Data Analysis and Quality Improvement Initiative Proposal Paper

Data Analysis and Quality Improvement Initiative Proposal Paper

Data Analysis and Quality Improvement Initiative Proposal

A Quality Improvement (QI) initiative is a set of logical activities developed to monitor, analyze, and enhance the quality of healthcare processes to improve health outcomes in an organization. Healthcare organizations can effectively implement change in a QI initiative by obtaining and analyzing data in key areas. QI initiatives enable organizations to plan and implement change effectively. They are crucial because they improve the efficiency of care, improve patient outcomes, and reduce wastage of resources. The purpose of this paper is to conduct data analysis and describe a QI initiative based on Catheter-associated urinary tract infection (CAUTI). The paper will discuss benchmark data, evidence-based recommendations to enhance the quality and safety of healthcare, and communication strategies.

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Health Care Issue or Area of Concern

The data analyzed from my healthcare organization (Trinity Health) is the incidence of CAUTI in the past two years (January 2020- December 2021). The hospital has a CAUTI rate of 2.555 per 1000 catheter days for the total patient population. The pediatric population (0–17 years) had a total of 5 531 catheter days from January 2020 to December 2021and a CAUTI rate of 2.23 per 1000 catheter days. On the other hand, the adult population (18 years and above) had a total of 25985 catheter days and a CAUTI rate of 2.763 per 1000 catheter days. The rate of CAUTI-free survival 96.6% at 10 days, 87.7% at 30 days and 70.4% at 60 days. The incidence of CAUTI in the organization reveals the impact of the interventions used to prevent urinary tract infections among hospitalized patients (Jazieh, 2020).

The organization could measure process data to enhance its knowledge on the interventions used to prevent CAUTIs by healthcare providers. Process data indicates the specific interventions in an organization that contribute to a specific outcome either positively or negatively (Jazieh, 2020). It represents the evidence-based interventions and best practices that healthcare providers implement to improve the quality of care provided to patients (Jazieh, 2020). Critical dashboard metrics related to CAUTI that can help the organization understand more about the issue include: the number of catheterized patients kept on antimicrobial therapy; the number of patients cleaned with an antiseptic solution; Number of catheterized patients who have timely catheter removal. The dashboard metrics can help the organization establish if CAUTIs are caused by gaps in measures such as lack of antimicrobial therapy, failing to use antiseptic solutions during meatal cleaning, or prolonged use of catheters. Furthermore, the metrics signify the accepted clinical practice recommendations in preventing CAUTI and establish the root cause of the CAUTI issue in the health organization.

The organization can sustain processes and outcomes due to its quality improvement (QI) initiatives. The quality improvement team analyzes the threats to the sustainability of processes and outcomes at the beginning of a QI project and when it is ready for implementation. Tools used to sustain processes and outcomes include performance boards, process control boards, standard work, and improvement huddles. The organization uses the process control and performance boards to convey improvement results to health providers and the leadership team.

Standard work is usually a visual outline of the current best practices for a task. It offers a framework that ensures that changes that have enhanced patient care are consistently and reliably implemented in every patient encounter. Improvement huddles are usually brief, regular meetings among health providers to predict challenges, evaluate performance, and support a culture of improvement (Silver et al., 2018). The data on CAUTI is reliable because it is obtained from patient’s health records and the CAUTI surveillance system in the organization. Heath providers are mandated to document every incidence of CAUTI in the EHR and report it in the surveillance system. It helps improve outcomes by pushing health providers to improve their healthcare interventions to further reduce CAUTIs in the organization.

Adverse Event/Near-Miss Data to Be Factored In The Outcomes and Recommendations

Performance failures in the nursing process could result in adverse events or near-misses in the care of catheterized patients. Inadequate assessment of catheterized patients for signs and symptoms of UTI can lead to failure to identify patients who develop CAUTI. Antimicrobial therapy can result in adverse effects if a patient is prescribed an antibiotic that causes an allergic reaction, such as administering Septrin to a patient with sulfur allergy or Penicillin drug to patients allergic to penicillin (Lee, 2021). Therefore, data on missed nursing care in the assessment process must be factored into the outcomes and recommendations. Trends and measures needed to analyze CAUTI outcomes critically include: Number of patients catheterized per month, Urine cultures for catheterized patients performed per month; Antimicrobial therapy in catheterized patients; Daily assessment routine of catheterized patients. The measures will analyze how patient care processes positively or negatively contribute to CAUTIs in the organization.

Adverse events and near-misses put patients’ safety at risk and negatively affect health outcomes. The desired outcomes connected with preventing adverse events or near-misses include increased reporting and reduced incidence of the events. The organization needs to have a culture that encourages health providers to report adverse and near-miss events (Lee, 2021). This will ensure that the necessary measures are taken to mitigate the consequences of these events. A reduced incidence of adverse and near-miss events is desired to increase patient safety, improve health outcomes, and improve their quality of life (Lee, 2021). Metrics that indicate future quality improvement opportunities include reduced adverse drug events, length of hospital stay, readmission rates, morbidity rates, mortality rates, and healthcare costs, as well as improved patient satisfaction rates.

QI Initiative Proposal

To attain CAUTI reduction and sustain the improvements, a QI initiative to address culture and clinical practice in the healthcare facility is necessary. Culture includes the healthcare team’s values, attitudes, and beliefs, which affect the team’s ability to enhance clinical practice (Silver et al., 2018). The QI initiative proposal will be a nurse-led initiative to reduce the incidence rate. The initiative will be designed to reduce the number of catheter days, decrease catheter utilization rate, and lower the CAUTI rate.

The Agency for Healthcare Research and Quality (AHRQ) has set QI initiatives to lower the incidence of CAUTI. Benchmarks aligning with these initiatives include the number of urine cultures and the urine cultures collected for every patient (with or without a catheter) every month (AHRQ, 2018). Another benchmark is the number of CAUTIs. CAUTI is calculated from the first day that the signs and symptoms, diagnostic reports, and the presence of a catheter for more than two consecutive days are identified together. The third benchmark is catheter days. Each day a patient stays with an indwelling urinary catheter is counted as one catheter day.

Existing QI initiatives in the organization related to CAUTIs include using an antiseptic solution for meatal cleaning during catheter insertion. The initiative is insufficient because it does not address other factors associated with CAUTIs, such as prolonged catheterization, lack of indication, and improper catheter care. An example of a QI initiative in another facility is a nurse-driven protocol in a Long-Term Acute Care Hospital (LTACH) aimed at reducing CAUTIs. It entailed a nursing QI education program focused on staff education, catheter care, and patient surveillance (Zurmehly, 2018). The initiative led to a significant decrease in total catheter days and CAUTI rates. Target areas for improvement include reducing inappropriate short-term catheter use, timely removal of indwelling urinary catheters, and catheter care (Zurmehly, 2018). Processes that need to be modified include antimicrobial stewardship, aseptic insertion, urine culturing, catheter removal, using alternatives to catheter use, regular patient assessments, and training of catheter care.

The QI proposal will include evidence-based clinical interventions to lower CAUTI, decrease unnecessary catheter use, and improve the care of patients with indwelling catheters. The first intervention in the QI proposal is the assessment of catheterized patients. Patients with indwelling catheters will be regularly assessed to establish whether they still need the catheters (Yu et al., 2020). If catheterization is not indicated, the nurse should remove the indwelling catheters to reduce the risk of CAUTI caused by unnecessary and prolonged catheter use. Besides, indwelling catheters will only be inserted if a patient meets the indications for catheterization, which include: Acute/chronic urinary retention; Bladder outlet obstruction; Promoting healing of stage III or stage IV open sacral or perineal wounds in incontinent patients; Improving comfort for end-of-life care patients (Yu et al., 2020).  The intervention will lower the total catheter days to less than 2000 days per year.

The second intervention is the aseptic insertion of indwelling catheters. Nurses will be required to practice hand hygiene before and after catheter contact. If catheterization is indicated, it will be important that trained nurses insert the indwelling urinary catheter. In addition, the QI initiative will involve training the staff and patients on catheter care and appropriateness (Yu et al., 2020). Nurses will be trained on catheter care, including maintaining a closed drainage system and an unobstructed urine flow. Patients will also be trained on proper catheter care since they can help with proper maintenance (Silver et al., 2018). Staff competency in catheter care will be maintained through in-service education, self-guided learning, new employee training and orientation, and competency training. The interventions will help lower the CAUTI rate from 2.555 to <1.0 per 1000 catheter days.

Healthcare organizations and the interprofessional team can face various challenges when working to meet the prescribed benchmarks. The challenges include inadequate finances needed for staff training. Lack of sustainability can affect the team’s effort in meeting the benchmarks. A rigid organizational culture can also hinder meeting the benchmarks, especially if it does not encourage innovations among employees.

Interdisciplinary Team Input To Improve Patient Safety And Quality Outcomes And Work-Life Quality

The QI initiative on reducing CAUTI will be implemented by an interdisciplinary team comprising the hospital administrator, a nurse manager, infection preventionist,  staff educator, and data coordinator. The administrator will be tasked with promoting the initiative’s goals and assisting the team with prioritizing patient safety concerns, policies, and procedures. The administrator will also ensure that the team has adequate resources, including time to train staff and have a review meeting to actively implement the QI initiative to meet the desired goals (AHRQ, 2018). The nurse manager will ensure that each team member completes assigned activities such as conducting surveys and data collection. Besides, the nurse manager will monitor and share progress toward meeting goals with the team.

The staff educator will review educational materials pertaining to the goals of the QI initiative and develop a plan to deploy education and support practices with the staff in the facility. Furthermore, the infection preventionist will ensure that data collection and entry on CAUTI is up to date and meet regularly with the team to review progress (AHRQ, 2018). Lastly, the data coordinator will be tasked with collecting and interpreting quantitative and qualitative data used to monitor the facility’s progress toward meeting the QI initiative goals.

Good leadership will ensure that the interprofessional team fully engages in this initiative. The organization’s leadership will be urged to commit to the initiative by ensuring the team has the time and resources to implement it and achieve the goals (AHRQ, 2018). The outcomes will be measured by comparing the rate of CAUTIs before and after implementing the QI initiative. Quantitative data will inform the interprofessional team of the QI initiative’s performance and evaluate the progress towards meeting the goals. The data will include catheter utilization ratio, urine culture collection rate, catheter days, and number of CAUTIs.

The proposed QI initiative will positively impact the work-life quality of the interprofessional team by improving their clinical practice. The initiative will reduce CAUTI rates, lowering the workload of managing patients with CAUTI. Health providers will therefore have more time to attend to other patient concerns. Besides, reduced CAUTI rates will increase patients’ confidence with the interprofessional team and improve patient satisfaction rates.

Evidence-Based Communication Strategies To Promote Quality Improvement Of Interprofessional Care

The interprofessional team should utilize strategic communication to convey essential input when making decisions related to the QI initiative and contribute to team-based care delivery. Communication in the interprofessional team will take both upward and downward approaches (Müller et al., 2018). It will be done during meetings, handoffs, ward rounds, and through memos, progress notes, and whiteboards. The team will be encouraged to meet regularly in the safety or quality committee meetings to discuss the initiative’s successes and barriers and evaluate data trends.

The SBAR (situation, background, assessment, and recommendation) format will facilitate communication among team members. SBAR is a tool that allows essential information to be communicated accurately. It promotes a brief, organized, and predictable flow of information between professionals and bridges the communication gap. Müller et al. (2018) explain that SBAR promotes the provision of all pertinent information, organized coherently. Besides, it allows preparation before communication, and since the sender and receiver use the same mental model, there is a higher level of understanding and awareness.

Conclusion

CAUTI was the selected problem of interest, and its data is important in determining the impact of healthcare interventions used to prevent the incidence. The QI initiative proposal is a nurse-led initiative to lower the incidence rate of CAUTIs. The proposed initiative is designed to reduce the number of catheter days, decrease catheter utilization rate, and lower the CAUTI rate. It includes evidence-based strategies such as antimicrobial stewardship aseptic insertion, urine culturing, timely catheter removal, using alternatives to catheter use, regular patient assessments, and staff and patient training on catheter care.

References

Agency for Healthcare Research and Quality. (2018). Guide to implementing a program to reduce catheter-associated urinary tract infections in long-term care. https://www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/guide.html#app-g

Jazieh, A. R. (2020). Quality Measures: Types, Selection, and Application in Health Care Quality Improvement Projects. Global Journal on Quality and Safety in Healthcare, 3(4), 144-146. https://doi.org/10.36401/JQSH-20-X6

Lee, J. (2021). Understanding nurses’ experiences with near-miss error reporting omissions in large hospitals. Nursing Open, 8(5), 2696–2704. https://doi.org/10.1002/nop2.827

Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ open, 8(8), e022202. https://doi.org/10.1136/bmjopen-2018-022202

Oman, K. S., Makic, M. B. F., Fink, R., Schraeder, N., Hulett, T., Keech, T., & Wald, H. (2021). Nurse-directed interventions to reduce catheter-associated urinary tract infections. American journal of infection control, 40(6), 548-553.

Silver, S. A., McQuillan, R., Harel, Z., Weizman, A. V., Thomas, A., Nesrallah, G., Bell, C. M., Chan, C. T., & Chertow, G. M. (2018). How to Sustain Change and Support Continuous Quality Improvement. Clinical journal of the American Society of Nephrology: CJASN, 11(5), 916–924. https://doi.org/10.2215/CJN.11501015

Yu, S., Marshall, A. P., Li, J., & Lin, F. (2020). Interventions and strategies to prevent catheter‐associated urinary tract infections with short‐term indwelling urinary catheters in hospitalized patients: An integrative review. International Journal of Nursing Practice, 26(3), e12834. https://doi.org/10.1111/ijn.12834

Zurmehly, J. (2018). Implementing a nurse-driven protocol to reduce catheter-associated urinary tract infections in a long-term acute care hospital. The Journal of Continuing Education in Nursing, 49(8), 372-377. https://doi.org/10.3928/00220124-20180718-08

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Data Analysis and Quality Improvement Initiative Proposal Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Analyze data to identify a health care issue or area of concern.	Does not analyze data to identify a health care issue or area of concern.	Attempts to analyze data, but misses trends or opportunities for quality improvement,	Analyzes data to identify a health care issue or area of concern.	Analyzes data to identify a health care issue or area of concern; evaluates data quality.
		or does not
		persuasively link data
		to a health care issue
		or area of concern.
Develop a QI initiative proposal based on a selected health issue and	Does not develop a QI initiative proposal based on a selected health issue and supporting data analysis.	Attempts to develop a QI initiative proposal, but proposal is missing benchmarks, is not evidence- based, is impractical, or is not clearly linked to the selected health issue or supporting data analysis.	Develops a QI initiative proposal based on a selected health issue and supporting data analysis.	Develops a QI initiative proposal based on a selected health issue and supporting data analysis. Proposal identifies knowledge
supporting data analysis.				gaps, unknowns, missing information, unanswered questions,
				or areas of uncertainty
				where further
				information could
				improve the proposal.
Communicate QI	Does not communicate QI initiative proposal, based on interdisciplinary team input, to improve patient safety and quality outcomes and work-life quality.	Attempts to communicate QI initiative proposal, based on interdisciplinary team input, but misses relevant roles or concepts related to patient safety and quality outcomes and work-life quality.	Communicates QI initiative proposal, based on interdisciplinary team input, to improve patient safety and quality outcomes and work-life quality.	Communicates QI initiative proposal, based on interdisciplinary team input, to improve patient safety and quality outcomes and work-life quality. Identifies assumptions on which the inputs are based.
initiative
proposal, based
on
interdisciplinary
team input, to
improve patient
safety and quality
outcomes and
work-life quality.
Integrate relevant	Does not integrate relevant sources to support arguments, correctly formatting citations and references using APA style.	Integrates irrelevant sources, integrates sources ineffectively, or formats citations and references with errors in APA style.	Integrates relevant sources to support arguments, correctly formatting citations and references using APA style.	Thoroughly integrates relevant sources to support arguments using error-free APA style and formatting in citations and references.
sources to
support
arguments,
correctly
formatting
citations and
references using
APA style.
Determine	Does not determine communication strategies to promote quality improvement of interprofessional care.	Attempts to determine communication strategies to promote quality improvement of interprofessional care, but strategies are limited and/or not evidence-based.	Determines communication strategies to promote quality improvement of interprofessional care.	Determines multiple evidence-based communication strategies to promote quality improvement of interprofessional care.
evidence-based
communication
strategies to
promote quality
improvement of
interprofessional

 

CRITERIA care.	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Communicate QI	Does not communicate QI initiative proposal in a professional, effective manner, writing clearly and logically, with correct use of grammar, punctuation, and spelling.	Attempts to communicate QI initiative proposal in a professional, effective manner, but lapses, omissions, and/or errors detract from the overall message.	Communicates QI initiative proposal in a professional, effective manner, writing content clearly and logically, with correct use of grammar, punctuation, and spelling.	Communicates QI initiative proposal in a professional, effective manner, writing content clearly and logically, with error-free use of grammar, punctuation, and spelling. Proposal includes multiple specifics, examples, and references to current scholarly and/or authoritative sources.
initiative proposal
in a professional,
effective manner,
writing clearly
and logically, with
correct use of
grammar,
punctuation, and
spelling.
Determine	Does not determine whether any adverse event or near-miss data must be factored in to outcomes and recommendations.	Attempts to determine whether any adverse event or near-miss data must be factored in to outcomes and recommendations; however, omissions and/or errors exist.	Determines whether any adverse event or near-miss data must be factored in to outcomes and recommendations.	Determines whether any adverse event or near-miss data must be factored in to outcomes and recommendations. Specifies the criteria by which the determination is made.
whether any
adverse event or
near-miss data
must be factored
in to outcomes
and
recommendations.