Imagine you have been asked to prepare and deliver an analysis of an existing QI initiative at your workplace. The QI initiative you choose to analyze should be related to a specific disease, condition, or public health issue of personal or professional interest to you. The purpose of the report is to assess whether the specific quality indicators point to improved patient safety, quality of care, cost and efficiency goals, and other desired metrics. Your target audience is nurses and other health professionals with specializations or interest in your chosen condition, disease, or public health issue.
In your report, you will:
- Analyze a current QI initiative in a health care setting.
- Identify what prompted implementation of the QI initiative.
- Evaluate problems that arose during the initiative or problems that were not addressed.
- Evaluate the success of a current QI initiative through recognized benchmarks and outcome measures as required to meet national, state, or accreditation requirements.
- Identify the core performance measurements related to successful treatment or management of the condition.
- Evaluate the impact of the quality indicators on the health care facility.
- Incorporate interprofessional perspectives related to the success of actions used in the QI initiative as they relate to functionality and outcomes.
- Recommend additional indicators and protocols to improve and expand outcomes of a current quality initiative.
- Ensure your analysis conveys purpose, in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly writing standards.
Be sure to address all of the bullet points. You may also want to read the Quality Improvement Initiative Evaluation Scoring Guide to better understand the performance levels that relate to each grading criterion.
Quality Improvement Initiative Evaluation 1
Quality Improvement Initiative Evaluation
Jonathan Fisher
School of Nursing and Health Sciences, Capella University
MSN-FP6016: Quality Improvement of Interprofessional Care
February 2021
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Quality Improvement Initiative Evaluation 2
Quality Improvement Initiative Evaluation
The purpose of this paper is to provide an analysis of a quality improvement initiative at
my workplace. I will provide an overview of our current initiative and examine our metrics related
to the initiative to evaluate its successes and shortcomings. I will include an overview of how
interprofessional teams impact the both the initiative and the related condition. Finally, I will
provide recommendations for how the initiative could be improved or expanded with the goal of
continuing to improve the quality of care that our organization is providing to our patients.
Analysis of Current Quality Improvement Initiative
The current Quality Improvement initiative I will be examining is the catheter-associated
urinary tract infection prevention bundle. Our institution’s current bundle has been in use for more
than five years and is largely unchanged. There has been increased focus and re-education on
specific aspects of the bundle at different times along with minor changes aimed at decreasing the
incidence of false positive results for urine cultures. Our CAUTI prevention bundle includes a
nurse-driven protocol for insertion and removal, emphasis on sterile insertion, proper maintenance
and cleaning, and early removal. When we have had an increased incidence of catheter-associated
urinary tract infections the primary re-education has focused on decreasing device days unless the
incident review discovered other problems such as inadequate foley care, inappropriate flushing of
the catheter, or other missteps in the maintenance bundle.
Success of Current Initiative
The current catheter-associated urinary tract infection prevention bundle that is in use has
been credited with a large part of our success as an organization in meeting or exceeding our
benchmark goals. Our current hospital-wide incidence over the past year is 1.14 per 1,000 catheter
days. In addition, our intensive care units across the hospital have also made significant
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Quality Improvement Initiative Evaluation 3
improvements over the last several years and despite the higher risk profile in our patient
population, the combined incidence in the intensive care units is 1.2 per 1,000 catheter days which
is only marginally higher than the average incidence across all units in the hospital.
While the organization has made significant progress using the current initiatives, it seems
to be difficult to maintain continuous improvement beyond this level. The primary focus at this
point seems to be to watch for areas or units that have significantly higher rates than the hospital
average in order to provide targeted education to the staff in those areas. When a particular unit or
provider group has a higher than average or higher than expected incidence the primary cause is
often determined to be an increase in device days. This leads to the primary intervention being to
simply reeducate on the appropriated indications for a catheter and a re-emphasis on early
removal. While there is evidence that a nurse-driven protocol can and should significantly reduce
device days (Schiessler, 2019), there also needs to be adequate measure in place to decrease the
risk of an infection in those patients who truly need a catheter, especially if that catheter is needed
for an extended period of time.
A further example of how we may be nearing the end of the capabilities of a catheter-
associated urinary tract infection prevention bundle is the fact that in recent months the focus
within the infection control department of the organization has shifted slightly towards ensuring
more accurate measurement. In other words, we have decreased our incidence of catheter-
associated urinary tract infections to the point where one or two false positives will not only mean
potentially unneeded treatment for that individual patient, it could also significantly skew our
metrics. In addition, given the size of the hospital, it is not unusual for an individual unit to go an
entire calendar year with only one or even no catheter-associated urinary tract infections. While
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Quality Improvement Initiative Evaluation 4
this is obviously a testament to the progress that has been made, it can make it hard to relay the
importance of continuous improvement to the front-line staff.
Interprofessional Perspectives
As with any hospital acquired condition, interprofessional cooperation is also a significant
factor in reducing catheter-associated urinary tract infections incidence. The primary
interprofessional interactions related to foleys is between nursing staff and physicians. While
CAUTIs are primarily viewed as nursing sensitive quality indicators, the entirety of the healthcare
team and the organization need to take responsibility for decreasing them. The Joint Commission
(2017) alludes to this need for a broader view of patient safety in their list of National Patient
Safety Goals as they name both preventing infections and improving staff communication as
important aspects for the organization as a whole to embrace as ongoing goals. In addition,
Shojania (2020) makes the case that a narrow focus on individual metrics has only a limited
potential for improvement in that particular metric. Rather than focusing solely on individual
interventions we also must focus on teamwork, cultural change, and communication and include
these aspects in our overall approach to patient safety.
One example of this need for interprofessional collaboration is in patients in our Neuro-
Intensive Care Unit. These patients frequently have a foley place at the recommendation or
request of the neurosurgery team. While there are definitely times when a foley is indicated, the
neurosurgery team frequently insists on the foley primarily for accurate monitoring of intake and
output when that is far from the only option. In discussion with members of the neurosurgery
team, it becomes obvious that they are focusing only on their specialty and not really looking at
the patient as a whole. In addition, they are frequently a consulting service and not the patient’s
primary care team so they may not receive any notification if the patient does develop a catheter-
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Quality Improvement Initiative Evaluation 5
associated urinary tract infection in the future. When a patient who is under their care has a foley
placed they are also very likely to have the foley in place for much longer than is necessary. This
is partly due to the fact that they typically bypass the nurse-driven aspect of the foley protocol and
want to decide as physicians whether the patient is ready to have the foley removed.
Additional Recommendations
While we have made steady improvements over the last several years, I think there are still
a number of areas where we as an organization can make a big difference in catheter-associated
urinary tract infections prevention. One recommendation is to put more emphasis on tracking
device days for foleys rather than focusing primarily on times when the foley causes a urinary
tract infection. This would allow units that have a very low overall number of infections to have a
measurable goal to work towards. In addition, all units and all physician service groups
throughout the organization should be included in receiving information about recent infections
and what parts of the prevention bundle may have been missed. If one of the intensive care units
receives the information that there was a recent catheter associated urinary tract infection and the
chart review showed that the foley should have been removed days earlier than it was they are
more likely to pay more attention in the future than if they are only told that one of the other units
in the hospital had an adverse event but they still have not had any.
An additional recommendation is to increase the accountability of all interprofessional
team members for catheter-associated urinary tract infections prevention. If neurosurgery thinks
that a patient, they are consulted on meets the criteria for a foley, there should be a discussion both
with the nursing team and with the primary physician service rather than a unilateral decision. The
organization as a whole needs to continue to work towards a culture where every catheter-
associated urinary tract infection is treated as a serious event that should have been prevented. In
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Quality Improvement Initiative Evaluation 6
addition, it needs to become the norm within the organization that foleys are used only when
absolutely necessary and they are taken out as quickly as possible. One simple way to decrease the
time to removal would be to simply make foleys a standard part of interdisciplinary rounds. While
the entire team is a part of rounds, the information is primarily presented by the physician team
and as such when devices are addressed the primary focus is on devices in which the physician
team must be involved in the removal of. Endotracheal tubes and whether the patient is ready to
have it removed is always a part of the discussion, but the foley and whether it can be removed
can easily be missed.
Conclusion
In conclusion, our organization has a wide-ranging bundle related to prevention of
catheter-associated urinary tract infections. The bundle addresses prevention of unnecessary foley
placements, sterile technique during insertion, multiple aspects of daily care during the
maintenance phase, and an emphasis on early removal of the device. This bundle has been shown
to be effective in many institutions and has led to a significant decrease in incidence of catheter-
associated urinary tract infections within our organization. Though we are consistently at or close
to our benchmark goals, we continue to look for ways to improve the care we are providing to our
patients. The primary recommendations that I provide are focused more on building the teamwork
and the culture necessary to both decrease our device days and decrease our incidence of catheter-
associated urinary tract infections.
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Quality Improvement Initiative Evaluation 7
References
Montalvo, I. (2007).The national database of nursing quality indicators. Online Journal of Issues in Nursing, 12(3), 1–11.
Schiessler, M., Darwin, L., Phipps, A., & Hegemann, L. (2019). Don't Have a Doubt, Get the Catheter Out. Pediatric Quality & Safety., 4(4). https://doi.org/10.1097/pq9.0000000000000183
Shojania, K. G. (2020). Beyond CLABSI and CAUTI: Broadening our vision of patient safety. BMJ Quality & Safety, 29(5), 361. doi:http://dx.doi.org.library.capella.edu/10.1136/bmjqs-2019- 010498
The Joint Commission. (2017). National patient safety goals. Retrieved from https://www.jointcommission.org/standards_information/npsgs.aspx
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By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
· Competency 2: Plan quality improvement initiatives in response to routine data surveillance.
· Recommend additional indicators and protocols to improve and expand outcomes of a quality initiative.
· Competency 3: Evaluate quality improvement initiatives using sensitive and sound outcome measures.
· Analyze a current quality improvement initiative in a health care setting.
· Evaluate the success of a current quality improvement initiative through recognized benchmarks and outcome measures as required to meet national, state, or accreditation requirements.
· Competency 4: Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work life quality.
· Incorporate interprofessional perspectives related to the success of actions utilized in a quality improvement initiative as they relate to functionality and outcomes.
· Competency 5: Apply effective communication strategies to promote quality improvement of interprofessional care.
· Convey purpose, in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly writing standards.