Nursing Leadership &
Management
Patricia Kelly-Heidenthal
0-7668-2508-6
Delmar Learning
Copyright © 2003 Delmar Learning, a Thomson Learning company
Chapter 20
Strategies to Improve Patient
Care Outcomes
Delmar Learning
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Objectives

Upon completion of this chapter, the reader should be
able to:
• Discuss the use of outcomes research in evidence-based
practice.
• Describe selected evidence-based models.
• Utilize the PDSA cycle framework for achieving
improvement to implement evidence-based practice for
specific patient care situations.
• Identify resources available to generate
outcomes/benchmarks for clinical practice.
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Evidence-based Practice Improvement
Defined
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Evidence-based practice (EBP) is defined as the
conscientious, explicit, and judicious use of current
best evidence in making decisions about the care of
individual patients.
Evidence-based practice is also referred to as
outcomes research.
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Evidence-based Practice Improvement
Defined

Its goal is to provide evidence about benefits, risks,
and results of treatments so individuals can make
informed decisions and choices to improve their
quality of life, and to identify potentially effective
strategies that can be implemented to improve the
quality and value of health care.
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Evidence-based Multidisciplinary
Practice Improvement Models
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Practice guidelines, pathways, or algorithms should
not replace individualized patient care.
Evidence-based practice has a medicinal focus, while
evidence-based nursing practice considers the
individual needs and preferences based on nursing
theory and research.
Various EBP models have been developed in health
care.
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University of Colorado Hospital Model
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This model is an evidence-based multidisciplinary
practice model.
It presents a framework for using various information
sources to change or support practice.
Health care team members use current and valid
research from sources such as journals, conferences,
and clinical experts as the basis for clinical decision
making.
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University of Colorado Hospital Model

This model depicts nine sources of evidence:
•
•
•
•
•
•
•
•
•
Benchmarking data
Cost-effective analysis
Pathophysiology
Retrospective/concurrent chart review
Quality improvement and risk data
International, national, and local standards
Infection control data
Patient preferences
Clinical expertise
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Plan-Do-Study-Act (PDSA) Cycle

The cycle begins with a plan and ends with action
based on the learning gained during the cycle.
•
•
•
•
Plan: develop a plan to change or test a process.
Do: implement the plan.
Study: summarize what was learned.
Act: determine what actual changes to make.
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Plan-Do-Study-Act (PDSA) Cycle

This cycle, which can be applied to a system or an
individual, is driven by three main questions:
• What are we trying to accomplish?
• How will we know that a change is an improvement?
• What change can we make that will result in improvement?
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Application of PDSA to Pain
Management

What are we trying to accomplish?
• Reduce or alleviate patient’s pain.

How will we know that a change is an improvement?
• Patient will indicate that pain is relieved.

What changes can we make that will result in
improvement?
• We can develop a protocol and other strategies.
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Application of PDSA to Pain
Management
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Combine the PDSA model for improvement with
JCAHO pain standards.
Identify location and quality of pain.
Document pain rating, degree of relief, and alleviating
or aggravating factors.
Consult with other health care team members to
identify, implement, and document best strategies that
reduce, minimize, or alleviate pain.
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Phases of Application of PDSA to Pain
Management
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Planning: multidisciplinary staff develops a plan to test
the effects of changes.
Doing: nursing staff conducts a trial using new
strategies and collects data.
Studying: data is collected and reviewed, and
improvements and issues are identified.
Acting: nursing staff shares findings with
multidisciplinary staff and decides whether to
implement change or continue testing it. In either case,
staff continues to look for ways to improve process.
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Application of PDSA to Pressure Ulcer
Management

What are we trying to accomplish?
• Treat and heal patient’s pressure ulcers. As part of this
process, improve patient’s mobility and activity level.

How will we know that a change is an improvement?
• Ulcers show signs of healing; patient expresses less
discomfort; patient demonstrates greater mobility and
activity.
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Application of PDSA to Pressure Ulcer
Management

What changes can we make that will result in
improvement?
• Initiate protocols and recommendations for treatment of
open skin.
• Conduct multidisciplinary conference to coordinate
strategies for pressure relief, skin care, mobility, and
nutrition.
• Involve patient in development of goals and
recommendations.
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Phases of Application of PDSA to
Pressure Ulcer Management

Planning: conduct multidisciplinary care conference,
including patient in conference; identify and agree to
changes in patient skin care and activity; provide
measures to relieve patient pain and anxiety; develop
and implement specific schedule of patient care,
positioning, and activity.
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Phases of Application of PDSA to
Pressure Ulcer Management

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Doing: implement plan of care; document status of
skin breakdown and preventive interventions; physical
therapist works with patient; nutritionist consults with
patient.
Studying: assess healing progress of patient’s ulcers.
Acting: determine whether to change or continue
treatment.
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Application of PDSA to Wound
Management

What are we trying to accomplish?
• Prevent wound infection & bleeding; control wound;
promote patient

How will we know that a change is an improvement?
• Wound will decrease with no signs of infection.

What changes can we make that will result in an
improvement?
• Consult wound care recommendations.
• Conduct multidisciplinary care conference to coordinate
strategies.
• Coordinate wound care.
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Phases of Application of PDSA to Wound
Management
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Planning: examine wound and recommend treatment
regimen.
Doing: implement agreed-upon plan of care; monitor
status of wound.
Studying: determine status of wound; evaluate
comfort of patient.
Acting: determine whether to continue or revise
treatment regimen.
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