Patient safety and quality

improvement in Nursing
By
Hidayat khan
Quality
 The IOM defines quality as “the degree
to which health services for individuals
and populations increase the likelihood of
desired health outcomes and are consistent
with current and professional knowledge”
(IOM).
What is Quality Improvement?
 A formal approach to the analysis of
performance and systematic efforts to
improve it
 Aims of Institute of medicine (IOM)
Six Aims for Improving Quality in
Health-Care (IOM).
Health care should be:
1. Safe: Avoiding injuries to patients from the
care that is intended to help them
2. Effective: Providing services based on
scientific
knowledge.
IOM aims cont…..
3. Patient-centered: Providing care that is
respectful of and responsive to individual
patient preferences, needs, and values and
ensuring that patient values guide all clinical
decisions
4. Timely: Reducing waits and sometimes
harmful delays for those who receive and
those who give care
IOM aims cont…..
5. Efficient: Avoiding waste, in particular
that of equipment, supplies, ideas, and
energy
6. Equitable: Providing care that does not
vary in quality because of characteristics
such as gender, ethnicity, geographic
location, and socioeconomic status
Joint Commission international
accreditation (JCIA)
 Founded in 1951, The Joint Commission
seeks to continuously improve health care
for the public, in collaboration with other
stakeholders, by evaluating health care
organizations and inspiring them to excel in
providing safe and effective care of the
highest quality and value.
Mission of (JCIA)
 The mission of Joint Commission
International (JCI) is to improve the safety
and quality of care in the international
community through the provision of
education, publications, consultation, and
evaluation services.
International Patient Safety Goals
 Key International safety goals for hospitals
Set by Joint Commission Updated yearly
 Goal is to promote specific improvements
in patient safety
 International Patient Safety
Goals (IPSG) by JCIA
Goal 1 Improve the accuracy of patient
identification.
 Use at least two patient identifiers when providing
care, treatment or services.
Goal 2 Improve the effectiveness of
communication among caregivers.
 The complete verbal and telephone order or test
result is written down by the receiver of the order
or test result and reconfirm.
 International Patient Safety
Goals (IPSG) by JCIA
Goal 3 Improve the Safety of using High-Alert Medications:
 High-Alert are Medications involved in a high
percentage of errors and/or sentinel events, carry a
higher risk for adverse outcomes or Look-alike.
Goal 4 Ensure Correct-Site, Correct Procedure, Correct-
Patient Surgery:
Uses an instantly recognized mark for surgical-site
identification and involves the patient in the
marking process. Uses a checklist or other process to verify
preoperatively the correct site, correct procedure, and
correct patient and that all documents and equipment
needed are on hand, correct, and functional.
 International Patient Safety
Goals (IPSG) by JCIA
Goal 5 Reduce the Risk of Health Care-Associated
Infections:
 The organization implements an effective hand-hygiene program
and infection control procedures.
Goal 6 Reduce the Risk of Patient Harm Resulting from
Falls:
 Measures are implemented to reduce fall risk for those assessed
to be at risk.
Total Quality Management (TQM)
 Total Quality Management (TQM) is a
comprehensive and structured approach to
organizational management that seeks to
improve the quality of products and services
through ongoing refinements in response to
continuous feedback.
Continuous quality improvement CQI
Continuous quality improvement
(CQI) is a process of identifying areas of
concern (indicators), continuously
collecting data on these indicators, analyzing
and evaluating the data, and implementing
needed changes.
 Common indicators
Common indicators include, for example,
 Number of falls,
 medication errors,
 and infection rates.
 Indicators can be identified by the accrediting agency or by the
facility itself.
 The purpose of CQI is to improve the capability continuously of
everyone involved in providing care, including the organization
itself.
Types of CQI program
The time frame used in a CQI program can
be
retrospective (evaluating past
performance, often called (quality
assurance),
concurrent (evaluating current
performance),
or prospective (future-oriented).
 Procedures
The procedures used to collect data depend on the purpose of the
program. Data may be obtained by
 observation,
 Performance appraisals,
 patient satisfaction surveys,
 statistical analyses length of stay and costs, surveys.
 peer reviews,
 and chart audits
(Huber, 2010).
CQI Process
 Assign Responsibilities
 Identify Vital Areas
 Define Scope of Care
 Analyze Area in Terms of:
 Aspects
 Standards
 Indicators
 Criteria
 Measure Actual Performance
 and
 Measure Patient Outcomes
 Evaluate Performance and Outcomes
 Recommend and Implement Actions
 Evaluate Degree of Improvement
CQI Process
Assign Responsibilities

Identify Vital Areas

Define Scope of Care

Analyze Area in Terms of:

Aspects Standards Indicators Criteria

Measure Actual Performance and Measure Patient Outcomes

Evaluate Performance and Outcomes

Recommend and Implement Actions

Evaluate Degree of Improvement

 Risk Management
 An important part of CQI is risk management, a process of
identifying, analyzing, treating, and evaluating real and potential
hazards.
 The Joint Commission ( JC) recommends the integration of a
quality control/risk management program to maintain
continuous feedback and communication.
 To plan proactively, an organization must identify real or
potential exposures that might threaten
 Risk events
Risk events are categorized according to severity.
1. Service occurrence. A service occurrence is an
unexpected occurrence that does not result in a clinically
significant interruption of services and that is without apparent
patient or employee injury. Examples include minor property or
equipment damage, unsatisfactory provision of service at any
level, or inconsequential interruption of service.
Risk events
2. Serious incident. A serious incident results in a
clinically significant interruption of therapy or service, minor
injury to a patient or employee, or significant loss or damage
of equipment or property. Minor injuries are usually defined
as needing medical intervention outside of hospital admission
or physical or psychological damage.
Risk events
3. Sentinel events. A sentinel event is an unexpected
occurrence involving death or serious/ permanent physical
or psychological injury, or the risk thereof. The phrase, “or
the risk thereof ” includes any process have a significant
chance of a serious adverse outcome. Such events are called
sentinel because they signal the need for immediate
investigation and response.
 When a sentinel event occurs, appropriate
individuals within the organization must be
made aware of the event; they must investigate
and understand the causes of the event; and
they must make changes in the organization’s
systems and processes to reduce the
probability of such an event in the future.
(jcaho.org/ptsafety_frm.html).
 Other Sentinel events
 The subset of sentinel events that is subject to
review by JC includes any occurrence that
meets any of the following criteria:
The event has resulted in an unanticipated
death or major permanent loss of function,
not related to the natural course of the
patient’s illness or underlying condition.
Other Sentinel events
suicide of a patient in a setting where the
patient receives around-the-clock care (e.g.,
hospital, residential treatment center, crisis
stabilization center),
infant abduction or discharge to the wrong
family,
rape
Other Sentinel events
hemolytic transfusion reaction involving
administration of blood or blood products
having major blood group
incompatibilities, surgery on the wrong
patient or wrong body part
(jcaho.org/ptsafety_frm.html 2008)
Common areas of risk for nurses
Common areas of risk for nursing include:
■ Medication errors
■ Documentation errors and/or omissions
■ Failure to perform nursing care or treatments correctly
■ Errors in patient safety that result in falls
■ Failure to communicate significant data to patients and other
providers
(Swansburg & Swansburg, 2008)
 Risk management for employee
 Risk management programs also include attention to areas of
employee wellness and prevention of injury.
 Latex allergies,
 repetitive stress injuries,
 carpal tunnel syndrome,
 barrier protection for tuberculosis,
 back injuries, and
 the rise of antibiotic resistant organisms
 all fall under the area of risk management
(Huber, 2000).
Quality Improvement
 If the desired goals are not met for
each area, quality improvement is
used to study how tasks are done
and how to improve them.

 When a problem is identified, an on

going cycle of improvement begins.
Method or Tool

 P - Plan
 D - Do
 S - Study
 A - Act
Plan
 Collection of
information or data
 Design or redesign
policies, procedures
services or products
 Specify objectives or
degree of
improvement.
DO
 Deliver care, perform
policy or procedure
in limited trial run
 Do a pilot test of the
plan to see how it
works.
Study
 The third step is to
Study to see if the
plan works.
 Obtain judgments of
improvement and
determine if solution
or change has been
successful.
Act
 CQI is a continuous
full circle.
 Implement solutions,
change, modify
tests, revise
standards.
 (develop standards)
and incorporate
revision in to day-to-
day practices.
 Communicate.
References:
 Escott-Stump S et. al.: Joint commission on accreditation of
healthcare organizations: friends not foe. JADA 2008;100:839-4.
 McLaughlin S: What to know about JCAHO. Health Facilities
Management Magazine, March 2009; 35-37.
 JCAHO web site:http://www.jointcommission.org/
 ADA member information on JCAHO
http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/advocacy_selectedqa
_ENU_HTML_(Draft).htm