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Applying Continuous Quality Improvement in Clinical Practice

NOTE: By completing an evaluation form, you are confirming that you have read the corresponding section of the Applying Continuous Quality Improvement in Clinical Practice. If you have not read the corresponding section, you must do so before completing the evaluation. If you would like to order the Applying Continuous Quality Improvement in Clinical Practice, click here.

Please note, only the CNE evaluation process for the Applying Continuous Quality Improvement in Clinical Practice is available in the Online Library - no chapter content for the Applying Continuous Quality Improvement in Clinical Practice is available for purchase online.

This new and expanded edition of ANNA's manual focusing on nephrology-specific continuous quality improvement (CQI) contains a practical overview of CQI, case studies, and tools to use in the majority of practice areas within the nephrology specialty. In addition to being designed to guide practitioners in their quest for excellence, the contents are also geared toward satisfying mandates of oversight organizations, such as The Joint Commission and the Centers for Medicare & Medicaid Services (CMS). Quality and formal programs ensuring quality outcomes are no longer optional in today's health care world; they are mandated. This publication is a valuable resource as nephrology nurses seek to implement successful quality initiatives and provide the best services possible in the most economical manner.

Contact Hours available through: 4/30/2011
22 Results Found, Showing 1 - 22
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CQI-Chapter #01 - Concepts and Principles of Quality Management
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Author:
Gail Wick , MHSA, BSN, RN, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Define quality.
  2. Discuss the basic principles and concepts of continuous quality improvement.
  3. Describe a tested continuous quality improvement model for use in the nephrology setting.

The basics of quality management with a focus on continuous quality improvement (CQI will be highlighted in this chapter. Quality, total quality management, and CQI will be defined, and an easy-to-implement CQI model will be presented.

 
CQI-Chapter #02 - Using Continuous Quality Improvement Tools
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Author:
Joan Camarro Simard , MS, RN, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Discuss strategies for using tools in a CQI/QAPI program.
  2. Describe tools that can be used in a CQI/QAPI program.
  3. Present examples of tools used for clinical performance measurements.
  4. Describe tools that can be used in the evaluation process.

Continuous quality improvement (CQI) is a process where teams come together to review and identify areas of clinical practice and environment that require improvement or change in the processes, procedures, or policies (Donabedian, 2003). There is a wide variety of tools available for the collection, evaluation, measurement, and mapping of data to streamline the approach the CQI team uses to reach its goals. This chapter will highlight some easy-to-use tools to assist with the process of CQI and quality assessment and performance improvement (QAPI). For more in-depth explanations and instructions, refer to textbooks written for that purpose (several are listed in the References section of this chapter).

 
CQI-Chapter #03 - Root Cause Analysis in Quality Improvement
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Author:
Leonor P. Ponferrada , BSN, RN, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Define root cause analysis (RCA).
  2. Identify 5 basic elements of a process.
  3. List 3 general principles of root cause analysis.
  4. Describe 5 steps in conducting a root cause analysis.
  5. Illustrate causal factor charting.

Root cause analysis (RCA) is a systematic investigation that looks into an identified event or undesirable outcome. This allows the investigator(s) and other involved parties to "dig deeper" in order to better understand the fundamental or "root cause" of the problem. The purpose of RCA is to determine what happened, how it happened, why it happened, and what actions can be implemented to reduce the likelihood of a recurrence.

 
CQI-Chapter #04 - Introduction to Six Sigma™
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Authors:
Jackie Miller , BSW, RN, CNN, CPHO
 
Billie Axley , MSN, RN, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Describe Six Sigma™ as referring to an operational philosophy, focusing on continuous improvement by decreasing the amount of variation that occurs in a process.
  2. Compare two similarities and differences between continuous quality improvement methodology and Six Sigma.
  3. List the steps in DMAIC methodology of Six Sigma.


 
CQI-Chapter #05 - Clinical Application: CQI in Anemia and Iron Management
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Author:
Gail Wick , MHSA, BSN, RN, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Explain how anemia and iron management are interrelated.
  2. Describe the Check-Plan-Do-Check-Act cycle as related to iron management and patients with anemia.


 
CQI-Chapter #06 - Continuous Quality Improvement and Bone Disorder Management: A Multi-Phase Approach Grounded in Research
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Authors:
MaryKay Shepherd , RD
 
Rebecca Lynn Wingard , MSN, RN, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Identify the risk of death for at least two elevated phosphorus ranges in the hemodialysis patient population.
  2. Define the Pareto principle.
  3. Discuss 3 principles of algorithm development.
  4. Identify a CQI project goal other than a parathyroid hormone (PTH) algorithm to address another cause of high PTH or phosphorus levels.
  5. Describe the impact the PTH cycle time can have on PTH outcomes.
  6. Identify one reason based on research data why patients on dialysis may require vitamin D supplementation, regardless of PTH level.


 
CQI-Chapter #07 - Clinical Application: Adequacy of Hemodialysis
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Author:
Maggie Tartarek , RN, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Describe the benefits of using urea kinetic modeling over urea reduction ratio to determine dialysis adequacy.
  2. List methods for analyzing adequacy data in a continuous quality improvement project.


 
CQI-Chapter #08 - Continuous Quality Improvement in Vascular Access Management
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Author:
Lesley Dinwiddie , MSN, RN, FNP, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. State two reasons why continuous quality improvement (CQI) in vascular access for hemodialysis (VA/HD) is essential.
  2. Relate the history of clinical performance measures (CPMs) designed to implement CQI for VA/HD nationally.
  3. Describe a recent large-scale clinical application of CQI in VA/HD.
  4. Describe the mandate for CQI and the use of a vascular access team (VAT) prescribed in the KDOQI™ update of 2006.
  5. List the data necessary for comprehensive CQI for VA/HD.
  6. List the actions of the VAT for accomplishing CQI for VA/HD.
  7. Cite one vascular access-related CQI example in the HD setting and one vascular access-related CQI example in the chronic kidney disease setting.


 
CQI-Chapter #09 - Clinical Application: CQI with Fluid Management in Hemodialysis
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Author:
Diana Hlebovy , BSN, RN, CHN, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Describe the importance of incorporating fluid management into the facility Quality Assessment and Performance Improvement Plan.
  2. Discuss the occurrence rate of intradialytic morbidities (ischemic events) during hemodialysis.
  3. List potential clinical performance measures.
  4. Identify root causes of inaccurate fluid management.
  5. Complete the Plan-Do-Check-Action-Cycle related to fluid management.


 
CQI-Chapter #10 - Clinical Application: Improvement Application in Acute Dialysis
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Author:
Sylvia Moe , BSN, RN, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Discuss how an improvement process can be applied to the acute dialysis setting
  2. Describe two examples of improvement projects in the acute dialysis setting


 
CQI-Chapter #11 - Clinical Application: CQI in Solid Organ Transplant
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Author:
Pat Weiskittel , RN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Discuss two quality indicators for solid organ transplantation and the continuous quality improvement method for each.
  2. Identify immunosuppressive medications commonly used post-transplant.


 
CQI-Chapter #12 - Clinical Application: CQI in Peritoneal Dialysis
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Authors:
Linda Dickenson , BSEd, BSN, RN, CNN, CPHQ
 
Billie Axley , MSN, RN, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Discuss how regulations and published standards of care can assist nephrology nurses in peritoneal dialysis in continuous quality improvement (CQI) activities.
  2. Identify nursing involvement in quality activities for quality assessment and performance improvement (QAPI).
  3. Describe a model for a CQI/QAPI program for peritoneal dialysis.
  4. Provide an example of the CQI process in a peritoneal dialysis home therapy program.

There is a growing focus on nurses' involvement in quality activities in the healthcare environment. Nephrology nurses can combine their knowledge and skills to deliver safe and effective patient-centered care using the principles and concepts of continuous quality improvement (CQI). This chapter will explore quality as a core competency for nephrology nurses and provide a description of how nurses working in peritoneal dialysis contribute to quality improvement for improved patient outcomes.

 
CQI-Chapter #13 - Clinical Application: CQI Aspects of the Therapeutic Apheresis Program
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Authors:
Judy Kauffman , MSN, RN, CNN
 
Linda Myers , BSN, RN, CNN, HP(ASCP)
 
Regina Rohe , BS, RN, HP(ASCP)
 
Billie Axley , MSN, RN, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Describe the use of continuous quality improvement for improving processes in the therapeutic apheresis program.
  2. Identify potential outcome indicators for application in a therapeutic apheresis program.


 
CQI-Chapter #14 - Clinical Application: CQI in Continuous Renal Replacement Therapy
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Authors:
Helen Williams , MSN, BSN, RN, CNN
 
Tana Waack , BSN, RN
 
Billie Axley , MSN, RN, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Explore quality indicators that could be applied to a continuous renal replacement therapy program.
  2. Describe an interdisciplinary improvement project conducted in an acute care setting.

In this chapter, the reader will find the focus is on using principles and concepts of continuous quality improvement (CQI ) to ensure every patient receives safe and effective continuous renal replacement therapy (CRRT). Suggestions are presented for the use of quality indicators in monitoring patient outcomes to identify opportunities for improvement.

 
CQI-Chapter #15 - Clinical Application: Improving Quality for Children with Kidney Disease: Unique Dimensions
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Authors:
Helen Currier , BSN, RN, CNN
 
Deborah Miller , MSN, RN, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Explain how children differ clinically from adults.
  2. Discuss benchmarking methodologies for assessing and treating chronic kidney disease and end stage renal disease in children.
  3. Describe one way to build a quality culture of care in a pediatric setting.


 
CQI-Chapter #16 - Clinical Application: Advanced Practice Nurses: Monitoring Outcomes to Improve Care to Patients with Chronic Kidney Disease
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Author:
Patricia McCarley , MSN, RN, ANCPc, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Identify patient outcomes.
  2. Describe the process of outcomes measurement.
  3. Explain the challenges of delivering quality healthcare outcomes.
  4. Discuss ways to improve outcomes in the nephrology setting and in patients with chronic kidney disease.


 
CQI-Chapter #17 - Clinical Application: CQI in Conservative Management
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Author:
Debra Hain , PhD, APRN, APN, GNP-BC
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Discuss the concept of self-management for the patient with chronic kidney disease.
  2. Describe The Model for Improvement as proposed by the Institute for Healthcare Improvement.


 
CQI-Chapter #18 - Clinical Application: Quality Improvement in Hemodialysis B Patient Safety
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Authors:
Barbara Cortez , RN
 
Billie Axley , MSN, RN, CNN
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Identify patient safety resources.
  2. Discuss application of continuous quality improvement for patient safety initiatives in the clinical setting.

The Institute of Medicine (IOM) released a report in 1999 that targeted errors occurring within the healthcare field as being a leading factor jeopardizing patient safety. The reported mortality statistics that resulted from errors were staggering (IOM, 1999). One of the report's main conclusions was that the majority of errors that occur in health care are not a result from "individual recklessness" or the actions of any particular group. Rather, the source of errors is the systems, processes, and conditions that lead people to make mistakes or fail to prevent mistakes (IOM, 1999). Recommendations were made for methods to identify errors, evaluations, and the actions needed to be taken for improvement. Continuing in its framework calling for improvement in the healthcare system, the IOM released a document in 2001 entitled, Crossing the Quality Chasm: A New Health System for the 21st Century. In this document, the IOM identified "Six Aims for Improvement" as core needs for health care:

  • "Safe: Avoiding injuries to patients from the care that is intended to help them."
  • "Effective: Providing services based upon scientific knowledge."
  • "Patient-centered: Providing care that is respectful of and responsive to the individual patient."
  • "Timely: Reducing waits and harmful delays."
  • "Efficient: Avoiding waste (equipment, supplies, ideas, energy)."
  • "Equitable: Providing care that does not vary" (IOM, 2001, p. 3).


 
CQI-Chapter #19 - Quality Assurance and Performance Improvement in the Outpatient Setting
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Author:
Bonnie Greenspan , BSN, RN, MBA
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Identify opportunities to close quality gaps through quality assessment performance improvement (QAPI) activities in the outpatient setting.
  2. List nine QAPI indicators mandated for review by the 2008 ESRD Conditions for Coverage.
  3. Identify two relevant strategies to keep QAPI on track in the outpatient setting.


 
CQI-Chapter #20 - CQI Application: Meeting the Challenges of ESRD Networks
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Authors:
Deuzimar Kulawik , MSN, RN
 
Angeline F. Wieler , MSN, RN, CNN
 
Mary Fenderson , RN, CNN, MSHSA
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Relate background pertaining to the ESRD Networks' work with dialysis facilities in improvement processes.
  2. Discuss continuous quality improvement concepts applied to the clinical setting.
  3. Describe a proposed framework for the working relationship between the ESRD Networks and dialysis providers.
  4. Discuss a patient-centered approach using an established model for improvement.

This chapter exhibits a brief background pertaining to the ESRD Networks' goals, objectives, attributes, and requirements relevant to the quality improvement process. Additionally, a review of the concepts of continuous quality improvement is provided and includes how to foster its application in a standardized way that is applicable to clinicians, providers, and stakeholders. A proposed framework is presented that highlights the relationship between ESRD Networks and providers using a patient-centered approach with the use of a model for improvement, the Plan-Do-Study-Act (PDSA) cycle. The reader is offered information on unifying the PDSA cycle in the work of determining the "how to" in delivering optimal quality care for patients with ESRD.

 
CQI-Chapter #21 - Team Collaboration in Continuous Quality Improvement
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Authors:
Billie Axley , MSN, RN, CNN
 
Raymond Hakim , MD, PhD
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Identify the continuous quality improvement team as an important part of the facility's quality assessment and performance improvement program.
  2. Describe a formula for successful team collaboration with a common quality agenda.


 
CQI-Chapter #22 - Continuous Quality Improvement and Research in Nursing
This package includes the content of this chapter (as a PDF) and the CNE Evaluation form. 

CNE credit for this article has expired.
Author:
Veronica Legg , MS, RN, FNP-BC
 
Resource:
 

Study of the information presented in this chapter will enable the learner to:

  1. Define continuous quality improvement.
  2. Understand basic tools of continuous quality improvement.
  3. Explain the difference between continuous quality improvement and research.

This chapter highlights the history of continuous quality improvement, basic tools, and an understanding of how continuous quality improvement and research interact.

 
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