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:
- Provide an overview of the problem and the setting in which the problem or issue occurs.
- Explain why a quality improvement initiative is needed in this area and the expected outcome.
- 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 course materials or textbook, that establish evidence in support of the quality improvement proposed.
- Discuss steps necessary to implement the quality improvement initiative. Provide evidence and rationale to support your answer.
- Explain how the quality improvement initiative will be evaluated to determine whether there was improvement.
- Support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded.
Expert Answer and Explanation
Quality Improvement Proposal
Overview of the problem
Nursing homes in the United States are said to serve approximately three million elderly Americans every year (Curran, 2017). Nursing homes provide care to the elderly, which they are not able to receive in their home setup. One of the common health issues frequently experienced by patients in nursing homes is the risk of infections. Working in a nursing home setup, I can also attest that infections are one of the major challenges which I frequently encounter. Given the nature of patients I serve, having a clear distinction of a patient who has been infected can be challenging, given that the descriptive symptoms can be elusive.
The elderly, because of the aging factor, have a much weaker immunity as compared to people who are much younger. This puts them at a higher risk of getting infections. Likewise, getting infected may cause more strain to their bodies, with the rate of healing being slower as opposed to younger people. This highlights the importance of infection prevention measures in nursing homes. Some of the common infections normally seen in nursing homes include influenza, pneumonia, methicillin-resistant Staphylococcus aureus (MRSA), urinary tract infections, to list a few (Curran, 2017).
There are various factors that may lead to cases of infections in elderly patients living in nursing homes. One of the factors is poor hygiene practices when handling elderly patients. Simple practices like hand washing and proper disposal of contaminated material are important to keeping infections at bay (Stone et al., 2015). Neglecting to carry such practices as they should, subject the patients to high risk of infections. There are other causes of infections, including coming into contact with infected persons. There are several instances where visitors carry with them infections, especially airborne infections like influenza, which also exposes the patients at risk of being infected. Patients in nursing homes are not always tended to by qualified nurses, they are at times looked after by people who have no prior qualifications in nursing (Curran, 2017). Some of the essential practices in the prevention of infections may not be known to them. This quality improvement proposal will, therefore, focus on hand hygiene and decontamination program, which will be aimed at reducing the instances of infections experienced in nursing care homes.
Why a quality improvement initiative is needed and the expected outcome
The previous section explained the issue of infections in nursing homes as being a major cause of morbidity and mortality experienced. This prompt actions to be taken to mitigate and reduce the number of infection cases experienced. This proposal considered proper hand hygiene and decontamination as the independent variables which can have an impact on the reduction of infection cases (dependent variable) in nursing homes. Hand hygiene techniques, including proper handwashing, during, and after handling patients in nursing homes, are considered to be vital in preventing the spread of infections (Stone et al., 2015). Many at times, the caregivers who are not always nurses, may forget to properly clean their hands when dealing with multiple patients. This exposes other patients to the risk of being infected.
Contamination is also one of the known issues which bring about infection in nursing homes. Contamination can be brought about by poor waste disposal procedures (Cousins, 2016), Handling of contaminated material within the confines of nursing homes, therefore, needs to be done properly. The environment which the patients live in should also be conducive enough to reduce the risk factors which result in infections.
The nursing home already has in place hand hygiene and decontamination procedures; however, they are not as stringent as they should be. This quality improvement proposal will, therefore, focus on reinforcing both hand hygiene and decontamination procedures used by restructuring how the two are implemented in the nursing home. This will be done to reduce the instances of infections experienced within the facility.
This quality improvement proposal will use the following hypothesis to test the outcome of the initiative. The first hypothesis, which is the null hypothesis, will be: There is no effect on using hand hygiene and decontamination program in reducing infections in nursing homes (H0). The alternate Hypothesis, on the other hand, will be: there is an effect on using hand hygiene and decontamination program in reducing infections in nursing homes (H1).
Previous research showing the viability of the quality improvement program
Several studies were carried out, highlighting the success of using the quality improvement methods established by this proposal to deal with the prevention of infections in nursing homes. The first research was conducted by Assab and Temime (2016). The study explained how hand hygiene could be used as a way of controlling norovirus. The results obtained by the research indicated a substantial reduction of infection cases was hand hygiene compliance was done by both the patients and the caregivers in nursing homes. The study also cited that instituting good hand hygiene measures provides a cost-effective way of controlling the spread of infections in nursing homes and should therefore be encouraged.
An article by Cousins (2016) also highlights the effectiveness of using proper decontamination processes in controlling the spread of infections in nursing homes. The author emphasized physical environmental and proper handling of equipment cleanliness as being one of the factors that help to prevent the spread of infections. Proper disposal of contaminants was also considered an essential part of the decontamination process.
The use of ultraviolet rays as a means of carrying out decontamination has been known to be effective in dealing with infection-causing organisms in nursing homes, as indicated by Kovach et al. (2016). The results obtained by the study done by Kovach et al. (2016), indicated by instituting decontamination protocols using ultraviolet rays had a significant impact on the reduction of infection-causing microorganisms in nursing homes. The studies clearly portray the effectiveness of the selected quality improvement initiative as a means to control and prevent infections in nursing homes.
Steps necessary to implement the quality improvement initiative
To make the quality improvement initiative successful, the process has to be done in a systematic manner. The first step in the quality improvement initiative will be to establish a proper plan of how the initiative will be implemented, including establishing the sources of funding. The intent of the quality initiative will be to strategically place hand wipes in places where they can be easily accessible by residents and the caregivers of the nursing home. The initiative will also propose changing the current decontamination policy to increase the frequency of decontamination but at the same time, not affecting the daily activities of the nursing home. Innovative technologies like the use of ultraviolet room disinfection technique will be advised, given its high effectiveness as indicated by Kovach et al. (2017).
The second step will involve educating both the residents and the caregivers on the new handwashing and decontamination program to accustom them to why it is important. The importance of training, as described by Andreasson, Eriksson, and Dellve (2016), is to also facilitate high uptake of an initiative resulting in a boost in the effectiveness of the program.
Implementation of the program will be the third step, which will be done seamlessly in a manner that, preferably, does not interrupt the normal functioning of the facility. Given the program does not involve a lot of restructuring of the facility, then it is expected that the implementation process will be conducted smoothly. The last step will be to continuously monitor and control the running of the program. Control entails establishing areas that need improvement in the program to further enhance it.
Assessment of the quality initiative
The quality improvement initiative will need to be evaluated for its effectiveness. One of statistical test which will be used to measure its effectiveness will include establishing the number of new infection cases after implementation of the initiative. The frequency will be measured against previous records of infection to evaluate whether there was an improvement or not.
Andreasson, J., Eriksson, A., & Dellve, L. (2016). Health care managers’ views on and approaches to implementing models for improving care processes. Journal of nursing management, 24(2), 219-227.
Assab, R., & Temime, L. (2016). The role of hand hygiene in controlling norovirus spread in nursing homes. BMC infectious diseases, 16(1), 395.
Cousins, G. (2016). Role of environmental cleanliness and decontamination in care homes. Nursing Standard. 30. 39-43. 10.7748/ns.30.19.39.s42.
Curran, E. T. (2017). Infection outbreaks in care homes: prevention and management. Nursing Times, 113(9), 18-21.
Kovach, C. R., Taneli, Y., Neiman, T., Dyer, E. M., Arzaga, A. J. A., & Kelber, S. T. (2017). Evaluation of an ultraviolet room disinfection protocol to decrease nursing home microbial burden, infection, and hospitalization rates. BMC infectious diseases, 17(1), 186.
Stone, P. W., Herzig, C. T., Pogorzelska-Maziarz, M., Carter, E., Bjarnadottir, R. I., Semeraro, P. K., … & Schweon, S. (2015). Understanding infection prevention and control in nursing homes: A qualitative study. Geriatric Nursing, 36(4), 267-272.