Organizational Quality Improvement Project Proposal

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice. Apply “The Road to Evidence-Based Practice” process, illustrated in Chapter 4 of your textbook, to create your proposal.

Include the following:

  1. Provide an overview of the problem and the setting in which the problem or issue occurs.
  2. Explain why a quality improvement initiative is needed in this area and the expected outcome.
  3. Discuss how the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes. Include a minimum of three peer-reviewed sources published within the last 5 years, not included in the Class Resources or textbook, that establish evidence in support of the quality improvement proposed.
  4. Discuss steps necessary to implement the quality improvement initiative. Provide evidence and rationale to support your answer.
  5. Explain how the quality improvement initiative will be evaluated to determine whether there was improvement.
  6. Support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded.

Answer

Organizational Quality Improvement Project Proposal

Healthcare practice is faced with various problems from time to time. These problems may impact the provision of good care quality, patient outcomes, and organizational performance. However, these practice problems and issues are good opportunities for quality improvement. Healthcare leaders are tasked with initiating quality improvement opportunities and implementing them based on the evidence-based practice process, thus addressing the issue and improving patient outcomes and organizational performance. One of the quality improvement opportunities in my practice is the high cases of catheter-acquired urinary tract infections. Therefore, the quality improvement project is a clinician education program focusing on addressing catheter-acquired urinary tract infections. This paper describes catheter-acquired urinary tract infections and a quality improvement project proposal on the issue.

Problem and Setting Overview

Catheter-acquired urinary tract infections (CAUTI), also known as catheter-associated UTIs, are infections in the urinary tract in which the positive culture is taken when an indwelling urinary catheter has been in place for more than two calendar days. Patients with indwelling catheters in the bladder are predisposed to UTIs and are susceptible to bacteria in the urine since the catheter is a foreign substance to the bladder. Additionally, the catheter inserted acts as an initiation site for infections due to the introduction of foreign bodies into the urinary tract. CAUTI infections affect any part of the urinary system, including the bladder, ureter, urethra, and kidneys. Catheter-acquired urinary tract infections are the most reported hospital-associated infections in the National Healthcare Safety Network. According to the Centers for Disease Control and Prevention (n.d.), approximately 75% of urinary tract infections acquired in hospitals are associated with catheters. Therefore, catheter-associated urinary tract infections are a severe problem in hospital settings.

Quality Improvement Initiative Justification/Expected Outcomes

All healthcare institutions aim to deliver care services that produce desirable outcomes and optimal quality. Providing quality healthcare services entails ensuring patient safety, the effectiveness of care, patient-centeredness, efficiency, timelessness, and equity. Healthcare institutions put in place various measures and tools to ensure quality, assess performance, and notice areas of quality improvement (Quentin et al., 2019). Additionally, patient safety is one of the measures of care quality. The primary patient safety concerns that raise questions about care quality include hospital-acquired infections. As mentioned earlier, the most frequently reported hospital-acquired infection is catheter-acquired urinary tract infections, despite being highly preventable. Therefore, initiatives to prevent cases of CAUTI are necessary.

Furthermore, CAUTI negatively impacts the patient’s health outcomes. According to Ladhani et al. (2020), CAUTI is usually associated with other complications, including sepsis and bacteremia, which may turn, lead to death, prolonged hospitalization, and increased cost burden for the patient and the healthcare system. More so, 15-25% of hospitalized patients receive urinary catheters during their hospital stay, showing that a considerable population is predisposed to the risk of CAUTI (CDC, n.d.). Hence, the quality improvement initiative on clinician education will improve quality and performance outcomes for the healthcare institution and patient outcomes. The expected project outcome is improved self-reported knowledge and confidence in CAUTI s management and prevention, which will translate to decreased prevalence of CAUTI and a reduction of mortality cases related to CAUTI.

Research Evidence Supporting the Proposed QI Initiative and Projected Outcomes

According to Reynolds et al. (2022), quality improvement initiatives using multifaceted interventions to reduce the prevalence and incidence of catheter-acquired urinary tract infections, especially in intensive care units, have effectively ensured a sustained reduction of CAUTI cases. Successful quality improvement interventions addressing CAUTI concerns include education, cognitive aids, and real-time feedback on patient care quality. The intervention outcomes are reduced urine culture rates, reduced catheter utilization, and decreased CAUTI incidence rates (Reynolds et al., 2022).

Furthermore, multidisciplinary teams-led QI initiatives on CAUTI have been found to considerably reduce the cases of CAUTI across different care institutions. A study by Ramakrishna et al. (2022) shows an improvement in infection prevention following reduced cases of inappropriate catheter insertions and prolonged removals. The outcomes resulted from implementing a quality improvement intervention that focused on care provider education (for doctors and registered nurses) and the design and implementation of appropriate urinary catheter practice algorithms. The initiative improved the confidence and knowledge of the care providers in the prevention, management, and control of catheter-associated urinary tract infections in the study.

Research shows that various catheter practice algorithms and urinary tract assessment tools have been developed to prevent CAUTI (Narula et al., 2019). However, most interdisciplinary team members are unaware of these evidence-based practices, and thus the need for clinician education to create awareness and improve knowledge and practices on CAUTI prevention, management, and control. Narula et al. (2019) note that education interventions can be used to create awareness of CAUTI prevention and management best practices, thus helping reduce the incidence of cases and improve patient safety and health outcomes.

From the research evidence presented above, the use of clinician education, specifically focusing on nurses and physicians as a QI initiative for CAUTI, is effective in leading to positive outcomes. The positive outcomes indicated in the research include increased knowledge and confidence in CAUTI prevention and management and reduced CAUTI incidence and prevalence.

Steps of Implementing the Quality Improvement Initiative

When implementing a quality improvement initiative, it is critical to identify a model that can be used as a framework to guide the implementation, assess the progress and obtain feedback for continuous improvement (Livesay, Zonsius & McNett, 2022). The model that will be used in this quality improvement initiative is the six sigma model. The six sigma model eliminates defects and errors in procedures and processes. The model mainly has two methodologies; Define, Measure, Analyze, Design, Verify (DMADV), which is used when developing a product from scratch, and the Define, Measure, Analyze, Improve, Control (DMAIC), which is used for the improvement of already existing procedures and processes. DMAIC is the most used model for quality improvement initiatives in healthcare.

The first step in this process is defining the project goals. The project goals are defined by identifying what needs to be accomplished, the people who should be involved in accomplishing the goal, and galvanizing the resources and support needed. In this case, the project goal is to conduct clinician education on nurses and physicians concerning the prevention, management, and control of catheter-associated urinary tract infections. The project will involve various stakeholders, including healthcare leaders, nursing managers from different units, nurses, physicians, and an external educator- a specialist in infection control and CAUTI prevention and management. Support from the healthcare institution leaders is also essential in this project. The project team will hold a meeting with the leaders and develop a presentation to explain to them the existence and intensity of the problem, thus garnering their support for the initiative. The resources needed include financial resources, educational materials, space, and time for conducting the clinician education program.

The second step is the measure. It involves measuring the performance of the existing process when it is unaltered. My healthcare institution uses a CAUTI best practice algorithm to control and manage CAUTI. In this step, the current intervention, which is the use of algorithms, will be measured on its effectiveness based on its purpose.

The third step is to analyze. The step entails an analysis of the possible causes of the current problem. The current process or measure is analyzed to identify the root causes resulting in the defects. In this case, the use of CAUTI best practice algorithms will be assessed to identify what could be the root cause of increased catheter-acquired urinary tract infection prevalence and incidence.

The fourth stage, improvement, involves addressing the problem, given that its root causes have already been identified. The changes that can be implemented to address the problem are modified into a plan of action for improving the condition and contributing to change. The fifth and final stage of the process is the control stage. The stage entails continuous monitoring and evaluation of the process while incorporating feedback learned from tracking the progress. Evaluation of the initiative at this phase would determine whether the improvement initiative has met the set outcomes, that is, increased knowledge and self-reported confidence among care providers on the prevention, control, and management of CAUTI.

Evaluation of the Quality Improvement Initiative

Evaluation of quality improvement initiatives assessing whether the project led to the desired outcomes and to what extent the project implementation the quality improvement project improved efficiency and effectiveness in the issue of concern (Livesay et al., 2019). There are various ways in which quality improvement initiatives are evaluated. In this case, the quality improvement initiative will be evaluated based on three improvement aspects; the acceptance and adherence to the revised practices, the extent to which the new practice impacts the delivery of patient-centered care, and the extent to which patient care and experience have improved. The number of care providers attending the training and the incidence of CAUTI is the measures that will be used to evaluate whether there was an improvement. The variables that would be used to test whether the initiative was successful include clinician education and self-reported confidence in the prevention and management practices of CAUTI. The hypothesis that would be tested to identify the improvement is that clinician education improves self-reported knowledge and confidence in CAUTI prevention and management. The statistical test that can be used is the t-test, which measures changes in a population before and after the intervention. These tests will help identify if the improvement initiative succeeded.

Conclusion

In summary, the issue of concern that is a perfect opportunity for quality improvement is the high incidence and prevalence of CAUTI. The proposed quality improvement initiative is clinician education for nurses and doctors. The projected outcomes include increased self-reported knowledge and confidence in CAUTI prevention/management. The six sigma model will be used in the initiative’s implementation. Evaluation will be done to identify project success.

References

Centers for Disease Control and Prevention (n.d.) Catheter-associated Urinary Tract Infections (CAUTI). Retrieved 17th February 2023 from https://www.cdc.gov/hai/ca_uti/uti.html

Ladhani, H. A., Tseng, E. S., Claridge, J. A., Towe, C. W., & Ho, V. P. (2020). Catheter-Associated Urinary Tract Infections among Trauma Patients: Poor Quality of Care or Marker of Effective Rescue? Surgical Infections21(9), 752–759. https://doi.org/10.1089/sur.2019.211

Livesay, S., Zonsius, M., & McNett, M. (2020). Evaluating data to guide care delivery: Quality improvement methods and implementation science. In Data for Nurses (pp. 59–86). Academic Press. https://doi.org/10.1016/B978-0-12-816543-0.00005-4

Narula, N., Lillemoe, H. A., Caudle, A. S., Chemaly, R. F., Anderson, J. J., Segal, C., Porter, C. A., Swisher, S. G., Levenback, C. S. & Aloia, T. A. (2019). Postoperative urinary tract infection quality assessment and improvement: the STOP UTI program and its impact on hospital-wide CAUTI rates. The Joint Commission Journal on Quality and Patient Safety45(10), 686–693. https://doi.org/10.1016/j.jcjq.2019.06.001

Quentin, W., Partanen, V.M., Brownwood, I., & Klazinga, N. (2019). Measuring healthcare quality. Improving healthcare quality in Europe: Characteristics, effectiveness, and implementation of different strategies [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK549260/

Ramakrishna, J. M., Schmidt, B., Hessler-Waning, M., Reddy, T., Hester, T., Kashlan, R., Tariq, O., McCready, T. & Tegeltija, V. (2022). 2028. Reduction in Health Care Facility Onset Catheter-Associated Urinary Tract Infections: A Resident-Led Quality Improvement Initiative. In Open Forum Infectious Diseases (Vol. 9, No. Supplement_2, pp. ofac492-1651). US: Oxford University Press. https://doi.org/10.1093/ofid/ofac492.1651

Reynolds, S. S., Sova, C. D., Lewis, S. S., Smith, B. A., Wrenn, R. H., Turner, N. A., & Advani, S. D. (2022). Sustained reduction in catheter-associated urinary tract infections using multifaceted strategies led by champions: A quality improvement initiative. Infection Control and Hospital Epidemiology43(7), 925–929. https://doi.org/10.1017/ice.2021.135

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