You are a team leader and have been asked to teach a short lesson to new employees during an orientation meeting concerning the value of continuous quality improvement (CQI).
Develop a 3-page (double-spaced) lesson plan that outlines the application of CQI practices to a safety issue that a medical facility is currently experiencing. Address the following:
Identify the safety issue and surrounding issue(s).
Determine the cause of the issue.
Apply CQI to solve the issue.
Identify the proposed outcome.
Provide an evaluation plan of the process.
Use APA format.
for reference I am an operating room nurse!
Unit 3 IP
Name
Institution
Date
Unit 3 IP
Safety Issue
The safety issue that will be addressed in this paper is wrong-site surgery. Wrong-site surgery refers to a surgical procedure that is performed on the wrong side, the wrong anatomy, the wrong patient, and the wrong spine level. According to Gloystein et al. (2020), in the United States, wrong-site surgeries range from 683 to 34,000 annually depending on the surgical procedure’s annual rates. Wrong-site surgeries may result in permanent injuries to the patients, a burden of costs of care as well as a ruined reputation for the surgeon and the surgical facility. The Joint Commission declared wrong surgery sites as preventable events which can be mitigated through compliance with the proper processes, safeguards, and checklists provided.
The Cause of the Issue
The common cause of wrong-site surgery is a communication breakdown between the surgeon and the other members of the team handling the patient (Moturu et al., 2018). Communication is a very vital process, especially during the preoperative preparation of the patient as well as the procedures that would be applied to verify the operative site. A comprehensive and effective preoperative patient assessment entails a review of the patient’s medical records and imaging studies. Similarly, it is vital to conduct a briefing that aims at assigning roles and establishing expectations for each team member. The introduction of the members is recommended for improved communication during the surgery.
Application of CQI to Solve the Issue
Continuous Quality Improvement (CQI) is a systematic process that involves the collection, analysis, and use of data to improve the quality of healthcare services in clinical settings. The goals include the enhancement of the work operations, system processes, and improvement of the work environment as well as compliance with laws and regulations. The hospital management utilizing the CQI would therefore need to rely on data collected from the facility from different sources such as from observation, feedback from employees and patients as well as hospital data, especially on patients’ health outcomes. Continuous Quality Improvement entails four steps namely plan, do, study and act.
The application of the CQI to solve the issue of wrong surgery sites would require the following four steps. In the first step of planning, the health facility stakeholders would require to identify a new approach during surgery that would lower the incidence rates of the identified issue. There would be a need to pool resources and personnel and at the same time define a time frame. For example, having identified the common cause of wrong surgery sites being communication breakdown, the facility leadership, could organize training on the essence of communication before, during, and after surgery. The training would also highlight the various information that the surgical team would need to verify verbally before starting a surgical procedure.
The second step would entail the implementation of the identified mitigation measure to counter the identified problem. The management should invite a speaker and a team of trainers to train the surgical team on effective communication and if need be simulate a surgical event. The third step of studying would involve tracking the results while at the same time analyzing the impact that the introduced approach has on the identified problem. Similarly, the results should be shared with the team while equally making the necessary adjustments. In the context of the wrong surgical sites, and communication breakdown being the underlying issue, there would be a need to assess the impact of improved communication among the team members at different times during surgery.
The fourth and last step is acting where the stakeholders are required to make any adjustment if need be. This step would entail making changes while at the same time determining what needs to be learned by the team members and lastly setting up the ground for the next round. Changes would be made based on measurable outcomes from the introduced approach.
The Proposed Outcome
Effective and open communication between the surgeon and the team members would be the proposed outcome. The team should be in a position to review and discuss the patient’s medical records as well as any imaging studies before beginning the surgery. The lead surgeon should equally assign roles and establish expectations while at the same time introducing team members for an improved communication process.
Evaluation Plan of the Process
The evaluation will be based on the surgical team’s behavior as well as the patient outcomes about wrong-site surgery. The surgeon and the team should be in a position to carry out the surgery on the correct surgical site, the right patient, the right side as well as the right spine level. The surgical team should therefore demonstrate collaboration, as the process of care will be evaluated based on care provided and level of accountability. The hospital data should indicate a significant reduction of the wrong site surgery cases improving patient satisfaction and minimizing the associated adverse events.
References
Gloystein, David M., Bradley A. Heiges, David G. Schwartz, John G. DeVine, and Deborah Spratt. “Innovative technology system to prevent wrong site surgery and capture near misses: A multi-center review of 487 cases.” Frontiers in Surgery (2020): 78.
Moturu, A., Howe, J., & Tran, G. (2018, June). Qualitative Review of Wrong-Site Surgeries: What Side Will My Surgery Take Place?. In Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care (Vol. 7, No. 1, pp. 267-273). Sage CA: Los Angeles, CA: SAGE Publications.