DISCUSSION QUESTION: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.
PEER POST 1:
As stated in our textbook, quality improvement in healthcare aides in ensuring
that current, clinically proven techniques and practices are being used to
deliver the safest and highest quality care for patients (Helbig, 2018). As part
of the nursing residency program, we needed to come up with a quality
improvement initiative as a team on whatever unit we worked on. I left before
it was finished and the educator leading the program recently quit so the whole
thing never came to fruition, but I thought it was a good idea anyway. Hospitals
are running rampant with the sepsis bundle protocol, in some ways
inappropriately, of which one of the main qualifiers is either a high or low
temperature. On the critical care unit, I worked on as on most critical care
hourly vitals are part of the day which in septic patients includes temperature.
Most patients who are septic are welcomed to the floor with an inserted
urinary catheter for which my idea was if you are giving them a catheter why
not insert one with a temperature probe. Having an elevated temperature
increases metabolic demand and oxygen consumption, which results in a
corresponding increase in cardiac output (Golding, Taylor, Gardner, &
Wilkinson, 2016). On the opposite end hypothermia has shown a greater
mortality rate in those who have been diagnosed with sepsis (Golding et al.,
2016). Targeted temperature control management has been proven to provide
better outcomes in patients post-cardiac arrest, traumatic brain injury and
preliminary studies of patients with sepsis (Golding et al., 2016). By placing a
temp-sensing catheter in a patient who is critically ill or meets the sepsis
criteria much more attention can be paid to the critical outcomes that
surround high or low body temperature.
References
Golding, R., Taylor, D., Gardner, H., & Wilkinson, J. (2016). Targeted
temperature management in intensive care – Do we let nature take its
course? Journal of Intensive Care Society, 17(2), 154-159.
https://doi.org/10.1177/1751143715608642
Helbig, J. (2018). Reengineering Health Care Management. In Nursing
leadership & management leading and serving. Retrieved from
https://lc.gcumedia.com/nrs451vn/nursing-leadership-and-managementleading-and-serving/v1.1/#/chapter/5
PEER POST 2:
Speaking of continuous quality improvement, it is hard not to mention Florence
Nightingale as a reminder that healthcare has constantly been evolving and
modifying. Florence Nightingale has greatly improved the quality of health care
back in the 19thcentury. One of her areas of improvement was infection
prevention. She reduced number of beds in the same room to avoid
overcrowding, provided ventilation and made sure the drains were disinfected
daily to provide sanitary conditions for sick and wounded (Sheingold & Hahn,
2014). Florence Nightingale is a stellar example of proving that the continuous
quality improvement is every nurse’s duty and should be taken into
consideration constantly. The purpose of continuous quality improvement (CQI)
programs is “to improve health care by identifying problems, implementing and
monitoring corrective action and studying its effectiveness” (Burrow, 2016). My
first nursing job was at a subacute rehab center patient population of which
was mostly geriatric population. I truly enjoyed working there and grateful for
the experience I gained. The area that needed improvement there was
definitely the admission/discharge process. Taking care of 10-11 patients is a
pretty heavy workload on its own. Besides that, a floor nurse was responsible
for the admission and discharge process such as verifying transferred
medication orders, placing medication orders into the computer system, 6
admission assessments (including full physical), orient to the patient room, etc.
It is very time consuming and I believe it should be done by a designated
rehabilitation nurse who does only admission and discharges. This would greatly
decease a risk for error or patient/employee dissatisfaction.
References:
Burrow, G. (2016). More circles in your practice. Retrieved
from https://essentialsofcorrectionalnursing.com/tag/continuous-qualityimprovement/
Sheingold, B. H., & Hahn, J. A. (2014). The history of healthcare quality: The
first 100 years 1860–1960. International Journal of Africa Nursing Sciences,1,
18-22. doi:10.1016/j.ijans.2014.05.002
PEER POST 3:
Continuous quality improvement emerged by American Deming in 1950 (Jing et al.,
2018). The current workplace made it mandatory to utilize 2 RN’s to place Foley catheter
to make sure that sterile protocol is followed. Both nurses have to initial the label and
place on bag which also has insertion date and time. I wish that we used that at last
hospital. There used to be no labels on foley to find out the insertion date for sure. This is
very important for patients who come with foley or get discharged with that. It needs to
be replaced monthly. Quality improvement topics focus on improving certain area
(Connelly, 2016).
Connelly, L. M. (2016). Understanding Research. A New Format for CQI
Articles. MEDSURG Nursing, 25(2), 120. Retrieved from https://searchebscohostcom.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=114665016&sit
e=eds-live&scope=site
Jing Hu, Zuoliang Liu, Jun Liu, & Hao Zhang. (2018). Reducing the occurrence rate of
catheter dysfunction in peritoneal dialysis: a single-center experience about
CQI. Renal Failure, (1), 628. https://doiorg.lopes.idm.oclc.org/10.1080/0886022X.2018.1515084
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