Identifying Practice Gaps for Quality Improvement
What should be happening in practice? What is happening or observed in practice?
These two questions help to identify where quality improvement practice gaps might exist in nursing practice. If we know what should be happening does not coincide with what is happening, we know there is an issue, or more appropriately, a practice gap.
A practice gap is the difference between a desirable or achievable state of practice and current reality. For example, a common gap in practice in healthcare organizations today, are healthcare associated infections (HAIs), such as central line associated blood stream infections (CLABSIs), or catheter associated urinary tract infections (CAUTIs).
The ongoing identification of practice gaps is critical to quality improvement and involves identifying the current state, comparing that current state to the desired state, identifying the causes of the gaps in practice, and validating those gaps to develop a process for improvement.
For this Discussion, reflect on quality improvement practice gaps that may exist in your practice or organization. Consider what quality improvement methods and/or tools might be useful in improving this practice gap. Then, think about how you might address these challenges and what strategies you might implement as a future DNP-prepared nurse.
- Review the Learning Resources on tools and methods for quality improvement.
- Reflect on a potential quality improvement practice gap, you have seen in your practice or organization, which you might consider using for your DNP project.
- Consider the tools and methods you might use to address this quality improvement practice gap.
By Day 3 of Week 3
Post a brief explanation of how you would identify a quality improvement practice gap in your practice or organization. Describe a potential quality improvement practice gap you might use for your DNP project, and explain why. Then, explain at least two types of tools and/or methods you might use to address this quality improvement practice gap, and explain why. Be specific and provide examples.
Identifying a Quality Improvement Practice Gap:
In my practice as a nurse in a busy emergency department, one quality improvement practice gap that I have observed is related to the timely administration of pain relief to patients with severe pain, particularly those with fractures or traumatic injuries. According to best practice guidelines and standards, patients should receive appropriate pain management as quickly as possible to alleviate suffering and improve their overall experience. However, in the fast-paced and often chaotic ED environment, delays in pain relief administration are not uncommon, and this can negatively impact patient satisfaction and outcomes.
Potential Quality Improvement Practice Gap for DNP Project:
The potential quality improvement practice gap I would consider for my DNP project is the delay in administering pain relief to ED patients with severe pain. This practice gap is significant as it directly affects patient outcomes, satisfaction, and overall quality of care. Addressing this gap aligns with the Triple Aim of improving patient experience, improving the health of the population, and reducing healthcare costs.
Tools and Methods for Addressing the Quality Improvement Practice Gap:
- Lean Six Sigma Approach: One effective tool for addressing this practice gap is the Lean Six Sigma methodology. Lean focuses on eliminating waste and optimizing processes, while Six Sigma aims to reduce variability and defects. By using Lean Six Sigma principles, we can streamline the pain relief administration process, identify bottlenecks, and reduce unnecessary delays. For example, we can map the patient’s journey from triage to receiving pain medication, identify areas where delays occur (e.g., pharmacy, documentation), and implement process improvements to expedite pain relief delivery.
- Plan-Do-Study-Act (PDSA) Cycle: Another valuable method is the PDSA cycle, which is a continuous improvement framework. It involves planning a change, implementing it on a small scale, studying the results, and then acting on those results to make further improvements. In the context of addressing the pain relief practice gap, we could pilot test changes in pain management protocols, such as nurse-driven pain relief orders for specific conditions like fractures. We would then study the impact of these changes on pain relief timeliness and patient outcomes, and if successful, implement them on a larger scale.
Example of Lean Six Sigma Application:
In applying Lean Six Sigma, we could use process mapping to create a visual representation of the pain relief administration process. This map would identify each step, the individuals involved, and the time taken at each stage. By analyzing this map, we might discover that certain steps, such as medication retrieval from the pharmacy, are causing significant delays. Using Lean principles, we could redesign this part of the process to minimize wait times, such as establishing a dedicated pharmacy technician for ED medication needs during peak hours. By continually monitoring and adjusting the process, we can sustain improvements and ensure timely pain relief for our patients.
Example of PDSA Cycle Application:
For the PDSA cycle, we might begin with a small-scale pilot program focused on nurse-driven pain relief orders for specific types of injuries, such as isolated extremity fractures. During this pilot phase, we would educate nursing staff on the new protocol and closely monitor its implementation. After a designated period, we would assess the impact on pain relief timeliness, patient satisfaction, and any potential adverse effects. If the results indicate improvement, we would then expand the use of nurse-driven orders to other eligible cases within the ED. In summary, identifying and addressing the quality improvement practice gap of delayed pain relief administration in the ED is essential for improving patient care and satisfaction. Utilizing tools and methods like Lean Six Sigma and the PDSA cycle allows for a systematic approach to process improvement, leading to more efficient and timely pain management practices in the healthcare setting.