Implementing a labor monitoring guideline and midwives responsibilities to increase the completion rate of partograph in Muhima Hospital, Rwanda

2016 ◽  
Vol 24 (4) ◽  
pp. 335-340 ◽  
Author(s):  
Jean Bosco Byukusenge ◽  
Eva Adomako ◽  
Stephanie Lukas ◽  
Cyprien Mugarura ◽  
Josette Umucyo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Workers ◽  
Leadership Skills ◽  
Completion Rate ◽  
Quality Improvement Project ◽  
Completion Rates ◽  
Improvement Project ◽  
Content Type ◽  
Root Cause ◽  
Complete Health

Purpose Complete health documentation during childbirth can reduce complications and improve maternal and foetal outcomes. One such document is the partograph which allows health workers to record and follow the labour progress. However, the completion rates of partograph remain low in some hospitals. This study describes the implementation of a quality improvement project to increase the completion rate of partograph in a district hospital in Rwanda. Design/methodology/approach The project team tackled the root cause of partograph incompletion by implementing a labour monitoring guideline, assigning patients and duties to midwives and by providing support and supervision. Findings The intervention successfully increased overall partograph completion rates from 11 to 61 per cent, p < 0.001. This study also showed that completeness of the partograph was statistically associated with a decrease in foetal deaths and higher Apgar score with p < 0.001 for both. Practical implications This study describes the establishment of a quality improvement project following the strategic problem solving approach to increase the completion rate of partograph documentation. The intervention was simple, data-driven and cost-neutral. The team achieved its objectives by integrating staff input, obtaining commitment from the multidisciplinary team and applying leadership skills. Originality/value The results are useful for hospitals in limited resources settings wishing to improve overall partograph completion and improve foetal and maternal outcomes during labour, in an efficient and cost-neutral way.

Increasing patient medical record completion by assigning nurses to specific patients in maternity ward at Munini hospital

2016 ◽  
Vol 24 (4) ◽  
pp. 327-334
Author(s):  
Yvonne Ufitinema ◽  
Rex Wong ◽  
Eva Adomako ◽  
Léonard Kanyamarere ◽  
Egide Kayonga Ntagungira ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Medical Record ◽  
Medical Records ◽  
Cost Effective ◽  
Completion Rate ◽  
Quality Improvement Project ◽  
Post Intervention ◽  
Improvement Project ◽  
Content Type ◽  
Efficient Care

Purpose The purpose of this paper is to describe the quality improvement project to increase the medical record documentation completion rate in a district hospital in Rwanda. Despite the importance of medical records to support high quality and efficient care, incomplete documentation is common in many hospitals. Design/methodology/approach The pre- and post-intervention record completion rate in the maternity unit was assessed. Intervention included assigned nurse to specific patients, developed guideline, provided trainings and supervisions. Findings The documentation completion rate significantly increased from 25 per cent pre-intervention to 67 per cent post-intervention, p < 0.001. The completeness of seven out of the ten elements of medical records also significantly increased. Practical implications The quality improvement project created a cost-effective intervention that successfully improved the documentation completion rate. Ongoing monitoring should be continued to learn sustainability. Originality/value The results are useful for hospitals with similar settings to improve completion of nursing documentation and increase nursing accountability on patient care.

Lessons learned in establishing a quality improvement project to reduce hospital acquired infections in the neonatology ward at a referral hospital in Rwanda

2016 ◽  
Vol 24 (4) ◽  
pp. 341-348 ◽  
Author(s):  
Naasson Gafirimbi ◽  
Rex Wong ◽  
Eva Adomako ◽  
Jeanne Kagwiza
Keyword(s):  
Quality Improvement ◽  
Lessons Learned ◽  
Referral Hospital ◽  
Quality Improvement Project ◽  
Injection Technique ◽  
Improve Quality ◽  
Improvement Project ◽  
Content Type ◽  
Hospital Acquired

Purpose Improving healthcare quality has become a worldwide effort. Strategic problem solving (SPS) is one approach to improve quality in healthcare settings. This case study aims to illustrate the process of applying the SPS approach in implementing a quality improvement project in a referral hospital. Design/methodology/approach A project team was formed to reduce the hospital-acquired infection (HAI) rate in the neonatology unit. A new injection policy was implemented according to the root cause identified. Findings The HAI rate decreased from 6.4 per cent pre-intervention to 4.2 per cent post-intervention. The compliance of performing the aseptic injection technique significantly improved by 60 per cent. Practical implications This case study illustrated the detailed application of the SPS approach in establishing a quality improvement project to address HAI and injection technique compliance, cost-effectively. Other departments or hospitals can apply the same approach to improve quality of care. Originality/value This study helps inform other hospitals in similar settings, the steps to create a quality improvement project using the SPS approach.

scholarly journals Exploration of a quality improvement process to standardised preoperative tests for a surgical procedure to reduce waste

2021 ◽  
Vol 10 (3) ◽  
pp. e001570
Author(s):  
Rabia Shahid ◽  
Malone Chaya ◽  
Ian Lutz ◽  
Brian Taylor ◽  
Lily Xiao ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Root Cause Analysis ◽  
Quality Improvement Project ◽  
Improvement Strategy ◽  
Improvement Project ◽  
Cause Analysis ◽  
Quality Improvement Process ◽  
Root Cause ◽  
Time To Build ◽  
Unnecessary Testing

BackgroundPreoperative tests are done to determine a patient’s fitness for anaesthesia and surgery.Local problemAlthough routine tests before surgery in the absence of specific clinical indications are not recommended, we observed high volumes of routine preoperative tests were performed in our institution. We describe a process to implement a standardised preoperative investigational approach to reduce unnecessary testing before surgeries.MethodsA series of six Plan-Do-Study-Act (PDSA) cycles was conducted for root cause analysis and process mapping, development of standardised tool (GRID), collection of baseline data, education and feedback, pilot testing and implementation and uptake of GRID.Root cause analysis revealed a lack of awareness of guidelines and a lack of a standardised tool to guide preoperative testing. We undertook a pilot quality improvement project to reduce unnecessary testing before knee and hip arthroplasty by developing and implementing a standardised tool (GRID) and engaging all stakeholders.InterventionsA clinical development team (CDT) was formed, including all the stakeholders. Our CDT focused on a continuous rapid cycle improvement strategy.ResultsAfter implementation of the tool in a subgroup of patients undergoing elective hip or knee arthroplasty, unnecessary coagulation tests (activated partial thromboplastin time and the international normalised ratio), electrolyte/renal panel tests and electrocardiograms were reduced by 81% (91%–17%), 81% (41%–7%) and 68% (35%–11%), respectively. No surgery was delayed or cancelled due to tests not performed before surgery.ConclusionsA standardised preoperative investigational approach based on patients’ medical conditions rather than routine testing can reduce unnecessary tests before surgery. Further, implementing guidelines is more complex than developing guidelines. Hence, continuous PDSA cycles are essential to evaluate the processes in a quality improvement project. It can take time to build teams and have shared goals; however, once this is achieved, the success of a quality improvement project is certain.

scholarly journals 54 A Quality Improvement Project on the Recording of Stool Charts

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i14-i17
Author(s):  
D Perera ◽  
M Kaneshamoorthy ◽  
Z Burdon ◽  
A O'Brien
Keyword(s):  
Quality Improvement ◽  
Variable Number ◽  
Quality Improvement Project ◽  
Completion Rates ◽  
Short Term ◽  
Improvement Project ◽  
Key Stakeholders ◽  
Sustained Change ◽  
Multidisciplinary Staff ◽  
Prompt Action

Abstract Introduction Change in bowel movement is a common complaint in frail patients, which can be indicative of conditions such as constipation, infection or malnutrition. Without prompt action, this can result in increased length of stay. The recording of stools can be variable. This quality improvement project was to improve stool chart completion rate and staff confidence. Methods We conducted two Plan-Do-Study-Act cycles over three months. We surveyed multidisciplinary staff confidence using Likert scales covering each element on the Bristol stool chart. We then reviewed patient stool charts. The first intervention was a poster. The second intervention was the addition of a sticker to the charts to help staff more easily identify them in the patient’s bedside notes. Staff-wide emails were sent to inform every one of the interventions and key stakeholders including ward managers were asked to hand this over. Results 44 multidisciplinary staff were interviewed and 217 individual stool charts assessed over a 3 month period. 43% of stool charts were not filled in as directed after the first cycle. Posters improved staff confidence in filling out the charts from 72.3% to 92.3% after the second cycle, while 61% of stool charts came to be filled in correctly - over the initial 57%. Healthcare assistants consistently scored the highest in terms of believing charts to be up to date being whereas doctors remained the most cynical. There was little sustained change in stool chart completion rates after three PDSA cycles. Eventually, after both interventions, completion rates returned to baseline. Conclusions Stool chart completion rates can be improved in the short term, but sustainability is a challenge. Factors contributing to this include the variable number of agency nurses. Further improvements include teaching at the nursing induction.

scholarly journals A Fall Prevention Quality Improvement Project in a Long Term Care Facility: Critical Analysis

2017 ◽  
Vol 2 (2) ◽  
Keyword(s):  
Quality Improvement ◽  
Fall Prevention ◽  
Quality Improvement Project ◽  
Term Care ◽  
Improvement Project ◽  
Prevention Education ◽  
Quality Improvement Process ◽  
Root Cause ◽  
Star Program

Falls are a main health burden among seniors, particularly in long term care facilities. A fall prevention quality improvement project was initiated in a geriatric care organization in Ontario, Canada. The purpose of this article is to critically analyze this quality improvement project for reducing fall incident rates by using a Six Sigma model. This quality improvement project consists of conducting a root cause analysis in post fall huddles, “Falling Star” program, and providing fall prevention education for residents and families. The strengths of this quality improvement process include the root cause analysis in post fall huddles and fall prevention education. Some limitations in this quality improvement process include insufficient collaboration with inter-professional team members and the exclusion of residents who are at fall risk, but had not fallen. Three recommendations are provided to increase the possibility of success for this project, including a monthly inter-professional fall safety meeting, the expansion of the “Falling Star” program for all residents at risk of falls, and staff education and training

Ninety to Nothing: a PDSA quality improvement project

2018 ◽  
Vol 31 (4) ◽  
pp. 361-372 ◽  
Author(s):  
Gayle Linda Prybutok
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Patient Care ◽  
Care Delivery ◽  
Quality Improvement Project ◽  
Care Hospital ◽  
Emergency Department Care ◽  
Improvement Project ◽  
Content Type

Purpose The purpose of this paper is to present a case study of a successful quality improvement project in an acute care hospital focused on reducing the time of the total patient visit in the emergency department. Design/methodology/approach A multidisciplinary quality improvement team, using the PDSA (Plan, Do, Study, Act) Cycle, analyzed the emergency department care delivery process and sequentially made process improvements that contributed to project success. Findings The average turnaround time goal of 90 minutes or less per visit was achieved in four months, and the organization enjoyed significant collateral benefits both internal to the organization and for its customers. Practical implications This successful PDSA process can be duplicated by healthcare organizations of all sizes seeking to improve a process related to timely, high-quality patient care delivery. Originality/value Extended wait time in hospital emergency departments is a universal problem in the USA that reduces the quality of the customer experience and that delays necessary patient care. This case study demonstrates that a structured quality improvement process implemented by a multidisciplinary team with the authority to make necessary process changes can successfully redefine the norm.

scholarly journals Closing the Gap: A Resident-Led Quality Improvement Project to Improve Colorectal Cancer Screening in Primary Care Community Clinics

2020 ◽  
Vol 12 (1) ◽  
pp. 104-108
Author(s):  
Cara E. Ruggeri ◽  
Rajika E. Reed ◽  
Bonnie Coyle ◽  
Jill Stoltzfus ◽  
Gloria Fioravanti ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Quality Improvement ◽  
Completion Rate ◽  
Quality Improvement Project ◽  
Screening Tests ◽  
Improvement Project ◽  
Crc Screening ◽  
Patient Surveys ◽  
Vulnerable Patient

ABSTRACT Background Despite the prevalence and mortality associated with colorectal cancer (CRC), 67.4% of US adults aged 50 to 75 years received recommended screening tests in 2016. Objective We created a quality improvement project in resident-run outpatient clinics to increase CRC screening rates to ≥ 50% from 2016 to 2018, with emphasis on vulnerable patient populations. Methods We applied a comprehensive, multidisciplinary approach involving internal medicine and family medicine residents and staff from various hospital network departments, selecting 4 clinics to participate whose screening rates were below our network's average of 41%. Our intervention consisted of a needs assessment, resident-led educational sessions for clinicians, staff, and patients, use of fecal immunochemical tests as a first screening option, and application of care gap analysts at each clinic to answer patients' screening questions and to follow up regarding their screening status. Results We obtained approximately 100 patient surveys from each clinic, a 100% staff completion rate (68 of 68), and a 90% clinician completion rate (85 of 94). Staff and clinician surveys revealed concerns about reducing patient screening fears, inconsistent documentation of screening outcomes, and need for education about CRC prevention, early detection, and screening recommendations. Patient surveys revealed educational deficits and concerns about perceived screening obstacles (eg, transportation and insurance). While CRC screening rates increased across all participating clinics, one clinic experienced an increase from 23% to 48%. Conclusions Our multitargeted approach in primary care residency practices yielded increased CRC screening rates in vulnerable patient populations.

Sign in / Sign up

Export Citation Format

Share Document