APPLYING PROCESS IMPROVEMENT MODELS

Teba L Seaborn

For this practice project, I will be working on safety improvement in the outpatient hemodialysis unit to reduce patient falls in the older adult population. The plan-do-study-act (PDSA) tool is the improvement model that would deliver the best patient outcomes for this practice problem.

The PDSA cycle model is one of today's most widely acknowledged quality improvement tools (Spath,2018). It is a tool that is a four-part action-based cycle that allows a group to:

- Plan: develop a plan that identifies the who, what, when, and where of a problem and a change to address it

-Do: workgroups facilitate interventions, gather data, and examine barriers.

-Study: data evaluation occurs by comparing results against goals to determine the intervention's effectiveness.

-Act: improvements or modifications are made to the changes implemented based on the information gathered (Quigley et al., 2007).

To develop the plan for my practice problem, the following steps of the PDSA will occur:

1. Plan phase-The first step in preventing falls via this practice exercise will include stating the objective of this project which is to decrease the number of older adult patient falls to zero in one month. They will be measured in the absolute number of monthly falls (Spath,2018). The process will begin by identifying which patients are most at risk for falls and when it is most occurring.

During ongoing conversations and our monthly quality assurance and performance improvement (QAPI) meeting, my mentor and other vital leaders identified eleven out of 72 patients needing a fall-risk assessment. Falls were underreported because staff did not define falls the same. Changes need to occur in these areas. This will be accomplished by educating staff on what constitutes falls, fall risks, accurate Morse fall risk screening documentation, and concise incident reporting (Thatphet et al., 2021). I expect an outcome of improved fall risk assessment screenings on admission and quarterly for each patient at 100%. 

2. Do phase- Information gathered from incident reports suggests that the facility has sustained five falls in-center or on the facility property. It was discovered that the majority of the falls occurred post-treatment. Interventions mentioned above will be implemented, and changes targeting evaluation of the patient's gait after the final blood pressure (BP) is at least 100/60. Another valuable measure to implement is the timed-up-and-go (TUG) test from the dialysis chair. During this test, the clinician has the client sit in a chair, then perform tasks like standing, walking certain distances, and turning at directed angles as the examiner evaluates how long it takes to complete (Sprint et al., 2015). This test will also help determine if it is safe for the patient to ambulate independently after treatment.

3. Study phase: In this phase, fall risk documentation and any results from the TUG test will be assessed. Evaluation of the standardized definition of falls and a review and selection of the most reliable fall risk screening tool occur (Quigley et al., 2007). Post-treatment blood pressure will also be reviewed. A comparison will be made to see if goals were met. An analysis of a reduction in fall rate to the expected goal of zero in one month will be determined. Risk assessment documentation will be reviewed to see if it increased to 100% of patients with assessments on file as expected.

4. Act phase-Fall assessment reminders will be taped to each entry/exit door on the treatment floor, staff breakroom, staff bathroom, and at the patient scale. A fall risk assessment compliance report will be activated to view changes. Suppose improvement is substandard and goals still need to be met. In that case, another cycle of PDSA will be implemented on a larger scale that might include targeting subgroups of patients or more actions to address fall risk assessment compliance.

The PDSA cycle would be repeated for multiple rounds until practice project goals are met.

 

References:

Quigley, P., Neily, J., Watson, M., Wright, M., & Strobe, K. (2007). Measuring fall program outcomes.  Online journal of issues in nursing,  12(2), 8.

Spath, P. (2018).  Introduction to healthcare quality management (3rd ed.). Chicago, IL: Health Administration Press.

Sprint, G., Cook, D. J., & Weeks, D. L. (2015). Toward Automating Clinical Assessments: A Survey of the Timed Up and Go.  IEEE Reviews in biomedical engineering,  8, 64–77.  https://doi.org/10.1109/RBME.2015.2390646Links to an external site.

Thatphet, P., Kayarian, F. B., Ouchi, K., Hogan, T., Schumacher, J. G., Kennedy, M., & Liu, S. W. (2021). Lessons Learned From Emergency Department Fall Assessment and Prevention Programs.  Cureus,  13(7), e16526.  https://doi.org/10.7759/cureus.16526Links to an external site.