Making It Meaningful: Finding Quality Improvement Projects Worthy of Your Time, Effort, and Expertise

Abstract

This article is the second of a 4-part quality improvement resource series for critical care nurses interested in implementing system process or performance improvement projects. The article is a brainstorming session on paper, written to assist nurses and managers in identifying possible quality improvement projects that are meaningful to them and will make a real difference in their critical care units. Every unit and institution has its own unique mix of resources, culture, physical environment, patient population, technology, documentation processes, health care providers, and multiple other factors. Thus specific patient care and safety challenges must be identified and prioritized individually for quality improvement by each unit. Projects also must be manageable and within the scope of time, effort, and expertise available-no quality improvement project is "too small" if it is applicable to your critical care area and will improve outcomes. A s the nurse manager of the trauma intensive care unit, you have just received the most recent patient satisfaction scores, and they are still below the preferred institutional benchmark. The lowest scoring items are (1) staff effort to include patients/families in decisions about treatment, (2) how well nurses kept patients/family informed, and (3) the amount of attention paid to the patient's special or personal needs. At the next team meeting, you invite your staff to offer suggestions on how to improve satisfaction scores. A lively discussion erupts, with some nurses recommending a research project and others a quality improvement (QI) project. Using published guidelines, 1 the group decides to use current evidence-based knowledge and best practices applicable to their patient population that will address the identified deficiencies (QI) versus trying to generate new knowledge or This article has been designated for CE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Describe how to determine process improvement priorities 2. Review the use of process improvement methods that will work for your facility 3. Review patient safety strategies and initiatives endorsed by the Agency for Healthcare Research and Quality to prevent harm

Critical Thinking Tools for Quality Improvement Projects

“…An early win for the team not only encourages them to continue but can help gain buy-in from leadership and staff. 3,14 In our pressure injury example, the team noted that all stage 3 pressure injuries were injuries to the ears and had been caused by respiratory equipment. 28 Although ear injuries were not represented in the "vital few," their severity was a concern.…”

“…Improving clinical practice and sustaining those improvements require leadership support from all levels within the organization. 3 Once the team has been assembled, it should thoroughly assess the problem or quality issue. When problems occur in the workplace-either as a clinical issue, such as an increase in the number of medication errors, or as a need for improvement, such as a change in workflow-health care workers often want to identify the cause and remedy the situation quickly.…”

“…Such high-quality assets provide 1 way to ensure that interventions are based on evidence and are useful in practice, without requiring the team to reinvent the wheel and resynthesize the literature. 3 To determine the quality of a clinical practice guideline, use the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. 29 This 23-item instrument is reliable and valid, and it is available online at no cost.…”

“…care to be benchmarked. 3 In addition, the use of electronic medical records has made it possible for nurses to gather information from patient records that can be tailored to investigations of specific quality questions or the care that patients with a given diagnosis or treatment receive while in the hospital. 4 As technology and levels of information advance, nurses must decipher and synthesize numerous reports, charts, and spreadsheets, and then implement that knowledge to improve the quality of patient care.…”

Driving Organizational Change From the Bedside: The AACN Clinical Scene Investigator Academy

“…Studies have shown that health care efficiency can be improved and cost can be decreased through programs in which nurses learn to understand and apply evidence-based practice (EBP) and QI processes. [2][3][4] However, although EBP and QI programs may include sound tools, these programs generally have less emphasis in the theory and practice of implementing change.…”