Quality Improvement (QI) and Informatics

by Rhonda Lawes, PhD, RN

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    00:00 One of the most exciting things about informatics technologies in the healthcare environment is how technology maximizes quality improvement initiatives. One advantage of these initiatives is there are so many approaches to using technology and information to improve care.

    00:17 One disadvantage is that there are so many to learn and work with.

    00:22 As a leader in informatics, for our discussion today, we'll discuss some of the major drivers of quality improvement: QSEN, Core Measures, HCAHPS, NDNQI, and IOM.

    00:36 Now, let's start with how the nursing profession uses a set of competencies to drive quality improvement through education standards.

    00:44 Imagine the health care system as a beehive.

    00:46 It's an interconnected world of professionals, patients and systems just buzzing and working together.

    00:53 Nurses form a part of this hive.

    00:55 Hence, quality safety education for them is crucial.

    00:59 This is where QSEN or quality safety education for nurses comes in. QSEN is like the online beekeepers manual that equips nurses with the necessary evidence based competencies in patient-centered care, Teamwork, Evidence-based practice, Quality improvement, Safety and informatics.

    01:19 Another way to think about how QSEN impacts nursing care is to think of it as a global positioning system, specific to nurses navigating through the healthcare hive. For example, one of the QSEN competencies centers on the use of technology and information to manage patient care, prevent medical errors, enhance decision-making, and encourage collaborative communication. If a student nurse or health care employee does not show, prove and document how they learn and implement this technology and information, they are not meeting the competency and, therefore, are not meeting the expectations of quality. Now that you understand how a competency can drive of quality. Now that you understand how a competency can drive quality specific to nurses, let's look at a competency specific to performance across the entire healthcare environment.

    02:09 Core measures set performance standards across commonly seen conditions in the healthcare environment.

    02:16 These measures, set by the Joint Commission, provide a consistent method to measure the use of appropriate treatments for patients across their experience with the healthcare environment.

    02:26 In the case of a core measure Standard for patients experiencing heart attack, there are priority checkpoints the Informaticist can evaluate.

    02:35 The Informaticist might ask, did the health care team know, implement, and document what actions they took related to the following whether aspirin was given on arrival. Beta blockers and statins as appropriate upon discharge.

    02:49 Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for all patients with left ventricular systolic dysfunction.

    02:59 Timely administration of fibrinolytic therapy within 30 minutes of hospital arrival. Timely initiation of percutaneous coronary intervention within 90 minutes of hospital arrival.

    03:10 Answering these questions with yes or no can be generated through data analysis of patient and treatment records for individual patients or patients across an entire healthcare system.

    03:22 This level of analysis allows the Informaticist to provide the healthcare organization with feedback on areas of excellence and areas that need improvement, thus driving quality forward through the power of data analysis. One of the most well-known drivers of quality improvement in the healthcare environment is also a mouthful to say, so people just use the acronym. But the Consumer Assessment of Health Providers and Systems Hospital Survey, or HCAHPS, is a wealth of information about what consumers think about the services that we provide.

    03:59 HCAHPS collects patient perspectives on health care like a restaurant review from cleanliness to communication.

    04:06 These patient reviews help hospitals to understand where their quality is perceived as high or low.

    04:12 Now, a controversial aspect of this survey feedback is the use of these scores to drive reimbursement for services.

    04:20 For example, in a restaurant, if you didn't like the food, you might expect the restaurant to comp your meal.

    04:27 In the healthcare industry, scores can influence as much as 30% of what the organization can be reimbursed for.

    04:34 Have you thought about how it might be interesting to compare the performance of one healthcare organization to another from a let's learn from each other kind of perspective? Well, that's the philosophy behind the National Database of Nursing Quality Indicator, or the NDNQI use of information.

    04:53 NDNQI is a treasure trove of nursing-sensitive measures.

    04:58 This helps nurses and hospitals identify and implement best practices for improving patient care.

    05:04 Now, what's interesting about this approach is that the data collected looks at more than just patient perceptions of quality.

    05:12 These indicators include data on workplace culture as healthy or not, in addition to indicators of quality such as low or nonexistent hospital-acquired infections.

    05:24 All these systems too broad for you.

    05:26 There are so many things being monitored in healthcare, you might think that it would be nice to see someone pay specific attention to just one thing as a quality indicator. Now, one example of a specific quality indicator that can change lives are adherence to sepsis protocols.

    05:42 These protocols are highly time-sensitive and require a great deal of precision on the part of the healthcare team.

    05:50 Every single choice and interpretation can result in a life-threatening consequence. Now, you might be thinking that all these approaches need a head chef who oversees quality improvement, like a chef who oversees their sous chefs and the healthcare environment.

    06:06 That chef is the Institute of Medicine or the IOM.

    06:10 This MasterChef provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. This agency is meant to know the best recipes and guide and teach everyone how to create the highest quality meal.

    06:30 Even with amazingly rich and complex research knowledge, every patient and situation is different and so the outcomes can sometimes be unpredictable.

    06:39 And remember, not everyone likes the same dish.

    06:43 But for most people, most of the time, it is most useful to follow the recipes of an established, reputable source.

    06:51 IOM helps improve the nation's health system by making recommendations designed to encourage innovation and improve health care delivery from broad to narrow quality indicators, from information databases to the protocols, and from the core measures to the governing bodies.

    07:09 Each piece of this healthcare puzzle plays a vital role.

    07:13 Together, they help deliver a healthcare experience that's not just about healing, but about quality, safety, and continuous improvement.

    About the Lecture

    The lecture Quality Improvement (QI) and Informatics by Rhonda Lawes, PhD, RN is from the course Healthcare Informatics.

    Included Quiz Questions

    1. Core measures
    2. Quality Safety Education for Nurses
    3. Consumer Assessment of Healthcare providers and Systems
    4. National Database of Nursing Quality Indicator
    1. Consumer Assessment of Healthcare Providers and Systems: Hospital Survey
    2. Core measures
    3. Quality Safety Education for Nurses
    4. National Database of Nursing Quality Indicator
    1. National Database of Nursing Quality Indicator
    2. Quality Safety Education for Nurses
    3. Core measures
    4. Consumer Assessment of Healthcare Providers and Systems: Hospital Survey
    1. Quality indicator
    2. Core principle
    3. Safety standard
    4. Care standard

    Author of lecture Quality Improvement (QI) and Informatics

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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