Quality improvement tools in nursing

An increasingly common job title is quality improvement management nurse. The person in that job does the following:. Experts have also made recommendations for quality improvement in critical care nursing. The process, of course, is similar to quality improvement in other nursing areas, as well as healthcare quality improvement in general.

Recommendations include the following:. Quality improvement tools in nursing are the same as quality improvement tools in healthcare in general.

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Report on key metrics and get real-time visibility into work as it happens with roll-up reports, dashboards, and automated workflows built to keep your team connected and informed. Try Smartsheet for free, today. In This Article. Continuous quality improvement in nursing includes a few broad areas: Quality Assurance: This ensures that your organization provides services that meet appropriate standards for good healthcare.

Quality Improvement: This ensures that everyone in every department of your organization is always working to deliver better healthcare for patients. See how Smartsheet can help you be more effective. Health Professionals Who Have a Role in Quality Improvement in Nursing Healthcare professionals, including nurses, play important roles in quality improvement in nursing.

Here are some important titles and groups: Nurse Executive: This person sets up the structure and ensures that resources are available for quality improvement work. Nurse Manager: A nurse manager oversees staff nurses and can implement a structure to encourage quality improvement.

Quality Assurance Coordinator: This person assists in executing quality improvement processes and collects data to show that the organization meets the requirements set out by insurers and regulatory agencies.

Quality Improvement Nursing Teams: These teams focus on specific ways in which professionals can improve nursing and healthcare in a facility. The guides and factsheets offer project ideas for quality improvement in nursing, including the following: Improving healthcare-related communication about individual patients during shift changes of nurses or other healthcare professionals Improving nursing teamwork Improving patient safety by improving the nursing workload Preventing catheter-related infections Preventing falls and injuries in patients within healthcare facilities Preventing pneumonia that can come from airway ventilators used on patients — called ventilator-associated pneumonia Preventing pressure ulcers bedsores in patients within healthcare facilities Reducing medication errors Reducing nurse fatigue and stress Reducing staff turnover among nurses.

What Is Quality Improvement in Nursing? Nursing and Other Organizations That Work to Promote Healthcare Quality Improvement A number of nursing and healthcare organizations work to promote healthcare quality improvement through education, publishing materials, and guidelines and standards. This article explains 4 critical thinking tools and 2 evidence-based practice tools that nurses can use as adjuncts to the nursing process assess, diagnose, plan, implement, and evaluate to facilitate QI.

In clinical practice, registered nurses use observations, communications, and a stethoscope to assess patients and formulate diagnoses. In quality initiatives, nurses replace their stethoscopes with critical thinking, QI, and evidence-based practice tools. Nurses can use these tools in conjunction with the familiar nursing process to identify areas for improvement and, when appropriate, to plan practices changes.

As in the nursing process, the first step in any quality initiative is to assess the process or problem that needs to be improved. An early initial step is to form an interprofessional team of caregivers. The team should include stakeholders whose practice could be involved in or changed by the initiative. Consider forming an interprofessional team including bedside nurses; physicians; respiratory, physical, and speech therapists; nursing assistants; and unit-based secretaries as well as patients and their families.

Improving clinical practice and sustaining those improvements require leadership support from all levels within the organization. Once the team has been assembled, it should thoroughly assess the problem or quality issue.

When problems occur in the workplace—either as a clinical issue, such as an increase in the number of medication errors, or as a need for improvement, such as a change in workflow—health care workers often want to identify the cause and remedy the situation quickly.

Solving complex problems, however, requires in-depth exploration of both the issue and the factors contributing to it.

Investing the time necessary to complete a thorough assessment is an essential step in improvement. Include as many means of examining the problem as possible, such as unit or hospital data, observations of current practices, conversations with caregivers and stakeholders, and information specific to the local problem. Clinical nurses who provide direct care to patients are in a unique position to identify quality issues.

In addition to clinical nurses identifying quality issues, hospital data—such as quality or risk reports that reveal, for example, an increase in the number of infections or falls—often alert nursing leaders to clinical triggers for improvement, but triggers can also arise from interactions with patients and families or from new knowledge.

Despite the type of trigger for a quality initiative, once the team has identified a problem, the next nursing actions are the same: Complete an inquiry to determine whether the event was a 1-time occurrence or a continuing problem.

Explore current practices to determine the scope of the problem. Also, determine whether this issue is a priority for the organization. In general, selecting continual problems that are a high priority for the organization will result in increased administrator and staff buy-in.

After the scope of the problem has been evaluated and the problem determined to be a priority, clinicians should review the current literature related to the problem. This step is still early in the QI process. During the literature review, look for background information to determine the characteristics of the problem, its prevalence at other centers, and factors that contribute to it. Many hospitals have adopted formal programs such as Lean methodology or Six Sigma to assess and manage improvement efforts.

The items in the toolkits can be combined to best suit the improvement need. Scoville and Little 17 suggest that no 1 method is superior to another and that a combination of tools that are specific to the problem, rather than to the QI method, might best serve patients. A foundation for any assessment is built from targeted, direct observations that qualified clinicians make at the point of care. Clinicians can gather important information by going into clinical units, watching care being delivered, and asking questions of the direct caregivers.

The purpose of these observations and questions to staff is not to assign blame but to understand fully the factors that have led to the clinical problem. When observing a unit, team members may find that more than 1 factor contributes to the quality issue.

For example, a nurse manager in a medical intensive care unit noted a high rate of central catheter—associated bloodstream infection. The nurse manager convened a team that included a nurse leader, a critical care medicine physician, staff nurses, an infection control nurse, and nursing assistants.

After being assembled, the team decided to observe the process of a nurse caring for central venous catheters on the unit. The team decided to investigate the workflow further to determine whether the multiple interruptions to care resulting from the nurse obtaining supplies was routine on the unit or an anomaly.

Conversations with staff confirmed that supply carts were inconsistently stocked, and the bedside carts did not always have the supplies necessary for dressing changes. The process in place for replenishing supplies seemed to be broken.

The team decided to complete a Spaghetti Diagram, a visual tool that allowed them to examine the flow of people within the unit to determine whether the layout or organization of supplies could be improved. After counting the lines on the diagram and the steps the nurse took to gather supplies, the team noted an excessive number of trips to the supply area; this finding indicated that the restocking process needed to be improved.

The observations also illuminated other workflow problems, such as the need to call frequently for more supplies on busy days or to leave the unit to obtain equipment.

A second Spaghetti Diagram created after the reorganization depicts improvements in workflow Figure 2. After assessment, the next step in the nursing process, diagnosis, requires nurses to synthesize what they found during the assessment into information that is meaningful for patient care. A report card on continuous quality improvement. Assessing the impact of continuous quality improvement on clinical practice: what it will take to accelerate progress.

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Research has shown that heavy nursing workloads adversely affect patient safety. NEJM study on the association of nurse workload and increased inpatient mortality. The following general resources provide key information on the role of nurses in improving quality of care. IOM report examining the future of the nursing workforce. Implementation guide for nursing sensitive care measures. CDC Publication, April Infectious Disease Special Edition, September Fact Sheet.

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Nurse turnover: a literature review. Int J Nurs Stud ; Content last reviewed November Browse Topics.