvement is not a single-time intervention. It requires constant action and feedback cycles so that timely improvements can be done and patient outcomes are improved. 

Pros of the Recommendations

1. Efficient applicability
2. Small-scale interventions – a guide for broader level implementation
3. Less workload and efficient implementation by the team
4. SMART goals ( Specific, Measurable, Achievable, Relevant, and Time-Bound).

Cons of the Recommendations

1. Time-consuming 
2. Many small teams – excessive workload for administrators
3. Difference of opinions 
4. Contradictory data

Conclusion

Quality improvement initiatives are essential for healthcare organizations and must be implemented in all cases. For the prevention of falls, it is important to bring a change in nursing practices. To measure the success of the QI initiative, key indicators related to fall rates and fall prevention practices are important. In addition to this, inter-professional collaboration is effective for successful outcomes. Although the strategies used are effective but more evidence-based strategies must be equipped for the successful evaluation of the Quality Improvement initiatives. 

References

Abrahamson, V., Jaswal, S., & Wilson, P. M. (2020). An evaluation of the Clinical Microsystems approach in General Practice Quality Improvement. Primary Health Care Research & Development, 21. https://doi.org/10.1017/s1463423620000158 

Brugman, I. M., Visser, A., Maaskant, J. M., Geerlings, S. E., & Eskes, A. M. (2022). The evaluation of an interprofessional qi program: A qualitative study. International Journal of Environmental Research and Public Health, 19(16), 10087. https://doi.org/10.3390/ijerph191610087  

Knudsen, S. V., Laursen, H. V., Johnsen, S. P., Bartels, P. D., Ehlers, L. H., & Mainz, J. (2019). Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-ACT projects. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4482-6  

NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients. Clinics in Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007  

Salari, N., Darvishi, N., Ahmadipanah, M., Shohaimi, S., & Mohammadi, M. (2022). Global prevalence of falls in the older adults: A comprehensive systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 17(1). https://doi.org/10.1186/s13018-022-03222-1  

Taylor, J. A., Parmelee, P., Brown, H., & Ouslander, J. (2017). The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities. AHRQ. Retrieved March 11, 2023, from https://www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx.html 

Venema, D. M., Skinner, A. M., Nailon, R., Conley, D., High, R., & Jones, K. J. (2019). Patient and system factors associated with unassisted and injurious falls in Hospitals: An observational study. BMC Geriatrics, 19(1). https://doi.org/10.1186/s12877-019-1368-8