Download - Quality improvement in the neonatal unit – how can nurses contribute? Denise Evans Lead Nurse Y&H Neonatal ODN March 16 th 2015

Quality improvement in the neonatal unit – how can nurses contribute?

Denise EvansLead Nurse Y&H Neonatal ODNMarch 16th 2015

Denise Evans March 2015 2

What do we want

QUALITY IMPROVEMENT

an essential or distinctive characteristic, property, or attribute : peculiar and essential character : An inherent or distinguishing characteristic; a property: the non-inferiority or superiority of something.

Improvement is the process of a thing moving from one state to a state considered to be better, usually through some action intended to bring about that better state.


Industry & NHSASQ is a global leader in quality and

consists of a community of passionate people who use their tools, ideas and expertise to make our world better.

[quality is] the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.


VisionThere is evidence of poor patient

experiences and outcomesEconomic downturn response - not

indiscriminate cuts1. Improving efficiency2. Driving up quality 3. Reducing levels of harm 4. initiatives such as quality accounts and

the Commissioning for Quality and Innovation (CQUIN) payment framework.


The Dimensions

Safe – avoiding harmEffective - evidence of benefitPatient-centred - partnershipTimely – avoid harmful delaysEfficient – avoid waste Equitable – does not vary in

quality


Nurse Led ChangeParalysis –Fixed head position.Visiting – Visitors corridorAccess – NO ENTRYPain reliefSeparation – bonding -

developmental care


MinutiaSometimes used to describe

trivia but the smallest details are what we share today.

‘How do we know what constitutes good care?’


10 key challenges

1. Convincing people that there is a problem 2. Convincing people that the solution chosen is the

right one 3. Getting data collection and monitoring systems right 4. Excess ambitions and ‘projectness’ 5. The organisational context, culture and capacities 6. Tribalism and lack of staff engagement 7. Leadership 8. Balancing carrots and sticks – harnessing

commitment through incentives and potential sanctions

9. Securing sustainability 10. Considering the side effects of change.


Bespoke Neonatal Safety Thermometer

Harm Free Care “Its not just counting its caring”

Neonatal Unit & Postnatal Care 1. Is there a measurable outcome of harm?

(can we define what the harm is?) 2. Does it happen enough on one day each

month to be picked up in point prevalence testing?

3. Is the information accessible and quick and easy to collect?

4. Does this affect the patient in all settings?


MeasuresDeteriorationExtravasationPainSkin Integrity

Measurement and gathering data are vital elements ofany attempt to improve performance or quality, and arealso needed to assess its impact.


Design principles for the instrument were agreed as follows: 1. Clinically valid with clear operational definitions for harm outcomes (in this case,

pressure ulcers, falls, catheter associated urinary tract infection and venous thromboembolism).

2. Efficient: it should not take longer than 10 minutes per patient and must fit within the daily work flow of frontline clinicians.

3. Equitable and capable of being used wherever the patient is located (e.g. in a home, community or hospital setting).

4. Timely: giving an immediate summary of results that can be used by teams in their improvement work.

5. Patient focused: measuring the absence of all four outcomes in individual patients ‘harm free’ care as well as the individual harms.

6. Focused on all harm irrespective of perceived availability or attribution.

7. Easy to aggregate to show results at the ward, region or national levels.


Meaningful Actions

Involving the clinical team early on when setting aspirations and goals

Ensuring senior clinical involvement and peer influence

Obtaining credible endorsement – for example, from the royal colleges

Involving clinical networks across organisational boundaries

Providing evidence that the change has been successful elsewhere

Embedding an understanding of quality improvement into training and education of healthcare professionals.


Planning, Doing, Studying, Acting

‘What are we trying to accomplish?’––‘How will we know that a change is

an improvement?’ ––‘What changes can we make that

will result in improvement?’

Each cycle starts with hunches, theories and ideas and helps them evolve into knowledge that can inform action and, ultimately, produce positive outcomes.


Focus on Quality

Focus on quality, not targets – if effective care is delivered and the focus is on quality, safety and outcomes, the targets are delivered as a consequence of that process, not the other way around.


Hurdles need to find ways of freeing up

staff time to take part in training programmes

‘We want everybody to feel that they have the opportunity to solve problems and improve the things that they see every day,’

The team across the pathway all need to work together with one goal. Improved outcomes not looking to blame “Not me”


What clinical care do neonates need?

Safe delivery &stabilisation +/-resuscitation at birth &

minimal handling!!!!

Competent staff to undertake procedures safely & deliver optimal care in hospital & on transport

Effective assessment of medical & nursing needs


Morecambe Bay ReportAll showed evidence of the same

problems of poor clinical competence, insufficient recognition of risk, inappropriate pursuit of normal childbirth and failures of team-working, as seen previously. Initial investigation was again deficient and failed to identify manifest problems.


Morecambe Bay We found clear evidence of distortion of

the truth in responses to investigation, including particularly the supposed universal lack of knowledge of the significance of hypothermia in a newborn baby

staffed and equipped to provide a restricted range of neonatal care, but not to deal with more pre-term babies who needed more intensive forms of care.


Paperless

Jeremy Hunt, Secretary of State for Health, has set a clear expectation of a Paperless NHS by 2018, stating that technology will be the saviour of the NHS. Only with world class information systems will the NHS deliver world class care.


If you have never measured it how do you know it has improved?

Thank you


References

Quality improvement made simple Second edition, August 2013.

© 2013 Health Foundation ISBN 978-1-906461-47-8© 2015 The Health Foundation

Building the foundations for improvement is published by the Health Foundation, 90 Long Acre, London WC2E 9RA

The Report of the Morecambe Bay Investigation March 2015

Download - Quality improvement in the neonatal unit – how can nurses contribute? Denise Evans Lead Nurse Y&H Neonatal ODN March 16 th 2015

Top Related