Quality Improvement project

Daytonite, BSN, RN · Sep 12, 2007

i was on hospital qi (quality improvement) committees for years both as a staff nurse and as a manager. actually, the way to go about this is at your fingertips, you just don't know it.

use the nursing process

you start by assessing. in assessment of a patient you use some sort of quideline to assess: a body system approach, gordon's functional needs, maslow's hierarch of needs, roper logan & tierney activities of daily living, etc. what do you use for a facility? the policies and procedures manual, osha laws, the schools own mission statement, the school's own rules about things. yup. one of the reasons a lot of people don't like the employees on qi committees or to be a member of qi groups is because these people tend to be looked at as policing the rules and regulations of the group. qi is a self-policing activity designed to increase a group's quality performance. the idea is that the group itself identifies and corrects it problems first before an outside agency does.

so, you have a broad category to choose from: school, building, or rn program. pick something. look at the school's or rn program's mission statement. list out all the wonderful qualities they say they are about. brainstorm how you would "assess" whether those qualities exist. then, pick one or couple of these qualities to assess as to whether or not they are being met. what's broken in the hallways? what needs to be fixed? does it violate an osha law? visit the osha website to find out. at my local cc none of the clocks in any of the classrooms has the correct time!!!

then, you develop a "tool", a kind of assessment questionnaire that asks critical questions that are going to help you determine how the goals of the item you are examining are/are not being met. score it. how much of a score do you want for the item to pass inspection? 100%? 90%? 75%? if something needs to be improved, you don't want it to pass, do you? a failure indicates you have identified a problem. this is step #2 of the nursing process.

for the problem you develop goals and interventions (step #3, a plan of action). be creative about it too. you have money to spend on paper. if you have laws or policies that have to be followed, then they must be incorporated in your interventions.

step #4 is the implementation of the plan.

your evaluation (step #5) will be to retest with your "tool" you originally developed in step #1 after all the interventions are completed or a certain amount of time has passed.

are you getting the idea of what i am saying? apply the nursing process to this with a little tweaking. include your "tool" as an exhibit with your paper you turn in.

when we did qi testing on the nursing department, we would go to the policy and procedure (p&p) manual and, as an example, test on whether the staff was washing their hands between patient contacts. we looked at what the p&p manual had to say. from that we developed a testing tool that pretty much mimic'd the step by step procedure in the p&p manual. someone from the qi committee would park themselves on a nursing unit with this tool and watch the staff to see if these steps as written in the p&p manual were being followed and scored the tool. this was done on different days, in different units, by different qi members. all the data from these tools were then compiled and a total score determined. for this actual hand washing project, the results were really dismal, i gotta tell you. it was the topic on our agenda for months and months. part of our step #3 (planning and interventions) were facility-wide inservicing and a campaign of hanging "wash your hands" signs at all sinks. we re-tested and re-tested in an attempt to bring the qi stats up. the staff was eventually sick to death of hearing about handwashing. oh, and the great joint commission (jcaho) looks at the qi activities as part of their survey and certification process.

see why i said above that qi people tend to be looked at as police--police without powers. some people on qi committees can also tend to get holier-than-thou attitudes toward the staff when they've been doing this for a long time. it can be very easy to sit in judgment when we are the ones doing the judging!

my advice would be to pick something that you can easily find written documents to back up and quote in your paper. i'm thinking that this is a collegiate activity so you will be expected to have references quoted for both the thing you are assessing and to support some of the interventions you are going to apply. therefore, pick something where there is a written list that you can reference in your paper. you don't want the instructors to think you are making something up out of thin air.

ibmaryann · Sep 12, 2007

Wow!!! That really puts it into a new prespective. One of the ideas that one of the team member threw out was a Nursing mothers room. She is a breastfeeding mother who pumps at school. She has to go into one of the teachers offices to pump everyday. What do you think of that idea or is that not what they were talking about?

Thanks and God Bless,

Mary Ann

Daytonite, BSN, RN · Sep 13, 2007

Well, do your assessment activity. This team member...are we talking about a student or an employee? What are the rules for students/employees? Find the manuals/policies where the rules are going to be and read them. You may have to talk to people in the administrative offices to get this information. Find out in these manuals/policies what the procedure is to file/request a new service like this be added. Do a survey. How many nursing moms are there? Design questions around this idea? Would they use such a room? How many students/employee would use a room if there were one? How would you get the word out that such a service was available? I'm thinking, answer the pros and cons of "who", "what", "where", "when", "how", and "why" questions. Get all your ducks in a row before you proceed. Then move onto your step #2, etc. See?