QI Initiative On Reducing Nosocomial Infections In Wards - Essay Example

QI Initiative On Reducing Nosocomial Infections In Wards Part 1: The problem and mission Selected nursing indicator The newly appointed director of the Clinix realized that the facility’s rate of nosomical infections particularly in the inpatient wards was overwhelming as the figures stood above that recorded by similar hospitals in the state. Clinix is a 200-bed hospital and it has been recording high rate of hospital-acquired infections, which stands at Standardized Infection Ratio (SIR) =2.9 and this figure is above average margin of the entire Nation, which stands at SIR= 0.6. This is according to The National Healthcare Safety Network (NHSN) 2011 data. NHSN is a public health surveillance system that Centers for Disease Control and Prevention (CDC) supports for its healthcare-associated infection (HAI) prevention program (Dudeck, et al, 2013). Standardized Infection Ratio (SIR) is the National metric used to make comparisons of observed number of nosomical infections in the entire US during a particular period with the national baseline experiences. For instance the 5 year National Prevention Target which ends in 2013 stands at 50% reduction in Central Line- Associated Bloodstream Infection (CLBSI) in both intensive care unit (ICU) and wards located patients. This figure translates to a National Standardized Infection Ratio (SIR) for CLABSI=0.5. In other words the national benchmark for nosomical infections is SIR=0.5 as at 2013. It is noteworthy that SIR is often adjusted based on a number of predictor of CLABSI, which include teaching status, location type, central line utilization and bedside. The SIR data is vital in the sense that it indicates whether the infection rate is better, worse, or at the national benchmark. For instance SIR 1 means more HAIs were observed than those predicted from the national baseline data during that particular reporting period while SIR=1 means that no difference was observed (Malpiedi et al, 2013). This means that Clinix’s SIR = 2.9 indicates high HAIs observation more than facilities of similar size and type. According to the director, Mr. Giznids this rate of infection was unfortunate and to that extent intolerable. This is because it translates to additional challenges especially prolonged stay in the hospitals and additional bills on the side of the clients. After exclamations about the fate of the large patient population who were seen to be ailing frequently from infections, the issue was finally brought to the attention of the top managers of the organization as well as clinicians. There was final consensus among all the stakeholders that the rate of infections was too high and thus the need for immediate response to contain the situation and finally bring the rates below average numbers. The problem of hospital-acquired infection looks solvable though it remains a nagging problem not only to Clinix but also to most hospitals across the globe. Nosomica infections are undoubtedly a major burden on all of us. They claim significant number of lives as well as large amount of money. A large number of patients succumb to such nosomical infections from time to time and our management team did not want our cherished clients to form part of the that unfortunate statistics. The infection rate of SIR=2.9 was alarming for the stakeholders and as such, the entire management team felt the entrenched need to reduce infection rates in the wards making it a priority for the organization. According to the previous rates recorded by the organization concerning Nosomical infections, the past two years have recorded the highest infection rates, which stood at SIR=2.1 and 2.4 respectively. In fact, there was great concern that if this issue is not addressed in good time then there was likelihood of higher prevalence in future. Quality improvement (QI) model-PDSA After considering high rate of nosomical infection as a major issue in the hospital wards the next major task was to come up with the most effective infection risk assessment tool that would help the unit improve safety of not only the patients but also other stakeholders operating within the unit. The key stakeholders settled for Plan, Do, Study, Act (PDSA) cycles as the best quality improvement model for the hospital. PDSA cycle was selected because of a number of a number of reasons however the main one the fact that three organizations with the same number of patient population in the state had initially developed and implemented this tool and they were highly successful so it was a nice opportunity for the organization to plan a small test. There is always no guarantee of good results when making changes to the entire organization system or at the unit level and therefore it is advisable to test out improvement plans on small scale before it is rolled out in the entire organization (Tiel et al, 2006). The advantage of testing changes bit by bit before wholesome implementation can only be enjoyed through PDSA cycles. This is because this tool gives the team an opportunity to study the proposed change and see if the desired results are achievable. In other words, PDSA cycle involves trying out new change ideas on a small scale before full implementation across the board. For instance, in our case PDSA will involve testing new ways of reducing hospital-acquired infection for one ward or nurses before moving to other wards or nurses. Change is such an important issue with the organization to an extent that its ownership heavily relies on its ownership. This is why it is vital to involve a number of individuals when introducing new ideas on a small scale before wholesale implementation in order to avoid barriers to change. PDSA cycle involves four major stages which include Plan (states the purpose of PDSA whether it is about developing, testing or implementing change idea), Do (Involves conducting test or change), Study (Analyze the data, study the results and make comparisons based on predictions) and finally Act (Plan for next cycle or full implementation) (Tiel et al, 2006). The team believed that PDCA cycle was the most appropriate tool to undertake continual process improvement in Clinix to solve the existing quality problem, which involves high rate of nosomical infections. This quality improvement (QI) model trains organization’s team on how to plan for an action; carry it out; assess if it is congruent to the plan and finally act on what has already been studied. In other words, PDSA is somehow a learning concept that allows the team to implement a change idea in the entire organization if the change cycle proves successful and ignore the idea if the test was unsuccessful (Tiel et al, 2006). The PDSA steps are important for ensuring that chances of errors are significantly minimized and little time as well as energy is used to improve productivity. Clinix thought of maintaining its quality improvement initiative small and manageable and at the same time build a strong momentum that would ensure early success and as such, PDSA cycle played a significant role in attaining this objective. PDSA ensured that the organization realized not only its short-term but also its long-term goals considering that every step of the cycle was being tested using unique ideas that were applicable in both short and long-term. The QI model for improvement adopted by Clinix has two common components as the PDSA cycle being one of the components only constituted part of the improvement guide that only dealt with the framework for designing, testing and implementing change ideas that would help the organization address its quality problem. The other component of the model covered three key areas, which include the Aim (What the organization was trying to accomplish), Measure (How the organization would know if the change is an improvement) and Change (The changes the organization will make in order to bring improvement). The QI initiative Aim is to reduce nosomical infection rates in Clinix to SIR=0.5 and this is to be accomplished in nine months. To answer the question of how the team will know if a change is an improvement the team will use the outcome and process measures. These QI initiative measures are important for ensuring that the team knows whether the change ideas they have developed, tested and implemented are promoting tangible improvement. Teams will use these measures as a strong evidence to push for change ideas in all the wards. Clinix currently operates three types of wards name male, female and pediatric wards and the focus will be to ensure total implementation of change ideas. The Clinix team plans to use PDSA to change ideas rather than change concepts in order to address the quality problem, which the facility is currently facing in its wards. For instance, the facility plans to test and implement increased hand hygiene in the wards to avoid spread of microorganisms through contact and invasive devices and procedures. Identifying the measures Measures are important in QI initiative to inform the team about their progress in addition to whether their change ideas are leading to a tangible improvement. The team utilized three types of quality measures to assist them in creating targets and achieving their aims. Key among these measures includes Outcome and Process measures. The Outcome measures took into consideration the voices of the clients as well as the system performance. This means that outcome measures lay emphasis on the results of the Quality Improvement model. For instance, it highlights infection rates within a specified period. Process measures on the other hand capture operations of the system considering that looks at the stages in the processes that makes up the system for effective performance. Process measures in our case focused on hand hygiene compliance rates considering that this was the main change idea that was being tested to provide concrete evidence for addressing quality problem. A huge amount of data is available online especially from the CDC’s National Healthcare Safety Network (NHSN) regarding outcome measures especially from other facilities of similar type and size (Bernard, 2012). The team took advantage of this readily available NHSN data to set up goals of the nursing indicator that required QI. For instance, the data from NHSN indicated that most hospitals of the same size and type in the state had SIR of slightly below one (SIR Read More