Nursing research & quality improvement

Quality Assurance Evaluations

1. Structure Evaluation

2. Process Evaluation

3. Outcome Evaluation

Structure Evaluation

• Focus on the setting where care is gien

• Answers the question: What effect does this setting have on the quality of care?

Process Evaluation

• Focuses on how the care was given

• Evaluates if care is releant to pt needs, appropriate, complete & timely & whether the nurse utilized the nursing process & followed policy

Outcome Evaluation

• Focuses on demonstrable changes in the pts health as a result of nursing dcare

• Examples: Rates of post op pneumonia follow hip surgery of blood clots post-COVID

Quality Improvement

The degree to which health services increase the likelihood of desired outcomes & are consistent w current professional knowledge

The QI process

Involves setting standards of care, taking measurements, evaluating care, recommending improvements, ensuring implemention, & evaluating the modifications

Key Principles of QI success

1. QI works as systems & processes

2. Focus on pts

3. Focus on being part of a team

4. Focus on the use of data

core philosophy

Bad systems-not bad ppl-lead to most errors

adverse event/pt safety event

An injury to a pt caused by medical management rather than the underlying condition

• Error of omission

• Error of commission

Error of omission

Occurs when a standard action of care is omitted

Error of commission

Occurs when the wrong action is taken

Unsafe act

Occurs in the presence of a potential hazard (failing to identify a pt prior to medication administration )

Near Miss

A potential error discovered & intercepted before it is carried out

Sentinel Event

A pt safety event resulting in death, permanent harm, or severe temporary harm requiring life-sustaining intervention Examples: Include pt suicide, wrong-site surgery, infant discharge to wrong parents, & incorrectly matched blood transfusions

The “second victim“

Refers to the nurse or healthcare provider impacted psychologically & emotionally following a pt safety event or error

Person approach

Focuses on individual unsafe acts & human behaviours; corrects behaviour through “naming, blaming, shaming & retraining“

system approach

Acknowledges human imperfection; focuses on system processes, work enviroments, & establishing barriers/safeguards against errors

Culture of Safety

A blame-free, nonpunitive environment emphasizing accountability, transparency, integrity & mutual respect

• CUS Tool: Encourages staff to voice concerns by stating “I am Concerned, I am Uncomforable, this is a safety issue“

Nursing sensitive indicators

Elements of pt care & outcomces directly affected by the quality & quanitity of nrusing practice include:

• Falls

• Pressure Ulcers

• Hospital Acquired Infections

• Nursing Turnover

Root Cause Analysis

A problem solving approach used after a pt safety event to identify & understand underlying system factors & deviations in practice

Components of Root Cause Analysis

Includes mapping the sequence of events, identifying causual factors & root causes, & formulating an action plan w specific strategies to prevent recurrence

Agency for healthcare research & quality (AHRQ)

Established the pt safety network (PSNet) to provide tips, tools, & measurement resources for preventing medical errors

American Nurses Association

Lauched the pt safety & quality initiative & established the national database of nursing quality indications

The joint commsion

Accredits & certifies healthcare organizations ,oversees reviews of sentinel events, manages the speak up pt advocacy programs & establishes National PT Safety Goals