NSG_4700 Quality Improvement and Safety Initiatives Samples

Quality Improvement and Safety Initiatives

Student Name

NSG 4700 – Leadership and Management in Nursing

Quality Improvement and Safety Initiatives

            Organizations strive to improve patient outcomes while containing costs (Kowalski et al., 2018). Often, teams are assembled to conduct research with the goal of identifying the root cause of an issue (Rowland et al., 2018). Identifying the root cause of a problem allows the organization to engage in quality improvement initiatives that will benefit patients’ safety and experience (Quality and Safety Education for Nurses [QSEN] Institute, n.d.). All three stages of Lewin’s change model must be completed to implement lasting changes (Bridges, 2019).

Quality Improvement in Nursing

            Quality improvement involves data collection of interventions and their outcomes to identify ways to improve current practices (QSEN Institute, n.d.). The goal of quality improvement is to enhance patient care and safety (QSEN Institute, n.d.).

Quality Improvement Topic

             Any issue can become a quality improvement topic as long as there is a team to identify its presence (Rowland et al., 2018). Once a problem is recognized, a diverse team dedicated to problem solving may reveal a larger underlying problem and initiate organizational change  (Rowland et al., 2018). A quality improvement committee can focus on a broad issue like falls and realize that the problem is ultimately due to an underlying issue such as budgetary constraints preventing the purchase of new equipment to prevent falls.

Purpose of Quality Improvement Committee

            Quality improvement committees should be composed of several members of an interdisciplinary team with a diverse knowledge base to encourage a wide range of possible solutions to a problem (Rowland et al., 2018). The team works together to identify a problem, formulate a solution, test their theories, and ultimately implement the plan that creates the most favorable results (Rowland et al., 2018).

The Problem 

            The incidence of falls in the acute care setting is increasing and leads to a decrease in patient safety with a consequential increase in hospital costs for treatment (Klymko et al., 2016). The hospital may have to pay between $3,500 and $27,500 per fall because a patient falling is considered to be a hospital-acquired condition that will not be reimbursed (Klymko et al., 2016).

Data Collection and Established Benchmarks

            Data collection for falls should include factors that contributed to falls, the number of falls in a given time period and measures in place to prevent falls (Klymko et al., 2016). Institutional fall rates can be compared to publically available regional, state, and national rates to determine fall prevention program efficacy (Centers for Medicare & Medicaid Services [CMS], 2020). Patient fall rates can be determined by dividing the total number of falls by the patient days multiplied by 1,000 patient days (CMS, 2020).

            The committee can collect data on budget allocation for fall related programs and compare them to other facilities’ budgets. Data related to available equipment, such as video monitoring, should also be gathered to determine if there is a correlation between certain types of equipment and the frequency of patients falling. Lastly, benchmarks can be created such as a minimum amount of days that should pass between patient falls; rates should be similar to other facilities with the same equipment availability.

Possible Causal Factors

            Falls can occur due to pharmacological therapy including central nervous system depressants or anti-hypertensives because this can make the patient dizzy and disoriented increasing their chance of falling (While, 2020). Age is also a factor in fall risk because with advanced age comes deterioration of vision and muscular strength, increasing an individual’s risk of falling (While, 2020). Environmental factors such as personal object placement and improper footwear can predispose an individual to falling and should be considered when trying to reduce risk (While, 2020). Assessment factors such as a lack of supervision or inadequate risk calculations can create a hazardous patient environment (While, 2020).  Lastly, equipment such as a lack of video monitor technology or IV poles obstructing a patient’s path can increase their chances of falling while hospitalized (Klymko et al., 2016).

Root Cause

            The lack of video monitoring on a unit experiencing an increase in falls can be attributed to the hospital’s lack of a budget allocated for fall prevention technology (Kowalski et al., 2018). Hospitals historically have used sitters to stay with fall risk patients; sitters can be a nurse assistant, licensed practical nurse, or registered nurse (Kowalski et al., 2018). No matter the role the sitter ordinarily fills on a unit, they must be removed from their typical duties in order to watch the patient, which is not a cost-effective use of resources (Kowalski et al., 2018).

            One hospital found that after moving funds from sitters to video monitoring equipment, the hospital saved $1.3 million by the third year of implementation (Kowalski et al., 2018). Facilities have reported up to a 35% decrease in falls after instituting video monitoring equipment (Votruba et al., 2016). An estimated reduction between $52,000 and $87,000 in fall costs annually and the reduction of patient falls are strong indicators that video monitoring is an effective tool to increase safety and reduce hospital costs related to falls (Votruba et al., 2016).

Recommended Solution To Problem

            The hospital can make a budget plan to invest in video monitoring equipment and the necessary training for select staff to reduce falls (Kowalski et al., 2018). It has been shown that video-monitor-trained staff can recognize behaviors that precede a fall (Klymko et al., 2018). Monitor staff can interpret motor movements indicating that a patient is likely to get up and can intercept the action via an in-room microphone or by notifying staff (Klymko et al., 2018).

            Video monitoring implementation has been estimated to reduce fall related costs by two-thirds, promote more cost effective use of staff members, and provide patients with a greater sense of security (Kowalski et al., 2018). The organization, with the help of the quality improvement committee, will need to create a plan to reallocate funds originally used for sitters to purchase new monitoring equipment.  

Change Theory For Planned Change

            Lewin’s change theory is a management model used by organizations to implement change that will have lasting effects (Bridges, 2019). It occurs in three stages: unfreeze, change, and freeze (Bridges, 2019). The unfreeze stage of the quality improvement process involves showing the organization why the presented problem is important and needs to be rectified (Bridges, 2019). This stage would require the quality improvement committee to show the organization the increasing number of falls on the unit compared to fall rates at other institutions. The financial impact of falls also needs to be relayed to the organization during this stage.

            Next is the change stage, which is when the organization is ready to make improvements to solve the presented issue (Bridges, 2019). In this stage, the newly created budget will be used to purchase video monitors and train operating staff. Lastly, the freeze stage consists of reinforcing the changes and ensuring that all members of the organization are aware and comfortable with the new solution (Bridges, 2019). In this case, all personnel involved with patient care should be aware of the purpose, policies and procedures related to video monitoring and how it can improve patient safety by reducing falls.

Conclusion

            Quality improvement in nursing is important to continually provide patients with the highest quality and safest care. A quality improvement committee can identify and address the root cause of any issue and attempt to solve the problem through a series of tests. For example, falls are a prevalent issue in healthcare and a quality improvement committee may identify several causal factors such as environmental issues or age related causes. The committee may pinpoint one particular causal factor, such as a lack of monitoring equipment, and figure out the root cause of that particular factor. In this case, the lack of video monitoring equipment may be from insufficient funds allocated for fall prevention technology.

            The committee can then collect research data from other organizations that utilize video monitoring and present the results to the leaders of their organization. The committee may present information that explains the cost effectiveness and overall improvements to patient safety provided by video monitoring and help to create a budget for new equipment. Ultimately, the long-lasting success of a plan is based on the organization’s ability to navigate the unfreeze, change, and freeze stages of Lewin’s change theory.

References

Bridges, M. (2019, February 22). Lewin 3-Step change management model: A simple and effective method to institute change that sticks. Retrieved September 08, 2020, from https://medium.com/@mark.bridges/lewin-3-step-change-management-model-a-simple-and-effective-method-to-institute-change-that-sticks-c0274316748d

Centers for Medicare & Medicaid Services. (2020, June 22). CMS measures inventory tool [PDF].

Klymko, K., Etcher, L., Munchiando, J., & Royse, M. (2016, September/October). Video monitoring: A room with a view, or a window to challenges in falls prevention research? Retrieved September 07, 2020, from https://insights.ovid.com/medsurg-nursing/mednu/2016/09/000/video-monitoring-room-view-window-challenges-falls/10/00008484

Kowalski, S. L., Burson, R., Webber, E., & Freundl20, M. (2018, November/December). Budgeting for a video monitoring system to reduce patient falls and sitter costs: A quality improvement project. Retrieved September 07, 2020, from https://www.questia.com/magazine/1P4-2161030050/budgeting-for-a-video-monitoring-system-to-reduce

QSEN Institute. (n.d.). QSEN competencies. Retrieved September 07, 2020, from https://qsen.org/competencies/pre-licensure-ksas/

Rowland, P., Lising, D., Sinclair, L., & Baker, G. (2018, March 31). Team dynamics within quality improvement teams: A scoping review. Retrieved September 07, 2020, from https://academic.oup.com/intqhc/article/30/6/416/4957970

Votruba, L., Graham, B., Wisinski, J., & Syed, A. (2016, July). Video monitoring to reduce falls and patient companion costs for adult inpatients. Retrieved September 13, 2020, from https://pubmed.ncbi.nlm.nih.gov/29975024/

While, A. (2020, April 2). Falls and older people: Understanding why people fall. Retrieved September 08, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/32267766