NURS FPX 9901 Assessment 2 Quality Performance Improvement (QI/PI) 

NURS FPX 9901 Assessment 2 Quality Performance Improvement (QI/PI)

Quality Performance Improvement

Quality/Performance Improvement (QI/PI) is a systematic approach used in various fields to enhance the quality, efficiency, and effectiveness of processes, products, or services. QI/PI involves identifying areas for improvement. The quality performance of the project related to improving staff education on nutritional modification and telehealth intervention for the efficient diagnosis of COPD will be measured. QI/PI methodologies aim to drive continuous improvement and achieve higher performance levels (AHRQ, 2020).

Describe the Current Practice Needing Improvement

The problem being addressed is the care provided to in-patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD). COPD is a chronic respiratory condition that can significantly impair lung function and quality of life (Konstantinidis et al., 2022). Patients with COPD often require specialized care to manage their symptoms, improve lung function, and prevent readmissions. The root cause of gap in practice include insufficient knowledge pertaining to nutritional practices, timely follow-ups, and discerning requisite care characterizes the current approach to COPD management at the practicum site. Regrettably, the hospital’s actions to enlighten patients about the crucial significance of smoking cessation and implementing lifestyle modifications for effective disease management remain inadequate. Moreover, the lack of appropriate emergency services accessible to patients further exacerbates the issue, resulting in prolonged periods of waiting. (Konstantinidis et al., 2022). The root cause suggests that the current practices or standard care for COPD patients are not optimized for achieving the desired outcomes.

The root cause analysis suggests a gap between the current practices or standard care provided to in-patients diagnosed with COPD and the desired outcomes. A root cause analysis implies that the existing care may not effectively address lung function values and readmission rates. Including nutritional interventions suggests a gap in the current approach to addressing the nutritional needs of COPD patients (Calvillo-Arbizu et al., 2021). The gap implies that the current practices may not sufficiently focus on optimizing the diet and nutritional intake to improve lung function and reduce readmissions. Inadequate home management due to increased COPD patients and readmissions caused a significant performance gap (Press et al., 2019). 

As per the project charter, inadequate nutritional knowledge, delay in timely follow-ups, and failure to identify care needs also referred to significant performance gaps. Patients lack access to adequate emergency services and experience longer wait times. The absence of any disease management program or specialized care services available for COPD patients causes a lack of awareness of COPD management techniques, including dietary considerations and other therapies, leading to readmissions (Press et al., 2019). Wong et al. (2022) indicated that the gap in the proposed project lies in the need to address the limitations or shortcomings of current practices in caring for in-patients diagnosed with COPD. The project aims to explore and compare nutritional and telehealth interventions to bridge this gap, improve lung function values, and reduce readmission rates in COPD patients.

 A QI/QP Framework that Will Support and Guide the Project

To support and guide the project aimed at improving the care for in-patients diagnosed with COPD, a QI/QP framework can be utilized. Such a framework like PDSA (Plan-Do-Study-Act) model provides a structured approach to identifying, implementing, and measuring the effectiveness of interventions. Several key accomplishments would be necessary to meet the project objectives and outcomes. Burkes et al. (2018) discussed the impact of quality improvement on COPD patients and used the PDSA model to guide COPD patients in correct pneumococcal immunization. The pre-intervention COPD patients were compared with post-intervention, which indicated adequate awareness and improved patient clinical visits for pulmonary function testing. 

Conducting a literature review, developing study design and protocol development, and implementing the nutritional and telehealth interventions can help meet project objectives through the PDSA model. Collecting relevant data on COPD patients on lung function values and readmission rates before and after the implementation of the intervention can also help significantly (White, 2020). The data involve utilizing standardized assessment tools, medical records, patient surveys, and other appropriate data sources. Assess the impact of nutritional and telehealth interventions on lung function values and readmission rates (White, 2020). Compare the outcomes achieved with the desired outcomes stated in the project objectives.

Formative assessments are essential for monitoring the progress of a project and ensuring that it stays on course. These assessments provide valuable feedback and insights that help identify areas of improvement and make necessary adjustments (Ko et al., 2019). Gathering feedback from stakeholders involved in the project, including healthcare professionals, researchers, project team members, and COPD patients, can lead to improved education on proposed interventions (Ko et al., 2019). The feedback can be collected through surveys, focus groups, interviews, or regular meetings. Assess stakeholders’ perceptions of the project’s progress, their satisfaction with the interventions, and any concerns or suggestions they may have. 

Continuously monitoring and analyzing the collected data related to lung function values and readmission rates and comparing the data against the baseline measures can help assess the progress (Konstantinidis et al., 2022). Administering surveys to the in-patients diagnosed with COPD can determine their satisfaction with the care received, including the nutritional and telehealth interventions (Sculley et al., 2021). Collecting feedback on their experiences, perceived benefits, and any concerns or suggestions for improvement can help gauge the effectiveness and acceptability of the interventions from the patient’s perspective (Sculley et al., 2021).

Several QI/PI frameworks can assist in guiding the entire project, and among them, one commonly used framework is the Plan-Do-Study-Act (PDSA) cycle. The PDSA cycle is a continuous improvement framework that involves iterative cycles of planning, implementing, studying, and acting upon changes to achieve desired outcomes (AHRQ, 2020). The PDSA cycle promotes a structured approach to quality improvement and performance measurement, helping guide the entire project toward achieving its objectives and desired outcomes. Here is how the PDSA cycle can be applied to guide the project:

Plan: Develop a detailed plan for implementing the nutritional and telehealth interventions, including the specific actions, resources, needed timelines, and responsible individuals (AHRQ, 2020). Determine the key measures and data collection methods to assess the effectiveness of the interventions.

Do: Implement the planned interventions according to the established protocols and timeline. This phase involves executing the nutritional and telehealth interventions and ensuring proper coordination among healthcare professionals, nutritionists, and technology specialists (AHRQ, 2020). Collect data during the implementation phase to monitor the progress and capture any unexpected issues or challenges.

Study: Analyze the data collected during the implementation phase to evaluate the effectiveness of the interventions. Compare the collected data against the predetermined measures and baseline benchmarks to assess the impact on lung function values and readmission rates (AHRQ, 2020). Identify any patterns, trends, or variations that may provide insights into the effectiveness of the interventions.

Act: Based on the findings from the study phase, take appropriate actions to make adjustments or improvements. If the interventions are effective, consider scaling them up or expanding their implementation. Identify necessary modifications to the interventions, implementation processes, or project plan if areas require improvement. Implement the changes and repeat the PDSA cycle to continue the improvement process (AHRQ, 2020).

How QI/PI data will be collected and analyzed

Collecting and analyzing QI/PI data is crucial for evaluating interventions’ effectiveness and identifying improvement areas. The data is needed to assess the impact of the nutritional and telehealth intervention on lung function values and readmission rates of COPD patients (Backhouse & Ogunlayi, 2020). Collecting data on lung function measurements, such as spirometry results or other relevant tests, can provide objective indicators of lung function improvement. Gathering information on readmission rates of in-patients diagnosed with COPD within a ten-week timeframe can be obtained from hospital records or other relevant sources. Record the demographic information of the participating COPD patients, such as age, gender, comorbidities, and relevant clinical characteristics as proposed data can help analyze the impact of interventions on specific patient subgroups (Backhouse & Ogunlayi, 2020).

Establish a system to record and organize the collected data in a structured manner. The system can be electronic databases like Electronic Health Records (EHRs) and spreadsheets for data management. It is necessary to ensure that data entry is accurate, consistent, and securely stored. Therefore, assign unique identifiers to each patient to maintain confidentiality (Wang et al., 2022). In addition, analyze the collected data to assess the impact of the interventions on the desired outcomes. For this purpose, depending on the nature of the data and research questions, various analysis methods can be employed, such as comparative analysis (Wang et al., 2022). 

Compare the outcomes between the different intervention groups (e.g., nutritional intervention, telehealth intervention, standard care) and use the appropriate data analysis method. This can be the descriptive summary, to calculate summary statistics, such as means, medians, standard deviations, or percentages, to describe the characteristics of the study population, lung function values, and readmission rates before and after the intervention. Interpret the results of the data analysis and draw meaningful conclusions (Wang et al., 2022). Evaluate the findings’ statistical significance, clinical significance, and practical implications. Consider any limitations or confounding factors that may have influenced the results.

To measure progress toward QI/PI objectives effectively, it is essential to employ a combination of strategies that align with the project’s specific objectives and desired outcomes. It includes analysis data, the COPD Knowledge Questionnaire (CKQ), and continuous improvement (Robertson et al., 2021). By administering the CKQ before and after implementing QI/PI interventions, stakeholders can assess any changes or improvements in staff knowledge over time. For this assessment, baseline assessment, targeted interventions, progress monitoring, and identifying knowledge gaps can be utilized. Ultimately, the CKQ provides a standardized and validated means of evaluating staff knowledge, which can be crucial in measuring progress toward QI/PI objectives related to enhancing COPD management practices (Robertson et al., 2021).

Describe proposed QI/PI Changes and Expected Outcomes

The proposed changes include nutritional and telehealth interventions. The proposed changes involve working with registered dietitians to develop personalized dietary plans, providing education on COPD-specific nutrition, and monitoring adherence to the prescribed dietary recommendations (Furulund et al., 2021). Introducing telehealth services can enhance COPD management for in-patients. The proposed change includes remote monitoring of vital signs, video consultations with healthcare providers, patient education via digital platforms, and facilitating self-management through telecommunication technologies (Furulund et al., 2021).

The expected outcomes include improved lung functions, reduced readmission rates, and enhanced nutritional knowledge. For improved lung function values, the nutritional and telehealth interventions aim to impact lung function values among in-patients with COPD positively. The expected outcome is improved spirometry results or other relevant lung function measurements (Haynes, 2018). Moreover, by providing targeted interventions and improved support, the desired outcome will be a decrease in hospital readmissions within a specified timeframe. Nutritional interventions will improve staff members’ knowledge and understanding of COPD-specific nutrition. The expected outcome can be assessed by measuring changes in staff CKQ scores related to nutrition-specific questions (Haynes, 2018).

Spirometry results, readmission rates, staff CKQ scores, and patient satisfaction surveys can be used for appropriate measures for determining actual improvement. Measure and compare spirometry results before and after the implementation of interventions, and monitor and record the number of COPD-related readmissions within a specified timeframe before and after the interventions to determine the staff knowledge (Haynes, 2018). Administering the CKQ to staff members before and after the interventions and comparing pre-and post-intervention scores can assess improvements in staff knowledge and understanding of managing COPD (Robertson et al., 2021). Conducting patient satisfaction surveys can help gather feedback on nutritional and telehealth interventions. Patients’ perceptions and feedback can help gauge the quality of care provided by staff, interventions’ effectiveness, and overall patient satisfaction (Robertson et al., 2021).

The feasibility of the proposed changes depends on various factors, including available resources, organizational support, staff engagement, and technological infrastructure. The availability of resources includes having access to qualified dietitians, telecommunication technologies, necessary equipment, and funding to support the interventions (Berry et al., 2020). Organizational support includes evaluating the level of support from organizational leadership and critical stakeholders. Similarly, assessing the willingness and readiness of staff members to embrace and implement the proposed changes can help to determine the feasibility of the changes. Additionally, evaluate the existing technological infrastructure to support telehealth interventions. For this purpose, factors such as internet connectivity, availability of suitable devices, and compatibility with electronic medical record systems can be considered (Berry et al., 2020).

Several contextual factors can influence the expected outcomes of the proposed changes. It includes organizational culture, staff collaboration and communication, patient population and characteristics, and external factors such as healthcare policies, regulations, reimbursement mechanisms, and regional healthcare infrastructure (Li et al., 2018). For articulating changes and outcomes clearly, ten weeks timeframe will be required. Moreover, the employment of measurable indicators that will effectively track progress, evaluate the success of the interventions, and make data-driven decisions throughout the QI/PI project will be needed (Li et al., 2018).

Changes in Quality or Performance will be Evaluated

Various evaluation tools and methods can be utilized to evaluate the effectiveness of the proposed QI/PI changes and measure the outcomes. Conducting pre- and post-assessments using standardized tools, such as COPD-related CKQ or spirometry tests, can measure changes in knowledge levels, lung function values, or other relevant outcomes (Robertson et al., 2021). Comparing pre- and post-intervention data allows for the evaluation of improvement over time. In addition, analyzing quantitative data collected throughout the project using appropriate statistical methods can help evaluate the effectiveness of the changes. The data involve analyzing readmission rates, spirometry results, patient satisfaction scores, or other relevant outcome measures to determine the impact of the interventions (Robertson et al., 2021).

To evaluate the outcomes of the QI/PI project, the following criteria can be considered including effectiveness, efficiency, stakeholder engagement, and stakeholder feedback. The criteria for evaluating outcomes should align with the project objectives, be measurable, and allow for comparison with baseline data or relevant benchmarks (Robertson et al., 2021). Regular monitoring and evaluation using these criteria will provide insights into the effectiveness and impact of the QI/PI changes and guide further improvements.

The evaluation outcomes will be based on increased staff knowledge, improved practice guidelines, enhanced clinical competence, and improved quality of care for COPD patients. The impact of staff education interventions, such as training sessions or workshops, on the knowledge and understanding of COPD management will be evaluated. It will assess changes in staff CKQ scores related to COPD-specific knowledge and identify areas of improvement (Robertson et al., 2021). The CKQ tool will measure the extent to which staff members adhere to evidence-based practice guidelines on nutritional and telehealth interventions for COPD management. Assessing whether education initiatives have resulted in changes in practice and increased compliance with established guidelines can help determine the status of the outcome (Robertson et al., 2021).

Assess whether the project has improved the overall quality of care for COPD patients. The data can include indicators such as increased staff knowledge of COPD management, reduced readmission rate, enhanced patient safety, increased patient satisfaction, and improved patient outcomes. By assessing these outcomes, the project can determine the effectiveness of staff education interventions in improving the quality and performance of COPD management (Backhouse & Ogunlayi, 2020).

Conclusion NURS FPX 9901 Assessment 2 Quality Performance Improvement (QI/PI) 

The project demonstrated the effectiveness of the proposed QI/PI changes in improving the quality and performance of care for in-patients diagnosed with COPD. The findings of this project provide valuable insights and can serve as a foundation for future initiatives to enhance COPD management practices and patient outcomes. Continued monitoring, evaluation, and ongoing quality improvement efforts will ensure the sustained success of the project and the continued delivery of high-quality care to COPD patients.

References

AHRQ. (2020). Plan-Do-Study-Act (PDSA) directions and examples. Www.ahrq.gov. https://www.ahrq.gov/health-literacy/improve/precautions/tool2b.html 

AHRQ . (2020, January). Section 4: Ways to approach the quality improvement process (page 1 of 2) | Agency for healthcare research & quality. Ahrq.gov (Agency for Healthcare Research and Quality). https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi-process/index.html 

Backhouse, A., & Ogunlayi, F. (2020). Quality improvement into practice. BMJ368(1)https://doi.org/10.1136/bmj.m865 

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