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Qip Project

This document summarizes a healthcare delivery systems improvement project focused on patient care at an orthopedic-surgical unit. It describes the unit's leadership, culture, patient and staff focus, care processes, and goals to improve staffing ratios and response times to alarms in order to enhance patient-centered care and reduce alarm fatigue. Data will be collected before and after implementing a nurse to patient ratio of 1:4 to evaluate the impact on staff and patient outcomes.

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157 views13 pages

Qip Project

This document summarizes a healthcare delivery systems improvement project focused on patient care at an orthopedic-surgical unit. It describes the unit's leadership, culture, patient and staff focus, care processes, and goals to improve staffing ratios and response times to alarms in order to enhance patient-centered care and reduce alarm fatigue. Data will be collected before and after implementing a nurse to patient ratio of 1:4 to evaluate the impact on staff and patient outcomes.

Uploaded by

api-534216481
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Healthcare Delivery Systems

Improvement Project: Patient Focus


Shyann Chaudhry, Brooke Cozen, Amy Dang, Bailey Gin,
Maycee Ruiz
December 2, 2020

1
Overview of Patient Care Delivery System

Northwest Medical Center- Tucson


o Orthopedic-Surgical Unit (Unit 2100), 50-bed unit
• Unit manager, unit clerks, charge RN, staff
RNs, PCTs
Focus
o Impaired patient-focused care related to alarm
fatigue due to high patient ratios and inadequate
staffing.

2
Microsystem Model: Leadership

Charge RN: Democratic Leadership


o Staff directed through suggestions and guidance; daily
huddles
o Constructive criticism
o Emphasis on “we”; staff encouraged to speak up about
any issues/concerns
Charge RN had patients
o Less control maintained
o Promoted autonomy
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed). Philadelphia: Wolters Kluwer Health.
3
Microsystem Model:
Organizational Culture and Support

Unit Management
o Nurse manager acts through democratic leadership
o Morning & evening huddles to briefly discuss
areas for improvement and also areas of success
o Monthly meetings to discuss continuing education,
staffing, quality improvement measures, special
events & recognition of staff members
(discontinued since March due to COVID-19)

Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from 4


http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model:
Patient Focus & Staff Focus

Patient Focus Staff Focus


o Primary RN performs o Nurse ratio - 5:1 or 6:1
total care o PCT - 6 during day shift
o Utilization of the 4Ps of o Career fairs and business
patient-centered services expos
o Bedside shift report o New graduate nurse
o Education on program
medications and plan of o Annual diversity training
care o Ongoing training and
o Call lights frequently career advancement
not answered opportunities

Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from


http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf 5
Microsystem Model:
Interdependence of Care Team

Trust, Collaboration, & Shared Purpose


o Nurses work together to accomplish tasks
• Delegation is successful and respectful
o Physical Therapy, Occupational Therapy, Speech
Therapy, Wound Care, PICC Team, Case Management
play a role in patient care
o Codes consist of team members from other units
• ICU nurses
• ER physician
• Charge RN
• House Supervisor
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from 6
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model:
Use of Information and Healthcare Technology

Integration of information with patients


o Medical records, discharge process
Integration of information with technology
o Cerner for electronic medical record, workstation on
wheels
o Call lights
o Versus
Integration of information with providers/staff
o Team huddles, bedside shift report
o Cerner, phones, fax information
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf 7
Microsystem Model:
Process for Healthcare Delivery Improvement

Process Improvement
o Continuing education is supported for all staff
• ACLS required for outpatient Ortho Med/Surg
unit
o Monthly meetings to discuss areas of
concern/praise
• Discontinued due to COVID-19
o Morning and evening huddles

Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from


http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
8
Microsystem Model:
Staff Performance Patterns
Annual evaluations
Monthly meetings to discuss areas for concern/praise
Morning and evening huddles
Quality measures (LeapFrog Hospital Safety Grade)
o Falls
o MRSA infections
o C. diff infections
o UTIs
o SSIs
o Pressure ulcers
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from 9
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Specific Aspect Targeted for Improvement

Staffing
o Impaired patient-focused care related to alarm
fatigue due to high patient ratios and inadequate
staffing.
o Adequate staffing and appropriate patient ratios
improve quality of care and prevent exhaustion
• Equal distribution of workload among staff
o Improvement in response to alarms decreases
alarm fatigue
• Strengthens patient-focused care
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
10
Integrative Nursing Principle

“Integrative nursing is person-centered and


relationship-based.”
Develops staffing and scheduling patterns that lead to
continuity of nurse/patient relationships and care.

Kreitzer M. J. (2015). Integrative nursing: application of principles across clinical settings. Rambam
Maimonides Medical Journal, 6(2), 1-8. https://doi.org/10.5041/RMMJ.10200 11
Leading the Plan for Healthcare Delivery
Improvement

Month 1 Month 2 Month 3 Month 4 Month 5


Week 1 Collect Implement Collect and Develop plan
Project plans and review nurse/ review data promoting
and goals for patient patient ratio;
nurse/patient data nurse/patient
provide
ratio (1:4) ratio; review
surveys to
Week 2-4 staff and
Present staff and
patients patient
relevant
information (HCAHPS) response to
to staff; ensure
provide a intervention
patient
12
questionnaire
References

Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from

https://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf

Kreitzer M. J. (2015). Integrative nursing: application of principles across clinical

settings. Rambam Maimonides Medical Journal, 6(2), 1-8.

https://doi.org/10.5041/RMMJ.10200

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in

nursing: Theory and application (9th ed). Philadelphia: Wolters Kluwer Health.

TheLeapFrog Group. (n.d.). LeapFrog Hospital Grade Safety. Retrieved from

https://www.hospitalsafetygrade.org/h/northwest-medical-center-tucson-az 13

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