Reducing the Incidence of Exposure to Blood and Body Fluids

Methods: We used a Pareto chart to identify priority areas for our project based on magnitude of incidence of BBF exposures. A driver diagram was developed with four main primary drivers including risk awareness, attitudes and practice, staff experience, and leadership engagement. Intervention ramps and changes were implemented using multiple PDSA cycles addressing staff knowledge and awareness about BBF exposure prevention and management using surveys and learning brochures and assessment of staff compliance with safe practice. The project included the following measures (i) outcome measure: number of days between BBF exposure incidents; (ii) Process measures: BBF exposure risk awareness score, attitude and practice score, and proportion of staff compliant with BBF exposure safe practice; (iii) BBF reporting exposure score and proportion of staff satisfied with BBF exposure prevention and management policy. Ethical approval of the project was not required. Results: About 80% of BBF exposure incidents were due to needlestick injuries. Emergency unit, operating theatre, hemodialysis unit, laboratory unit, and utility services accounted for 80% of all BBF exposure incidents. Around 47% of the incidents occurred among nurses. Our project was associated with increase in attitude and safe practice score form 75% to 100%. The compliance with safe practice increased from 77% to 86%, and reporting of exposure increased from 75% to 100%. Staff satisfaction increased from 65% at baseline to 96%. Knowledge about prevention and management of BBF exposure (safe practice) increased from 60% to 92% in the hemodialysis unit. However, the median number of days between BBF exposures increased from 13 days at baseline to 18 days in May 2019. Conclusion: Our quality improvement project has identified the priorities clinical areas accounting for the majority of BBF exposure incident. The initial phase of the project in hemodialysis unit was associated with significant increase in knowledge scores about prevention and management of BBF exposure, compliance with safe practice, and staff satisfaction. In addition, the project was associated with significant increase in reporting of BBF exposure, which explains why we were not able to increase the median number of days between BBF exposures to 50 days. We have started spreading our interventions and change ideas to other units in Al-Khor general Hospital. Quality improvement projects can reduce the incidence of BBF exposure having the priority areas identified and the relevant drivers are addressed appropriately

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Effect of intervention on a quality measure of pain management at Medstar Washington Cancer Institute.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.218 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 218-218

Author(s):

Vishal Navnitray Ranpura ◽

Puja Chokshi ◽

Charan Yerasi ◽

Sundeep Agrawal ◽

Lynne Wood ◽

...

Keyword(s):

Quality Improvement ◽

Pain Scale ◽

Quality Improvement Project ◽

Administrative Staff ◽

Improvement Project ◽

Pareto Chart ◽

Numeric Pain Scale ◽

American Society ◽

Oncology Practice ◽

Pain Documentation

218 Background: Appropriate cancer pain documentation is one of the quality indicators in American Society of Clinical Oncology (ASCO)’s Quality Oncology Practice Initiative (QOPI). Medstar Washington Cancer Institute (MWCI) has participated in QOPI since 2008. Documentation of plan of care for moderate/severe pain defined as a pain score of ≥4 on a numeric pain scale was 69%, (compared to QOPI aggregate of 79%) during the fall 2011 round which led to a quality improvement project with an aim of ≥ 90%. Methods: MWCI created a team of physicians, nurses and administrative staff. We attended ASCO’s quality training workshop from October 2013 to March 2014 for guidance. We implemented a Plan Do Study Act (PDSA) methodology for our quality improvement project. We created a process map, cause and effect diagram and Pareto chart based on survey of physicians citing common reasons for lack of documented plan of care for pain. Results: Baseline rate of documented plan of care for pain control in November 2013 was 70%. In January 2014, we implemented action plans to increase the awareness of pain documentation (Electronic Health Record (HER) trigger for pain ≥ 4, fellows and mid level education and faculty consensus on documenting management for pain unrelated to cancer). After intervention, the pain documentation rate was improved to 90.2% (Table). Conclusions: After one cycle of PDSA, we achieved our goal of pain documentation rate. In order to sustain our project, we will continue to monitor the pain documentation rate quarterly in 2014 and continue the process of education and orientation to new staff as well rotating residents and fellows. [Table: see text]

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Standardization of cardiac monitoring practices in patients receiving cardiotoxic cancer therapy at an ambulatory oncology center.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.251 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 251-251

Author(s):

Hannah DeLuna ◽

Thomas A. Hensing ◽

Bruce Brockstein ◽

Amit Pursnani ◽

Poornima Saha ◽

...

Keyword(s):

Breast Cancer ◽

Quality Improvement ◽

Treatment Plan ◽

Strain Imaging ◽

Quality Improvement Project ◽

Cardiac Monitoring ◽

Improvement Project ◽

Pareto Chart ◽

Ambulatory Oncology

251 Background: A significant number of cancer-directed therapies are associated with cardiotoxicity. This adverse effect is well-established in anthracyclines and anti-HER2 agents. At our ambulatory oncology practice, the recent availability of echocardiograms with strain imaging has prompted an evaluation of current practices for cardiotoxicity monitoring. A review of the electronic health record (EHR) in 2019 found that although our institution maintains high rates of baseline monitoring, follow-up monitoring is not standardized and not consistent between different practices. Methods: A multidisciplinary team was formed to conduct a quality improvement project with the aim of increasing the rate of follow-up monitoring in patients who receive anthracyclines or infusional anti-HER2 agents. A survey of providers identified the potential reasons that follow-up cardiac monitoring was not completed. A Pareto chart showed that lack of familiarity with clinical necessity and appropriate timing were the most common barriers to follow-up monitoring. Our first plan-do-study-act focused on addressing these barriers, and a pilot in breast cancer treatment plans was started. Cardiac monitoring orders were added to curative intent protocols containing doxorubicin, trastuzumab, or pertuzumab. Education was provided to physician and nursing teams regarding utility and timing of cardiotoxicity monitoring. Collaboration with the cardiology group ensured timely access and result turnaround time. Results: An initial review of the EHR was conducted to identify current trends in cardiac monitoring. The review showed that there was an increase in the use of echocardiograms with strain imaging for baseline and follow-up monitoring in our patients. From January to April 2020, there was a total of 102 echocardiogram orders which was a 23% increase compared to the same timeframe in the previous year. The majority (61%) of those echocardiogram orders included strain imaging compared to 8% in the previous year. Review of treatment plan utilization and appropriate timing of cardiac monitoring in breast cancer patients is ongoing. Conclusions: This quality improvement project suggests that efforts to standardize cardiac monitoring practices can be achieved through provider education and workflow modifications. Further long-term review of the EHR will be needed to determine whether the timing of follow-up monitoring is appropriate and to identify what changes to the intervention should be made.

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Chlorhexidine-impregnated transparent dressings decrease catheter-related infections in hemodialysis patients: a quality improvement project

The Journal of Vascular Access ◽

10.5301/jva.5000658 ◽

2017 ◽

Vol 18 (2) ◽

pp. 103-108 ◽

Cited By ~ 9

Author(s):

Ibironke W. Apata ◽

John Hanfelt ◽

James L. Bailey ◽

Vandana Dua Niyyar

Keyword(s):

Quality Improvement ◽

Phase 1 ◽

Insertion Site ◽

Hemodialysis Patients ◽

Quality Improvement Project ◽

Study Phase ◽

Phase 2 ◽

Improvement Project ◽

Hemodialysis Unit ◽

Gauze Dressing

Purpose Central venous catheters (CVC) are associated with increased infection rates, morbidity and mortality compared to other hemodialysis vascular access. Chlorhexidine-impregnated transparent (CHG-transparent) dressings allow for continuous antimicrobial exposure and easy visibility of the CVC insertion site. We conducted a quality improvement project to compare catheter-related infection (CRI) rates in two dressing regimens – CHG-transparent dressings and adhesive dry gauze dressing in hemodialysis patients with tunneled CVCs. Methods The study was conducted in two phases. In phase 1, CHG-transparent dressing was introduced to EDC hemodialysis unit, while EDG and EDN hemodialysis units, served as the control sites and maintained adhesive dry gauze dressing. Phase 2 of the study involved replacing the adhesive dry gauze dressing with CHG-transparent dressing at EDG and EDN and maintaining CHG-transparent dressing at EDC. CRI rates at each hemodialysis unit during the 12-month intervention were compared to CRI rates for the 12-month pre-intervention period for each study phase. CRI rates were also compared between all three hemodialysis units. Results In phase 1, CRI rates (per 1000 days) in EDC (intervention site) decreased by 52% (1.69 vs. 0.82, p<0.05) and increased by 12% (1.80 vs. 2.02, p = 0.75) at EDG, and 35% (0.91 vs. 1.23, p = 0.40) at EDN. In phase 2, CRI rates at EDG and EDN (intervention sites) decreased by 86% (1.86 vs. 0.26 p<0.05), and 53% (1.89 vs. 0.88, p<0.05), respectively, and decreased by 20% at EDC (0.73 vs. 0.58, p = 0.65). Conclusions Replacing adhesive dry gauze dressing with CHG-transparent dressing for hemodialysis patients with tunneled CVC was associated with decreased CRI rates.

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“Relax City Homecare team; protocols are ready for you” – A Quality Improvement Project Conducted on Behalf of the City Homecare Unit Team at the Trivandrum Institute of Palliative Sciences

Indian Journal of Palliative Care ◽

10.25259/ijpc_408_20 ◽

2021 ◽

Vol 27 ◽

pp. 204-210

Author(s):

M. M. Sunilkumar ◽

Amirtha Thampi ◽

S. Lekshmi ◽

Stephanie M. Harman ◽

Nandini Vallath

Keyword(s):

Quality Improvement ◽

Satisfaction Score ◽

Improvement Project ◽

Pareto Chart ◽

Registration Process ◽

Total Satisfaction ◽

Key Drivers ◽

The Impact ◽

The City

Context: The city homecare unit (CHU) of the Trivandrum Institute of Palliative Sciences was dissatisfied with the quality of care provided to their patient population. Aims: This study aims to improve the average satisfaction score of CHU during their daily homecare services. Settings and Design: The improvement project for the CHU activities was conducted with a prospective plan-do-study-act design, with stepwise application of improvement tools. Materials and Methods: The A3 quality improvement (QI) methodology, which uses tools for (i) analysing contributors (process mapping, cause-effect diagram); (ii) to derive key drivers (Pareto chart) and (iii) for measuring impact of interventions and sustainability (annotated run chart) was applied. The project was conducted as a mentored activity of the PC-PAICE program. The team’s weekly average satisfaction score was recorded prospectively as the outcome parameter, with 0 representing total dissatisfaction and 10 representing total satisfaction. Accuracy of triaging and appropriateness of registration process were the process parameters selected. These were recorded as run charts across the project period of 9 months. Analysis and Results: The cause-effect tool and the impact effort tool were used to analyse the mapped CHU processes. Even though we identified 22 contributors to the problem, eight of them were found to be significant. Key drivers were determined based on these eight and applied to the CHU processes. Over the project period, the satisfaction scores of the CHU improved significantly from 5.82 to 7.6 that is, satisfaction levels were high on most days. The triaging and registration goals were achieved. The team also built its own capacity for QI. Conclusion: The application of the A3 methodology simplified and streamlined efforts and achieved the quality goal for the CHU team.

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