Qip

Quality Improvement Project:
Process Improvement
🙠 🙢
Alyson Seall, Courtney Waisath, Himani Sullhan, Jillian Gunderson, & Sonia
Garcia
1
Overview of Patient Care Delivery System
❏ Banner University Medical Center

❏ Adult Emergency Department
❏ Focus: Process improvement related to

handoff communication and report
2
Microsystem Model:
Leadership
“Leaders are in the front, moving forward, taking risks, and
challenging the status quo” (Marquis & Huston, 2017, pp. 40)
Examples of Leaders in ED:
❏ Charge Nurse/Nurse Manager ❏ Radio Room
❏ Floats: extra support from ED nurses ❏ Unit Clerk
Servant Leadership:
❏ Emphasis on “we”, promotes collaboration, team work
Leadership influencing care:
❏Increases patient safety
❏Accountability of staff & autonomy of patients
❏Highlight improvements needed & made
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed. p. 40). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
3
Microsystem Mode
Organizational Culture and Support
� “..expectations, experiences, philosophy, and the values that
hold it together and is expressed in its self-image, inner
workings, interactions with the outside world, and future
expectations” (Marquis & Huston, 2017, pp. 306).
� Banner values: Customer obsessed, relentless improvement,
courageously innovating, disciplined focus, fostering
accountability, continuously earning trust
� Support in the ED:
o SWAT, chaplains, case management, security
o “Huddle” at every shift change
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p.
306). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
4
Microsystem Model:
Patient Focus & Staff Focus
Patient focus in the ED: “the nurse’s primary commitment is
to the patient…” (Marquis & Huston, 2017)
❏ Satisfaction surveys
❏ Health education: discharge teaching
❏ Responding to special requests
❏ Establish relationships
Staff focus in the ED:

❏ Continuing education
❏ Shift differentials
❏ Self scheduling
❏ Staff meetings to address any concerns
❏ ED nurses week
application (9th ed. p. 138). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 5
Microsystem Model:
Interdependence of Care Team
“...more than one entity working together to accomplish a

shared goal..” (Huth, Kelly, & VanSell, 2017).
Benefits:
○ mutualism
○ well-rounded team→ better patient outcomes
○ allows care team to be more competent and
resourceful in the care they provide
Examples of interdependence in the ED:
o “Doc Box,” Respiratory, Pharmacy, Tele monitor room
surveillance & communication, Radio room manager
Huth, C., Kelly, B., & VanSell, L. S. (2017). Interdependence: A concept analysis. International
Journal of Nursing & Clinical Practices, 4(225). doi: https://doi.org/10.15344/23944978/2017/225 6
Microsystem Model:
Use of Information and Healthcare Technology
� Healthcare technology increases patient safety, strengthens

the interaction between patients and healthcare providers,
and decreases medical errors.
Use of healthcare information in the ED:
� Close communication with ICU
� Doc box
Healthcare Technology in the ED:
� Phones/Pages
o wifi would go down and pages wouldn’t go through;
resorted to intercom over entire hospital
� Cerner
application (9th ed. p. 510-511 ). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
OpenMRS. (2016). The Importance of Health Information Technology in Developing Areas. Retrieved from
https://openmrs.org/2017/07/the-importance-of-health-information-technology-in-developing-areas/.
7
Microsystem Model:
Process for Healthcare Delivery Improvement
� Purpose of Delivery-Improvement Techniques

� “… to identify inefficiencies, ineffective care, and
preventable errors to then influence changes
associated with systems” (Hughes, 2008, pp. 2).
� Performance & Improvement:

o Evals from nurse managers
o Mandatory quarterly staff meetings
o Mock JCAHO days
Hughes, G. R. (2008). Chapter 44: Tools and strategies for quality improvement and patient safety. In
R.G. Hughes, Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD:
Agency for Healthcare Research and Quality. 8
Microsystem Model:
Staff Performance Patterns
� “Quality measures are used in an effort to better standardize
its valid, reliable, and evidenced-based data sets” (Marquis
& Huston, 2017, p. 626)
� Quality measures
o Sepsis control compliance
o Stroke protocol compliance
• Time from ED to cath lab

o Falls
o Compliance with scanning meds
� “Report cards” from lab/other units
application (9th ed. p. 626). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Specific Aspect Targeted for Improvement:
Process Improvement
� Evidence-Based: An estimated 80% of serious medical

errors involve miscommunication during hand-off
between medical providers
� Nurses noted that the implementation of bedside handoff
helped reduce the number of poor patient outcomes
� Nurses found the SBAR handoff method was easy to
use and prevented the loss of patient information
Campbell, D. & Dontje, K. (2019). Implementing bedside handoff in the emergency department: A practice
improvement project. Journal of emergency nursing, 45(2), 149-154. doi:
https://doi.org/10.1016/j.jen.2018.09.007
Johnson, A., Guirguis, E., Grace, Y. (2015). Preventing medication errors in transitions of care: A patient case
approach. Journal of the american pharmacists association, 55(2), 264-276. doi: 10.1331/JAPhA.2015.15509
10
Specific Aspect Targeted for Improvement
(continued)
� Proposed intervention: improve bedside handoff in

the Emergency Department with standardized report
sheet
� Bedside report
o Allows nurses to provide accurate information about
patient, treatments or services, and any recent or
anticipated changes
� Standardized report sheet
o Ensures nurses are discussing key points of patient
plan of care and assessment
o Consistency of communication and continuity of
treatment
11
Specific Aspect Targeted for Improvement
(continued)
� Integrative Nursing Principle IV: Integrative

nursing is patient-centered & relationship based
o The modality is a bedside handoff to
incorporate patients and families along with

nurses in the safe transition of care
o This modality fosters a nurse-patient
relationship and builds trust
Campbell, D. & Dontje, K. (2019). Implementing bedside handoff in the emergency

department: A practice improvement project. Journal of emergency nursing, 45(2),
149-154. doi: https://doi.org/10.1016/j.jen.2018.09.007
12
Leading the Plan for Healthcare Delivery
Improvement
� Plan
o PDSA model, unit leader forms committee,
standardized report sheet is finalized, handouts and
poster created, PowerPoint class is created
� Introduce to staff
o Intervention is introduced to staff, handouts are
given, told deadline to complete education within 3
months
� Start to Implement
o Deadline for all nurses to complete PowerPoint
Education and begin to use in practice
� Fully Integrated & Track Outcomes
o New report process should be fully integrated into
practice within 3 months, begin to look at outcomes
13
Timeline of Events
14
References
� Campbell, D. & Dontje, K. (2019). Implementing bedside handoff in the

emergency department: A practice improvement project. Journal of
Emergency Nursing, 45(2), 149-154. doi:
https://doi.org/10.1016/j.jen.2018.09.007
� Johnson, A., Guirguis, E., & Grace, Y. (2015). Preventing medication errors in
transitions of care: A patient case approach. Journal of the American
Pharmacists Association, 55(2), 264-276. doi: 10.1331/JAPhA.2015.15509
� Hughes, G. R. (2008). Tools and strategies for quality improvement and patient
safety. In R.G. Hughes, Patient Safety and Quality: An Evidence-Based
Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and
Quality.
� Huth, C., Kelly, B., & VanSell, L. S. (2017). Interdependence: A concept analysis.
International Journal of Nursing & Clinical Practices, 4(225). doi:
https://doi.org/10.15344/23944978/2017/225
� Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management
functions in nursing: Theory and application (9th ed. p. 40). Philadelphia, PA:
Wolters Kluwer Health/Lippincott Williams & Wilkins.
15
References

functions in nursing: Theory and application (9th ed. p. 138).
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams &
Wilkins.
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
functions in nursing: Theory and application (9th ed. p. 510-511).
� OpenMRS. (2016). The Importance of Health Information Technology in
Developing Areas. Retrieved from https://openmrs.org/2017/07/the-
importance-of-health-information-technology-in-developing-areas/.
16

Qip

Uploaded by

Copyright:

Available Formats

Qip

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Qip

Uploaded by

Copyright:

Available Formats

Quality Improvement Project:

❏ Banner University Medical Center

❏ Focus: Process improvement related to

Staff focus in the ED:

“...more than one entity working together to accomplish a

� Healthcare technology increases patient safety, strengthens

� Purpose of Delivery-Improvement Techniques

� Performance & Improvement:

o Mock JCAHO days

o Stroke protocol compliance

• Time from ED to cath lab

o Compliance with scanning meds

� “Report cards” from lab/other units

� Evidence-Based: An estimated 80% of serious medical

� Proposed intervention: improve bedside handoff in

� Integrative Nursing Principle IV: Integrative

incorporate patients and families along with

relationship and builds trust

Campbell, D. & Dontje, K. (2019). Implementing bedside handoff in the emergency

� Campbell, D. & Dontje, K. (2019). Implementing bedside handoff in the

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

You might also like