Evidence-Based Geriatric Nursing - Springer Publishing

20
Evidence-Based Geriatric Nursing Protocols for Best Practice
colleagues. Yet, we should not adopt existing measures blindly. Instead, we need to
subject them to a thorough review using the characteristics identified previously. Also,
health care organizations that have adopted these measures can offer their experience.
It may be that after an exhaustive search, we cannot find measures that meet the
various requirements outlined previously. We decide instead to develop our own inhouse
measure. The following are some important guidelines:
1. Zero in on the population to be measured. If we are measuring an undesirable event, we
must determine the group at risk for experiencing that event, then limit the denominator
population to that group. If we are measuring a desirable event or process,
we must identify the group that should experience the event or receive the process.
Where do problems tend to occur? What variables of this problem are within our
control? If some are not within our control, how can we zero in even more on the
target population? In other words, we exclude patients from the population when
good reason exists to do so (e.g., those allergic to the medication being measured).
2. Define terms. This is a painstaking but essential effort. It is better to measure 80% of
an issue with 100% accuracy than 100% of an issue with 80% accuracy.
3. Identify and define the data elements and allowable values required to calculate the measure.
This is another painstaking but essential effort. The 80/100 rule applies here, as well.
4. Test the data collection process. Once we have a prototype of a measure ready, we must
examine how easy or difficult it is to get all the required data.
IMPLEMENTING THE QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT PROGRAM
Successful Performance Improvement programs require an organizational commitment
to implementation of the Performance Improvement processes and principles
outlined in this chapter. Consequently, this commitment requires a defined, organized
approach that most organizations embrace and define in the form of a written plan.
The plan outlines the approach the organization uses to improve care and safety for
its patients. There are several important elements that must be addressed in order to
implement the Performance Improvement program effectively. The scope of service,
which addresses the types of patients and care that is rendered, provides direction on
the selection of performance measures. An authority and responsibility statement in
the document defines who is able to implement the quality program and make decisions
that will affect its implementation. Finally, it is important to define the committee
structure used to effectively analyze and communicate improvement efforts to the
organization.
The success of the Performance Improvement program is highly dependent on a welldefined
structure and appropriate selection of performance measures. The following is a list
of issues that, if not addressed, may negatively impact the success of the quality program:
1. Lack of focus: a measure that tries to track too many criteria at the same time or is too
complicated to administer, interpret, or use for quality monitoring and improvement
2. Wrong type of measure: a measure that calculates indicators the wrong way (e.g., uses
rates when ratios are more appropriate; uses a continuous scale rather than a discrete
scale; measures a process when the outcome is measurable and of greater interest)
3. Unclear definitions: a measure that is too broad or too vague in its scope and definitions
(e.g., population is too heterogeneous, no risk adjustment, unclear data elements,
poorly defined values)