Data Analysis and Quality Improvement Initiative Proposal
Data refers to information, particularly facts and numbers, collected to be analyzed and considered and to guide decision-making. Data is utilized to make clinical judgments, solve questions, and track and foster healthcare quality improvement (QI) initiatives (Shah, 2019). QI initiatives purpose to bring a difference in patient care by improving effectiveness, safety, and care experience. They require health providers to apply their understanding of the complex healthcare environment, use a systematic approach, and design, test, and execute changes using real-time measurement for quality improvement. The purpose of this paper is to carry out a data analysis in a healthcare organization and discuss a QI initiative proposal based on a health issue of interest.
Health Care Issue or Area of Concern
Sepsis is the identified healthcare issue at Katherine Shaw Bethea Hospital in Dixon, IL. The hospital is an 80-bed “not-for-profit” facility that provides general and specialized health services. Data on sepsis in the last three years (2019-2021) was analyzed from the hospital’s dashboard metrics. During the period, 10,589 patients above 18 years were admitted to the facility. Sepsis was identified in 230 patients, accounting for a cumulative incidence rate of 7.4% among hospitalized adult patients. In addition, most of the septic cases (56%) were secondary to community-acquired infections. Severe sepsis occurred in 45 patients, which leads to an incidence rate of 45 cases per 100,000 adults annually.
Furthermore, 17 patients developed septic shock, an incidence rate of 9 cases per 100,000 adults per year. Moreover, most patients met the diagnostic criteria for severe sepsis or septic shock on a day they would have also qualified for the septic status. Besides, some patients had a median time of two days between the sepsis and severe sepsis, while between severe sepsis and septic shock was three days. The facility’s mortality rate due to sepsis was 4.8%; for severe sepsis, it was 5.1%, and for septic shock was 8.7%.
The hospital could measure and use process data to improve its knowledge of the causes of the high sepsis rate in the inpatient units. Process data typically includes information on interventions implemented by healthcare providers to alleviate or prevent incidences of sepsis among hospitalized patients. On the other hand, outcome data includes the outcome of these QI interventions and is used to assess their impact. Vital dashboard metrics that act as process data include The number of patients whose blood cultures drawn before antibiotic administration; The number of patients on antibiotic therapy; The number of patients whose lactate levels were assessed; The number of patients with signs of sepsis administered IV fluids (Shahsavarinia et al., 2020). The process data metrics can enable the facility to identify whether the sepsis rates are contributed by failure to implement crucial measures that prevent sepsis, such as putting patients on antibiotic therapy, reassessing lactate levels, and administering IV fluids.
The hospital can sustain QI processes and outcomes since it has a QI team tasked with ensuring QI initiatives are effectively implemented by the staff in the facility. In addition, the organization’s culture supports innovations in supportive leadership style, effective communication styles, shared values, behaviors, attitudes, and working practices. The hospital’s data on sepsis is reliable since it has been collected and analyzed using scientific methods. Each case of sepsis is reported and recorded in case report forms. In the forms, nurses document the patient’s demographic data, the reason for admission, comorbidities, the origin of primary infection, the date of sepsis diagnosis, and cultures performed with their results.
QI Initiative Proposal
Ineffective screening for sepsis has been attributed to the high sepsis rates at Katherine Shaw Bethea Hospital. Nurses play a major role in recognizing patients with sepsis since they are constantly interacting with patients. However, nurses inadequately screen patients due to inadequate nurse training on screening measures for sepsis and management interventions (Shahsavarinia et al., 2020). Therefore, the proposed QI initiative is nurse training on a nurse-driven sepsis screening tool and management protocol to recognize patients with sepsis and initiate early treatment. Nurses will be trained on the sequential (sepsis-related) organ failure assessment (qSOFA) tool. This is a sepsis screening tool that helps in the early identification of sepsis and is crucial to improving patient care and health outcomes (Guirgis et al., 2018). qSOFA is a bedside score that helps identify patients outside the intensive care unit with suspected infection and who are at higher risk for a poor outcome.
The qSOFA score includes one point for three clinical variables: Respiratory rate ≥ 22 breaths/min, systolic blood pressure (SBP) ≤ 100 mm Hg, or an altered mental status. A patient is considered to have a high chance for sepsis when two of the three clinical criteria are present (Guirgis et al., 2018). The qSOFA is a useful clinical tool, especially for nurses and other providers outside the ICU setting, since the tool relies only on clinical exam findings. It quickly identifies patients with infections with a high likelihood of having poor outcomes (Guirgis et al., 2018). Another advantage is that this simple bedside screening tool is especially applicable in poor-resource settings where diagnostic data is not readily available. Shahsavarinia et al. (2020) found that qSOFA has an acceptable value for the severity of risk stratification, multi-organ failure, and mortality. The study recommended training medical staff and regular screening of patients for warning signs to help increase the qSOFA value in predicting mortality in critically ill septic patients.
The QI initiative proposal will include training nurses on sepsis and using the qSOFA tool to attain the desired patient outcomes. Nurses require to be offered in-service training on the signs and symptoms of sepsis and its impact. Bedside nurses need to exhibit mastery of sepsis before using the qSOFA screening tool on patients (Threatt, 2020). The proposed initiative is to have a two-hour nurse training on sepsis’s pathophysiology, clinical features, and management protocol, which will help them understand the screening parameters. Besides, training is essential to improve nurses’ confidence in using the qSOFA. The training will be conducted when implementing the screening tool, yearly, and when new nurses are hired (Threatt, 2020). This will ensure that all nurses have the required knowledge and skills to identify patients with sepsis and use the qSOFA to promptly identify patients at risk of sepsis in the medical and surgical units.
In addition to the sepsis screening tool, nurses will be trained on the sepsis management protocol to ensure that early treatment interventions are initiated. The prompt treatment interventions aim to prevent sepsis from progressing to severe sepsis, septic shock, and even death (Threatt, 2020). Nurses will be trained on the interventions to take when a patient has a qSOFA score of two or greater using the nurse-driven care bundle-based sepsis protocol. A protocol or care bundle refers to a selected set of patient care interventions designed for implementation when a patient meets the clinical criterion threshold. The care bundle is founded on recommendations from Surviving Sepsis Campaign (Gripp et al., 2021). Nurses will be trained on taking prompt interventions like measuring a patient’s serum lactate, obtaining two blood cultures prior to initiating antibiotics, and initiating antibiotics within three hours.
The QI initiative proposal of a nurse-driven sepsis screening tool and management protocol is expected to lower sepsis rates from 7.4% to below 2.5% within one year. The mortality rate is also expected to reduce to < 2.0 for sepsis, < 3.5% for severe sepsis, and <7% for septic shock within one year. In addition, training nurses is expected to increase their knowledge scores on sepsis, including screening and management interventions. The number of patients who are promptly screened and initiated sepsis treatment interventions is projected to increase from 88% to 98% within a year.
Ensuring nurses have adequate education on sepsis critical for instituting highly functional sepsis screening and management protocols. Therefore, educating all nurses about sepsis management and translating clinical guidelines into practice will improve their capacity to identify sepsis and initiate early treatment measures (Threatt, 2020). However, it is unknown whether training can increase compliance with sepsis performance measures and reduce mortality rates in patients with severe sepsis and septic shock in ICU and medical-surgical settings. Thus, further research is needed to establish the most effective approach to achieve compliance with sepsis screening and treatment protocols by healthcare providers.
Interdisciplinary Team Input to Improve Patient Safety and Quality Outcomes and Work-Life Quality
Interdisciplinary team input will be crucial in implementing the QI initiative on a nurse-driven sepsis screening tool and management protocol. The interdisciplinary team will comprise the chief nursing officer (CNO), hospital administrator, nurse educator, data coordinator, and bedside nurses. The CNO is tasked with developing policies and advising on the best nursing practices that benefit nurses and improve clinical care. Thus, the CNO’s role will include advising the team on the best practices to implement the QI initiative to attain the desired results. Besides, the CNO will ensure the initiative is sustained and conduct performance assessments regarding implementing the protocol. The hospital administrator will ensure adequate resources to facilitate the QI initiative, including the nurse training. Moreover, the administrator will keep the team focused on implementing the initiative to improve patient outcomes.
The nurse educator will facilitate the nurses’ training and evaluate outcomes to ensure that the expected outcomes are attained. In addition, the educator will be involved in developing the education plan and identifying evidence-based recommendations that should be included in the training. Furthermore, the role of the data coordinator will be to collect and interpret data on the implementation of the nurse-driven sepsis screening tool and management protocol in the hospital. The data coordinator will also ensure that patients’ data on sepsis is correctly collected by healthcare providers, which will help monitor the impact of the QI initiative in reducing the incidence of sepsis and related mortalities. Lastly, the bedside nurses will be key members since they will be involved in implementing the screening tool and management protocol in the hospital and must attend the training.
Quality improvement interdisciplinary teams are key strategies to start and execute improvement efforts within healthcare organizations. Much of the QI initiative’s success relies on the team’s ability to identify a problem, develop a solution, lead change, and execute a sustainable QI plan (Erjavec et al., 2022). The proposed QI initiative will depend on the interdisciplinary team’s ability to lead change and implement a plan to sustain the initiative. However, this is based on the assumption that the team will have effective communication, coordination, collaboration, conflict management, and leadership (Erjavec et al., 2022). These are critical factors in ensuring that the interprofessional team is fully engaged in the QI initiative. There is also an assumption that the team members will have a common vision, which is key in steering the team to achieving the overall goal.
Evidence-Based Communication Strategies to Promote Quality Improvement of Interprofessional Care
It is essential for healthcare professionals to engage actively and competently in interprofessional healthcare teams to utilize their specialized knowledge and skills to solve complex healthcare challenges. However, members of the interprofessional team must be aware of the communication requirements for working effectively in QI teams. Erjavec et al. (2022) explain that evidence-based communication strategies should be developed within interprofessional care teams to promote cooperation between members, share pertinent information, and foster coordination in making pertinent QI decisions. Adopting an all-direction communication approach (downward, upward, horizontally, and diagonally) will be an effective communication strategy. It encourages the dissemination of information from lower-level employees to upper management and vice-versa (Renfro et al., 2018). It also encourages peer-to-peer communication, which will allow members to request support and coordinate activities.
Another communication strategy will be electronic messaging through the hospital’s electronic health record (EHR). The EHR provides read-only access and secure messaging features, which will be ideal for the interprofessional team. They can send and receive secure messages among themselves regarding the QI initiative (Renfro et al., 2018). Communication models like the SBAR (situation, background, assessment, and recommendation) will be incorporated to foster communication among the interprofessional team members. Shahid and Thomas (2018) describe SBAR as a reliable and validated communication tool, which reduces adverse events, improved communication among health care providers, and enhances patient safety. SBAR creates a shared mental model around a patient’s condition and is used to transfer patient care in various care settings. Thus, it can be used to communicate care to patients at risk of sepsis and in handing off.
Adverse Event/Near-Miss Data to Be Factored In the Outcomes and Recommendations
The QI initiative’s outcomes and recommendations must account for data on adverse or near-miss events. Inadequate assessment of patients’ mental status, respiratory rate, and systolic blood pressure can result in failure to identify patients with sepsis. Adverse events like antibiotic allergy in the management protocol must also be factored in the QI recommendations. Besides, defective equipment like BP machines can lead to failure to identify a septic patient or unnecessary tests in low-risk patients. Medication errors such as wrong patient or wrong drug will also be factored into the outcomes. The adverse or near-miss events will be determined by documenting the incidences in a case report form.
Conclusion
Dashboard metrics from the Katherine Shaw Bethea Hospital show that sepsis is a major health safety concern with an incidence rate of 7.4% and a mortality rate of 4.8%. The proposed QI initiative is a nurse-driven sepsis screening tool and management protocol to recognize patients with sepsis and initiate early treatment. Nurses will be trained on using the qSOFA screening tool and a sepsis management protocol. The interprofessional team members will employ communication strategies to offer essential input on QI initiatives, address patient safety concerns, and improve health outcomes.
References
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