Running head: QUALITY IMPROVEMENT PROCESS
Quality Improvement Process
Megan Davis
Ferris State University
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Quality improvement process
Health care is always changing and there is room for improving on care to provide the
best patient experience. Nurses need to participate in quality improvement initiatives, nurses are
the ones that implement new processes and use them on a daily bases. Nursing’s goal is to
provide safe quality care to all patients, with quality improvement (QI) initiatives it enables
nurses to change processes for the better. The QI that this paper addresses is nurse to nurse
handoff in surgical services at Metro Health Hospital. “Data shows that communication is
identified 65% to 70% of the time in the more than 3,000 root cause analyses reviewed between
1995 and 2005” (Adamski, 2007, p. 10). Nurse to nurse handoff is happening in the rest of the
hospital, nurse to nurse handoff is best practice and needs to be hospital wide.
Identify Clinical Need
The clinical activity for review is nurse to nurse handoff in surgical services. Currently at
Metro health in surgical services there is no nurses to nurse handoff. Ideally there would be
nurse to nurse report when the patient is taken from surgical prep and recovery (SPR) to surgery,
then report from surgery to post anesthesia care unit (PACU). “The National Patient Safety Goal
(NPSG) requiring healthcare organization to implement a standardized approach to handoff
communications went into effect in January 2006” (Adamski, 2007, p. 10). Implanting nurse to
nurse handoff in theses departments will promote patient safety and increase patient satisfaction.
The three departments within surgical services will need to work together to collaborate how
each handoff will look. Each unit can customize what information is of value to them. The goal
of having a standardized nurse to nurse handoff is communicating patient care in a consistent
manner.
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Interdisciplinary team
Nurse to nurse hand off between SPR, surgery, and PACU will have impact on the entire
health care team. Interruption to flow is going to happen, the pathways need to be reorganized
for the whole team. After reorganizing the patient flow and pathways, the entire team needs to be
involved in testing each members flow in the new process. The interdisciplinary team will
consist of nurse educators, nursing leadership, and staff nurses from SPR, surgery, and PACU,
environmental services, surgical technologists, operating room assists (ORAs), chief of surgery,
and chief of anesthesia. “Quality improvement team members should represent a cross section of
workers who are involved with the problem” (Yoder-Wise, 2014, p.253). Along with the
interdisciplinary team the Unit Based Council (UBC) will also have an enormous input into
creating and reorganizing the nurse to nurse handoff. On the UBC there is nurse educators,
nurses from all three departments, and surgical technologist.
When the health care team is ready to start testing the new process, each day for a two
week period two team will trial the new process. The team will consist of SPR nurse, OR nurse,
PACU nurse, anesthesia, the surgeon, environmental services and an ORA. This team will make
up the testing group. Each member of the health care team have different rolls in caring for the
patient, but the entire group has the patient best interest in mind. The goal of the health care
group is to provide patient centered care while delivering safe quality care to the patient and
family.
Data collection method
The UBC will go step by step from the patient entering SPR until they are discharged
from PACU. Each step of all the team members will be looked at by the unit based council. To
help be aware of any areas of conflict a plan-do-study-act (PDSA) will be implemented. Also the
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two test team will attend group meetings to address what is working and what needs to be
improved before initiating the new process for all departments.
Establish outcomes
Nurses to nurse handoff is a standard of care for surgical services in West Michigan.
Currently at Metro Health Hospital in surgical services there is no nurse to nurse handoff. Nurse
to nurse handoff at the bedside happens in all of the inpatient care units at Metro, for best
practice nurse to nurse handoff needs to be implemented throughout surgical services. Research
shows that an informed patient participants more in their care and participation from patients and
family creates better outcomes. Patients that play an active part in their health care are less
stressed and that in turns equals a faster recovery (Zarro, Connolly, Cardinal, & Gruppi, 2011).
Nurse to nurse handoff will happen with every patient. After implementing the new process,
outcomes from nurse to nurse handoff will show higher patient satisfaction rates, a decrease in
patient errors, and improved satisfaction from staff related to patient care and being well
informed.
Implementation strategies
The project aim is implementing nurse to nurse handoff between SRP and surgery,
surgery and PACU. The goal is 100% compliance within six months of testing the process. There
will be a date announced that testing will start happening. Testing will happen simultaneously in
all three departments. Testing will be composed of the health care team working with two doctor
each day for two weeks. After the two weeks data will be collected, getting feedback on what
worked well and what needs improved before implementing the process for the whole surgical
services.
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Implementing a culture of change can take time and often comes with bumps in the road.
Once a new procedure is tested and tried it is clear to see areas that may need to be improved.
Change does not come without challenges. Between the three units, each unit has their own
challenges. Nurse’s unwillingness to change habits is a challenge that is always in the fore front.
Hopefully with having nurse to nurse handoff tested before implemented in all units and having
unit bases councils involved in the decision making process the goal is to have staff encouraging
co-works and excited about the new procedure. A change in flow for nurses in all three
departments, surgeons, and anesthesia will be a challenge. Also time is a factor that will play into
challenges of rolling out nurse to nurse handoff. Processes cannot just be thrown out and except
staff from three department to embrace change. Quality improvement is key by testing the
process and addressing barriers quickly. When nurses have education and encouragement change
will happen, improving patient care and safety.
Evaluation
Not having nurse to nurse handoff throughout surgical services, the department is started
from the ground up. Evaluation of how well the new process is going and being accepted by the
health care team will be from receiving feedback from staff and patients. Leadership will have an
overall presents in all three departments for nurse observation to check for compliance of nurse
to nurse handoff. Evaluation is key when starting a new process, there is going to be areas that
need improving.
Conclusion
A change in culture can be difficult and takes time, with education, vigilance, and
encouragement the health care team will adapt to change. “The development of a standardized
handoff communications tool is a dynamic process that allows for continued opportunities to
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improve the delivery of patient care for the perioperative patient”(Association of Perioperative
Register Nurses, n.d.). After testing the new process it will be clear where there is a need for
tweaking. With some revisions the surgical services team will prefect nurse to nurse handoff.
Implementing and improving nurse to nurse handoff is best practice and will help nurses to
provide quality safe care.
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References
Adamski, P. (2007, January). Implement a handoff communications approach. Nursing
Management, 10-12. Retrieved from www.nursingmanagement.com
Association of Perioperative Register Nurses. (n.d.).
http;//www.aorn.org/PracticeResources/ToolKits/PatientHandofftoolkit/
Yoder-Wise, P.S. (2014). Leading and managing in nursing (5th ed.) St. Louis, MO: Elsevier
Mosby.
Zarro, D., Connolly, A., Cardinal, M., & Gruppi, L. (2011). Improving Nursing Handoff During
Change of Shift [PowerPoint slides]. Retrieved from
www.uvm.edu/.../G%20Improving%20Nursing%...