4-Continuous Quality Improvement (CQI) is defined by the American Society for Quality (ASQ) as “a philosophy and attitude for analyzing capabilities and processes and improving them repeatedly to achieve customer satisfaction”. (Huber 292) CQI is something that is relevant to all nurses as we all need to be responsible for continual improvement at work. As professionals we should always have this as a top priority. There are many challenges in the workplace, and by looking for ways to improve, we are constantly learning and growing as a profession, this is a large piece of evidence-based practice, which is something we all hold as a standard in healthcare today.
An example of how I would apply CQI in my current position working as a nurse circulator in the operating room, is to ensure that the time out procedure is followed every single case I circulate. This is important as we often get complacent in rules and regulations, as do surgeons that we are trying to keep happy as they are customers just as much as our patients are.
I had circulated a case with another nurse during orientation in which not all implants for a total knee replacement were in the room. I was not notified of this until after the case started, the patient was anesthetized, and time out had been completed though this requirement was not stated/asked. Later the rep for the implants then stated the implants were in route from another location. This is unacceptable, and I am glad that I was still in orientation at the time this occurred as it was a great learning experience for me. I learned how to write an incident report that day, and why the time out procedure is so important.
Huber, Diane. Leadership and Nursing Care Management, 5th Edition. Saunders, 10/2013. VitalBook file.
5-Health care delivery requires structure (staff, education, equipment, prospective data collection), and process (policies, procedure, protocols), which when integrated provide a system (programs, organizations, cultures) leading to outcomes (patient safety, quality, satisfaction). An effective health care system has all of these elements – structure, process, system, and patient outcomes in a framework of continuous quality improvement, or CQI (Kronich et al., 2015).
The purpose of QCI is to improve health care by identifying problems, implementing and monitoring corrective action and evaluating its effectiveness. Hospitals use a specific process to find areas in the health care delivery system that need improvement. When an area has been found, staff develop and implement strategies for improvement. General areas that are being studied include access to care, continuity of care, the intake process upon admission, emergency care, and adverse patient events, including all deaths (National Commission on Correctional Care, 2018).
In my previous position, working as a NICU RN, we initially did not use two RN’s to verify the content in the TPN-bags for each patient. Shortly after I started working at this facility, this change was implemented. The purpose was to catch medical errors from pharmacy that sadly was occurring more frequently. This new process of reading labels with another RN while verifying the content with the document from pharmacy, and then hanging the TPN required more time in the nurses’ day. In addition, all this was done toward the end of day-shift around 1730. This process resulted in stress among the RN’s and often overtime, which was not appreciated by management. Thankfully, a solution was found by changing the time of day TPN was delivered to the unit. By working together and brainstorming solutions, everyone was satisfied in the end; quality of care was improved, and the nurses were able to finish their duties in time.