Quality improvement in healthcare essay
Through the RCA, health systems factors are analyzed and provide feedback on both the latent causes of errors as well as the active error causes within the system. The Institute of Health Improvement (IHI), identifies RCA as a retrospective systematic approach through which errors and the causes of adverse events within the healthcare system can be identified and corrective measures are taken to prevent the occurrence of such errors in future (IHI, 2015). IHI elaborates that an RCA process ought to occur in six steps and involves a team of people from different professional backgrounds (IHI, 2015). The steps of RCA according to IHI include; i. Identification of the incident The identification of the incident involves a reconstruction of the occurrence in chronological order to capture the events that occurred accurately and completely.
The RCA teams examine the direct causes of the adverse event as well as the contributory causes. The 5 whys approach is utilized in this stage to identify why the adverse event or the problem occurred(IHI, 2015). The subsequent whys are determined by the responses to the initial why and aim at identifying the root causes of the problem. Another quality improvement approach in determinant the causes of the adverse events is the fishbone diagram which identifies different contributory factors that could have contributed to the occurrence of the problem. iv. Solutions should e timely and an implementation plan with designated persons responsible and timelines should be included to ensure effective implementation. Applying the RCA to The Case Scenario The scenario involved a patient who had been brought to the emergency room following a fall and dislocation of his hip.
He was sedated using multiple doses of morphine (4 mg) and diazepam (10mg) within 20 minutes. The patient was a frail elderly patient who had a history of prostate cancer and elevated cholesterol and had a history of oxycodone use. The patient was sedated after 20 minutes and a reduction of the hip joint completed. Another cause was the failure by the staff to call for back up support for additional staff that was available in case they were strained. The physician at the emergency room was not trained on the minimum sedation analgesia module which was a requirement for the hospital for all providing sedation. Causal statements; a. The physician was not trained in the minimum sedation module which led to the oversedation of the patient resulting in respiratory distress.
b. The fourth recommendation will be for the hospital to improve the nursing and physician staffing in the emergency room to minimize staff burnout and enhance the quality of care. Increased staffing reduces the risk of errors and care left undone to patients and minimizes the patient waiting time in the emergency department as well as enhancing the admission and discharge time(Xie & Or, 2017). Staffing will also ensure effective triaging for the patients to ensure higher acuity patients are attended to as per the priority needs. Process Improvement Plan The process improvement plan will aim to enhance patient throughput at the emergency department to minimize patient waiting times. The plan will be executed by a team that will comprise of the physician and nurse unit leads, one nurse staff representative, the hospital administration representative,2 members of the quality assurance committee and a member of the evidence-based committee.
The staff training will enhance driving forces and reduce the restraining forces in adapting to new approaches to care. The changing stage of the cycle will involve incorporating the actual change which will include the installation of digital systems and staff deployment within the department as well as training of staff. In the refreezing stage, the new process will be incorporated in the unit's standard operating procedures to ensure the sustainability of the change and prevent reversal to the old processes. Failure Mode and Effects Analysis (FMEA) Process. The FMEA process is a stepwise approach or process analysis tool that is aimed at identifying any faults in the design of a process. Improved healthcare providers staffing in the emergency room Nurses are unable to provide one to one patient care to high acuity patients 1 9 6 54 3.
Nurses discuss sedation medication with physician before procedure Wrong medication doses administered to patient 3 6 5 90 4. Nurses triage patients in the emergency ward prior to offering care Delayed care for high acuity patients 2 5 6 60 288 *do not include more than four steps in the improvement plan process Measuring the Process Improvement Process The process improvement plan to enhance patient throughput in the emergency department can be measured through comparison of specific patient indicators such as patient waiting time, the incidence of adverse patient occurrences, staff satisfaction and patient satisfaction of care. A baseline data is collected on patient waiting times, the occurrence of adverse events and boarding time in the emergency department before implementing the improvement process. Patient exit interviews are conducted to assess their level of care satisfaction before the change.
Involvement of nurses in RCA and FMEA processes enhances nurse leadership through ensuring that the nurse takes a lead in the analysis of the designs and processes within the healthcare environment to identify actions and interventions for improvement. The involvement also avails nurses the opportunity to lead or influence the quality improvement processes and apply their knowledge and skills in the enhancement of quality processes. The involvement further builds the nurse's capacity to initiate quality improvement and ensure the sustainability of the care processes and designs. References Charles, R. , Hood, B. Journal of Injury and Violence Research, 9(1). doi: 10. 5249/jivr. v9i1. 794 Griffiths, P. 13564 Natafgi, N. , Zhu, X. , Baloh, J. , Vellinga, K. , Vaughn, T. aspx The Institute of Health Improvement (IHI), (2017). Failure Modes and Effects Analysis (FMEA) Tool.
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