8: QUALITY IMPROVEMENT AND PATIENT SAFETY INITIATIVES ■ 207concerns about quality and safety, as well as to track their performance over time.
The toolkit supports hospitals that want to improve their quality performances and
includes Inpatient Quality Indicators and Patient Safety Indicators. Table 8.2 outlines
the AHRQ (2012) QI Process which supports the development, implementation, and
evaluation of QI processes.
Implementing this QI approach begins with preparing the environment through
the assessment of barriers including gaps in knowledge, communication, and data
sources. Applying these well- defined QIs is the cornerstone of the NQS, and AHRQ’s
activities are designed to bring about quality health care across the country. The use
of this common lexicon of measurement makes quality “measureable” and consistent.
Inpatient Quality Indicators include 28 provider- level indicators that can be used with
hospital inpatient discharge data to provide a perspective on quality. They are grouped
into four sets of indicators as described on Table 8.3.
Patient Safety Indicators include 18 provider- level indicators that screen for adverse
events that patients experience as a result of interacting with the health care system.
These are defined on two levels as described on Table 8.4.
DNP students and educators can make use of these national strategies to guide
their DNP QI projects. An ideal DNP project could be one that works within the NQS
implementing these national standards and processes within local organizations. This
dissemination of nationally developed QI approaches and programs is an opportu-
nity to increase the relevance of DNP projects within organizations as well as to sup-
port DNPs in their role as leaders in QI and patient safety. By integrating the NQS and
AHRQ’s coordinated QI approach with DNP QI Projects, the impact of DNP practice on
health care’s transformation can begin to be realized.
TABLE 8.2 AHRQ’s Quality Improvement Process
Steps to Set Priorities, Plan, Implement, and Sustain Quality
Improvement Initiatives- Determining readiness to change
- Applying QIs to the hospital data
- Identifying priorities for quality improvement
- Implementing improvements
- Monitoring progress for sustainable improvement
- Analyzing return on investment
- Using other resources
Toolkit’s Five- Step Improvement Cycle Based on the Well- Known PDSA
(Plan, Do, Study, Act) - Diagnose the problem
- Plan and implement best practices
- Measure results and analyze
- Evaluate effectiveness of actions taken
- Evaluate, standardize, and communicate
AHRQ, Agency for Healthcare Research and Quality; QIs, quality indicators.