Reducing prolonged fasting for abdominal ultrasound scans

How to plan a quality improvement project

RATIONALE AND KEY POINTS

Measuring and enhancing the quality of patient care has become a central aspect of healthcare. Quality improvement (QI) can have many purposes, but its overall aim is to enhance patient care in a structured and systematic manner. It is essential that nurses, as part of the healthcare team, understand the importance of QI and their role in QI projects. Nurses who lead QI projects need the knowledge and skills required to do so effectively within their level of competence. • The Model for Improvement based on the Plan, Do, Study, Act (PDSA) cycle has become a framework of reference for QI. • It is important to allocate sufficient time to the planning stage of a QI project and clearly identify the issues and their root causes, what interventions to test and how to measure success. • Involving stakeholders from the outset, eliciting their views and gaining their support, is a major determinant of success. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your skills in planning a QI project. • How you could use this information to educate nursing students or colleagues about the appropriate steps in planning a QI project.

Initiative to improve handover notes in a tertiary psychiatric hospital

Clinical handover is an important process in hospital settings, but it is often carried out inadequately, posing potentially serious consequences for the patients. This project aimed to increase the effectiveness of handover notes when patients were transferred between a general psychiatric ward and other wards in a tertiary psychiatric hospital. Effective handover notes in this project were defined to have the following five components: brief psychiatric history, reason for the patient to be transferred, significant risk issues, reason for psychotropic medication change and active medical issues. Baseline measurement obtained from audits revealed that the completion rate of effective handover notes was only 27.27%, which could potentially compromise patient safety and staff work efficiency. To address this problem, a series of plan-do-study-act (PDSA) cycles was implemented to improve the handover process. The interventions included education to junior doctors, reminders to complete effective handover notes and implementation of a handover template. Following each PDSA cycle, data were gathered to assess whether an effect had been achieved and to identify ways to enhance interventions to maximise impact. After the final PDSA cycle, the percentage of effective handover notes among all transfer cases reached 90.50%. Postintervention feedback from inpatient team indicated that effective communication between different teams was ensured, and staff satisfaction and time savings were improved. This study highlights the importance of employing PDSA cycles to assess and refine interventions and the usefulness of structuring the content of key components of handover notes to obtain measurable improvements.