Quality Improvement In Nursing Essay

Nurses are pivotal in hospital efforts to improve quality because they are in the best position to affect the care patients receive during their hospitalization. Data collection and analysis is the core of quality improvement assisting in understanding how the system work, identifying potential areas in need for improvement, monitoring the effectiveness of change and outcome. Nurses are also the eyes and ears of the hospital to positively influence patient outcome. For example, nurses are the ones catching medication errors, falls, and identifying barriers to delivering care. In this nurse’s facility, in order to minimize patient falls the hospital implemented a falls risk assessment tool called, “The Humpty Dumpty Scale” upon admission

and to be completed every 7 days. This tool includes seven parameters: Age, gender, diagnosis, cognitive impairments, environmental factors, response to surgery/sedation/anesthesia, and medication usage. Each of these seven parameters comprises of various criteria which are then given a score and documented in their electronic chart. If the total score is greater than 12 the patient is determined to be at falls risk. For those that are at risk, the unit implemented a red “falls risk” sign to place by the door so not only the nurse is aware but physician’s, volunteers, PT/OT, etc. will also be mindful. The unit also audits various element such as the documented falls score, if the falls risk sign is placed by the door, and if there is a falls risk care plan initiated for the patient. If a fall occurs, nurses are required to file an incident report to inform administrators and unit managers with detailed documentation of how, when, what was done, and etc. From this report, quantitative data are gathered and tracked for quality assurance to identify and fix the problem. After the unit gathers the data, staff are updated quarterly on the result of the falls percentage and ways to improve such as educating parents upon admission by keeping the crib side rails up at all times, no clutter on the floor, or calling staff for assistance when ambulating. Hence, improving falls score and patient outcome.
Another example of quality improvement project done in this nurse’s unit includes incorporating evidence-based practices to eliminate Central Line-Associated Blood Stream Infections (CLABSI).

There have been an incidents of prolonged hospital stay due to central line infections putting patients at risk for mortality, morbidity, and increase in medical cost. When central lines are placed at bedside or in interventional radiology, the inserter is required to document the steps and sterile procedure that took place in the electronic health record. Furthermore, with weekly and as needed dressing changes, nurses are required to use central line bundles and document what was used (ex: Chloraprep, biopatch, tegaderm, etc.) to track how the dressing was done. From these documented records, staff can gather data and measure the compliance of sterile procedure. Additionally, if a patient with a central line develops a fever without an unknown cause physician will order blood culture from the central line if catheter-related infection is suspected. If the test comes back positive, the team will initiate antibiotics immediately. By integrating electronic health records it can assist in CLABSI prevention strategies, raise the standard for best practices, and essentially reduce central line infections. With the quarterly results of CLABSI in our unit, CVC committee have re-educated the staff on appropriate dressing changes using sterile technique, transitioned to a different end

cap manufacturer, and also implemented the use of swab caps.