The Joint Commission journal on quality improvement
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Jt Comm J Qual Improv · Feb 1997
Using a CQI team to produce a more efficient nursing home placement process.
Caldwell Memorial Hospital, a 120-bed not-for-profit community facility in a rural area in western North Carolina, is within a 12-mile radius of three 120-bed skilled nursing facilities. Generally, one-fourth to one-third of its inpatients are from a nursing home. THE NURSING HOME PLACEMENT PROCESS PROJECT: Since 1992 Caldwell has utilized the data-driven, six-step Juran method for its continuous quality improvement (CQI) projects. A CQI team working on social workers' efficiency and visibility recommended that another team begin work on the nursing home placement process. Area nursing homes complained that they were not receiving their fair share of referrals and that transfer documentation was, at times, lacking. THE TEAM ARRIVES AT REMEDIES: The nursing home placement process was streamlined and forms were improved and standardized. A notebook was created and procedures for nursing home placement and for using forms were placed in this notebook. In addition, the team identified and created the long term care fax list, which included all 28 facilities within a 50-mile radius. ⋯ There have been no complaints from the nursing homes through 1996. The team spirit that originated during the team time carried over into everyday work, resulting in a better relationship between the hospital and nursing home staffs.
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In April 1994 at the University of California at Los Angeles Medical Center the Surgical Intensive Care Unit's (SICU's) Quality Improvement Council unanimously agreed on pain management as one of the major factors that negatively affect outcomes for their patient population. Using the FOCUS-PDCA (plan-do-check-act) model for quality improvement (QI), the council chartered a subcommittee to improve the pain management in their ICUs. ⋯ The Quality Improvement Council felt that improvements in pain management were due largely to their having provided staff with the right tools to use in assessing, documenting, and controlling pain. Gains in pain management continue to be made.
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Jt Comm J Qual Improv · Oct 1996
Cancer pain management: pilot implementation of the AHCPR guideline in Utah.
Using the Agency for Health Care Policy and Research's (AHCPR's) 1994 Clinical Practice Guideline for Management of Cancer Pain, HealthInsight, the peer review organization for Utah and Nevada, organized a cooperative project with physicians and nurses from seven acute care hospitals in Utah. The project's purpose was to adapt the guideline into action plans for participating hospitals and provide the tools necessary to address six "core" guidelines-to assess and relieve pain, educate the patient/family and health care workers, measure patient satisfaction, and provide a continuum of care postdischarge. GUIDELINE DEVELOPMENT: The guidelines were further adapted to meet the needs of the individual hospitals and were implemented in January 1995. Baseline data was collected on 10 patient records per hospital. ⋯ The project team continues to monitor progress in guideline implementation. Surveys demonstrate that, at the time of diagnosis, up to 45% of cancer patients experience moderate to severe pain; 65%-90% experience severe pain when cancer reaches the advanced stages. Unrelieved cancer pain can cause intense suffering, diminished activity, loss of appetite, and loss of sleep.
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The National Nosocomial Infections Surveillance (NNIS) System, begun in 1970 by the Centers for Disease Control to collect data on hospital-acquired infections, is one of the oldest continuously operating clinical performance indicator systems in the United States. Growth of the system, from 19 to 230 hospitals, has been accompanied by developments such as the evolution from hospitalwide to targeted surveillance, improved data processing and telecommunications for data collection and reporting, and risk adjustment. ⋯ The NNIS experience can be used as a source of guidance for assessing the effectiveness and utility of other indicator systems.