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NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation

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    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

    Examine a Present Quality Improvement Initiative

    Healthcare institutions globally confront diverse challenges necessitating the implementation of Quality Improvement (QI) initiatives to achieve positive patient outcomes. Similarly, Miami Valley (MV) Hospital has implemented a QI initiative aimed at preventing patient falls. Patient falls are a pervasive issue in hospitals globally, with an annual occurrence of 70,000 to 1 million incidents, leading to approximately 250,000 injuries and up to 11,000 fatalities (LeLaurin & Shorr, 2019). Elderly populations are particularly susceptible to these falls.

    A study indicates a 26.5% prevalence of falls in older people, with Oceania having the highest rate at 34.4%, followed by America at 27.9% (Salari et al., 2022). National benchmarks reveal a ratio of 3.44 falls per 1000 days in medical and surgical units, with about one-fourth of these falls resulting in injuries costing around $7000 per case. Injurious falls rank among the 14 hospital-acquired public health issues, imposing a financial burden on healthcare facilities as the costs are not reimbursed (Venema et al., 2019). In light of these statistics and the increasing trend of patient falls, MV Hospital administration initiated QI initiatives to prevent these adverse events, thereby enhancing quality and ensuring patient safety.

    MV Hospital’s QI plan is based on two approaches:

    1. Immediate response to patient falls: Involves prompt evaluation and analysis of risk factors and triggering elements to prevent future falls.
    2. Long-term management: Identifies risk factors during admission, after three months, yearly, and upon changes in condition, categorizing high-risk patients and implementing continuous interventions to ensure their safety.

    These approaches enable the hospital to develop a comprehensive fall assessment, continuously adapting interventions based on individual patient needs. However, the initiative has drawbacks, such as not addressing falls caused by healthcare professionals’ mishandling and increasing the nursing staff’s burden in terms of time consumption and excessive documentation.

    Assessing the Success of the Quality Improvement Initiative

    A fundamental principle of any QI initiative is “if you can’t measure it, you can’t improve it.” Key indicators for evaluating the success of QI programs, according to the Agency for Healthcare Research and Quality (AHRQ), include fall rates and fall prevention practices (Taylor et al., 2017). The Tracking Record for Improving Patient Safety (TRIPS) is used for this purpose.

    Key indicators for the fall management program include:

    1. Number of falls per month.
    2. Number of patients falling per month.
    3. Number of patients experiencing more than one fall each month.
    4. Number of falls causing serious injuries each month.

    The evaluation of MV Hospital’s QI initiative, using TRIPS key indicators, indicates a reduction in monthly fall events from 27 to 15. Only 10 patients experienced falls, with 3 having more than one event and one resulting in a fatal injury. Fall events reduced by approximately 100 every six months, leading to a 50% reduction in associated costs compared to the standard cost.

    This data analysis suggests that the two QI initiative approaches have positive impacts on patient safety by identifying risk factors early, effectively planning and implementing interventions, resulting in fewer fall events and injuries.

    Inter-professional Perspectives and Actions

    Successful QI initiative implementation requires inter-professional collaboration. MV Hospital’s implementation involved collaboration among nurses, nurse educators, quality control, finance, and administrative personnel. Nurses played a crucial role in identifying risk factors and implementing prevention strategies, while nurse educators developed a curriculum to educate healthcare professionals. The finance department analyzed costs, and quality control and administration audited clinical areas for improved patient outcomes.

    While effective, the analysis lacks information on initiatives taken to reduce nurses’ workload and time consumption, potentially leading to burnout.

    Additional Recommendations

    To enhance QI initiative outcomes, two approaches are recommended: the microsystems approach and the PDSA cycle.

    Microsystems approach:

    This approach emphasizes small, replicable, and achievable services through smaller teams working together. It is suggested to adopt this approach for the fall prevention QI initiative at Miami Valley Hospital to ensure effective implementation with measurable outcomes.

    PDSA cycle:

    This model promotes continuous improvement through continuous data collection, small-scale interventions, and theoretical reasoning. The cycle involves planning, implementation, monitoring outcomes, and continuous reassessment. Continuous action and feedback cycles are essential for ongoing improvements in patient outcomes.

    Pros of the Recommendations:

    1. Efficient applicability.
    2. Small-scale interventions facilitate broader implementation.
    3. Less workload and efficient team implementation.
    4. SMART goals.

    Cons of the Recommendations:

    1. Time-consuming.
    2. Potential excessive workload for administrators.
    3. Differences of opinions.
    4. Contradictory data.

    Conclusion

    QI initiatives are crucial for healthcare organizations and should be implemented universally. To prevent falls, a change in nursing practices is imperative. Key indicators related to fall rates and fall prevention practices are essential for evaluating QI initiative success. Inter-professional collaboration is effective for successful outcomes, but evidence-based strategies must be continuously integrated for thorough QI initiative evaluation.

    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

    NURS FPX 6016 Assessment 2 Quality Improvement Initiative Evaluation

    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