The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

DEVELOPMENT AND IMPLEMENTATION OF A RESPIRATORY CARE QUALITY IMPROVEMENT PROGRAM

Susan Ferry, Karen B. Caslin, Mark Sheedy, Linda Napoli; Respiratory Care, The Children’s Hospital of Philadelphia, Philadelphia, PA

BACKGROUND: Emphasis on organizational outcome data as indicator of performance coincident with outcome-based reimbursement by Centers for Medicare & Medicaid Services (CMS) and private insurers and the need to meet standards compliance goals in an environment of educated healthcare consumers drives the need to demonstrate better and safer patient care through quality improvement (QI) work. METHODS: A research respiratory therapist (RT) was reallocated responsibilities to include QI oversight for our 150 member department. The QI RT attended interdisciplinary QI and safety working groups to provide liaison to and representation of the Respiratory Care (RC) Department. Participation in organization-wide and interdisciplinary groups provided in situ education and orientation. RESULTS: An audit committee evolved into a QI working group in the RC department. The QI focus allowed group members more immediate and direct communication with quality professionals in other disciplines and provided stable membership allowing opportunity to gain insight and experience in the use of QI language and processes. Focus shifted from data collection to problem recognition and resolution. A large data collection tool for a national registry, the National Emergency Airway Registry (NEAR) became a RC-driven QI project examining provider and team performance during emergency airway placement. RC-specific QI indicators were developed. Staff met regularly to identify risk, define elements of surveillance, recommend improvements, devise communication and implementation strategies and review outcomes. Members worked ad hoc on projects defined by immediate risk identified from the electronic event reporting system (Safety Net, Marsh & McLennan 2006) but maintained large group membership. Improvements included identification and mitigation of a faulty Pharmacy distribution process which contributed to missed bronchodilator therapy. CONCLUSION: Quality improvement relies upon closed loop communication between those doing the QI work and those doing clinical work at the point of care. Active engagement by care providers in a quality improvement program can help create a culture of safety among staff, improve communication of quality improvement goals and findings to caregivers through their active participation in QI processes, provide input regarding feasibility for implementation at the bedside and provide peer resources for best practices for bedside staff based on QI initiatives. Sponsored Research - None

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