Debra Huddleston   	 2 Feb 07    7:57 PM MST
	Well, it appears that I am the only one in this group. :(
I can't say that quality improvement has ever been a topic of interest for me, but it has been an area that I have reflected upon through many years of nursing. When we saw the quality staff walking the floors, we always worried that we were going to be "targeted" for failing to meet standards. Even though it is one of, if not the, most important area of standards control, it may be the area that we try most often to avoid facing.
When I began working with Diversified Clinical Services and the hospital to form the foundation of the wound care center, I began to have a sincere appreciation for the area of quality improvement. When you are being held to very high standards, and being judged by not only how you perform, but also how your staff performs, you truly learn to appreciate quality management theories of practice. I counted on specific quality standards to set the stage for my clinic and my expectations. I will never say that doing things the right way is easier or more efficient, but it has become a necessity. JCAHO has been at our facility this week. It was very stressful for everyone. Fortunately, we did very well. We had 3 recommendations for improvement, which is low compared to other facility reviews. One very important thing that we all need to keep in mind regarding quality audits is that they are only trying to protect the interest of the patient...even if it makes our lives a little more difficult, the end result is a safer care provision and a lower risk facility.
Debra


Kim Zolnier 	2 Feb 07    8:58 PM MST
	Quality audits always seemed to be a waste of time until we started to get feedback from them. The nurses did not always follow the policies or standards that were being audited so I began to involve them in the audits. Our compliance increased as they realized what the standards were. It was more effective that having them read policies or memos.


Debra Huddleston 	3 Feb 07  10:44 AM MST
	Kim,
I agree that involving the staff improves results. I think that the fear of standards comes from simply not knowing exactly what to expect in a review. If you empower your staff and inform them on the expectations, the end result is more positive.


Margaret Imbrock 	2 Feb 07  11:30 PM MST
	Debra,
This is a hard area to really inspect and evaluate the quality of the care that you deliver. National Patient Safety Goals have definitely increased the spotlight on safety and they keep bringing more new ones every year. The one thing about quality that has become easier is that there is more involvement of all staff members. From the high school diet aide to maintenance to nurses we all have a role to ensure that the patient and family receives the best care and service during their stay and that they go home in somewhat better shape than when they entered our environment, when possible. I think this force is also getting at does everyone know and can they articulate what quality initiatives they are involved in as a department. When I ask the staff this question during our mock tracers, I usually get a look like, lady, what are you talking about. Managers can rattle it off in nothing flat, but staff approach it like they have never heard it before and I know it has been discussed and they have been involved. Congratulations on a successful inspection!


Debra Huddleston 	3 Feb 07  10:49 AM MST
	Thank you!
For the last 2 months we have been getting the "warning" of an anyday now JCAHO inspection. One thing that I have done, and will continue to do in the future, is random mini drills. We do it with a little humor and the staff don't seem to mind it...but if I asked them today what our patient safety goals are or who our compliance officer is..they could answer correctly. They appreciated these drills when they were questioned and knew the answers.
Debra


Amy Fanning 	3 Feb 07    3:37 PM MST
	Debra,

Great posting! This is a difficult area for all nurses to monitor and correct. Our quality improvement nurse does not always take the best approach to her suggestions for us however, she is in a difficult position and has a difficult job. One way to approach staff regarding ways to improve and correct deficiencies is to first start on a positive note and congratulate the group on a job well done with another area(s) then introduce changes. I have seen this tactic work and believe it is effective. Our agency is expecting the State Department of Health in February or March and so we are having a meeting on Tuesday to prepare ourselves. We had one deficiency last year and so we expect them back to check up on us and see if we have made improvements. It can be a stressful time however, I think if we consistently are aware of the right way to do things and practice in that fashion as you mention then we will breeze through these inspections.

Amy Fanning