vascular access infection prevention
The Cycle of Improvement to Lock in Quality
The topic of discussion last month was establishing standardization with procedures and while it is beneficial to aim for standardization there must be a systematic process for evaluation , planning , education and implementation of the goal . Types of systematic approaches that work together are the Lean Six Sigma and the Plan Do Study Act ( PDSA ) methods . Through the application of these methods a procedure or problem is evaluated , a goal established so an implementation plan achieves the goal .
One example of a Lean Six Sigma and PDSA initiative was the PIV5Rights Bundle performed at Hartford Hospital published by Steere and colleagues . The PIV5Rights was a study and quality improvement process that applied a bundle of practices to a comparative cohort unit with one group of patient rooms under current practice and the other group with the bundle approach . The outcomes of each cohort were compared to evaluate the intravenous catheter insertions , attempts , complications and number of catheters sustained to end of treatment . By applying the PDSA approach the PIV5Rights was implemented with the goal of one PIV per patient admission .
The Lean Six Sigma and the PDSA Cycle move through three processes of investigation , Lean , Six Sigma and PDSA methods . Lean is a method taken from manufacturing that relies on a collaborative team effort to evaluate and improve performance . Lean methods can systematically pinpoint variability in current practice leading to elimination of waste and defects resulting in greater efficiency and cost reduction . In simple terms Lean is about learning to do things better .
The Lean approach works to identify inefficiencies and waste within healthcare through situational analysis of current intravenous activities and outcomes within the 5-Ps of Process , Protocol , Practice , Products & Patient Outcomes . The Process works with clinical decision makers to uncover the current activities , and the authority for establishing and enforcing policies for past , present and plans for the future . Protocol investigation evaluates the facility policies looking at the why , when and what of protocols , then the how of procedures . The processes for Practice studies current work to define standard work considered as ideal for the procedure or practice , often associated with outcomes . Product review incorporates data collections on quantities used that relate to current practice establishing a baseline to aid in the before and after analysis . Patient outcomes applies to results of current practice that pinpoint areas that need improvement to inform the later comparison . Each of the 5-Ps are used within the Lean approach working together with Six Sigma evaluation strategies for healthcare data analysis toward improvement .
The Six Sigma strategy adds a data-driven quality tool to specifically guide a programmed approach and activity called DMAIC ( pronounced Duh-May-Ick ). DMAIC is an acronym for the five phases that make up the quality approach for improving , optimizing and stabilizing processes such as establishing intravenous access and delivery of infusion therapy . Six Sigma