bateful

Model of Nursing Clinical
Practice Work Group
 Ginette Rodger • grodger@
ottawahospital.on.ca
Communication Work Group
Co-Chairs:
 Sue Eggleton • Ext. 71546
 Valerie Wilkie • Ext. 16235
Vol. 7 No. 3 • Fall 2005
Special Edition
NURSING QUALITY IMPROVEMENT
From the desk of the
Vice-President
Professional Practice and
Chief Nursing Executive
T
Photo: Couvrette/Ottawa
The Quality Improvement Month is a time to reflect on our progress in the pursuit of enhanced quality of care. I recall five years ago
when the Board of Directors asked “what is the quality of nursing
care at TOH?” It was not possible to answer the question from the
data we had, so we embarked on a journey… To date
the hospital has identified a commitment to quality
as one of its core values, the Board of Directors has
established a Quality Committee and the hospital
has a Quality Council which includes now, two nurses
elected by you; Carole St Denis and Jennifer WainmanMcNaught. In nursing we have a Nursing Quality
Improvement Work Group which guides our program
both for the continuous quality improvement projects
and for monitoring overall nursing quality. As we go
to print there are 297 improvement projects being
pursued and we have implemented four of the five
nursing sensitive indicators of quality; skin care, falls,
Ginette L. Rodger
restraints, patient and nurses’ satisfaction, plus we are
Vice-President Professional
working on pain management indicators. We are comPractice and Chief Nursing
Executive
mitted to quality and will keep pace with monitoring
validated nursing sensitive indicators as they are developed. We will be able to answer the Board’s question by
sharing
our results among ourselves, with the Board,
I n s i d e t h i s i s s ue…
and with our community. It is part and parcel of our
 What is Continuous Quality
professional accountability and I commend you for
Improvement (CQI)?
this incredible progress.
 How do we do CQI at TOH?
Dr. Ginette Lemire Rodger
 Highlights of Nursing Quality
VP
Professional Practice and
Improvement activities at TOH
Chief Nursing Executive
Nursing Quality Improvement
Work Group
Co-Chairs:
 Marlene Mackey • Ext. 16979
 Gail Marcogliese
Nursing Informatics Reflective
Group
Contact:
 Barbara Blair • Ext. 12639
Nursing Research Work Group
Co-Chairs:
 Chantal Mercier • Ext. 16035
 Diane Fillion • Ext. 71366
Nursing Policy, Procedure,
Protocol Work Group
Co-chairs:
 Susan Madden • Ext. 13945
 Lucie Bussière • Ext. 71510
Nursing Professional Practice
Committee
Chair:
 Ginette Rodger • Chief Nursing Executive • grodger
@ottawahospital.on.ca
Nursing Week Work Group
Co-chairs:
 Nancy Jacobs • Ext. 88236
 Ginette Rodger • grodger@
ottawahospital.on.ca
ONA Local 83
Contact:
 731-1314 •
ottawahospitallocal83
@sympatico.ca
Corporate Nursing Clinical
Practice Committee
Co-Chairs:
 Evelyn Kerr • Ext. 16060
 Angie Stackhouse
Recruitment, Retention,
Recognition Work Group
Co-Chairs:
 Cheryl-Anne Smith •
Ext. 17894
 Nancy Jacobs • Ext. 88236
Education Work Group
Contact:
 Riek van den Berg • Ext.
78439
 Nancy Frazer • Ext. 16522
Management Work Group
Chair:
 Lorraine Clark • Ext. 13571
Advanced Practice Nurse
Work Group
Co-Chairs:
 Sharon Brez • Ext. 13038
 Dianne Rossy • Ext. 13448
What is Continuous
Quality Improvement
(CQI)?
Q
Quality can have a very different meaning for a
family member standing at the patient’s bedside, a
transportation worker taking a patient to the operating room or a nurse hurrying down the corridor to
answer a patient call bell.
Each one holds different perceptions of quality.
You may have heard people talking about Quality Assurance (QA). It is the traditional approach
to quality management in which monitoring and
evaluation focus on individual performance, deviation from standards, and problem solving. Over
the past 2 decades, quality principles have evolved.
Now CQI programs instruct staff to prevent, innovate and develop personnel (rather than direct,
inspect and repair.)
Yearly Nursing Quality
Improvement Activity
Pressure Ulcer
Prevalence Study
(PUP)
Continuous Quality Improvement (CQI)
u Uses scientific, data-driven approaches to study
work processes that lead to long-term system
improvements.
u Is based upon the philosophy that a frontline
worker knows their clientele better than any
other member of the organization.
u Empowers staff to participate in the quality
improvement process.
u Involves everyone in the continuous improvement of work processes to achieve better outcomes of patient care.
It is important to remember that quality is part of
every employee’s job. It is not a department; it is
our way of working.
Pressure Ulcer Prevalence Study (PUP) surveyors (September 21,
2005) – General Campus (top), Civic Campus (bottom)
October is Quality Improvement Month!
Did you know that October is Quality Improvement Month? The Nursing Quality Improvement Work
Group is publishing this special edition of Nursing News to celebrate Quality Improvement Month and to
promote quality care for our patients at TOH.
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The Ottawa Hospital Nursing News Fall 2005
Quality of care and Continuous Quality
Improvement (CQI)
Q
Quality is central to The Ottawa Hospital’s Mission,
Vision, and Values. The significance of Quality at
TOH is emphasized in one of the stated core values
of the Hospital – a commitment to quality.
The goals for this plan were developed by looking
at national and international trends, and current
research.Input was also received from:
Quality at TOH (as defined by the Board of Governors, 2003) is:
u priorities identified by clinical programs
u providing the patient with appropriate, consistent health care in a clean and safe environment
in which the patient is treated with respect.
u feedback from our patients
u the Department of Infection Control
u our recent Accreditation Survey Report
u research on adverse events that has been conducted at TOH
To that end, a Quality Plan has been developed. The
Purpose of this plan includes:
Goals of the Quality Plan
u Promotion of an organizational commitment to
quality and safety of care through the selection
of priority patient care and support initiatives.
1. Enable access to care
2. Ensure appropriateness of care
u Improvement and enhancement of patient care
through the implementation of a focused plan
with objectives, measures and accountabilities.
4. Improve satisfaction with care
u Facilitating the allocation of appropriate
resources for quality improvement processes.
Fall 2005
The Ottawa Hospital Nursing News
3. Ensure safety of care
By participating in CQI activities, nurses and other
staff help meet these goals and improve quality of
care.
3
What is the Nursing
Quality Improvement
Work Group (NQIWG)?
Membership
2005-2006:
T
This group meets monthly to plan, implement, evaluate and monitor the quality of nursing care at TOH. Sub Group work often involves multidisciplinary
team members and focuses on specific patient care initiatives.
Who are the members?
u Representatives from all campuses at TOH
u Clinical nurses, educators, managers, directors, advanced practice nurses
u Nursing Quality Coordinators from Nursing Professional Practice
u Community representative
u Corporate Quality Department representative
Marlene Mackey (co-chair)
Gail Marcogliese (co-chair)
Susan Draper
Susan Philips
Diane Fillion
Helen Hunter
Sharon Ann Kearns
Mary-Ann Borduas
Jennifer Smylie/Rosalie Lavoie
Jackie Mace
Christine Ferguson
Kathy Cullen
Linda Pouchet
Lynne Jolicoeur
Janet Brintnell/Marilyn Baskey
Lynn Kachuik
Kleo Campagna
Helen McGurrin
(community rep)
Ginette Rodger
(ex-officio)
Clara Ballantine
(ex-officio)
How do we know we are providing quality
care for our patients?
Quality is a multidimensional concept, encompassing many elements. It may be intimidating to figure out
how to measure the quality of the care we give, but there are models to help us.
First it helps to decide which element of quality we are looking at. There are three categories:
u Structure describes the conditions in which the care is delivered; for example, equipment, professional staff, budgets issues, supplies, policies, etc.
u Process projects look at what we do and how we do it; for example, skin care program, patient satisfaction, discharge planning, pain management
u Outcomes are defined as the achievement of desired results or the occurrence of undesired events;
for example, length of stay, or the occurrence of complications (e.g. pressure ulcers, falls, medication
errors, or nosocomial infections).
Nursing sensitive indicators specifically measure outcomes of nursing care.
Examples are: falls, restraint use, pain, skin care, nursing satisfaction, patient satisfaction.
Often we see many potential projects that could be addressed; the challenge is to prioritize them. One
way is to look for areas that are:
u high risk
u high volume
u high cost
u problem prone
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The Ottawa Hospital Nursing News Fall 2005
PDSA (Plan, Do, Study, Act)
S
So, we have decided which problem area we want to address, now what is our next step?
At TOH, we use the PDSA model which provides a systematic method of proceeding through the CQI
process
What does PDSA stand for?
u
u
u
u
Plan: select a project, establish current knowledge, select measures
Do: implement the change, measure the results
Study: analyze the data, evaluate the impact (What worked? If it did not work, why not?)
Act: make decision to accept the change, make modifications, assess the implications of the change,
or develop a new plan to meet your aim.
Fall 2005
The Ottawa Hospital Nursing News
5
What are some examples of CQI projects
that nursing has implemented at TOH?
T
There are many exciting and innovative projects that have been implemented
or are ongoing at TOH. Some have come from the Nursing Quality Improvement Work Group (NQIWG), others are unit based.
The NQIWG has used some nurse sensitive indicators in order to
enhance the quality of nursing care at the TOH. Three evidence based
program have been developed to help nurses provide better care for their
patients:
u Falls Prevention Program
Nursing News
Edited and Coordinated
by the Nursing Communication
Work Group
u Least Restraint Last Resort Program
u Skin Care Program
The Nursing News is a quarterly
corporate newsletter written by
nurses for nurses at The Ottawa
Hospital to:
These programs are available on each nursing unit.
Other initiatives are in development:
u Pain
 inform nurses of new programs
and processes, upcoming
events, and new trends in
Nursing in regards to patient
care, education and research
u Delirium
u Documentation
u Patient Satisfaction
Are you are interested in working on any of these initiative?
Contact the Nursing Quality
Improvement Coordinators
(Marlene Mackey at 16979, or Diane
Fillion at 71366) or your clinical manager if you would like to get involved.
We are always looking for
enthusiastic people!
(l-r) Diane Fillion, Associate Coordinator
Nursing Quality Improvement, and Marlene
Mackey, Corporate Coordinator Nursing Quality
improvement
 recognize individual nurses
or groups of nurses for
specific accomplishments
including quality improvement initiatives, research
projects, educational achievements, publications as well as
presentations at internal and
external conferences
 promote camaraderie amongst
nurses throughout The Ottawa
Hospital
 provide a venue for feedback
on issues as appropriate.
For information contact
Co-Chairs
Sue Eggleton – ext 71546 or
Valerie Wilkie – ext 16235
Members:
Barb Kyd-Strickland
Sue Eggleton
Anne Gilchrist
Carol Harkness
Louise Gravelle
Wendy Diegel
Examples of QI projects conducted
at the unit level include:
u Unit based patient satisfaction surveys
u Development of patient teaching booklets
Layout: Mario Lafond,
TOH Printing Services
u Revision of documentation forms
Printing: TOH Printing Services
u Reorganizing narcotic box to prevent medication errors
Distribution: TOH Volunteer
Services
u Development of protocols for managing strokes
u Development of discharge guidelines for patients with endometrial
cancer
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The Ottawa Hospital Nursing News Fall 2005
To facilitate monitoring and reporting of ongoing CQI projects, a system was designed to
assign them to one of four quadrants. These
in turn are aligned with the Corporate Quality
Plan goals.
How do I learn more about
the CQI process?
Every October several 2 hour workshops are
provided by Nursing Professional Practice.
This year they will be held from 1200 to
1400 hours on the following days:
u October 18 Civic – Fisher Room
u October 20 Civic – Fisher Room
u October 25 General – Administration
– Room L
u October 27 Riverside – Executive Board
Room
u October 31 General – Administration
– Room L
Look for flyers on your unit. If you want to register, call Lellina Palanza at 14314.
Corporate Education also holds Quality
Workshops throughout the year. Information
is available on the Infonet or through Human
Resources.
Fall 2005
The Ottawa Hospital Nursing News
Patient Safety Initiative
Safety Tips
One high profile quality initiative you may have been
hearing about recently is patient safety.
Patient Safety Tips
As part of the Ontario Hospital Association’s commitment to involve patients as partners in their
health care, the OHA Patient Safety Support Service
launched the province-wide “Patient Safety Tips”
campaign on September 13, 2005.
Patient Safety Tips is a well-documented strategy, guided by the concept of empowering patients
to make informed decisions about their health
care, to positively transform the culture of safety
within healthcare organizations. The Ottawa Hospital supports this initiative and will promote the
program by making the information available to its
patients.
“Your Health Care – Be involved” is the tagline
for the Patient Safety Tips campaign. The tool kit
is posted on the Infonet under Patient Safety Tips.
(Click on Departments & Services then chose
Quality, then Patient Safety)
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A Word From Our Community
Representative
B
Being the community representative on the QIWG
(Quality Improvement Working Group) does present its share of challenges, humorous moments and
grateful appreciation for the work that nursing staff
perform.
On the challenge and humorous fronts, the
exposure to acronyms in my first two QIWG meetings was definitely a challenge but it had its funny
moments. I could often figure out what the acronym stood for by listening to the discussion where
often the actual terms were used, but in writing
the acronyms were easier and quicker. I figured
out that NE stood for Nursing Education or Educator, CM for Clinical Manager, APN for Advanced
Practice Nurse. But for some acronyms, I had to
ask the other members of the QIWG for help. For
example, PUP just threw me. I was desperately
trying to think of what PUP stood for. I wondered
if it had to do with a Visiting Dog Program, as one
of my neighbours has a dog with his own Hospital
ID card so he can visit patients with her. I knew
PUP must have something to do with skin care and
what in my nursing days (back in the last millennium) was referred to as bedsores. For those of
you who know the comic strip Peanuts, you may
recall Lucy’s horror at being licked by Snoopy the
dog, andthat picture did come to mind when I
first heard PUP used in the context of skin care. I
had to ask the Committee to spell that one out.
PUP stands for Pressure Ulcer Prevalence. To the
credit of the nurses on the QIWG, for the rest of
the meeting they made an effort to define each
acronym. Once I heard what the acronym stood
for it made so much sense that I thought I would
remember it forever. I was wrong. One example
is LRLR, I know it stands for Least Restraint, but
what does the second LR stand for?
Some of the terminology besides acronyms can
also conjure up a funny image. The first time
I saw on the Agenda, “Delirium Best Practice”
update, I wondered if there was a prize for practicing the best delirium. Every profession has its
terminology and acronym usages. And it makes
sense to use these within the profession. And as
a member of the QIWG, I will learn and become
familiar these terms over time but I also know I
can ask for clarification anytime.
I am so grateful and appreciative at the choice
of areas chosen for study in quality improvement.
Preventing bedsores, assessing the patient’s level
and possible cause of confusion or delirium, trying
to limit use of restraints either physical or pharmaceutical, patient satisfaction with pain management, all these studies involve direct contact
and interaction with the patient as a human being
worthy of respect, care and kindness. Despite the
high-tech world of medicine and nursing, it is nice
to know that patients can still count on the nurse
for TLC (Tender Loving Care).
Helen McGurrin
Community Representative
Online!
Check out the Nursing Quality Improvement Workgroup on our web-site!
http://10.249.5.254:7000/hp/dept/nursing/qi/direction-e.asp
and the Corporate Quality Page on the Infonet (under departments and services)
http://infonet/body_quality.cfm?id=4424&department=Quality
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The Ottawa Hospital Nursing News Fall 2005