Infusing Quality Improvement into clinical education

Submitter Information

Author: Donna B. Lupinski, MSN, RN
Title: Faculty
Institution: Lorain County Community College
Email: dlupinsk@lorainccc.edu

Competency Category(s)
Quality Improvement, Safety

Learner Level(s)
Pre-Licensure ADN/Diploma

Learner Setting(s)
Clinical Setting

Strategy Type
Paper Assignments

Learning Objectives

1. Faculty and students will “seek information about quality improvement projects in the care setting” (Knowledge).
2. Students will identify the potential impact of quality improvement measures on patient care (Knowledge).
3. Students will evaluate evidence based practice with observed practice (Skills).
4. Students will gain an appreciation “that continuous quality improvement is an essential part of the daily work of all health professionals” (Attitudes).
5. Students will “value vigilance and monitoring (even of own performance of care activities) by patients, families, and other members of the health care team” (Attitudes).

Strategy Overview

This strategy may be used to educate students on how patient safety may be improved through quality improvement audits and the Plan-Do-Study-Act (PDSA) cycle. The audit subjects were chosen in collaboration with several nurse managers and administrators at clinical facilities utilized by our nursing program.
1) Provide each clinical faculty member the Quality of Care Audit instructor guide (Attachment #1) and a set of audits (Attachment #2): Computer screen; Fall precautions; Hand hygiene; Hourly rounds; IV labeling; and Pain medication reassessment.
2) Have clinical faculty member assign students an audit to complete (Attachment #2). Have students read the directions and perform the audit.
3) Have students discuss their findings and reflections in post conference. Invite the unit manager or charge nurse to participate or provide them a copy of the findings. If the facility allows have the students create a PDSA plan and implement it. Then complete the audit again at a later date and compare the findings to determine if the plan improved care.

Submitted Materials

Quality-of-Care-Audit.Instructor-1.docx
Fall-Precaution_Hourly-rounds.audit_-1.doc
Hand-Hygiene_IV-site.audit_-1.doc
Pain-medication_Computer-screen.audit_-1.doc

Additional Materials

Quality of Care Audit-Instructor guide
Set of Audit tools-total of 6

Evaluation Description

Students are to discuss audit findings in post conference with clinical group and clinical unit representative if available.
Compare if actual practice varies from best practice guidelines or facility policy.
Explore possible barriers to implementing best practice or facility policy and if barrier is a personal or systemic barrier.
Have students discuss if a practice change is indicated, if indicated have them create a quick change plan using the PDSA cycle format. If facility allows, have students implement their plan and re-evaluate later in clinical rotation.
Submit audit form at end of clinical day to instructor for evaluation. If student response on audit form minimal or shows lack of reflection the student is to resubmit the assignment.

Results from our assignment:

Students performed their assigned audit, wrote a reflection on barriers nurses may have faced in performing the action, and how the results of this activity would affect their personal practice and client care. These reflections were then shared during post conference with the clinical group and an available clinical unit representative. Students were prompted to explore if variation from best practice and facility policy appeared to have a systemic cause rather than placing blame on a singular individual. Students were then asked to decide if a practice change was indicated and to create a quick change plan using the PDSA cycle format.
Unfortunately students were not able to implement a PDSA cycle change due to clinical facility preference. Students noted some eye opening behaviors such as: nurses not sanitizing hands prior to or after care of a patient with c-diff; a respiratory therapist who went from room to room to apply treatments without performing hand hygiene; and over 50% of IV sites and tubing not labeled at one institution. Students noticed healthcare workers were more likely to perform an action correctly when they were aware someone was watching.
Students compared past and current clinical facility experiences and noted some generalized practices between facilities that seem to help improve consistency of care and infection control practices such as similar yellow color coding practices for fall risk clients. Students indicated the healthcare facility had policies in place and that employees need to follow them more diligently. Students suggested the facility perform more frequent random audits and share the results with staff with a reward system for the unit with best compliance.
Students submitted their completed audit forms to be evaluated by the clinical instructor. If student reflection or comparison to evidence based guideline response on the audit form was minimal the student was instructed to resubmit the assignment. Students repeatedly reported that this exercise helped to reinforce the need to habitually perform the action in order to provide best practice care for improved patient outcomes, infection control, and cost effectiveness and to be aware of others and their adherence to or alteration from best practice.