Topic 8: Overview of Quality in Health Care
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Topic 8: Overview of Quality in Health Care
Healthcare quality is the extent to which health services for persons and populations increase the chances of achieving desired outcomes and are congruent with the current professional knowledge. Nearly every healthcare organization is involved in continuous quality efforts to identify and employ better and more effective clinical care practices (Allen-Duck et al., 2017). In this regard, this paper will explore a patient safety concern and discuss how EBP, research, PI, and QI process can address the issue and organizational culture to consider.
Description of Issue and Challenges
Catheter-associated urinary tract infection (CAUTI) is a common patient safety concern accounting for approximately 25% of hospital-acquired infections (HAIs). However, most CAUTI cases are preventable. The risk factors for CAUTI include prolonged periods of catheterization, errors in catheter care, colonization of the drainage bag by microbes, and catheterizat
ion late in the hospital course (Chuang & Tambyah, 2021). Patients at a higher risk of developing CAUTI include those not antimicrobial therapy, females, immunocompromised, and those with diarrhea, diabetes, and renal insufficiency (Chuang & Tambyah, 2021). Besides, critically ill patients with neuro-diseases have a 2-5 times higher risk of developing CAUTI due to increased use of indwelling urinary catheters since they have neurogenic urinary retention.
More than 25% of all hospitalized patients have a short-term, indwelling urinary catheter inserted during their hospital stay. However, a significant number of these urinary catheters are inserted without proper indications. CAUTI is associated with adverse consequences, including prolonged hospital stay, increased health care costs, reduced quality of life, and mortality (Cortese et al., 2018). According to Bysshe et al. (2018), the additional costs for hospital-acquired CAUTI are approximated to be $13,793. In addition, the excess mortality is approximated at 0.036 per Hospital-Acquired Condition case, meaning for every 1,000 hospital-acquired CAUTI cases, there are 36 excess mortalities.
Utilizing EBP, Research, and PI
Evidence-based practice (EBP) can be utilized to address CAUTI through its seven-step approach. The first step is asking a clinical question in a PICOT format by identifying an intervention of interest, which will be compared with the current practice, and determining the outcome of interest (Cullen et al., 2020). For instance, the intervention of interest can be using 0·1% chlorhexidine solution for meatal cleaning, comparing it with the current practice of using 0·9% normal saline for meatal cleaning with an expected outcome of reduced CAUTI. The next phase will be to search for the best evidence related to the intervention of interest and critically appraise the evidence to establish if the literature identified from the search is relevant and reliable (Cullen et al., 2020). The evidence from the literature search will then be integrated with patient assessments, clinical expertise, outcome data, patient preferences, and values. After implementing the intervention of interest, the outcomes will be evaluated and the EBP results disseminated.
Research in healthcare involves advancing current knowledge about clinical care by constantly developing and assessing new ideas about diseases, procedures, and strategies. Research would address CAUTI through developing, testing, and evaluating various interventions of interest (Chien, 2019). A clinical trial is an example of a research approach that can test an intervention to determine its effectiveness in reducing CAUTI. A randomized control trial can compare the effectiveness of two interventions. The clinical trial results would generate knowledge on strategies to implement to reduce CAUTI.
Performance improvement (PI) in health care is a continuous process whereby interventions related to defining, measuring, and improving quality are incorporated into the structure and functioning of the organization (Allen-Duck et al., 2017). PI can establish long-term interventions to improve the quality of care related to catheterization. It can be applied to evaluate current practice in catheterization, identify gaps, and implement interventions to improve practices in catheterization to reduce the incidence of CAUTI. The interventions can then be continuously evaluated to promote the best quality of care possible.
PI and QI Process
The Plan Do Study Act (PDSA) is a QI process applied to improve a practice or make a change. It is a cyclical four-stage problem-solving process that involves dividing a task into steps, then evaluating the outcome, improving it, and evaluating again (Knudsen et al., 2019). When using PDSA, one should define what they want to accomplish, how they will establish that a change is an improvement and the changes in practice that will improve the process. PDSA can be applied to address CAUTI by first defining the desired outcome from a QI initiative, for example, reducing CAUTI cases by 50% (Knudsen et al., 2019). The next step can be to establish what change will be defined as an improvement, such as decreased CAUTI incidence. This will be followed by identifying changes in clinical practice that will help achieve the decreased incidence of CAUTI, such as using an antiseptic solution in cleaning.
The PDSA cycle was selected because it works best when an organization establishes new processes and would thus effectively implement new practices in catheterization. Besides, PDSA is a cyclical approach and would help apply a new practice on a few units and gradually expand it (Knudsen et al., 2019). PDSA helps promptly identify a non-value-added practice and find approaches to eliminate it while saving costs.
Data Sources: Describe your data sources, including outcome and process data.
Data on CAUTI will include outcome and process data from outcome and process measures. Outcome data determines the effect of the health care interventions or services on patients’ health status (Jazieh, 2020). On the other hand, process data indicates what an organization or the health providers have done to improve or maintain clients’ health. It reflects the accepted clinical practice recommendations and is used to identify the root cause of a problem in a health organization (Jazieh, 2020). Outcome data will include the number of hospitalized patients diagnosed with CAUTI. The data will be sourced from patient health records. Process data will include: the percentage of patients cleaned with an antiseptic solution during catheterization; the number of days a patient stays with an indwelling catheter; the number of catheterized patients on antibiotic therapy; the number of reported errors in catheter care; the number of catheterized patients with proper indications. The data will be sourced from patient health records and patient charts.
Capturing and Disseminating Data
Data on the incidence of CAUTIs will be captured via the HAI database, which registers all incidences of HAIs. The data to be obtained from the database include Patient age, sex, medical diagnosis, number of catheter days, current medication, the solution used in meatal cleaning, indications for catheterization, and length of hospital stay. Data will be disseminated to healthcare professionals, including physicians, nurses, infectious disease specialists, and healthcare leaders. Data on the incidence of CAUTI will be disseminated via the hospital’s website. Besides, EBP results will be disseminated through medical journals and publications to target health professionals from other organizations.
Organizational Culture Considerations
Organizational culture denotes the common ways of feeling, thinking, and acting in healthcare organizations. Evidence links organizational culture with quality of care, and cultural ideas are considered fundamental to QI methods (Mannion & Davies, 2018). Organizational cultures vary, including dynamic, people-oriented, process-oriented, and results-oriented. A QI initiative can easily be adopted in organizations with a dynamic culture since they are flexible and not limited by bureaucratic procedures and policies. Besides, the culture emphasizes continuous innovation and improvements (Mannion & Davies, 2018). Organizations that are result-oriented have a strong focus on customer satisfaction. Therefore, a QI initiative would thrive since innovation is encouraged to improve outcomes and patient satisfaction.
Conclusion
Quality improvement efforts can significantly improve the quality and safety of patient care in an organization. EBP can address CAUTI by integrating best evidence from literature search with patient assessments, clinical expertise, outcome data, patient preferences, and value. Research can address CAUTI by developing, testing, and evaluating various interventions to generate knowledge on their efficacy. PI can address CAUTI by implementing long-term interventions to improve the quality of care. The organization’s culture should be considered when proposing a QI initiative since it determines how well the initiative will be adopted.
References
Allen-Duck, A., Robinson, J. C., & Stewart, M. W. (2017). Healthcare Quality: A Concept Analysis. Nursing Forum, 52(4), 377–386. https://doi.org/10.1111/nuf.12207
Bysshe, T., Gao, Y., Heaney‐Huls, K., Hockenberry, J., Hovey, L., & Laffan, A. M. (2018). Estimating the additional hospital inpatient cost and mortality associated with selected hospital‐acquired conditions.
Chien, L. Y. (2019). Evidence-based practice and nursing research. The Journal of Nursing Research, 27(4), e29. https://doi.org/10.1097/jnr.0000000000000346
Chuang, L., & Tambyah, P. A. (2021). Catheter-associated urinary tract infection. Journal of Infection and Chemotherapy, 27(10), 1400-1406. https://doi.org/10.1016/j.jiac.2021.07.022
Cortese, Y. J., Wagner, V. E., Tierney, M., Devine, D., & Fogarty, A. (2018). Review of Catheter-Associated Urinary Tract Infections and In Vitro Urinary Tract Models. Journal of healthcare engineering, 2018, 2986742. https://doi.org/10.1155/2018/2986742
Cullen, L., Hanrahan, K., Farrington, M., Anderson, R., Dimmer, E., Miner, R., … & Rod, E. (2020). Evidence-based practice change champion program improves quality care. JONA: The Journal of Nursing Administration, 50(3), 128-134. https://doi.org/10.1097/NNA.0000000000000856
Jazieh, A. R. (2020). Quality Measures: Types, Selection, and Application in Health Care Quality Improvement Projects. Global Journal on Quality and Safety in Healthcare, 3(4), 144-146. https://doi.org/10.36401/JQSH-20-X6
Knudsen, S. V., Laursen, H. V. B., Johnsen, S. P., Bartels, P. D., Ehlers, L. H., & Mainz, J. (2019). Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects. BMC health services research, 19(1), 1-10. https://doi.org/10.1186/s12913-019-4482-6
Mannion, R., & Davies, H. (2018). Understanding organizational culture for healthcare quality improvement. BMJ, 363. https://doi.org/10.1136/bmj.k4907
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