Literature Review
August 23, 2018
Mc Donald’s Project
August 27, 2018

Project Topic: Readiness to wean patients from mechanical ventilation Create a quality improvement project based on the following information. Readiness to wean compliance 53 mechanically ventilated patients in the 2 months in icu Count of sbt’s: Total ventilated days 283 Charted sbt 199 Terminal 15 Short term vent 9 Coded 9 Missing sbt 51 The issue is some staff members don’t do the SBT trials Some forget to chart Some lack the proper education

1 create a why why chart for spontaneous breathing trials that were not done, and explain 2. Create a spontaneous breathing flow chart as to how It’s supposed to be done. And explain what this is. 3.Create a fishbone diagram of common issues found that may act as barriers to charting SBTs. And explain what it means. Create a run chart for:reason sbts are not charted. Ex.Unknow, terminal,codes, md order hold, or accidental extuabtion. Research the rest of information. QI Final Project Module 02 – QI References (40 points): Due by deadline in Course Schedule. Use the template provided and include the following information:

I. References: All of your references must be cited and discussed or quoted in your paper – no exceptions • You must review at least five (5) peer-reviewed journal articles and discuss or include applicable quotes that support the points you will make in your QI project. These must be included in your QI Final Project and be cited in-text using APA format. • Provide Five Reference Peer-Reviewed Articles from the Current Literature – additional books or websites are allowed in addition to the five (5) peer-reviewed journal articles • You must obtain the FULL TEXT article online via Albertson Library or another online source that can be accessed by the instructor for verification – no sites requiring username/password • Must put references in APA format • References heading must be centered • References must be double-spaced (use Microsoft Word Paragraph Spacing) • Indent 5 spaces for 2nd and remaining lines • Alphabetize references A-Z (Community, Harbrecht, Kallam, Kollef, Kress, The College of William & Mary, Venes) • Italicize Journal Name and Volume information • Volume (Italicized)/Issue/Pages. For example: Volume(Issue), Page-Page • Date retrieved and web address where accessed must be provided – do not use doi in this course • Put cursor at the end of the web address and hit backspace once to remove hyperlink

Examples: In 431, you provide the web address where the article is found and date accessed. All articles must be found online. Community Hospital of the Monterey Peninsula. (2012). Respiratory care policy: Assess and treat protocol. Monterey, CA. Retrieved August 10, 2017 from http://www.chomp.org/policy/assess_and_treat Harbrecht, B., Delgado, E., Tuttle, R., Cohen-Melamed, M., Saul, M., & Valenta, C. (2009). Improved outcomes with routine respiratory therapist evaluation of non-intensive-care-unit surgery patients. Respiratory Care, 54(7), 861-867. Retrieved July 13, 2017, from http://rc.rcjournal.com/content/54/7/861.full.pdf+html Kallam, A., Meyerink, K., & Modrykamie, A. (2012). Physician-ordered aerosol therapy vs. respiratory therapist-driven aerosol protocol: the effect on resource utilization. Respiratory Care, 58(3), 431-437. Retrieved July 10, 2017, from http://rc.rcjournal.com/content/58/3/431.full.pdf+html Kollef, M., Shapiro, S., Clinkscale, D., Cracchiolo, L., Clayton, D., … Willner, R. (2000). The effect of respiratory therapist initiated treatment protocols on patient outcomes and resource utilization. Chest, 117(2), 467-475. Retrieved July 10, 2017, from http://journal.publications.chestnet.org/article.aspx?articleid=1078573 Kress, J., Pohlman, A., O’Connor, M., Hall, J. (2000). Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation. The New England Journal of Medicine 342(20), 1471-1477. Retrieved July 6, 2017 from http://www.sciencedirect.com.libproxy.boisestate.edu The College of William & Mary. (n.d.). The William & Mary mission statement. Retrieved August 1, 2017 from http://www.wm.edu/about/administration/provost/about/mission/ Venes, D. (2001). Taber’s Cyclopedic Medical Dictionary (19th ed.). Philadelphia: F.A. Davis Company. QI Final Project Outline Module 03 – QI Outline (50 points): Due by deadline in Course Schedule. This is part of the Define step of DMAIC. Use the template provided and include the following information:

D. Problem Description: • What is the Problem identified that was being evaluated in the QI Project, or • What is the Thesis Statement – what are you attempting to prove (or disprove) based upon your evaluation of the process identified (do not use bullet points – these are for you to make sure to address each element) • Describe your Problem Statement and/or Thesis • Make sure to provide at least one reference or quote in this section (See References, Module 02)

E. Project Process: • Be specific – you must include at least one paragraph on each of the QI Tools and Indicator listed below in your QI Project and do the following: o Demonstrate an understanding of the QI tool and how it is used o Discuss specifics on how you intend to use the QI tool in your project and what you expect to find (do not use bullet points – these are for you to make sure to address each element) • DMAIC Process o Define o Measure o Analyze o Improve o Control • Quality Indicators • Why-Why Chart • Fishbone Diagram • Flowchart • Run Chart

For example: You might create a flowchart, which shows the correct steps in a procedure or process. You could use a fishbone diagram or other RCA tool to “dissect” an event and then make recommendations based on your findings. Module 05 – QI Data (100 points): Due by deadline in Course Schedule. This is the Measure step of DMAIC. Use the template provided and include the following information: E. Measure: Provide the data measurements (Summarized Checklists or worksheet(s) used to obtain data for your project (do not use bullet points – these are for you to make sure to address each element). • Provide a complete description of the process (4 paragraphs minimum) • Copy the worksheet(s) into your Word document, only one document can be submitted • Make certain to remove all Protected Health Information (PHI) • Provide headers so that the information is readily understandable • Include necessary QI Tool Charts and Figures in your narrative at the exact point where you discuss them (Why-Why, Fishbone should be here, 2 paragraphs minimum for each) • Provide appropriate markings and a summary for every Chart or Figure used. For example: Chart 1: This chart details the…blah, blah, blah (keep to one sentence). • Discuss the contents of the Chart or Figure in your narrative. Do not simply refer to the Chart – I want to know your findings and do not want to have to figure out the information on my own. • Make sure to provide at least one reference or quote in this section (See References, Module 02)

Module 06 – QI Analysis (100 points): Due by deadline in Course Schedule. This includes the Analysis, Improve and Control steps of DMAIC. Use the template provided and include the following information: E. Analysis: Discuss the results of your findings and analyze the information based upon your Problem Statement or Thesis Statement (do not use bullet points – these are for you to make sure to address each element) • Discuss findings from your data measurements in detail (Run Chart should be here, 2 paragraphs minimum) • Analyze the data – What does the data tell you? Support your comments with statistics from your results (4 paragraphs minimum) o Compare your analysis with your Problem Statement or Thesis Statement • Evaluate your findings with your original Purpose Statement – were results achieved or not? o If results were achieved, what does this tell about the process and people? o If results were not achieved, what does this tell about the process and people? • What actions will be implemented as a result of the findings to Improve the process? Be specific (Flow Chart should be here, 2 paragraphs minimum) o If check sheets or other tools will be used, provide them o If a change in process will be implemented, provide it – maintain privacy • What actions will be implemented to ensure that actions taken are Controlled in the future? (2 paragraphs minimum) o If check sheets or other tools will be used, provide and discuss them o If a change in process will be implemented, provide and discuss it – maintain privacy • Make sure to provide at least three references or quotes in this section (See References, Module 02) • The Analysis, Improve and Control sections are critical to a successful QI Project and must have sufficient detail

QI Final Project A. Project Title: Replace with your Title – use Title Case B. Purpose Statement: The purpose of this project is (finish statement here, should be one sentence – remove this section and parentheses) C. Problem Description • What is the Problem identified that was being evaluated in the QI Project, or • What is the Thesis Statement – what are you attempting to prove (or disprove) based upon your evaluation of the process identified • Describe your Problem Statement and/or Thesis • Make sure to provide at least one reference or quote in this section (See References, Module 02)

D. Project Process: Begin your introductory paragraph here before discussing your project’s Indicators • Using DMAIC, discuss your project and include evidence of QI Tool use and results, including charts, graphs. Be specific! You must identify how you used each of the QI Tools in your project, including the raw data on surveys and observations (summarized). • This part of your presentation should be very detailed and include comparisons, including applicable quotes and proper in-text citations per APA. See the APA Writing Style Guide, p.4 for details on how to cite in-text. • Your graphs and charts should be included and appropriately indexed (Figure 1, etc.) and discussed. Do not make your reader figure out the results of a figure or chart – you discuss the results. • Neatness counts. Your presentation should be detailed and of good quality. 1. Indicators: Begin your Indicators here 2. Define: Begin your Define section here • This should be your outline for the entire project. Use each of the tools within this structure where they are most appropriate (in the Measure, Analyze or Improve sections). Also, make sure to put your charts and graphs in your paper at the point where they are discussed. Charts and Graphs should be the full-width of the paper so that they can be seen. If I can’t review your data due to size, they are of little value. • All QI Tools must be included in your paper: Why-Why Diagram, Fishbone Diagram, Flowchart, Run Chart 3. Measure: Begin your Measure section here • This section should have your data measurement data – if possible, provide summarized data in any checklists, observation sheets or survey tools. Details count! 4. Analyze: Begin your Analyze section here • What did you find? What does the data tell you? Your analysis should be detailed and must be based upon facts – statistics help here. Do not make a statement unless you are able to back it up with your data. 5. Improve: Begin your Improve section here • I cannot stress the importance of this element enough.

E. Project Outcomes: 1. Project Outcomes: Begin your Project Outcomes section here • What outcomes were initially desired, then obtained as you reported findings to them at the conclusion of your research? Discuss this fully. 2. Next Steps: Begin your Next Steps here • What are next steps as a result of your research? (Additional projects, training, monitoring, new processes?). Do not restate your Improve section here. One QI project usually uncovers others – what is next? • The goal of QI, Quality Improvement, is to improve processes and procedures. This section should be forward-thinking and should be performed, ideally, with your QI Supervisor and/or other members of your QI or management team.

F. Personal Outcomes: 1. What I Learned: Begin your What I Learned section here • What did you learn about QI through this project and the course? 2. Future QI Tool Use: Begin your Future QI tool Use here • State how will you use one or more of these tools in your personal and professional life in the future 3. Takeaways: Begin your Takeaways section here • What is one (or more) takeaway(s), that is, positive and/or negative – something you did well or could do better the next time you tackle a QI Project? Why this Supervisor?: Your manager • Why was this individual your project supervisor? 1. Assistance Provided: • What did they do to assist you in the project? Tell what actually happened (be discreet if not a great situation), don’t tell me what you think I want to hear. Good and not-so-good situations can bring benefits in future projects or working situations. 2. Supervisor Reporting: • How did you report to them during the course of your research? (Department meeting, One-on-one discussion, etc.). Tell what actually happened (be discreet if not a great situation), don’t tell me what you think I want to hear. Good and not-so-good situations can bring benefits in future projects or working situations.

J. References: All of your references must be cited and discussed or quoted in your paper – no exceptions • You must review at least five (5) peer-reviewed journal articles and discuss or include applicable quotes that support the points you will make in your QI project. These must be included in your QI Final Project and be cited in-text using APA format. • Provide Five Reference Peer-Reviewed Articles from the Current Literature – additional books or websites are allowed in addition to the five (5) peer-reviewed journal articles • You must obtain the FULL TEXT article online via Albertson Library or another online source that can be accessed by the instructor for verification – no sites requiring username/password • Must put references in APA format • References heading must be centered • References must be double-spaced (use Microsoft Word Paragraph Spacing) • Indent 5 spaces for 2nd and remaining lines • Alphabetize references A-Z (Community, Harbrecht, Kallam, Kollef, Kress, The College of William & Mary, Venes) • Italicize Journal Name and Volume information • Volume (Italicized)/Issue/Pages. For example: Volume(Issue), Page-Page • Date retrieved and web address where accessed must be provided – do not use doi in this course • Put cursor at the end of the web address and hit backspace once to remove hyperlink Examples: In 431, you provide the web address where the article is found and date accessed. All articles must be found online.

This overview should help you as you put together the QI Project Outline: • Tree Diagram • Fishbone Diagram • Flowchart • Run Chart • DMAIC Process Tree Diagram / Fishbone Diagram Tools and Methods for Root Cause Analysis Root cause analysis generates and sorts hypotheses about possible causes of problems within a process by asking participants to list all of the possible causes and effects for the identified problem. This analysis tool organizes a large amount of information by showing links between events and their potential or actual causes and provides a means of generating ideas about why the problem is occurring and possible effects of that cause. Root cause analyses allow problem solvers to broaden their thinking and look at the overall picture of a problem. Root cause diagrams can reflect either causes that block the way to the desired state or helpful factors needed to reach the desired state. When to Use It A graphic presentation, with major branches reflecting categories of causes, a cause-and-effect analysis stimulates and broadens thinking about potential or real causes and facilitates further examination of individual causes. Because everyone’s ideas can find a place on the diagram, a cause-and-effect analysis helps to generate consensus about causes. It can help to focus attention on the process where a problem is occurring and to allow for constructive use of facts revealed by reported events. However, it is important to remember that a cause-and-effect diagram is a structured way of expressing hypotheses about the causes of a problem or about why something is not happening as desired. It cannot replace empirical testing of these hypotheses: it does not tell which is the root cause, but rather possible causes. Types of Root Cause Analysis The slide presentation you watched introduced you to two of the most common RCA tools, Fishbone Analysis and Why questions. There are two ways to graphically organize ideas for root cause analysis. They vary in how potential causes are organized: 1. by category

Leave a Reply

Your email address will not be published. Required fields are marked *

My Account