Quality Improvement Strategies II

1.       What did I expect to learn about this topic before beginning the unit?

I wanted to understand more of how my role as a nurse can influence/help improve quality improvement in the facility I work in. I also expected to learn about customer satisfaction and be reminded of the importance of those surveys.

2.      What I actually learned:

Patient satisfaction is a very important part of quality improvement. It is also very important in the hospital industry. People do their research. I would not want to work at a hospital that has a bad reputation in any sense. I know that my nursing practices have an influence on the scores my hospital/unit receives from each patient I interact with. I like the definition of satisfaction that was presented in this unit: satisfaction is how closely the result matched the expectation. This is very simple and very true. I would hope that those patients on my unit feel that their expectations were/are met. HCAHPS is a very important aspect of satisfaction and overall quality of the hospital. I know there is a website anyone can go onto and see the scores of many different hospitals in many different areas. These scores can make a huge difference in the decision making process of the patients or future patients. I want to help keep those scores of the hospital I work at high.

The case study this week helped me understand more of the importance of risk management. It is important to always pay attention to details and trends (good trends but especially negative trends).  It’s amazing what can happen if all the team members are noticing things all the time and paying attention to their practices and procedures. We are all here to help people heal and go back to living their lives. We owe it to them to do our jobs and reduce risks.

The discussion about EBP helped me realize how I can be an influence to other coworkers regarding EBP. I do feel intimidated to speak up sometimes to other coworkers because I know I am a new grad and they have much more experience than I do. However, I feel empowered from this discussion and know that I can speak up just like we tell patients to do. I need to be the example and follow EBP myself before I can expect others to do the same. I can encourage others just by doing it. I also want to focus on being proactive and doing the research for myself to understand why we do things a certain way. By taking the time to understand it for myself, I can help teach others and have data and evidence to back me up.

3.      My feelings/experiences from the individual and team activities:

I though the discussion this week went well. I liked that is was focused on a topic that we are dealing with right now. I think it was good for all of us to share our feelings about being a new nurse and how that can come across to others and what things we can do to combat that with EBP. The case study was good in reminding us of the risk management resources we have. It is good to know that if we miss something as nurses there is another team double checking us. I though the reading was interesting and easy to understand. Patient satisfaction is a fun topic to discuss and one that definitely makes a huge difference in the overall quality of the hospital.

4.      How I will utilize the information learned in my nursing practice:

Being reminded of customer satisfaction scores and their importance makes me want to ensure that I really focus on those things with my patients. I want to make sure they feel their pain needs are addressed and under control. I want them to feel they have direct and effective communication with myself as well as the doctors if I can help it. I want to make sure they feel comfortable in their rooms and that I do what I can to ensure its cleanliness. I want to be a part of a magnificent hospital. While I think the hospital I work at is very close to that, there is always room for improvement and that begins with me. I want to be an example to my coworkers and help influence them to not be lazy and follow EBP with everything they do.

5.      My personal feelings about the material covered:

I thought this week was nice. The material was not complicated but still very important. Customer satisfaction, survey scores, risk management, and EBP are all things I felt were focused on and they all have an influence on each other as well as contributing to continuous quality improvement. 

Quality Improvement Strategies

1.      What did I expect to learn about this topic before beginning the unit?

I was expecting to learn about strategies to improve quality improvement meaning things we can do as nurses or what other members of the interdisciplinary team can do to improve quality.

2.      What I actually learned:

Measurement is essential in continuous quality improvement. I guess I realized the value of collecting accurate data and being able to display it using charts/graphs/pictures/explanation in a way that makes sense and shows trends or issues. It does take time to gather the information but without it, how does a facility know what areas to improve in? I can apply this to myself and my nursing practice. Each day after a shift I can take some time to reflect on that day-what went well, what still needs improving. I can organize it in my head or even write some things down in a way that allows me to analyze the “data” and see progression/digression over time. By doing this I will be able to continuously improve my quality of care and that will translate to the continuous quality improvement of my facility.

I also realized that everything is going to vary-variability is not a bad thing but you have to identify what the variability is and either remove it or minimize its overall influence in order to reach the goal in mind.

I also learned about care processes and how analyzing the processes I use as a nurse can help determine why errors are made. This goes back to what I previously mentioned about reflecting on my day. As I look at the care processes I use for patients, I may notice a trend I have or way of doing something that may be setting me up for failure or potentially causing harm to patients. I don’t want that to happen so I can use these strategies to minimize that risk.

The group discussion this week helped me realize how much I do know about involving other members of the interdisciplinary team. I work very closely with PT, OT, speech, and dietary on my  floor because its neuro/rehab. Patients are always battling with learning how to eat again and many have feeding tubes because they cannot tolerate oral intake yet. Dietary is so helpful in helping the patients as well as me to understand how to decide what is best to eat and to help provide patients with their preferred options so they want to eat and are able to meet their daily calorie goal.

The critical thinking exercise made me realize that it is important to read all the options and pick an option that is all encompassing…especially when we are defining something (in this case, a fall). I think it was beneficial that the definition I chose outlined from beginning to end what a “fall” in the hospital actually is.

3.      My feelings/experiences from the individual and team activities:

I always enjoy the discussions and felt this week that my team had a many of the same views as to how to involve the patient/family with eating and who we can call upon for help from the interdisciplinary team. It’s always helpful to have insight from other class members and I feel that I learned some things. The individual activities were very straight forward this week and really helped to solidify some concepts for me.

4.      How I will utilize the information learned in my nursing practice:

I mentioned this previously but I really feel that I can benefit from this week by learning how to analyze my own care processes, identify the variables, and organize the information in a way that allows me to improve my quality of care. In addition, this will help improve the quality care at my facility. I have realized how helpful other members of the team are to a patient’s care and the fact that we all work together for the same common goal.

4.      My personal feelings about the material covered:

I thought this week was full of good concepts. It was very straightforward, not too deep, and are concepts we can all apply and relate to.

Quality Applications: Benchmarking

 1. What did I expect to learn about this topic before beginning the unit?

I have to be honest and say that I really had no idea what to expect with this unit. The term "benchmarking," especially when related to healthcare was foreign to me. I guess I got the idea from looking over the objectives but I really had no expectations and was completely curious.

2.      What I actually learned:

Benchmarking was somewhat of a foreign idea to me at first but through reading and some research I realized that essentially it is a way for hospitals to create goals and targets and compare results with other hospitals. Not having a benchmark is a big deal…it’s like not having a goal in mind or anything to work toward. I think that these benchmarks are a way for the public to see how well a hospital is doing with certain aspects and decide if that is where they would like to receive their care. Benchmarks can be very beneficial to hospitals if created, used correctly, and actually met.  This goes along with the balanced scorecards of hospitals. I think it is important for those scores to reflect many different aspects and come together to show/prove that a hospital is successful and the main outcome/goal should be patient centered.

In the case study this week , I was reminded of the importance of proper catheter care for patient safety. I’m happy to say that through my research I realized the way we do it on my floor is correct and the most recommended. I think it is so important to research these things and make sure there is evidence based practice out there supporting a certain care. At the hospital we can use the CPGs for basically anything and those will provide the proper protocol.

Electronic health records can save lives!!! I was reminded of the importance and the responsibility I have to utilize the computer charting system to read about the histories of my patients to ensure proper continuity of care as well as safe medication administration. 

3.      My feelings/experiences from the individual and team activities:

The discussion this week was very difficult for me. I think the main reason was because I was not understanding the questions being asked and I was still trying to grasp the concept of benchmarking. After reading the posts of my teamates, I think I mostly understood what it meant but we all had somewhat different ideas. The critical thinking assignment about the score cards was also new and different. I liked looking those up and seeing the different variations of what is included and think I found a great one that really focuses on patient outcomes. The case study about the catheter care was a good reminder as well and I realized how it sort of ties in with the benchmarking. 

4.      How I will utilize the information learned in my nursing practice:

I think this information is helpful because now I realize the goals that are set for the hospital I work for or even goals on my unit specifically are all essentially contributing to that benchmark and comparison to other hospitals around the state and nation. I feel lucky to participate in these targets and goals and hope I have a positive influence. It is a good reminder to me to always practice safely and uphold the guidelines and evidence based practice that is in place because those were created as a result of benchmarks/goals met/not met. 

5.      My personal feelings about the material covered:

The material this week definitely made me think outside the box and it was abstract in many ways. I think I understand what it all means and how it ties together but I still can't say for sure. I like being challenged and understand that this is a high level class so some weeks like this is expected. I could have benefitted from some clarification or more guidance on this topic as well. 

Roles of Health Professionals

1.      What did I expect to learn about this topic before beginning the unit?

I know the interdisciplinary team includes many different specialties and that each member plays a special/important role in the outcome of the patient. I wanted to learn more about how I can involve other members of the team and how I can utilize those other members to provide more complete care to my patients.

2.      What I actually learned:

I learned/realized many different things from working on this unit this week. I was reminded of the importance of team work in healthcare and the positive impact it has on the overall functioning and quality of the hospital, the patient’s outcome, and the happiness of the employees. Working as a team can be difficult at times but this past week I have really been reminded how important it is and to realize that we as healthcare workers are in this together. We all have a common goal at the hospital no matter what department/specialty you work in: we all come to work each day to serve others and want our patients to have the best outcome possible. In order for teams to be successful we have to have that open communication, respect, and collaboration. With my current job on the Neuro/Rehab unit, I work with PT, OT, and speech on a daily basis. My medication administration schedule is partly dictated by the patient’s therapy schedule. Therapy is SO important for these patients and I try my very best to never interrupt them to give medications. On a weekly basis each member of the team meets to discuss each patient for 5-10 minutes and the progression/digression that is happening. Every member is there: MD, nurse, PT, OT, speech, SW, dietary…care notes are made and e-mails are sent out to the nurses who primarily care for those patients. I feel like this is an exceptional example of team work on our unit and how beneficial it is to do this so that every member of the team is updated on the patient’s status and we all understand where the patient needs help.

I have also learned this week the many different ways I can involve other members of the interdisciplinary team with diabetic education specifically. It’s also important to make sure the family understands what is being said/does a return demonstration of insulin administration or just explain the information given in their own words. Diabetic counselors/educators can be so helpful to us as nurses. They can take the time to educate our patients. Home health nurses are also good resources to use so we get a more complete picture of what home/daily life is like for these families. This is especially important with diabetes because daily lifestyle (what we eat/exercise) can impact a person’s diabetic management and overall health.

3.      My feelings/experiences from the individual and team activities:

The discussion this week was really good. I think we had a lot of different perspectives and input as a team to decide how we were going to approach the situation with our diabetic 11 year old with different family dynamics and need for interpretation services. Although each of us was functioning as the nurse, I felt like we represented an interdisciplinary team and we discussed how we wanted to approach this patient. We went back and forth about what needs this patient may have and came to a consensus. This is exactly how the team really works! J

The case study and critical thinking assignment required more complex thinking and I needed to find a solution to a dilemma that is something that will happen in my nursing career. With research, I have had times that I have not been able to find proper articles for EBP and I feel like I come to a dead end. I was able to reflect on ways to prevent this from happening again and I explored resources I have for help.

4.      How I will utilize the information learned in my nursing practice:

I want to make sure I am actively participating in my team duty and being collaborative and respectful to the other team members. I can remember these scenarios and examples of how I can utilize other team members to help the patient (interpretation services, dietary, diabetic counselors/educators, home health nurses).

5.      My personal feelings about the material covered:

I felt that the material this week was very valuable and a good reminder of how important it is for us as nurses to recognize all the team members involved in each of our patient’s care and that a successful team is only successful if we are actively participating and doing our part.

Legal and Ethical Issues with Quality Improvement

1.       What did I expect to learn about this topic before beginning the unit? Ethics and legal issues are always a difficult and sometimes uncomfortable subject in my book. I honestly didn’t know what to expect regarding the ethical/legal issues with quality improvement. This was one of those subjects that I couldn’t really grasp.

2.       What I actually learned: Although quality improvement (QI) efforts are usually always good, there are times where ethically, they can cross the line or patients may feel that their rights are being violated. While doing my research, I found an article that discussed ways in which QI can seem unethical at times. The article also gave recommendations on how to help that not to happen. This article helped me to understand that QI activities are not always the same as research studies. They aim not to find a new problem but to fix what is already there. It was very interesting to read about even though I didn’t completely understand it all.

The group discussion made me really think about assisted suicide or planned suicide and what might drive people to do it. I can’t imagine having to deal with chronic pain or illness, losing my dream job because of it, and being disabled for life at such a young age.  I know that assisted suicide is illegal here in Utah but people can commit suicide themselves unfortunately. They have that right…although I hate to even call it that. It is devastating to think about because I know there are people out there suffering and maybe even contemplating suicide. I hope I can stop this from happening. I hope I can be a light or a solution for someone out there.

Regarding falls and injuries and those legal implications…I was reminded that incident reports can be my friend as well as thorough documentation. I get a pit in my stomach whenever I think about having to go to court about a patient I might have had 5 years ago. Being a new nurse, this is intimidating!!! But that gives me more of a drive to learn charting the best I can and always ask questions. I also need to remember to document things as I see them and to never assume anything.

3.       My feelings/experiences from the individual and team activities:

I really enjoyed the team discussion and felt we were all able to express our views about suicide/assisted suicide and I think we really provided some good resources for our patient. I liked discussing this with my team because I learned even more what was out there for people suffering. I liked the case study as well and felt that it was a good practice and reflection on what a fall is and why documentation/incident reports are important.

4.       How I will utilize the information learned in my nursing practice:

I have already mentioned this but I will definitely make sure my charting and documentation are very thorough and I document what I see and don’t let the previously charted findings dictate what I see/hear on my patients.  I am also very motivated to ensure my patient’s pain is always under control. Chronic pain can be one of the worst feelings out there and I would hate to be the cause of that because I am “too busy” or not attentive to my patients. I know the other resources I have for pain management and hope to utilize those when necessary.  I also want to be sure to talk with my patients and get a good sense of their feelings so I know if they are at risk for depression or even suicide.

5.       My personal feelings about the material covered:

I felt that material covered had a good variety of the legal/ethical issues that nurses face. I especially liked this week’s discussion (as depressing as it was) and felt that it was beneficial and a good reminder to us all about chronic pain and how life altering that can be for som

Quality Improvement Strategies

1.      What did I expect to learn about this topic before beginning the unit? I expected to understand what continuous quality improvement is and how it can help me in my nursing practice on a day to day basis. I also wanted to understand more about the QSEN competencies and what those are exactly.

2.      What I actually learned: Finding a problem and making a decision on how to solve it…this is the important part.

In systems, a common cause (constantly active in a system) is predictable where a special cause (new, unanticipated) is unpredictable.

Reacting to common causes is like scraping burnt toast. Deming says this is how most of us make our decisions…we react to common cause and just scrape the burnt part of the toast hoping to expose the good part. We do this by using different methods (knife, fork, faster, slower). We may even just cover up the problem with peanut butter. The solution is this: fix the toaster itself which is the root cause or in other words, the special cause. That is where the problem is.  

One quality improvement goal is to reduce variability-all processes vary.  When we interfere with processes, things get worse. In healthcare and in my nursing practice, sometimes it is easy to make a type 2 error, or react to something based on the last piece of information (complaint from a patient for example).

Quality improvement goes hand in hand with patient safety. It’s crazy to hear the numbers of catheter associated UTIs or the number of surgeries where the wrong body part gets worked on. Quality is everyone’s responsibility.

Our healthcare system in the U.S. is not perfect. However, with our commitment to CQI, we can learn, grow, and develop in a positive way and provide better patient outcomes and create a more satisfied people.

3.      My feelings/experiences from the individual and team activities:

I thought our team discussion went well, but nobody was really coming to a consensus. I think we all understand what roles each member of the interdisciplinary team plays and that is it important as nurses not to overstep the nurse-patient relationship boundaries.

For the critical thinking assignment, I thought it was good to think about how I would help a new graduate RN provide better patient centered care using the QSEN competencies. Since I am in the new grad position right now, it made me stop and think about how I plan my day and what I base it off of. Learning what resources are available for myself as well as what I can turn to if I have questions or am in the position to teach someone else is always good.

4.      How I will utilize the information learned in my nursing practice:

I will continue to strive to provide better patient centered care which will help increase patient safety as well as provide a more well-rounded, wholesome care to my patients. I’ll remember the burnt toast analogy and rather than reacting to the immediate complaint or problem I can take a step back and analyze the situation. I can try and find the real source of the problem and solve it from there.

5.      My personal feelings about the material covered:

I thought this week was interesting. The concepts were somewhat hard to grasp right away but as I watched each video and did some reading it started to fit together and make more sense. As I have reflected and answered more questions I realize the relationship between each concept and how they fit together.

Quality Improvement

1-      What did I expect to learn about this topic before beginning the unit? I really didn’t know what to expect. I wanted to review what quality improvement is and how that can be achieved.  I also wanted to have a better understand of how I can personally apply it in my career as a nurse and how I can be involved.

2-      What I actually learned: Quality has developed/evolved overtime. Continuous quality improvement is necessary in healthcare. Poor quality care results in greater costs to patients not only monetarily but possible their health or even their life. So quality improvement, from my understanding and what was explained to me, is basically the science of process management. There are many different processes that take place in the realm of quality improvement. A few aspects of quality that made an impact on me are: quality is meeting the customer’s expectations and we should always do the right things and make sure we are doing them right. Quality is especially important in healthcare because good quality helps decrease incidences of healthcare acquired infections (HAIs). Deming’s 14 points were interesting and good things to think about. I feel that IHC has successfully followed some of these such as continuous improvement, training on the job, leadership, constancy of purpose (their mission and values), don’t be dependent on inspection to achieve good quality, drive out fear, break down barriers between departments,  vigorous continuing education, accomplish transformation by encouraging every employee to participate. I have been able to see many of these in action. While these are important things to think about, I remember in a video that they said not to get so caught up in these “catchphrases.” It’s so true! I feel like these phrases I mentioned are obvious things a facility can do to maintain that good quality. They are important but the point of the video was to remind us to think about it. As a nurse I really need to stop and think about everything and anything I am doing. That is also part of good quality healthcare.

3-      My feelings/experiences from the individual and team activities: The reading from the book was difficult and long to get through. I enjoyed the shorter videos and feel that I learned the most from those and that content really made the most sense.  Deming’s models were interesting to learn about and I feel that I can apply that to my thinking and problem solving. I also really enjoyed the M & M activity and the discussion I had with my team. We all had very similar ideas about what quality is and why it is important in healthcare. Discussions are always great! J

4-      How I will use this information in my nursing practice: I feel that I have really gained a new perspective on what quality is and how to deliver good quality healthcare. I will always keep this in mind as I am practicing as a nurse. I will apply the skills, concepts, and aspects of quality into my nursing. I also have a better understanding of how IHC functions and how it as a whole demonstrates some of the characteristics/concepts discussed in the videos. Because I have this knowledge and understanding I hope to be a contributing member to the quality improvement of IHC and deliver the best care possible.

5-      Feelings about the material covered: I felt that this material was interesting. I definitely learned some new things and I like that some of the videos required me to think outside of the box in an abstract way or at least think of things I have never thought of before. I remember learning about quality improvement during my 4^th semester and I realize it was very basic compared to what content was covered this past week and the concepts that were introduced. I felt it was a success.