Nursing Leadership and management

Continuous quality improvement (CQI) is the responsibility of all nurses and is vital when addressing the challenges of the health care industry. Provide an example of how you would apply CQI in your current or past position. The purpose of QI is to use a systematic, data-guided approach to improve processes or outcomes (Conner, 2014). Principles and strategies involved in QI have evolved from organizational philosophies of total quality management and continuous quality improvement.

Connor (2014) emphasizes that while the concept of quality can be subjective, QI in healthcare typically focuses on improving patient outcomes.

So the key is to clearly define the outcome that needs to be improved, identify how the outcome will be measured, and develop a plan for implementing an intervention and collecting data before and after the intervention. Connor (2014) points out QI methods as follows:

Various QI methods are available. A common format uses the acronym FOCUS-PDSA:
Find a process to improve.
Organize an effort to work on improvement.

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Clarify current knowledge of the process.
Understand process variation and performance capability. Select changes aimed at performance improvement. Plan the change; analyze current data and predict the results. Do it; execute the plan.
Study (analyze) the new data and check the results.
Act; take action to sustain the gains.

Unlike research and EBP, QI typically doesn’t require extensive literature reviews and rigorous critical appraisal. Therefore, nurses may be much more involved in QI projects than EBP or research. Also, QI projects normally are site specific and results aren’t intended to provide generalizable knowledge or best evidence states Conner (2014).

Examples of QI projects include implementing a process to remove urinary catheters within a certain time frame, developing a process to improve wound-care documentation, and improving the process for patient education for a specific chronic disease. The institution I have been at has been working on decreasing central line associated bloodstream infection and peripheral line blood stream infections. Numerous risk factors for CLABSI associated with needleless connectors have been proposed. Some are attributed to poor hand washing before manipulation, inability to properly disinfect the connection site due to poor design, aseptic device management, and frequency of the connector exchange.

In addition, several studies looking at intraluminal contamination from the needleless connector have demonstrated that high levels of contamination can be seen colonizing the connector and subsequently moving into the CVC (Ramirez, Lee, & Welch, 2014). Even with varying levels of disinfection, colonization can still occur. Studies of current I.V. practices demonstrated that 56% of Registered Nurses typically do not believe it is necessary to disinfect catheter hubs and >90% of nurses do not cover an intermittent infusion (Ramirez, Lee, & Welch, 2014). The 70% isopropyl alcohol cap known as “Curos” is used as an attempt to reduce intraluminal contamination. The cap requires ongoing training and encouragement to change practice. Studies indicate that consistent use of the caps does influence CLABSI rates substantially in terms of morbidity and the financial resources that are expended because of CLABSI’s.

References

Conner, B. T. (2014). Differentiating research, evidence-based practice, and quality improvement. American Nurse Today, 9(6), 26-31. Ramirez, C., Lee, A. M., & Welch, K. (2012). Central Venous Catheter Protective Connector Caps Reduce Intraluminal Catheter-Related Infection. Journal Of The Association For Vascular Access, 17(4), 210-213. doi:10.1016/j.java.2012.10.002