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Nursing, Research paper

Quality Improvement Initiative Evaluation

Quality Improvement Initiative Evaluation

Diabetes mellitus is a common chronic disorder worldwide. Type 1 Diabetes mellitus occurs when pancreatic beta cells are damaged. This leads to little or no insulin production by the pancreas. Type 2 Diabetes mellitus occurs when the pancreas produces insulin, but there is insulin resistance or insufficient insulin. Gestational Diabetes mellitus occurs when there is hyperglycemia during pregnancy. Pregnant women with the greatest risk of developing Gestational Diabetes mellitus: over 35 years old, obese, family history of diabetes, their past medical history reveals Polycystic Ovarian Syndrome. Deficiency or resistance to insulin impairs the ability of body cells to utilize glucose to produce energy. This leads to hyperglycemia. When diabetes mellitus is not properly controlled, it can cause macrovascular and microvascular complications. Macrovascular complications include heart disease, atherosclerosis, and stroke. Microvascular complications include diabetic retinopathy, nephropathy, and neuropathy.

Type 1 Diabetes mellitus is managed by administering insulin. Insulin therapy aims at achieving glucose control that mimics physiological insulin secretion as much as possible (Koliaki et al., 2020). Type 2 Diabetes mellitus is managed by administering Oral- Hypoglycemic agents such as Metformin. Lifestyle modification is also important in the management of type 2 Diabetes mellitus (Arkiath et al., 2018). Lifestyle modification entails eating a diet rich in fruits, vegetables, low fats, and regular exercise. Cigarette smoking and alcohol intake should be avoided.

The current quality improvement initiative focuses on the enhancement of the care of Diabetic patients. Various principles constitute the quality improvement initiative. The first principle is targeting high-risk patients and focusing on high-impact issues. This principle recognizes the fact that the cost of quality improvement is high, and the resources needed are scarce. When selecting high-risk patients, those with the highest variations from the normal value of specific parameters are prioritized. The normal glycosylated hemoglobin (HbA1C) value is 3.5 to 6% (Arkiath et al., 2018). It is desirable to maintain the levels of HbA1C below 7%. When two patients have levels of 8% and 10%, respectively, priority is given to the second patient. Intensive pharmacological treatment and special attention should be given to patients with HbA1C levels of 10%. The same criterion is used for the blood glucose levels of patients.

The principle recognizes that patients with poor control are at the highest risk of developing macrovascular and microvascular complications. The principle also emphasizes the importance of continued patient education on the benefits and risks of treatment. This enables healthcare providers to select optimal treatment plans for their patients. Targeting high-risk patients increases the probability of the next measurements meeting the performance standard.

The second principle is engaging the healthcare providers to adopt a system-based patient preparation process and avail patients’ individualized data. This principle advocates for dialogue between healthcare providers and patients. This leads to the identification of a particular target process and measures of outcomes. The target process and outcome measures include examining eyes and feet annually, measuring microalbumin annually, and administering pneumococcal vaccinations and A1C testing. Healthcare providers should modify their workflows and tools and document their actions in the electronic medical record.

This principle also advocates for the provision of patients’ individualized data. The healthcare facility has a data reporting system that acts as the main source of data for diabetes care. The reporting system gets its data from the Electronic medical record and the laboratory systems. It generates a report of the data every month. The reported data focuses on individual patients, their laboratory results, and the palliative quality measures that have been initiated. Furthermore, the generated report identifies the primary healthcare provider of each patient.

The third principle is targeting processes that are most likely to improve the outcome of the patient. This aspect of the quality improvement initiative recommends the use of screening, current technology, the newest medications, and patient education to improve patient outcomes. When a condition such as diabetic retinopathy is detected early, the prognosis is improved. After its detection, prompt intervention with photocoagulation therapy will delay or prevent visual impairment. Annual screening for various diabetic complications is recommended. Screening should be distinguished from surveillance. The latter refers to a follow-up to the patients with a particular complication. Other than retinopathy, diabetic patients should be screened annually for other microvascular conditions, such as diabetic nephropathy and diabetic neuropathy.

Various factors prompted the implementation of the quality improvement initiative. This took place after the evaluation of the quality measures that are discussed annually at the workplace. The evaluation revealed that suboptimal care was being provided to patients. The cases of diabetic foot, retinopathy, and nephropathy were reported to be very high. Furthermore, compared to other hospitals, the healthcare setting was lagging behind them in the annual reports on diabetes management. All health care providers and the hospital administration recognized the need for an improvement in the care of diabetic patients. The multi-disciplinary improvement team decided that a quality improvement initiative should be put in place.

The problem not addressed by the quality improvement initiative is directly monitoring the patients during medication use. The high incidence of diabetic complications could be caused by low patient compliance with their medications and insulin. The quality improvement initiative did not address this problem directly. It only offered patient education on medication use. Compliance could have been emphasized by the use of medication calendars and encouraging the patients to set alarms for taking medications. The issue that arose from the quality improvement initiative is that of surveillance. The initiative focuses on screening; however, findings suggested that suboptimal timing of photocoagulation resulted from inefficient surveillance of the patients known to have early retinopathy. Therefore, surveillance is as important as screening.

The reported cases of diabetic foot problems in the hospital declined from 60% to 20%. This was the most significant improvement noted in the hospital after the implementation of the quality improvement initiative. Furthermore, foot examination rates in the hospital improved from 25% to 58%. This was indicated by an increase in monofilament tests by 10 percent, a constituent of the annual foot exam. The percentages were reported during the annual meetings. These results indicate that the quality improvement initiative successfully curbed this microvasculature problem. Furthermore, after its implementation, the hospital was ranked fifteenth nationally in terms of quality services provided in the management of diabetes. This was an improvement from the previous rank of thirty.

The incidences of amputation due to diabetic foot decreased from 30% to 15%. The cases of diabetic nephropathy also dropped by 5 percent, while retinopathy decreased by 4%. The hospital only reported one case of a macrovascular diabetic complication compared to the previous year’s ten cases. An improvement of 6% was also noted in the number of patients who received pneumococcal vaccinations. These improvements are attributed to the strict adherence to the quality improvement initiative by the health care providers. Furthermore, training that entailed practical and didactic skills greatly contributed to the success of the quality improvement initiative.

The outcome measure that could be added to evaluate the success of the initiative is a change in the lifestyle of the patients. The initiative included patient education. During patient education, the health care providers advised the patients on the recommended diets, such as fruits and vegetables. Furthermore, the patients were advised against using alcohol, cigarettes, and other drugs. The need for exercise was also emphasized. Therefore, the lifestyle of the patients who visit the facility should be reported. This can be accomplished through interviews or questionnaires or by giving impromptu visits to specific patients. The findings will indicate whether the patients followed the instructions and whether the lifestyle changes greatly contributed to the success.

The interprofessional team members involved in the initiative are nutritionists, physicians, pharmacists, and nursing officers. Nutritionists provided details of the type of diet suitable for diabetic patients. They recommended vegetables, fruits, grains, proteins, and low fat. Non-starchy vegetables such as broccoli, carrots, and peppers and starchy ones such as green peas are useful. They advised that at least half of the grains the patients consume should be whole grains. Such foods include pasta, cereals, and tortillas. Cardiovascular-healthy fatty foods such as avocado, nuts and seeds, salmon, tuna, and olive oil are recommended (Houghton et al., 2018). The prohibited foods for these patients are those high in sodium, saturated and trans fats, and sugary foods. Furthermore, patients should avoid smoking and excessive use of alcohol.

The pharmacists emphasized the importance of patient compliance with drug use and recommended patient-centred care. They noted that both Oral-hypoglycemic agents and insulin should be taken as directed by the physicians to avoid instances of hypoglycemia. Severe hypoglycemia can lead to the death of the patient. Furthermore, they noted that by adhering to tight glucose control, the instances of diabetic ketoacidosis and Hyperosmolar Non-Ketotic Hyperglycemia Coma would be greatly reduced (Koliaki et al., 2020). The pharmacists pledged to help in the education of the patient on the use of their medications and the subcutaneous administration of insulin.

Physicians emphasized the importance of giving priority to high-risk patients. They also pointed out the impacts of long-term poorly or unmanaged diabetes. These long-term complications include macrovascular and microvascular complications (Papatheodorou et al., 2018). Macrovascular complications include heart disease, atherosclerosis, and stroke. The microvascular complications include diabetic retinopathy, nephropathy, and neuropathy. The Nursing Officers pledged to educate the patients on the importance of early detection of diabetic foot. Furthermore, a consensus was reached to increase foot examinations during the quality improvement initiative. The Nursing Officers ensured that all diabetic in-patients received their medications and insulin on time and in the right doses.

Additional protocol changes and added technology can be used to provide quality outcomes. Technological changes include the use of insulin pens, insulin pumps, and use of jet injection devices (Castle et al., 2017). The jet injection is suitable for diabetic patients who can not tolerate needles. Insulin pumps can be computerized and increase the flexibility of use. The pump is not implanted but attached to a catheter (Castle et al., 2017). Insulin is delivered through the catheter attached to the abdominal region. Insulin pens have cartridges and disposable needles. It allows accurate delivery of insulin doses by simply selecting the required dose (Castle et al., 2017). This is in contrast to the traditional vial and syringe associated with under-dosing and overdosing. These three insulin delivery systems will lead to an increase in patient compliance since they are easy to use and easily portable. Improved patient compliance will lead to an improvement in the quality of the outcome.

A recommendation in the protocol change is to initiate a daily diabetic follow-up clinic. Patients will be required to report to the hospital daily. This will enable the health care providers to closely monitor the patients and supervise medication use. This will lead to an improvement in the treatment outcomes of the patients because they can ask questions and receive relevant feedback.

References

Akriath, V., Raveendran, Elias, C., Chacko, Joseph, M., Pappachan(2018). Non-pharmacological Treatment Options in the Management of Diabetes Mellitus. The Journal of the Indiana State Medical Association, 40(9), 854–857.

Castle, J. R., DeVries, J. H., & Kovatchev, B. (2017). Future of automated insulin delivery systems. Diabetes Technology and Therapeutics, 19, S67–S72. https://doi.org/10.1089/dia.2017.0012

Houghton, D., Hardy, T., Stewart, C., Errington, L., Day, C. P., Trenell, M. I., & Avery, L. (2018). A systematic review assessing the effectiveness of the dietary intervention on gut microbiota in adults with type 2 diabetes. Diabetologia, 61(8), 1700–1711. https://doi.org/10.1007/s00125-018-4632-0

Koliaki, C., Tentolouris, A., Eleftheriadou, I., Melidonis, A., Dimitriadis, G., & Tentolouris, N. (2020). Clinical Management of Diabetes Mellitus in the Era of COVID-19: Practical Issues, Peculiarities, and Concerns. Journal of Clinical Medicine, 9(7), 2288. https://doi.org/10.3390/jcm9072288

Papatheodorou, K., Banach, M., Bekiari, E., Rizzo, M., & Edmonds, M. (2018). Complications of Diabetes 2017. Journal of Diabetes Research, 2018. https://doi.org/10.1155/2018/3086167

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Question 

Quality Improvement Initiative Evaluation

Overview:

Deliver a 5–7-page analysis of an existing quality improvement 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 specific quality indicators point to improved patient safety, quality of care, cost and efficiency goals, and other desired metrics. Nurses and other health professionals with specializations and/or interest in the condition, disease, or the selected issue are your target audience.
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Questions to Consider:

Reflect upon data use in your organization as it relates to adverse events and near-miss incidents.

  • – How does your organization manage and report on adverse events or near-miss incidents?
  • – What data from your organization’s dashboards help inform adverse events and near-miss incidents?
  • – What additional metrics or technology are you aware of that would help ensure patient safety?
  • – What changes would you like to see implemented to help the interprofessional team better understand data use and data trends as quality and safety improvement tools?

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Assignment Instructions:

You have been asked to prepare and deliver an analysis of an existing quality improvement 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 specific quality indicators point to improved patient safety, quality of care, cost and efficiency goals, and other desired metrics.

Quality Improvement Initiative Evaluation

Quality Improvement Initiative Evaluation

Your target audience consists of nurses and other health professionals with specializations or interests in your selected condition, disease, or issue. In your report, you will define the disease, analyze how the condition is managed, identify the core performance measurements used to treat or manage the condition and evaluate the impact of the quality indicators on the healthcare facility:

The numbered points below correspond to the grading criteria in the scoring guide. The bullets below each grading criterion further delineate tasks to fulfil the assessment requirements. Be sure that your Quality Improvement Initiative Evaluation addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels that relate to each grading criterion.

  1. Analyze a current quality improvement initiative in a healthcare setting.
    • – Evaluate a QI initiative and explain what prompted the implementation. Detail problems that were not addressed and any issues that arose from the initiative.
  2. Evaluate the success of a current quality improvement initiative through recognized benchmarks and outcome measures.
    • – Analyze the benchmarks that were used to evaluate success. Detail what was the most successful, as well as what outcome measures are missing or could be added.
  3. Incorporate interprofessional perspectives related to initiative functionality and outcomes.
    • – Integrate the perspectives of interprofessional team members involved in the initiative. Detail who you talked to, their professions, and the impact of their perspectives on your analysis.
  4. Recommend additional indicators and protocols to improve and expand quality outcomes of a quality initiative.
    • – Recommend specific process or protocol changes as well as added technologies that would improve quality outcomes.
  5. Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
  6. Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

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Suggested Resources:

Quality Improvement Initiatives
Quality Improvement Initiative Evaluation

Quality Improvement Initiative Evaluation

These resources explore how quality initiatives are applied in clinical settings.

  • Vachon, B., Desorcy, B., Gaboury, I., Camirand, M., Rodrigue, J., Quesnel, L., . . . Grimshaw, J. (2015). Combining administrative data feedback, reflection and action planning to engage primary care professionals in quality improvement: Qualitative assessment of short term program outcomes. BMC Health Services Research, 15, 1–8.
  • Abdallah, A. (2014). Implementing quality initiatives in healthcare organizations: Drivers and challenges. International Journal of Health Care Quality Assurance, 27(3), 166–181.

This article addresses competing quality improvement projects in organizations.

  • Nyström, M. E., Garvare, R., Westerlund, A., & Weinehall, L. (2014). Concurrent implementation of quality improvement programs: Coordination or conflict? International Journal of Health Care Quality Assurance, 27(3), 190–208.
Benchmarks for Quality Indicators

These databases provide recognized benchmarks for quality indicators.