Scholarly Paper - Quality Initiative

7/24/2019 Scholarly Paper - Quality Initiative

1/22

Running head: THE QUALITY IMPROVEMENT APPLICATION 1

The Quality Im!"#ement Ali$ati"n

Anth"ny %ailan" &"me'( PT( RN( )*N( M*N( L**( LEU( +NP,( CPHQ

-alden Uni#e!,ity

O!gani'ati"nal and *y,tem, Leade!,hi ."! Quality Im!"#ement

May1/( 012


2/22

THE QUALITY IMPROVEMENT APPLICATION 0

The Quality Im!"#ement Ali$ati"n

In the $u!!ent ,tatu, ". the health$a!e indu,t!y 3he!e $"n,ume!, a!e .ully a3a!e ". the

,e!#i$e, they ,h"uld !e$ei#e and 3ith the ad#ent ". te$hn"l"gy 3hi$h ma4e, the,e ,e!#i$e,

a$$e,,i5le( $"ntinu"u, 6uality im!"#ement ". ,e!#i$e, and atient $a!e i, im"!tant t" meet

de,i!ed atient "ut$"me, and $a!e7!e$iient ,ati,.a$ti"n8 )!"3n 9011 de.ined Quality

Im!"#ement a, an a!"a$h ;."$u,ed "n im!"#ing de.e$ti#e !"$e,,e, t" im!"#e the 6uality

". the "utut,< 98 = that aim, t" !"#ide high76uality ,e!#i$e, 3hi$h i, d"ne t" the utm",t

!e$i,i"n e#e!y time ,e!#i$e, a!e deli#e!ed8

Quality im!"#ement i, a ma>"! a!t in the 6uality management !"$e,, de#el"ed 5y M!8

?",eh M8 ?u!an te!med a, the ?u!an T!il"gy8 Thi, t!il"gy !"#ide, a l"gi$al 3ay ."! the

unde!,tanding the 3h"le !"$e,, ". Quality Management( 3hi$h in$lude, Quality Planning and

Quality C"nt!"l8 )!"3n 901 emathi'ed that Quality Im!"#ement i, u,ed t" dete!mine

$au,e, ". !"$e,, .ailu!e "! ine..i$ien$y( utili'ati"n ". $"m5ined e.."!t, ". a team t" ,tudy and

!"g!e,, e@i,ting !"$e,,e, in an "!gani'ati"n( and ."! the ad#an$ement ". !"$e,, e!."!man$e

t" 5e a5le t" a$hie#e de,i!ed g"al,8

Quality management and im!"#ement ha, 5een a d!i#ing a ."!$e in health$a!e indu,t!y

en,u!ing atient ,a.ety and ,ati,.a$ti"n8 Quality management and im!"#ement i, a #e!y tedi"u,

!"$e,, that !e6ui!e, $e!tain .a$t"!,( e@te!nal and inte!nal( 3hi$h di!e$tly a..e$t, the health$a!e

!".e,,i"nal, e.."!t8 A, )!"3n 901 ,tated ;the!e i, in$!ea,ed emha,i, la$ed "n im!"#ing(

in a !i"!iti'ed a!"a$h( all the inte!!elated !"$e,,e, and ,e!#i$e, that ima$t the 6uality ".

$a!e and a..e$t atient "ut$"me,: g"#e!nan$e( manage!ial( and ,u"!t a$ti#itie,( a, 3ell a,

$lini$al a$ti#itie,< 981=8


3/22


Needlestick Injury

The Cente!, ."! +i,ea,e C"nt!"l and P!e#enti"n 9C+C 9012 indi$ated that the!e a!e an

e,timated 2=/( e!$utane"u, in>u!ie,( $iting needle,ti$4, a, "ne( "$$u!!ing in h",ital, e#e!y

yea!8 The,e tye, ". in>u!ie, a!ti$ula!ly needle ,ti$4 in>u!ie, 9N*I la$e, the health$a!e 3"!4e!,

and atient, at !i,4 ."! t!an,mi,,i"n ". in.e$ti"n8 The agen$y al," ,tated ;The g!eate,t !i,4 ".

in.e$ti"n t!an,mi,,i"n i, th!"ugh e!$utane"u, e@",u!e t" in.e$ted 5l""d< 98 28

Inte!nati"nally( "$$uati"nal "! 3"!4 !elated e@",u!e t" 5l""d and 5"dy .luid, !emain, the

num5e! "ne $au,e ". "$$uati"nal ha'a!d, ."! health$a!e 3"!4e!,( a!ti$ula!ly ."! nu!,e,8 Needle

,ti$4 in>u!ie, "$$uy the la!ge,t e!$entage am"ng the "$$uati"nal ha'a!d,8 Needle ,ti$4

in>u!ie, #a!y .!"m dee 3"und( middle( and ,u!.a$e 3"und in>u!ie, 9&"u!ni( P"li4and!i"ti(

Va,il""ulu,( Malt'i( B &"u!ni( 0108

A g!eat num5e! ". !e,ea!$he, $u!!ently a!e 5eing d"ne t" dete!mine and e,ta5li,h the !i,4 ".

5l""d and 5"dy .luid e@",u!e t" health$a!e 3"!4e!, and the im"!tan$e ". !"te$ting the,e

3"!4e!,8 In e#e!y h",ital 3hethe! de#el"ing "! de#el"ed $"unt!ie,( the !i,4 ". $"ntaminati"n

"! t!an,.e! ". in.e$ti"n th!"ugh e!$utane"u, e@",u!e !emain, t" 5e a th!eat8 A, a !e,ult(

de#el"ment ". an e..e$ti#e !"g!am ."! !e#enti"n and management ". e!$utane"u, in>u!ie, t"

in.e$ted 5l""d "! 5"dy .luid, i, i#"tal8

&"u!ni et al8 9010 ,tated( ;It i, 3idely a$$eted that the m",t $"mm"n "$$uati"nal ha'a!d,

."! all health$a!e !".e,,i"nal, in#"l#ed in $lini$al $a!e a!e the needle,ti$4 and ,ha!, in>u!ie,

mainly $au,ed 5y inade6uate di,",al and !e$aing ". needle,< 98D8 The auth"!, added that

e@",u!e t" 5l""d and u!ine i, $"n,ide!ed t" 5e the m",t .!e6uent dange!8

Problem and Mission Statement


4/22

THE QUALITY IMPROVEMENT APPLICATION D

&ha!yan Uni#e!,ity Tea$hing H",ital( ."!me!ly 4n"3n a, &ha!yan H",ital i, the "nly

medi$al h",ital in the $ity ". &ha!yan8 &ha!yan i, a #illage l"$ated in the Na."u,a M"untain, in

the N"!th3e,t a!t ". Li5ya 3ith a "ulati"n ". =/(018 One ". the de.ining $ha!a$te!i,ti$, ".

the h",ital i, that( it ha, 5een $"n,ide!ed a, the t!aining in,tituti"n ."! medi$al( nu!,ing( and

a!amedi$al ,tudent, ". Al ?a5al Al &ha!5i Uni#e!,ity8

&ha!yan H",ital 3a, e,ta5li,hed 3hen the $ity ". &ha!yan needed a .a$ility t" deal 3ith the

health $a!e need, ". the $"mmunity8 The h",ital ha, a 275ed $aa$ity( $aa5le ". admitting

and managing medi$al( ,u!gi$al( gyne$"l"gi$( ediat!i$( $!iti$al $a!e( $"mmuni$a5leFin.e$ti"u,(

and t!auma $a,e,8 Thi, in,tituti"n i, enti!ely g"#e!nment "3ned and all ". the ,e!#i$e, !"#ided

in$luding medi$ati"n, and t!eatment, a!e .!ee ."! the $iti'en, ". &ha!yan8

*in$e the ,ta!t ". the !e#"luti"n( &ha!yan Uni#e!,ity Tea$hing H",ital 5e$ame the $ent!al

h",ital in the 3h"le Na."u,a M"untain,8 Ma>"!ity ". admi,,i"n, 3e!e .!"m the neigh5"!ing

$itie,( 3hi$h $ann"t 5e handled 5y thei! l"$al medi$al $ente!,8 Thi, ,ituati"n la$e, all the

health$a!e e!,"nnel at !i,4 ."! 5l""d and 5"dy .luid in.e$ti"n t!an,mi,,i"n8

Quality im!"#ement lan, 3hi$h ."$u,e, "n needle ,ti$4 in>u!y( in$luding a3a!ene,,(

!e#enti"n( and management 3ill 5ene.it the "!gani'ati"n8 Ch"3( et al8 90 added ;Thi,

!e6ui!e, m"!e than a $"mmitment t" the "li$y ". a ,a.e 3"!4 !a$ti$e,( it !e6ui!e, a leade!,hi

$ultu!e that i, de#"ted t" the $"n$et ". 3"!4ing ,a.ely and !edu$ing !i,4( a$6ui!ing and ,ha!ing

in."!mati"n a5"ut 3"!4la$e ,a.ety $"n$e!n,( maintaining !ig"!"u, ,a.ety management ,y,tem,

and the !a$ti$e ". !egula!ly auditing and im!"#ing in."!mati"n and management ,y,tem,u!ie,8 *in$e(

&ha!yan Uni#e!,ity Tea$hing H",ital ha, n" a#aila5le data "n needle,ti$4 in>u!ie,( the,e !e,ult,

$an 5e 5ene.i$ial in ,etting ,tanda!d, in the "!gani'ati"n8

In a ,tudy d"ne in Egyt( it 3a, !e#ealed that 80G ". health$a!e 3"!4e!, had e@e!ien$ed

any ."!m ". needle,ti$4 in>u!ie, and thi, 3a, due t" a la$4 ". in.e$ti"n $"nt!"l "li$y 9I,mail(

A5"ul( El7*h"u5a!y( B Maha5a( 08 A,4a!ian( *haghaian( B M$La3, 90 indi$ated that

needle ,ti$4 in>u!ie, in I!an( e,e$ially am"ng nu!,e,( a!e high 3ith a !ate ". D N*I, in a yea!8

C"n,e6uently( M"5a,he!i'adeh( A5ne7*hahidi( M"hammadi( Ya'dani( B A5a'a!i 90

,t!engthen, the,e $laim, in I!an ,tating that ;in>u!y !e,ulting .!"m $"ntaminated ,ha! de#i$e,

am"ng health$a!e 3"!4e!, 9HC-, i, "ne ". the m",t im"!tant $"n$e!n, in medi$al $ente!,u!ie, in the "!gani'ati"n8 P"li$ie, a, de.ined 5y +ay,"n 91 ;a!e the

guiding !in$ile, 5y 3hi$h ,e!#i$e i, !"#ided< 98108 The auth"! e@lained that "li$ie, and

!"$edu!e, a,,i,t all "!gani'ati"n, 3ith thei! de$i,i"n7ma4ing and h"3 the 3"!4 i, ,u",ed t"

5e d"ne in that "!gani'ati"n8 elly 9011 ,t!e,,ed( ;"li$y initiati#e, ha#e hi,t"!i$ally ta!geted

the 6uality ". thestructural elements ". the health$a!e deli#e!y ,y,tem( ,u$h a, e"le( hy,i$al

.a$ilitie,( e6uiment( and d!ug,< 98108 The auth"! added that the,e initiati#e, ."$u, "n the

!e,ult, and !"$e,,e, ". the "!gani'ati"n and !"#ide! le#el,8

Quality Improvement Model

The ?u!an M"del ". Quality Management identi.ied Quality Im!"#ement a, "ne ". the

im"!tant a,e$t, ". the Quality Management Cy$le al"ng 3ith Quality Planning and Quality

C"nt!"l Mea,u!ement8 A$$"!ding t" thi, m"del( Quality Im!"#ement 9QI dete!mine, $au,e, ".

!"$e,, .ailu!e( alte!ati"n, and ine..e$ti#ene,,( and analyti$ally !"",e, ,"luti"n, t" de.e$t, in

the !"$e,,8 QI al," $!iti$ally $"n,ide!, data ."! ;5ette! "! 5e,t !a$ti$e< 9)!"3n( 018


7/22

THE QUALITY IMPROVEMENT APPLICATION

The a!"!iate 6uality im!"#ement m"del ."! the 6uality im!"#ement initiati#e ."!

&ha!yan Uni#e!,ity Tea$hing H",ital 3ill 5e the ?u!an, Quality Im!"#ement P!"$e,, 9QIP8

)!"3n 901 e@lained that thi, a!"a$h i, $"m",ed ". ."u! im"!tant ,te, that 3ill a,,i,t an

"!gani'ati"n in identi.ying !i"!iti'ed a!ea,( $"lle$ting data( initiate a$ti"n ."! $hange( dete!mine

e..e$ti#e team( and a,,e,, im!"#ement8 The ."u! ,te, a!e:

*te 1: P!">e$t +e.initi"n and O!gani'ati"n

*te 0: +iagn",ti$ ?"u!ney

*te 2: Remedial ?"u!ney

*te D: H"lding the &ain,

The 6uality im!"#ement team that 3ill 5e identi.ied in the Adult Inten,i#e Ca!e Unit ". the

&ha!yan Uni#e!,ity Tea$hing H",ital 3ill .i!,t identi.y the !"5lem( in thi, $a,e( needle,ti$4

in>u!ie, in the unit8 The team then 3ill $"n,"lidate "n the de#el"ment ". a "li$y !ega!ding

N*I, in in the ICU8 The ne@t ,te 3ill 5e "n identi.ying !""t $au,e, and ."!mulating $au,e

the"!ie, ali$ati"n t" the unit8 A, a!t ". the !emedial >"u!ney( the team 3ill $"n,ide! a d!a.t

"li$y "n need ,ti$4 in>u!ie, in the unit a, an alte!nati#e ,"luti"n t" the !"5lem8 Thi, "li$y 3ill

5e il"t te,ted in the unit 3ith the imlementati"n and !e,ult, d"$umented8 Che$4ing the

e!."!man$e ". the unit !ega!ding N*I, management 3ill 5e h"lding the gain, ,te ". the QIP8

The ,amle "li$y ."! N*I, in the ICU i, ,h"3n 5el"38


8/22

THE QUALITY IMPROVEMENT APPLICATION =

&HARYAN UNIVER*ITY TEACHIN& HO*PITAL&HARYAN( LI)YA

+"$ument I+

N*I J 1

Title

Needle *ti$4 In>u!y P!"t"$"l

Re#i,i"nKK

P!ea!ed 5y:Anth"ny %8 &"me'( PTRP( )*N( RN( M*N(

LEU( +NP,

+ate:KK

E..e$ti#e +ate

KK

Re#ie3ed 5y:

+!8 KK 7 Head 7 ICU +ea!tment

+ate:

KK

A!"#ed 5y:

+!8 KK 7 +euty Medi$al +i!e$t"!

+ate:

KK

P!"g!am

A!ea 9,

%a$ility and Unit 5a,ed $!i,i,

Pu!",e: T" ,et ."!th me$hani,m, and !"$e,,e, ."! the management ". needed ,ti$4 in>u!ie,8

P"li$y: 18 Thi, "li$y in$lude, a,,e,,ment and management ". needle,ti$4 in>u!ie,

am"ng health$a!e 3"!4e!, at &ha!yan Uni#e!,ity Tea$hing H",ital8

08 Thi, "li$y i, intended ."! all health$a!e 3"!4e!, eml"yed at &ha!yan

Uni#e!,ity Tea$hing H",ital8

28 Thi, "li$y i, intended t" !"#ide !"e! !e"!ting( a,,e,,ment( and

management ". needle,ti$4 in>u!ie, in all a!ea, "! unit ". &ha!yan Uni#e!,ity

Tea$hing H",ital8

P!"$edu!e: 18 U"n e@",u!e "! needle ,ti$4 in>u!y( !in,e 3ith 3ate!8 +i,in.e$t 3ith Gal$"h"l and !in,e mu$"u, mem5!ane 3ith 3ate!8

08 Re"!t, t" the Head Nu!,e828 The Head Nu!,e 3ill a$$"mli,h the Needle,ti$4 In>u!y Re"!t %"!m8

D8 I. in>u!y .!"m a n"n7in.e$ti"u, atient( the!e 3ill 5e n" a$ti"n needed8

/8 I. in>u!y .!"m an in.e$ti"u, atient( !e.e! t" T!i"li Cent!al H",ital JIn.e$ti"n C"nt!"l C"mmittee ."! Anti75"dy tite! te,ting( immun"gl"5ulin

admini,t!ati"n( and ."ll"3 u management8

8 I. the in>u!y i, .!"m a ",iti#e Heatiti, ) #i!u, atient( dete!mine i. thehealth$a!e 3"!4e! ha, a,t H)V "! .ull #a$$inati"n,8 I. the health$a!e 3"!4e!

ha, a .ull #a$$inati"n, "! a,t H)V( n" a$ti"n i, needed8

8 I. the in>u!y i, .!"m a ",iti#e Heatiti, ) #i!u, atient( dete!mine i. the

health$a!e 3"!4e! ha, a,t H)V "! .ull #a$$inati"n,8 I. the health$a!e 3"!4e!

ha, n" .ull #a$$inati"n, "! a,t H)V( admini,te! H)I& in le,, than D= h"u!,8=8 I. the in>u!y i, .!"m a ",iti#e Heatiti, C #i!u, atient( ."ll"3 u a.te! 710

m"nth,8 I. the HVC i, negati#e( n" a$ti"n needed8

8 I. the in>u!y i, .!"m a ",iti#e Heatiti, C #i!u, atient( ."ll"3 u a.te! 710

m"nth,8 I. the HVC i, ",iti#e( admini,te! Alha7inte!.e!"n and Ri5a#i!in8

18 I. the in>u!y i, .!"m a ",iti#e HIV atient( immediate PEP Te,t *"u!$e i,

d"ne and ."ll"37u a.te! 1( 2( and m"nth,8


9/22

THE QUALITY IMPROVEMENT APPLICATION


d"ne and ."ll"37u a.te! 1( 2( and m"nth, and i. the te,t i, ",iti#e(

immediate t!eatment 5y AI+* e@e!t8


d"ne and ."ll"37u a.te! 1( 2( and m"nth, and i. the te,t i, negati#e and n"

in.e$ti"n ,t" the PEP8

The ,amle d!a.t ."! Needle *ti$4 In>u!y &uideline i, ,h"3n 5el"38

Needle,ti$4 In>u!y Management &uideline


10/22


Primary Measurement

Mea,u!ement indi$at"!, he!e in Li5ya a!e di..i$ult t"

"5tain "! n"ne at all 5e$au,e

medi$al in,tituti"n, a!e u,ually

E@",u!

e

E@",u!

e

Rin,e 3"und 3ith 3ate!

+i,in.e$t 3ith G al$"h"l

Rin,e mu$"u, mem5!ane 3ith 3ate!

Re"!t t" the Head Nu!,e

In.e$ti"

u,

N"

Ye,

Re.e! 7 T!i"li

Cent!al

H",ital

N" A$ti"n

%"ll"3 U

H)V

H)C

HIV

H)V "!

%ull V

P",iti#e

."ll"3 u

a.te! 710m"nth,

PEP

Ye,

N"

HVC

Ye,

N" A$ti"n

H)I& D= h!,

Ye,

N"

N" In.e$ti"n

Alha7Inte!.e!"n and Ri5a#a!

PEP ."ll"3 u a.te!

1(2( m"nth,

HIV 7

Ye,

N"

*TOP

T!eatment 5y

AI+* E@e!t

Y


11/22


unde! the Mini,t!y ". Health ". Li5ya( 3hi$h d"e, n"t u,ually gathe!, data ."! mea,u!ement8

Mea,u!ement indi$at"!, ."! 6uality im!"#ement "! 6uality management a!e n"t yet

a$$"mli,hed in thi, $"unt!y8 In,tead( the team 3ill ma4e u,e ". data ."!m neigh5"!ing A!a57

Mu,lim $"unt!ie, ."! $"ma!i,"n8

Man'"u!( +aud( Ha,hmi( *a!da!( )a5a!( Rahman( B Mali4 901 !e"!ted that in Pa4i,tan

18G ". nu!,e, in a te!tia!y health $a!e .a$ility had N*I,8 The auth"!, al," n"ted that in *audi

A!a5ia( 18/G ". nu!,e, 9801 and 82= in>u!ie,Fe!,"nFyea! e@e!ien$ed N*I, in 08

&al"ugahi 901 indi$ated that in I!an( /8G ". health$a!e 3"!4e!, in hane#ade H",ital

had a hi,t"!y ". at lea,t "ne needle,ti$4 in>u!y in 0 and $"n$luded that thi, !ate 3a,

,igni.i$antly le,, than "the! ,imila! ,tudie, in I!an8

The initial "#e!all g"al ". the team 3ill 5e t" ha#e a !"e! !e"!ting and management ".

needle,ti$4 in>u!ie, in &ha!yan Uni#e!,ity tea$hing H",ital8 The Cente!, ."! +i,ea,e C"nt!"l

and P!e#enti"n 9012 ,t!e,,ed the im"!tan$e ". ,ha!, in>u!y !e"!ting a, a!t ". 5a,eline

a,,e,,ment ."! e..e$ti#e !e#enti"n lanning8 Thi, !e"!ting( 3hi$h i, a!t ". the !"",ed

!"t"$"l "n N*I, 3ill !"#ide the team meaning.ul data 3hi$h $an 5e utili'ed ."! inte!nal

5en$hma!4ing( !e,ea!$he,( and 5a,i, ."! !"g!am de#el"ment8

Strategies for Managing Ethical Dilemmas

The $u!!ent ,ituati"n ". the health$a!e ,y,tem ". Li5ya !e6ui!e, a num5e! ". ."!eign t!ained

health$a!e 3"!4e!, ,e$ially nu!,e, t" .ill the $"unt!y, demand ."! health$a!e ,e!#i$e,8 In

&ha!yan Uni#e!,ity Tea$hing H",ital( ma>"!ity ". nu!,e, a!e n"nnati#e a!ti$ula!ly in ,e$ial

a!ea, li4e ICU8 The,e nu!,e, a!e .!"m the Philiine,( U4!aine( R"mania( India( )anglade,h(

?"!dan( Egyt( and Tuni,ia8 -ith health$a!e 3"!4e!, ". di..e!ent nati"nalitie,( $ultu!e( and

!eligi"n( !e"!ting ". needle,ti$4 in>u!ie, might 5e di..i$ult t" attain8


12/22


Managing thi, tye ". i,,ue $an 5e d"ne th!"ugh an e,ta5li,hment ". a $ultu!e ". ,a.ety8 A,

C+C 9012 ,tated ;T" $!eate a $ultu!e ". ,a.ety( "!gani'ati"n, mu,t add!e,, th",e .a$t"!, 4n"3n

t" in.luen$e eml"yee, attitude, and 5eha#i"!,8 O!gani'ati"n, mu,t al," di!e$t mea,u!e, t"

!edu$e ha'a!d, in the en#i!"nment< 98 2=8 The agen$y "inted "ut that en$"u!aging health$a!e

3"!4e!, t" !e"!t any tye ". in>u!ie, 3"uld .",te! a $ultu!e ". ,a.ety and $!eate a 5lame7.!ee

en#i!"nment8

eam Description

-hen a g!"u ". indi#idual, >"ined t"gethe! t" 3"!4 ."! a u!",e( they a!e 5uilding a team(

3hi$h a$$"!ding t" elly 9011 ;may $"m!i,e ,e$ialtie, 3ithin a ,ingle di,$iline( a$!",,

dea!tment,( "! a$!",, "!gani'ati"n,< 98 108

The ?u!an In,titute 9012 e@lained the im"!tan$e ". a team ."! $"mleting a !">e$t( 3hi$h

,h"uld 5e multi.un$ti"nal in natu!e8 Thi, a!"a$h 3ill en,u!e that indi#idual 5ia,e, 3ill 5e

minimal 5e$au,e e#e!y"ne i, 3ell !e!e,ented8 The C+C 9012 .u!the! e@lained(

;Re!e,entati"n ". ,ta.. .!"m a$!",, di,$iline, en,u!e, that needed !e,"u!$e,( e@e!ti,e( and

e!,e$ti#e, a!e in#"l#ed8 The !e,"n,i5ility and auth"!ity ."! !"g!am $""!dinati"n ,h"uld 5e

a,,igned t" an indi#idual 3ith a!"!iate "!gani'ati"nal and leade!,hi ,4ill,8 The team ,h"uld

al," in$lude e!,"n, .!"m $lini$al and la5"!at"!y ,e!#i$e, 3h" u,e ,ha! de#i$e,( a, 3ell a, ,ta..

3ith e@e!ti,e in in.e$ti"n $"nt!"l( "$$uati"nal healthFindu,t!ial hygiene( in7,e!#i$e t!aining "!

,ta.. de#el"ment( en#i!"nmental ,e!#i$e,( $ent!al ,e!#i$e( mate!ial, management( and

6ualityF!i,4 management( a, a#aila5le< 98 0D70/8

*in$e the lanned 6uality im!"#ement 3ill "nly 5e alied in the ICU( a .un$ti"nal team

$"m",ed ". nu!,ing ,ta.. ". di..e!ent nati"nalitie, 3ill 5e ,ele$ted8 A .un$ti"nal team 3ill 5e

5ene.i$ial 5e$au,e the QI lan aim, t" im!"#e !"$e,,e, in the a!ea8 A %iliin" nu!,e 3ith


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e@ten,i#e e@e!ien$e, in the Middle Ea,t( a ?"!danian nu!,e .!"m Inte!nati"nal Medi$al C"!,( a

*y!ian nu!,e( a Li5yan nu!,e .!"m the )*N P!"g!am 3ill 5e a!t ". the team8 The head ". the

ICU +ea!tment and the Manage! ."! In.e$ti"u, C"nt!"l O..i$e 3ill al," 5e in$luded a, a!t ".

the team8 The,e mem5e!, 3e!e $h",en !ima!ily 5e$au,e ". thei! edu$ati"nal and eml"yment

5a$4g!"und8 Al,"( the,e nu!,e, ha, the a5ility ". u,ing the Engli,h and A!a5i$ language,

e..e$ti#ely( the!e."!e( limiting $"mmuni$ati"n 5a!!ie!,8 The ,t!ength ". the mem5e!, ". the team

3ill 5e a, ."ll"3,:

18 Head ". the ICU +ea!tment 7 a medi$al d"$t"! that 3ill !e!e,ent the

Admini,t!ati"nF*eni"! Management8 Thi, e!,"n 3ill ,e!#e a, the mean, ".

$"mmuni$ati"n ."!m the ICU t" the t"7le#el manage!, and 3ill 5e the .a$ilitat"! du!ing

meeting,8

08 Manage! ". In.e$ti"n C"nt!"l O..i$e 7 thi, e!,"n 3ill a,,e,, in.e$ti"n $"nt!"l

imli$ati"n, and ,ha!, in>u!y !e#enti"n !"g!am,8

28 %iliin" Nu!,e 3ith e@ten,i#e e@e!ien$e in the Middle Ea,t 7 thi, e!,"n 3ill ,e!#e a, the

In7,e!#i$e T!aine!F*ta.. +e#el"e!( 3hi$h 3ill !"#ide in."!mati"n "n $u!!ent edu$ati"n

and t!aining !a$ti$e, and 3ill e@lain !"",ed !"t"$"l and any edu$ati"nal

inte!#enti"n,8

D8 ?"!danian Nu!,e .!"m the Inte!nati"nal Medi$al C"!, 7 thi, e!,"n 3ill 5e the Ri,4

C"nt!"lFQuality Manage!( 3hi$h 3ill hel de,ign !"$e,, !elated t" the needle,ti$4

!"t"$"l8

/8 *y!ian and Li5yan Nu!,e 7 the,e e"le 3ill 5e the %!"nt7line Clini$al and La5"!at"!y

*ta..( 3hi$h deli#e! in,ight int" the !"",ed !"t"$"l and 3ill ha#e an a$ti#e

a!ti$iati"n in the e#aluati"n ". the !"t"$"l8


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THE QUALITY IMPROVEMENT APPLICATION 1D

The meeting ". the team 3ill 5e d"ne e#e!y %!iday m"!ning( ,in$e thi, i, the "nly a#aila5le

day ."! the mem5e!, t" $"n#ene due t" ,$hedule !e,t!i$ti"n,8 One mem5e! ". the team 3ill ta4e

a!"!iate d"$umentati"n, ". e#e!ything that t""4 la$e in the meeting8 The d"$umentati"n,

3ill 5e then ,ent t" the O..i$e ". the +euty Medi$al +i!e$t"! ."! !"e! $"mmuni$ati"n8

Pa!ti$iati#e Management Pa!adigm u,ed 5y the ?aane,e i, a!"!iate in "!de! ."! the QI

lan t" ,u$$eed in the "!gani'ati"n8 )!"3n 9012 e@lained that thi, tye ". management 3"uld

.",te! enthu,ia,m am"ng 3"!4e!, i. they .eel they a!e ,a.e and ,e$u!e( ,ha!ing ". in."!mati"n i,

!a$ti$ed( eml"yee, a!e a$ti#e a!ti$iant, 3hi$h la$e, it, e"le .i!,t( and e"le a!e

em"3e!ed 5y in$luding them in de$i,i"n ma4ing !"$e,,8 )y utili'ing thi, tye ". a!ti$iati#e

management( mem5e!, ". the team 3ill 5e m"ti#ated 5e$au,e the .eeling ". in#"l#ement in the

!"$e,, i, !e,ent8

!eadership Qualities

The Head ". the ICU +ea!tment 3ill 5e the leade! ". the team8 The leade! 3ill ha#e ,ha!ed

and un,ha!ed !e,"n,i5ilitie, ."! the attainment ". the !">e$t8 The ?u!an In,titute 9012

e@lained that the leade! ha, the "#e!,ight "5ligati"n 3hi$h 3ill m"ti#ate the mem5e!, t"

$"nt!i5ute and 3ill a,,i,t in !e,"l#ing $"n.li$t, that may a!i,e8 The leade! ,h"uld ha#e multile

,4ill, and mu,t 5e t!ained a!"!iately t" handle e"le( ha#e a ,t!"ng 5a$4g!"und a5"ut the

,u5>e$t matte! and ". the 6uality im!"#ement !"$e,,8

The leade! ". the team 3ill in,i!e e#e!y mem5e! t" .un$ti"n ma@imally( e@hau,ting e#e!y

e.."!t t" a$hie#e the g"al8 )y d"ing thi,( the e!,"n 3ill e#"l#e ."!m a manage! t" a

t!an,."!mati"nal leade!( 3hi$h a$$"!ding t" a$$agnini B -hite 9011( ;lead 3ith a $lea! #i,i"n

and u,e $"a$hing( in,i!ing( and ment"!ing t" t!an,."!m them,el#e,( ."ll"3e!,( and


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THE QUALITY IMPROVEMENT APPLICATION 1/

"!gani'ati"n,< 98 0/08 Thi, leade! 3ill then d" the !ight thing, in,tead ". d"ing thing, !ight

9)!"3n( 018

"ormulate E#P and an $ction Plan to $chieve Improvement %utcome

A, The ?"int C"mmi,,i"n 9012 ,tated ;-hen ,e!i"u, e#ent, "$$u!( 3hethe! they in#"l#e

atient, "! eml"yee,( The ?"int C"mmi,,i"n e@e$t, health $a!e "!gani'ati"n, t" $"ndu$t a !""t

$au,e analy,i, that i, ;!"5u,t< and n"n7uniti#e< 98128 The team 5elie#e, that a !""t $au,e

analy,i, 3ill 5e 5ene.i$ial t" add!e,, the i,,ue ". needle,ti$4 in>u!ie, in the "!gani'ati"n8 The

RCA %!ame3"!4 Temlate 5y the ?"int C"mmi,,i"n 3ith 0D 6ue,ti"n, ."! analy,i, that $an 5e

hel.ul "n "!gani'ing the ,te, in a !""t $au,e analy,i, 3ill 5e utili'ed8

)a,ed "n the !""t $au,e analy,i, d"ne( it 3a, n"ted that the de.e$t in the "!gani'ati"n 3a, due

t" a la$4 ". !"t"$"l in needle,ti$4 in>u!ie,8 Human .a$t"!, in$lude .ailu!e t" ."ll"3 e,ta5li,hed

"li$ie,F!"$edu!e,8 The e6uiment e!."!man$e( a#aila5ility( and $"nditi"n ha#e n"

de.i$ien$ie,8 En#i!"nmental .a$t"!, in$lude ,a.ety and ,e$u!ity !i,4,( 3hi$h a!e $"nt!"lla5le8 Thi,

needle,ti$4 in>u!y in the ICU +ea!tment ha, a !"5a5ility ". haening t" "the! unit, ,u$h a,

T!auma7ER( O)7+eli#e!y +ea!tment( Hem"dialy,i, Unit and Medi$al and *u!gi$al -a!d, ".

the H",ital8 Rega!ding the ,ta..( the!e 3a, n" "!ientati"n "! t!aining d"ne "n needle,ti$4 in>u!y

!i"! "! du!ing the $"u!,e ". eml"yment8 The!e 3a, n" identi.ied !"5lem !ega!ding the ,ta..ing

!ati",( h"3e#e!( ,4ill and e@e!ien$e le#el mi@ 3a, a $"n$e!n8 The!e 3a, neithe! lan n"!

$"ntingen$ie, in an e#ent 3hen a health$a!e 3"!4e! e@e!ien$ed needle,ti$4 in>u!y8 Al," the!e

3a, n" .ailu!e7m"de !e,"n,e, lanned "! ha#e 5een te,te, in the "!gani'ati"n8

A.te! a $"m!ehen,i#e !""t $au,e analy,i,( the team 3ill de#el"ed a d!a.t !"t"$"l "! "li$y

!ega!ding needle,ti$4 in>u!ie, in the ICU unit8 Thi, "li$y "! !"t"$"l 3ill 5e il"t te,ted in the

ICU unit( d"$umenting the imlementati"n and !e,ult,8


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#arriers of the Project

C"mmuni$ati"n 5a!!ie!, 3ill 5e the ma>"! $"n$e!n8 *in$e m",t ". the e"le in the

"!gani'ati"n $ann"t unde!,tand Engli,h( $"n#eying the lan t" the t" management 3ill 5e a

$hallenge8 The ,ame i, t!ue 3ith the in#"l#ement ". the medi$al !a$titi"ne!, 3h" $ann"t

unde!,tand 3ell the Engli,h language& *in$e ma>"!ity ". the health$a!e 3"!4e!, in the

"!gani'ati"n a!e ."!m di..e!ent $ultu!al 5a$4g!"und, and u,ing A!a5i$ and Engli,h language a,

the m"de ."! $"mmuni$ati"n( the team 3ill e#entually !ea!e t3" ,et, ". d"$ument,8 All the

d"$ument, that 3ill 5e utili'ed( !"$e,,ed( and di,,eminated 3ill 5e !ea!ed u,ing the Engli,h

and t!an,lated t" A!a5i$ language8

The ?u!an In,titute 9012 identi.ied $"mmuni$ati"n e!!"!, a, "ne ". the ,"u!$e, ". human

e!!"!, that $an a..e$t the ,u$$e,, ". the !">e$t8 Alth"ugh t!"u5le,"me( m",t ". the,e e!!"!, a!e

managea5le8 O. the identi.ied $"mmuni$ati"n e!!"!,( the team 3ill 5e ,e$i.i$ "n T!an,mi,,i"n

E!!"!,8 The ?u!an In,titute 9012 e@lained( ;They a!i,e .!"m limitati"n in human

$"mmuni$ati"n8 Identi$al 3"!d, ha#e multile meaning,( ," t!an,mitte! may ha#e "ne meaning

in mind( 5ut the !e$ei#e! ha, a di..e!ent meaning in mind< 98D8 T" !emedy the,e di..i$ultie,(

the team 3ill 5e #e!y meti$ul"u, in t!an,lating 3"!d "! 3"!d, and a,$e!tain that e#e!y d"$ument

t!an,lated ha, it, di!e$t and e@a$t meaning8

Summari'e the Impact of the eam Process

The team made u,e ". the ?u!an Quality Im!"#ement P!"$e,, and R""t Cau,e Analy,i, in

"!de! t" de#el" a d!a.t "li$y "! !"t"$"l that 3ill add!e,, the i,,ue ". needle,ti$4 in>u!ie, in the


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ICU +ea!tment8 Ea$h ,te ". the Quality im!"#ement P!"$e,, 3ill ta4e at lea,t t3" m"nth,

ea$h( and the la,t ,te( th!ee m"nth,8 -ithin the .i!,t .i#e m"nth,( the team 3ill ha#e a $lea! and

de.ined !">e$t 3ith an "ng"ing .un$ti"nal team8 Thi, 3ill 5e e#iden$ed 5y a de#el"ment ". a

d!a.t "li$y "! !"t"$"l ."! needle ,ti$4 in>u!y8

-ithin thi, e!i"d( the team 3ill 5e a5le t" dete!mine the !""t $au,e ". the !"5lem(

dete!minati"n ". the"!ie, and te,ting them( and .inally 5e a5le t" dete!mine the de.e$t, in the

!"$e,,8 The !emaining ."u! m"nth, 3ill 5e all"tted t" the te,ting ". the d!a.t !"t"$"l "! "li$y

!ega!ding needle ,ti$4 in>u!y8 )y thi, time( the!e 3ill 5e !"e! !e"!ting ". any ,ha! in>u!ie, in

the unit and the team 3ill 5e a5le t" ha#e a 5a,eline data t" !e,ent8

The,e data 3ill then 5e utili'ed t" dete!mine ,tanda!d, 3ithin the "!gani'ati"n and 3ill 5e

u,ed ."! !e,ea!$h and ",,i5ly the 5a,i, ."! an"the! !"g!am de#el"ment8 Thi, #ital in."!mati"n

3ill al," 5e $"n,ide!ed a, the 5a,i, ."! !e#i,ing the !"t"$"l and ma4ing it a ,tanda!d !"t"$"l t"

5e u,ed 5y the h",ital8 A.te! the nine7m"nth e!i"d( the h",ital 3ill ha#e a ,tanda!d !"t"$"l

."! needle,ti$4 in>u!y and 3ill 5e utili'ed 5y e#e!y unit t" !e#ent( !e"!t( and manage the,e

in>u!ie,8

Summary of the eam Process in (reating Improvement

The ?u!an In,titute 9012 ,tated( ;Nume!"u, $"manie, ha#e initiated 6uality im!"#ement(

5ut .e3 ha#e ,u$$eeded in in,tituti"nali'ing it ," that it g"e, "n yea! a.te! yea!< 98 8 The

team, g"al ."! thi, "!gani'ati"n i, n"t >u,t t" initiate a 6uality im!"#ement !">e$t 5ut al," t"

in,tituti"nali'e the $hange8 The team 5elie#e, that 5y d"ing the,e initiati#e,( &ha!yan Uni#e!,ity

Tea$hing H",ital might 5e a m"del in,tituti"n he!e in Li5ya 3he!e 6uality management i,

ta4ing la$e8 A, a t!aining in,tituti"n( the h",ital $an t!ain n"t "nly the .utu!e health 3"!4e!, ".

Li5ya 5ut the .utu!e 6uality manage!, a, 3ell8


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THE QUALITY IMPROVEMENT APPLICATION 1=

The g"al ". the team t" add!e,, the i,,ue ". needle,ti$4 in>u!ie, in the ICU +ea!tment 3ill

5e ,u$$e,,.ul "nly i. the!e 3ill 5e an e..e$ti#e !e"!ting ". e#e!y in$ident t" 5e a5le ."! the,e

in>u!ie, t" 5e managed a!"!iately8 -ith"ut the !e"!ting ". $a,e,( the "!gani'ati"n 3ill ha#e

n" 5a,eline data t" u,e8 The team leade! 3ill dem"n,t!ate the ,4ill and a5ility ". a

t!an,."!mati"nal leade!( 3hi$h 3ill m"ti#ate the team mem5e!, t" 3"!4 e..e$ti#ely and

e..i$iently8

The team 3ill d" thei! a!t 5y .un$ti"ning a$$"!ding t" thei! de,ignated !"le, and

!e,"n,i5ilitie,( a5le t" meet the demand, ". the !">e$t8 E#e!y meeting 3ill 5e !"e!ly

d"$umented and $"mmuni$ated t" the t" management ."! in."!mati"n di,,eminati"n8 An "en

line ". $"mmuni$ati"n 3ill 5e "en t" all mem5e!, ". the team( !e,e$ting thei! "3n 5elie.,(

$ultu!e( and !eligi"n8 P!"e! and a!"!iate t!an,lati"n, 3ill 5e d"ne t" en,u!e e#e!y"ne

unde!,tand, the t"tality ". the !">e$t8

(onclusion

The health$a!e deli#e!y ,y,tem ". Li5ya i, in $ha", and thi, i, e#ident 5y la$4 ". 6uality

management in m",t ". it, 5!an$he,8 In &ha!yan Uni#e!,ity Tea$hing H",ital 3he!e !e,"u!$e,

a!e !eadily a#aila5le( 6uality management i, i#"tal t" manage the,e !e,"u!$e, and !"du$e

atient ,ati,.a$ti"n8 Thi, $an 5e d"ne th!"ugh a Quality Im!"#ement initiati#e8 C"mmen$ing in

a ,ingle unit 3ith a !"5lem that $an 5e add!e,,ed 5y alying 6uality management !in$ile,

and e#iden$e75a,ed !a$ti$e( 3ill .",te! $hange, that $an in.luen$e the 3h"le health$a!e deli#e!y

,y,tem ". the $"unt!y8

Re.e!en$e,

A,4a!ian( M8( *haghaghian( *8( B M$La3,( M8 908 Needle,ti$4 in>u!ie, am"ng nu!,e, ".

%a!, !"#in$e I!an8Annals of Epidemiology( 17( ==708


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)!"3n( ?8 A8 9018 The Healhcare Quality Handbook: A professional Resource andStudy

uide90/th ed88 ?) Quality *"luti"n,( In$8

Cente!, ."! +i,ea,e C"nt!"l and P!e#enti"n 90128 The !ational Healthcare Safety !et"ork

#!HS!$ %anual8 Ret!ie#ed .!"m +i#i,i"n ". Health$a!e Quality P!"m"ti"n 3e5,ite:

htt:FF3338$d$8g"#Fnh,nFa$ute7$a!e7h",italF$la5,iFinde@8html,m

Cente!, ."! +i,ea,e C"nt!"l and P!e#enti"n 90=8 &orkbook for designing' implementing' and

e(aluating sgarps in)ury pre(ention program8 Ret!ie#ed .!"m Cente!, ."! +i,ea,e

C"nt!"l and P!e#enti"n 3e5,ite:

htt:FF3338$d$8g"#F,ha!,,a.etyFd.F,ha!,3"!45""40=8d.

Ch"3( ?8( Edu( &8( Rayment( &8( -"ng( ?8( ?e..e!y,( A8( B *u!anyi( M8 908 Needle ,ti$4

in>u!y: A n"#el inte!#enti"n t" !edu$e the "$$uati"nal healht and ,a.ety !i,4 in the

haem"dialy,i, ,etting8*ournal of Renal +are( 10710/8

+y,"n( M8 918Ho" and "hen to "rite policies and procedures90nd ed88 Vi$t"!ia( Au,t!alia:

Au,t!alian C"un$il ."! the Reha5ilitati"n ". the +I,a5led8

&al"ugahi( M8 9018 E#aluati"n ". needle,ti$4 in>u!ie, am"ng nu!,e, ". hana#edeh h",ital

in Teh!an8,ranian *ournal of !ursing and %id"ifery Research( 1-9D( 1078

&ane'a4( M8( )a!,,( P8( Al7Ma!a,hda( A8( Al7Ma!'"u6i( A8( B Al7u3aiti( N8 908 U,e ". the

Hadd"n mat!i@ a, a t""l ."! a,,e,,ing !i,4 .a$t"!, ."! ,ha!, in eme!gen$y dea!tmen, in

the United A!a5 Emi!ate,8,nfection ontrol and Hospital epidemiology( ./( /17/D8
http://www.cdc.gov/nhsn/acute-care-hospital/clabsi/index.htmlhttp://www.cdc.gov/nhsn/acute-care-hospital/clabsi/index.html


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&"u!ni( P8( P"li4and!i"ti( M8( Va,il""ulu,( &8( Malt'i( E8( B &"u!ni( M8 90108 O$$uati"nal

e@",u!e t" 5l""d and 5"dy .luid, ". nu!,e, at eme!gen$y dea!tment8Health Science

*ournal( 091( 7=8

I,mail( N8( A5"ul( %8( El7*h"u5a!y( -8( B Maha5a( H8 908 *a.e in>e$ti"n !a$ti$e am"ng

health$a!e 3"!4e!, in &ha!5iya Egyt8*ournal of the Egyptian ublic Health

Association( 12( =278

elly( +8 L8 90118Applying Quality %anagement in Healthcare: A Systems Approach92!d ed88

Chi$ag"( IL: Health Admini,t!ati"n P!e,,8

Man'""!( I8( +aud( *8( Ha,hmi( N8( *a!da!( H8( )a5a!( M8( Rahman( A8( B Mali4( M8 9018

Needle,ti$4 in>u!ie, in nu!e, at a te!tia!y health $a!e .a$ility8* Ayub %ed +oll

Abbottabed( ..92( 1D71=8

M"5a,he!i'adeh( *8( A5ne7*hahidi( *8( M"hammadi( N8( B A5a'a!i( %8 908 inte!#enti"n ,tu,y

". needle ,ti$4 in>u!y in I!an8 Saudi %edical *ournal( .0( 100/78

Mu,ha!!a.ieh( U8( )i'!i( A8( Na,,a!( N8( Rahi( A8( *h"u4ai!( A8( B +"uda4ian( R8 90=8

Health$a!e 3"!4e!, e@",u!e t" 5l""d75"!ne ath"gen, in Le5an"n8 3ccupational

%edicine( -/( D7=8

The ?"int C"mmi,ii"n 90128 ?"int C"mmi,,i"n: *e!i"u, HC- in>u!ie, a!e n"3 ,entinel e#ent,8

Hospital Employee Health( 2.90( 1270D8

The ?"int C"mmi,,i"n 9n8d88 Topic 4etails 5 *oint +ommission8 Ret!ie#ed May 0( 012( .!"m

htt:FF3338>"int$"mmi,,i"n8"!gF%!ame3"!4."!C"ndu$tingaR""tCau,eAnaly,i,a

ndA$ti"nPlanF
http://www.jointcommission.org/Framework_for_Conducting_a_Root_Cause_Analysis_and_Action_Plan/http://www.jointcommission.org/Framework_for_Conducting_a_Root_Cause_Analysis_and_Action_Plan/http://www.jointcommission.org/Framework_for_Conducting_a_Root_Cause_Analysis_and_Action_Plan/http://www.jointcommission.org/Framework_for_Conducting_a_Root_Cause_Analysis_and_Action_Plan/


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The ?u!an In,titute 9n8d88 The Source for 6reakthrough *uran8 Ret!ie#ed May 1( 012( .!"m

htt:FF3338>u!an8$"m

a$$agnini( M8 E8 B -hite( 8 -8 90118 The doctor of nursing practice essentials: A ne"

model for ad(anced practice nursing8*ud5u!y( MA: ?"ne, B )a!tlett Pu5li,he!,8


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Scholarly Paper - Quality Initiative

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