In the current era, nursing care to patients in healthcare institutions has become a critical exercise that requires compound practice in order to offer value care. In this sense, patients’ safety has gained significance and becomes a vital tool to elicit scientific volume of commitment to structured evaluation and prevention practices in an attempt to reduce undesirable outcomes. According to the American Geriatrics Society, a fall is an unexpected displacement of a patient to a lower position without loss of consciousness. Postoperative falls are described as falls that occur after a patient has been operated. The falls have been reported to both in-patients and out-patients though most of the cases have been reported to occur within healthcare organizations’ setting. In a healthcare context, postoperative period (PO) is considered from the point patients leaves operating rooms to the end of monitoring by nurses after their endpoint evaluation. In-patients in PO stage are prone to risks among them risk of falls and thus falls among the most challenging events reported in PO hospitalized patients. This incident has been reported to result from conditions of recovery, change of situations or pharmacological therapy in place. This situation has sometimes resulted in considerable morbidity to some patients and consequent responsibility for the healthcare organizations. This paper aims to support the implementation of quality improvement using Evidence-Based Practice in nursing, drawing evidence from previous researches. The paper also provides necessary steps for implementing the quality improvement, its evaluation, proposed variables, hypothesis and statistical test that could be used to measure the success of the initiative.
Why Quality Improvement Initiative is Necessary
As healthcare institutions make an effort to improve care value and affordability, there is a need to understand the essentials of quality improvement especially in cases associated with postoperative falls. Robert Wood Johnson Foundation defines quality improvement as the process-related, information-driven approach to upgrade the value of service or product. This definition works under the belief that there is always a chance to improve and increase the quality of activities and processes. Quality improvement in postoperative (PO) patients is essential for primary reasons that facilitate the readability of patients’ health status after leaving the operation room. Proper analysis of patients’ condition would help to minimize the number of PO falls. Quality improvement is necessary to provide Electronic Health Record (EHR) for patient discharged from the theatre which is ultimate of significance to nurses in preventing the risk of falls. The initiative also helps nurses to consult the surgeons of impending risks of fall that could occur to patients after surgical operations. EHR of postoperative patients reflects the real-time health data in the nurses’ records thus enhancing close monitoring and initiating strategies that reduce the risk of falls. When quality improvement initiative is taken in nursing practice, positive outcomes are expected to reflect in practice (Singh & Sitting, 2016). Safety would be enhanced and as the initiative offers protective shields to avoid patients’ injuries resulting from PO falls. The initiative would also result in a patient-focused strategy that would ensure special care provided to PO patients in an attempt to prevent falls.
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Previous Researches
Various researches have been conducted to measure the effectiveness of quality improvement in nursing practice. Though some previous researches stated that quality improvement involves costly strategies to implement, most studies supported the initiative stating that quality improvement facilitated service delivery. Earlier studies on postoperative pain have shown that the poorly managed pain resulted among others, patient falls. The studies demonstrated a variety of interventions that could be applied in the process of quality improvement to reduce postoperative pain, and hence patients fall. One of the challenges experienced is that postoperative pain and its related results were complex to interpret. However, evidence gathered from EHR which draws from and inform practices was revealed to bypass this challenge and informed decisions which resulted in efficient and more effective strategies on postoperative pain management. In support of quality improvement, this research recommended three quality improvement aims which would ensure the achievement of the set objectives. One, to establish a systemized electronic definition of pain-associated care procedures, Two, to extract meaningful data in electronic medical record (EMR) and asses the connection between recommended care and the outcomes of postoperative pain such as patient fall. Another research conducted to establish the relationship between preoperative and postoperative falls stated that postoperative falls had become a quality assessment target. In a bid to reduce postoperative inpatient falls, the study pointed out that the National Institute for Health and Care Excellence had issued guidelines to reduce inpatients falls since the condition had become an important quality metric.
Steps for Implementation
For quality improvement initiative of preventing postoperative falls to be successfully implemented, there are necessary steps to be followed in nursing practice. Though quality improvement (QI) models differ in approach and methods, the primary underlying principle is that QI is a continuous activity. The primary quality improvement implementation involves four main steps; plan, do study, act. Planning involves developing improvement objectives. By setting the objectives, the team for implementation can communicate the goal to the concerned parties. The goal needs to reflect on a specific factor of Consumer Assessment of Health Providers and System (CAHPS). For instance, preventing postoperative falls as the main goal, need to be communicated to all relevant parties. Planning also includes identification of possible tactics, choosing specific intervention to implement and preparing a written action plan. “Do” involves specifying performance metrics to evaluate whether the change leads to improvement. In preventing patients’ falls after the operation, the action is to measure the probability of occurrence of postoperative fall (D’Andreamatteo, Lanni, Lega & Sargiacomo, 2015). There is also the need to test the acceptance of the proposed practices, examining the effectiveness of the new practices in preventing the occurrence in addition to assessing patients’ response to the new approach. “Study” involves measuring the specific changes to be implemented. Small scale tests of interventions to be implemented helps to refine improvements by assimilating small modification progressively. Preventing postoperative falls will need to be incorporated in the healthcare organizations’ system to cater with the help of patients and nurses to enhance efficiency. “Act” involves adopting intervention and evaluating it against the objective of improvement, and strategies put in place for tracking improvement. There is occasional monitoring on improvement on responses that would enable to reduce patients fall at this stage.
Evaluation for Quality Improvement
Assessment is an essential component of the quality improvement initiative. Evaluation is useful in different ways including monitoring the impact of implementation and the effectiveness of the initiative. Implementation evaluation records the process of establishing and implementing the initiative and pinpoints key success, challenges and lesson learned. Within the initiative such as preventing postoperative falls, evaluation comprises an integral part of the quality improvement process tied to an explicit assessment of the impact of implementing the proposed changes in the nursing practice. For instance, in models of continuous quality improvement, the third stage of the Plan-Do-Study-Act cycle would involve collecting information to evaluate whether changes introduced in the second stage have been realized in an attempt to prevent postoperative falls. In this case, also, some methods of evaluation will need to be put in place to assess the success or failure of preventing postoperative falls initiative (Goodman et al. 2016). The clinical audit will involve evaluation of care alongside established criteria and standards through which performance or changes of performance in ensuring the improvement of the situation will be measured. Focus group and personal interviews are important traditional methods for gathering information about patients and nurses experiences. This technique will involve listening to stories from patients and nurses perspective.
Statistical Measures
In order to determine whether the expected quality improvement has been met, statistical data analysis would be used. Statistical analysis would be essential since it gives accurate assumption when all variables in place are considered and analyzed using different tests. Several independent and dependent variables would need to be considered such as the setting, patients’ and caregivers’ responses. Hypothesis tests would be necessary to determine the progressive improvement in preventing postoperative patients falls. Since the test for improvement would come mostly through observation, the null hypothesis would be used in the process. Statistical tests, on the other hand, would provide the basis for making quantitative conclusions on whether there have been measures of improvement recorded on the patients or nurses responses to prevent patients falls after surgical operations. The statistical tests would include the use of the chi-square test. This test would help to determine the goodness of the initiative.
References
D’Andreamatteo, A., Ianni, L., Lega, F., & Sargiacomo, M. (2015). Lean in healthcare: A comprehensive review. Health policy, 119(9), 1197-1209.
Goodman, D., Ogrinc, G., Davies, L., Baker, G. R., Barnsteiner, J., Foster, T. C., ... & Leis, J. (2016). Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V. 2.0: examples of SQUIRE elements in the healthcare improvement literature. BMJ Qual Saf, 25(12), e7-e7.
Singh, H., & Sittig, D. F. (2016). Measuring and improving patient safety through health information technology: The Health IT Safety Framework. BMJ Qual Saf, 25(4), 226-232.
