ECO 605 Discussion 5.2: Structure—Process—Outcome Approach

A quality improvement plan I have been a part of in the past is reducing hospital-acquired pressure injuries (HAPIs). These ulcers are common in the hospital and completely avoidable with the proper interventions. Using the Structure/Process/ Outcome model and two examples of each step for ways in which HAPIs can be reduced will be examined.

Structure can be viewed as the inputs or resources utilized to provide patient care (Hicks, 2021). For HAPIs this would be the number of nurses and support staff involved in patient care and the proper education on how to reduce HAPIs. Ensuring that patients are moved from each position at the proper interval requires the necessary staff to perform such activities. Reviewing the workload and staff on each shift is crucial to meet a staffing metric that allows for HAPI reducing interventions. If nurses need to change dressings, remove, or shift equipment and implement device use, then time for these actions needs to be allocated (Cooper et al., 2020). Education and utilizing best practices is another element that needs to be considered in this quality improvement plan. Nurses and other staff members need to be educated not only on preventative interventions of HAPIs, but also the primary causes. This education will take need to be completed on a rolling basis. New interventions are being used each day and an MSN nurse educator will have to be hired and help to disseminate information to staff.

Process is the second step in this quality improvement model which has to do with policy and procedure (Hicks, 2021). What exactly are the policies that dictate the proper procedure for reducing HAPIs? How often are patients being moved off bony prominences? What happens if initial interventions are unsuccessful? Which model of care is the best approach to this improvement project? A multi-interventional approach has been shown to greatly reduce the pressure put on the area and reduce tissue breakdown (Gaspar et al., 2019). On the unit I worked on, each room had a turn clock with the name of the nurse responsible was at each two-hour interval. A signature was required to be next to the name after the turn was completed. The policy was that each at risk patient have this intervention and of breakdown was detected additional measures such as compression stockings and pressure-free mattress use would be implemented (Cooper et al., 2020).  This was a standard operative procedure or (SOP) for these patients. The model of care delivery that is best suited to reducing HAPIs is the team model of nursing. This multifaceted approach allows for collaboration across the care team. Nutrition, ambulation, and unlicensed support staff members are vital to the success of reducing HAPIs (Gaspar et al., 2019). Utilizing a team approach reduces the workload and the burden of care on the nurse which allows for better patient outcomes.

Outcomes is the last element in this quality improvement strategy (Hicks, 2021). The cost of a HAPI is that the hospital or facility is not reimbursed for care during that stay. This has a considerable impact on the bottom line for that facility (Cooper et al., 2020). The investment of the initial program also impacted our facility, but not as severely as receiving a zero payment for a lengthy hospital stay with multiple disciplines utilized. This opportunity would provide the foundation for a future reduction in liability for the facility as HAPIs cost several billion dollars annually to the healthcare system (Cooper et al., 2020). We were able to add a nurse educator and invest in continuing education materials and reduce the HAPI rate on the floor by 12%. The consequence of HAPIs involves patient outcomes. Is the number of patients who acquire pressure ulcers comparable to other facilities utilizing similar interventions? Adding in enhanced quality measures can improve outcomes and help patients improve their quality of life (Gaspar et al., 2019).  This can also contribute to a reduced 30-day readmission rate which also impacts the cost to the facility. Increased costs from preventable injuries can greatly reduce the reimbursements a facility receives, which can impact staffing, services offered, and the populations served. Similarly, patients who receive substandard care will suffer worse outcomes and be less likely to return for additional treatment.

 

Cooper, K. D., McQueen, K. M., Halm, M. A., & Flayter, R. (2020). Prevention and treatment of device-related hospital-acquired pressure injuries. American Journal of Critical Care, 29(2), 150-154.

Gaspar, S., Peralta, M., Marques, A., Budri, A., & Gaspar de Matos, M. (2019). Effectiveness on hospital‐acquired pressure ulcers prevention: a systematic review. International wound journal, 16(5), 1087-1102.

Hicks, L. (2021). Economics of health and medical care. Jones & Bartlett Publishers.

Discussion Guidelines

Initial Post

1. Identify a health service quality improvement that you have been involved in or would like to see implemented.
2. Refer to the Structure/Process/Outcome approach to quality improvement. Identify two structures, two approaches, and two outcomes for your selected quality improvement.

Response Post(s)

Respond to at least two of your peers’ posts. In each response, provide two additional items that you believe relate to either the structure or process or outcome of the peer’s selected quality improvement.

Submission

Post your initial and follow up responses and review full grading criteria on the page.