Quality Improvement Initiative Evaluation
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Abstract
Quality improvement includes corrective actions that measurably improve the community’s health status. Unfortunately, the healthcare industry encounters various challenges that put the patient’s safety and well-being at risk. This report focuses on the impact of Health Acquired Infections (HAIs) and strategies that have been implemented to reduce their incidence rates. It provides an overview of the current state of HAIs and narrows down to the most prevalent type; Ventilator-Associated Pneumonia (VAP). This disease has presented an enormous challenge for the ICU staff and health care professionals. For this reason, the essay examines in detail the approaches constituted in the initiative and mentions their success thus far. It evaluates this success by evaluating the benchmarks and applying outcome measures like quality improvement meetings. Notably, incorporating the inter-professional perspectives aids in obtaining a coherent analysis. Since the initiative has not fully addressed all the emerging issues, this report recommends additional protocols, including technology, which could further improve the outcomes’ quality.
Keywords: quality improvement, healthcare, HAIs, VAP, nursing
Quality Improvement Initiative Evaluation
Quality Improvement entails continuous and structured strategies that result in a measurable improvement to medical services delivered. The healthcare industry often encounters numerous pressing problems, including medical errors, clinical variation, dwindling cash flow, and insufficient resources, that affect patient care. To effectively handle these challenges, health systems have enacted quality improvement initiatives to identify, analyze, implement, and assess disease control and prevention interventions. One major issue that has strained the healthcare sector is the rise of health acquired infections (HAIs). These diseases have caused adverse health effects and mortality and laid a heavy financial burden on the patients and facilities. An in-depth analysis of HAIs reduction encompasses understanding the diseases’ incidence, which prompted the need for quality improvement, and whether the quality indicators led to the intended outcomes of patient safety.
HAIs, also referred to as nosocomial infections, are contracted from viral, bacterial, and fungal pathogens in a healthcare setting. In a study conducted by Kritsotakis et al. (2017), the estimated daily and annual prevalence of HAIs was 9.1% and 5.2%. Patients in the Intensive Care Unit (ICU) are highly susceptible to these infections. Specifically, the most prevalent type of HAI is Ventilator-associated pneumonia (VAP). Its risk factors include the patient’s underlying conditions, increased duration of exposure to more extended periods of mechanical ventilation, consciousness disorders, comorbidities, invasive operations, etc. VAP is ranked among the leading causes of mortality in critically ill and mechanically ventilated patients. Its incidence rates range from approximately 5% to 67% (Timsit et al., 2017). In the United States, instances of VAP span between 2 and 16 episodes within 1000 ventilator-days. Additionally, prior studies have shown that hospitalization due to VAP increases by seven days, and the costs rise by nearly $40,000 (Timsit et al., 2017). This development has prompted healthcare facilities and medical organizations to enact quality improvement initiatives that would reduce VAP occurrence and cushion the subsequent health and economic effects.
Currently, improvement initiatives have focused on reducing cases of VAP using the “bundle approach.” Azab et al. (2015) integrated this technique into their prevention scheme. Numerous patients are admitted to the ICU, but very few come out alive once they are put on mechanical ventilation. Therefore, for this initiative to function adequately, the first step that organizations take is to tailor training and educational programs that inform the nurses and other ICU health professionals on the pathogenesis, risk factors, and implications of VAP (Azab et al., 2015). Afterward, the initiative dictates that the professionals be enlightened on the bundle’s items. They include proper positioning of the patient’s head (elevation of 30 to 45 degrees), reinforcing hand hygiene practices, encouraging ventilated patients’ mobility, adequate oral care, and appropriate handling of respiratory equipment. Moreover, the staff members are urged to use non-invasive techniques to lessen patients’ possibility of being exposed to mechanical ventilation. Nonetheless, this quality improvement initiative does not address every aspect of the healthcare system. For instance, inadequate staffing in the ICU setting can limit the initiative’s objectives. There are very few qualified and experienced professionals to incorporate the VAP bundle approach to their practice. Furthermore, the presence of limited resources and equipment is not addressed. Even though the number of patients admitted to the ICU increases considerably, institutions lack the necessary amenities to adequately care for them.
This initiative has proven successful in reducing VAP occurrences. Azab et al. (2015) realized a significant reduction – from 67% to 38% – in VAP incidences after the bundle approach was implemented. To evaluate the initiative’s effectiveness and success, the management strictly follows the inclusion criteria developed by the National Healthcare Safety Network (Ceballos et al., 2013). According to this study, the infection rates were recorded before and after the initiative implementation. The data was posted on a unit outcomes bulletin board that was reviewed regularly during the staff meetings. The quality improvement team assed the identified outcome by comparing prior and current VAP infection rates. Root cause analysis was employed to foster the interventions’ continuous improvement (Ceballos et al., 2013). Additionally, healthcare professionals’ feedback about the bundle’s functionality was encouraged through emails, consistent communication, and quality improvement meetings. These techniques were most successful since they allowed the nurses and other professionals to openly their opinions, views, and thoughts on how the initiative could be improved. Nonetheless, it is advisable to add an alternative outcome measure that would assess the training sessions’ impact and determine whether follow-up education sessions are necessary.
The reduction of the VAP incidence rate requires an interprofessional approach. Various health professionals are involved in this quality improvement initiative, primarily the nurses, ICU physicians, nurse managers, and the facility’s administration. First, human resource managers are the overseers and launchers of policies meant to support the initiative. They ensure that professionals have unlimited access to resources that will foresee the scheme’s effectiveness. They believe that in addition to increasing the facility’s productivity through the workforce, they also ensure that the healthcare professionals’ well-being is promoted. As for the nurse managers, they have been tasked with supervising the operations of nurses working in ICU wards. They are in-charge of ensuring that the nurses are well-educated and trained on how to implement the initiative procedures. To them, the initiative’s success implies that they have fulfilled their legal and ethical obligations to the patients. The nurses and ICU physicians are the patients’ primary caregivers, and their crucial duty is to ensure that the patients receive safe and high-quality care. This responsibility also entails preventing any action that may bring harm or deteriorate the patients’ conditions. This initiative provides them with an opportunity where they can improve the patients’ quality of life.
Notwithstanding, to enforce the quality improvement scheme’s functionality, the management could consider incorporating expertise from other professional fields in healthcare. Bosch & Mansell (2015) state that collaboration can reduce preventable medical errors, mortality and morbidity rates, and improve medication dosages. It can also lessen the workload that ICU staff handle and increase both patient and care provider workforce. It will not only build a collaborative environment but also encourage a diversity of ideas and viewpoints for continuous improvement. ICU staff members can procure substantial knowledge and practices from other departments. Since technology is continuously penetrating the healthcare industry, this improvement initiative must incorporate several technological advances. For example, the automated hand hygiene system monitors and provides feedback on whether the staff members comply with the handwashing guidelines. It does not necessitate additional work for the health workers; hence it will not impact its progress. Besides, Rajakaruna et al. (2017) discovered that most countries reported a shortage of medical equipment that failed to support their HAIs reduction initiatives. Other technology shortfalls include poor infrastructure to support isolation. Most of these ICU wards are usually overcrowded, increasing the risk of VAP incidence rates. For this reason, the quality improvement initiative should consider incorporating an online system that would reduce patient density through online appointments and information queries. A similar system can also be built specifically for healthcare professionals to share their information and knowledge on VAP or any other HAI. This way, the staff members can ensure that they stay updated on the changing HAI reduction practices.
In conclusion, quality improvement initiatives aiming to reduce HAIs are vital for the healthcare industry. Since nurses are the core care providers, including them in the plan is essential. HAIs have posed a significant challenge to health promotion and protection. This initiative has proposed to reduce the incidences of VAP through professional training and the bundle approach. It is vital to ensure that all healthcare professionals understand the standard and effective procedures for reducing VAPs. Although issues like inadequate staffing and limited resources have not been addressed, the improvement scheme has successfully attained its intended outcome. Nonetheless, integrating interdisciplinary expertise and technology can reinforce its purpose. An inter-professional team is critical as it builds a collaborative environment and diverse ideas. On the other hand, modern technology, like the automated handwashing and online system, will hasten the scheme’s progress to accomplish the set objectives. Overall, quality improvement is a crucial strategy in promoting patient safety and quality of care.