By Christina Lauderman RN, BSN, CEN

The learner will be able to..  Define Quality Care  Identify Standards of Care/Benchmarks  Identify drivers of quality and their roles in the continuous quality improvement (CQI) process.  Describe How Total Quality and Continuous Quality Management, Six Sigma, and Lean Six Sigma Addresses Quality.

 Identify when an Incident report needs filed.  Perform a Chart Review on Given Stroke Charts  Develop a continuous quality improvement project on a nursing unit.

What Is Quality?

 Right Care at the Right time to the Right Patient.  Compassionate/Empathetic  Competent  No Harm  Meets Standards  No Complications  Nondiscriminatory/Fair

 Involves the pursuit of excellence in the delivery of care and ongoing prevention of potential errors  The degree to which patient care services increase the probability of desired patient outcomes and reduce the probability of undesired outcomes given the current state of knowledge (JCAHO, 2009)

 Florence Nightingale  Jean Watson- Theory of Caring  Dorothea Orem-Self care Deficit  June Larabee-Quality Theories

 Medicare and Medicaid  The Joint Commission (JCAHO)  State regulators  Payers  Professional groups  Patients

Why Is Poor Care Sometimes Given?

 Under Or Inexperienced Staff  Human Error  Time, Money, and Space Constraints  Attitude

 Ineffective Communication  Complications  Inability To Meet Patient’s Expectations.  System Error

 Care Deemed Appropriate Based on Scientific Evidence and Expertise of Expert Professionals in that Area of Care.  Come From JCAHO, DOH, ANA, NLN, NIH, AHA, ATA, ABA, UPMC Standards, Medicare/Medicaid, Insurance Companies etc.

 First learn standards in Nursing School.  Learn Policies and Procedures of Facility employed by.  As you incorporate Evidence Based Practice  As you become involved in Research.

 Structure Standards- Physical Environment, Organization  Process Standards-Delivery Of Care  Outcome Standards-The End Results

Examples of Standards

 After the Fact Identification  Prevention of Failed Standards and Problems  Based on Data Collection and Accountability  Uses Measurement Tools  Focus on “No Blame”

 4 Characteristics  Customer/Client Focused  Total Organizational Involvement  Use of Quality Tools and Statistics for Measurement  Key Processes for Improvement Identified

 Customer Client Focused  Internal Clients  Employees, lab, housekeeping  External Clients  Patients, Visitors, Physicians  Insurance Companies

 Total Organizational Involvement  Team Approach  Empowerment of Employees  Management-Team

 Use of Quality Tools and Statistics for Measurement  Tools such as Graphs, charts  Statistic tools such as percentages, Probability

 Key Processes for Improvement Identified  Systems Related  Clinical  Managerial

 Plan, Do, Check, Act Cycle

 TQM Philosophy CQI Process  Never Ending Process  Involves Evaluation, Actions, and a Mind Set to Constantly Strive for Excellence

 4 Key Players  Resource Group  Coordinator  Team Leader  Team

 Comprehensive Quality Management Plan  Multidisciplinary  Standards  Benchmarking  Critical Paths  Indicators

 Performance Appraisals  Intra/Interdisciplinary Assessments and Improvements

Audits  Retrospective  Concurrent Peer Reviews Utilization Reviews Outcomes Management

Six Sigma Uses Quantitative Data As a Measure As a Goal

 As a Management System  Customer focus  Data Driven  Process Emphasis  Proactive Management  Boundary-less Collaboration  Aim for Perfection, Tolerate Failure

 Institute of Medicine- To Err Is Human:  JCAHO- Patient Safety Goals  Institute of Healthcare Improvement

 Right Patient, Right Medication, Right Dose, Right Route, Right Time  Patients Involved In Own Care  Educate Patients About Medications  Errors Need Reported

 Problem Focused-  Identify  Analyze  Evaluate Risks  Develop Plan

 Education Based  Monitors Laws and Codes Related To Patient Safety.  Collects Data In Legal Complaints  Provides Reports to Administration, Medical Staff, and Board of Directors.

 Incident  Actual or Potential Risk.  Document in Chart and in Incident Report.  Be Factual, Non Disciplinary, Honest  Case Followed Up by Risk Management

 Medication Errors  Falls  Complications from diagnostic or treatment procedures  Patient/Family dissatisfaction with care  Refusal of Treatment or to sign consent  Skin Breakdown  Iv Infiltrations

 Encourage Staff To Report Incidents  No Blame or Disciplinary Action Unless Absolutely Necessary  No Finger Pointing  Encourage a Culture of Safety and Quality

 Clear Communication  Maintain Professional Caring Attitude  Listen to Complaints  Determine Expectations of Patient or Family  Quick Follow Up and Action

 Personal Contact-Utilize Charge Nurse, Nurse Manager, Nursing Supervisor.  Maintain Safety For Yourself and For the Patient.  Make Restitution/Meet Expectations When Applicable.

 Meeting Standards Helps to Provide Quality  TCM- Philosophy Uses Plan, Do, Check, Act  CQM-Never Ending, Strive for Excellence.  Six Sigma- Reduce Waste Increase Productivity

 Risk Management Role in Quality  Increase Patient Safety  Incident Reporting  Handling Complaints

 Textbook- Effective Leadership and Management in Nursing by Pearson  Google Images