Research Topics: Berwicks Theory

1. Describe Berwicks theory of continuous improvement and how it applies to this scenario. Which of Deming’s obstacles agrees with this theory?

Clinical Scenario:   Mrs. Grambal( aged 73) presented at emergency department at 4pm with a bad headache accompanied by her husband. They spent 12hours in the waiting room. When she was asked about the events leading up to her arrival in emergency department, she said that her headache had been constant for about one week and had made her feel so sick that she had been vomiting whenever she tried to eat. She had visited her general practitioner during the week and had told him it felt like a bad sinus headache. She did not have a history of suffering from migraine headaches. Her current medications included wafarin for management of atrial fibrillation. She reported that her most recent INR result was about 2.   After assessment by a medical officer, an urgent CT scan was booked for Mrs. Grambal and she was went to get the scan done 90 minutes later. Afterwards, she was told that the neurology registrar would come and discuss the results of the scan with her. Her husband noticed that she was asking repetitive questions and did not seem to remember the information that the staff had told her. Another hour passed, the neurology registrar arrived and explained that she had a significant bleed in her brain and mentioned something about ‘a subdural haematoma with significant midline shift’. He went on to say that she would need to go to operating theatre to have the clots removed but her INR levels required stabilization before this could be done. He expected that it would take 12 hours to stabilize her before surgery could be done.   She was transferred to the neurology ward for observation over night and an intravenous line and indwelling catheter were inserted. The staff seem to very busy, and could not answer the patient call buzzer very quickly. At 8am the next morning it was determined that her INR was satisfactory and she was prepared for theatre. She kept complaining that she was badly need to go to toilet, and appeared to be very distressed and restless. Her urine output was approximately 50 mls for the previous 4 hours. Three hours later the nurse manager discovered that the catheter was kinked, and straightened it, and immediately drained 1300 mls. The manager commented that she would be speaking to the staff about looking after catheter properly. She asked Mrs. Grambal about the pain in her head and was concerned to hear that it was no better, and that the nausea was very bad. She promised to check and see whether Mrs. Grambal could have something to relive the pain and nausea. An hour later, another nurse arrived and gave her an injection, explaining that her chart had been misplaced and had been difficult to locate and the nurse manager was not impressed. About 6pm an operating theatre become available and she was sent for surgery. Postoperatively, Mrs. Grambal had a wound drain on free drainage and continued to receive intravenous fluids with the addition of potassium. This therapy was interrupted for an hour when nursing staff discovered that there were no more fluid orders available and medical staff had to be paged to provide those orders. Her family was asking a lot of questions about whether she had suffered a stroke.   Three days later, she was transferred to a rehabilitation ward in a different hospital. There was a lot of confusion about whether she should have another CT scan after the surgery and when it should be done. Initially, it was supposed to be done prior to the transfer, then a new decision was made and it was scheduled for a week later.   There was also some confusion about the medications she required. When she was provided with her medications she noticed some additional, unfamiliar tablets. She enquired about those tablets and what they were for, and it was explained to her that some were salt tablets to correct her sodium levels, and some were to relieve her constipation. She was not constipated and declined to take those tablets.   A few days later, Mrs. Grambal was walking past a hand basin and slipped in some water on the floor and fell heavily against the wall. The nurse manager came to see her after fall and found her hip was extensively bruised and she was suffering some pain. He provided some ice packs and promised to ‘investigate the incident and to deal with the staff responsible’. Mrs. Grambal was subsequently sent for an X-ray of her hip.   Questions: 1.          Describe Berwicks theory of continuous improvement and how it applies to this scenario. Which of Deming’s obstacles agrees with this theory? 2.          Comment about the organizational culture in this scenario. 3.          Identify three unintended outcomes from this scenario that could impact on patient satisfaction/perception of the services delivered. 4.          Describe how the key principles of quality could be used to prevent these outcomes. 5.          Describe three processes in this scenario that were patient safety issues. 6.          Describe a process improvement method/model that could be used to improve one of these processes, and how it could be used. Include data required and how it could be analyzed. 7.          Describe the role of clinical governance in the prevention of the problems that occurred in this scenario? 8.          Provide information about tools, resources and other Quality Improvement(QI) strategies that could be used to improve services monitoring and evaluation in this organization.           Credit:ivythesis.typepad.com

1. Describe Berwicks theory of continuous improvement and how it applies to this scenario. Which of Deming’s obstacles agrees with this theory?

Clinical Scenario: Mrs. Grambal( aged 73) presented at emergency department at 4pm with a bad headache accompanied by her husband. The...

1. Describe Berwicks theory of continuous improvement and how it applies to this scenario. Which of Deming’s obstacles agrees with this theory?

Clinical Scenario:   Mrs. Grambal( aged 73) presented at emergency department at 4pm with a bad headache accompanied by her husband. They spent 12hours in the waiting room. When she was asked about the events leading up to her arrival in emergency department, she said that her headache had been constant for about one week and had made her feel so sick that she had been vomiting whenever she tried to eat. She had visited her general practitioner during the week and had told him it felt like a bad sinus headache. She did not have a history of suffering from migraine headaches. Her current medications included wafarin for management of atrial fibrillation. She reported that her most recent INR result was about 2.   After assessment by a medical officer, an urgent CT scan was booked for Mrs. Grambal and she was went to get the scan done 90 minutes later. Afterwards, she was told that the neurology registrar would come and discuss the results of the scan with her. Her husband noticed that she was asking repetitive questions and did not seem to remember the information that the staff had told her. Another hour passed, the neurology registrar arrived and explained that she had a significant bleed in her brain and mentioned something about ‘a subdural haematoma with significant midline shift’. He went on to say that she would need to go to operating theatre to have the clots removed but her INR levels required stabilization before this could be done. He expected that it would take 12 hours to stabilize her before surgery could be done.   She was transferred to the neurology ward for observation over night and an intravenous line and indwelling catheter were inserted. The staff seem to very busy, and could not answer the patient call buzzer very quickly. At 8am the next morning it was determined that her INR was satisfactory and she was prepared for theatre. She kept complaining that she was badly need to go to toilet, and appeared to be very distressed and restless. Her urine output was approximately 50 mls for the previous 4 hours. Three hours later the nurse manager discovered that the catheter was kinked, and straightened it, and immediately drained 1300 mls. The manager commented that she would be speaking to the staff about looking after catheter properly. She asked Mrs. Grambal about the pain in her head and was concerned to hear that it was no better, and that the nausea was very bad. She promised to check and see whether Mrs. Grambal could have something to relive the pain and nausea. An hour later, another nurse arrived and gave her an injection, explaining that her chart had been misplaced and had been difficult to locate and the nurse manager was not impressed. About 6pm an operating theatre become available and she was sent for surgery. Postoperatively, Mrs. Grambal had a wound drain on free drainage and continued to receive intravenous fluids with the addition of potassium. This therapy was interrupted for an hour when nursing staff discovered that there were no more fluid orders available and medical staff had to be paged to provide those orders. Her family was asking a lot of questions about whether she had suffered a stroke.   Three days later, she was transferred to a rehabilitation ward in a different hospital. There was a lot of confusion about whether she should have another CT scan after the surgery and when it should be done. Initially, it was supposed to be done prior to the transfer, then a new decision was made and it was scheduled for a week later.   There was also some confusion about the medications she required. When she was provided with her medications she noticed some additional, unfamiliar tablets. She enquired about those tablets and what they were for, and it was explained to her that some were salt tablets to correct her sodium levels, and some were to relieve her constipation. She was not constipated and declined to take those tablets.   A few days later, Mrs. Grambal was walking past a hand basin and slipped in some water on the floor and fell heavily against the wall. The nurse manager came to see her after fall and found her hip was extensively bruised and she was suffering some pain. He provided some ice packs and promised to ‘investigate the incident and to deal with the staff responsible’. Mrs. Grambal was subsequently sent for an X-ray of her hip.   Questions: 1.          Describe Berwicks theory of continuous improvement and how it applies to this scenario. Which of Deming’s obstacles agrees with this theory? 2.          Comment about the organizational culture in this scenario. 3.          Identify three unintended outcomes from this scenario that could impact on patient satisfaction/perception of the services delivered. 4.          Describe how the key principles of quality could be used to prevent these outcomes. 5.          Describe three processes in this scenario that were patient safety issues. 6.          Describe a process improvement method/model that could be used to improve one of these processes, and how it could be used. Include data required and how it could be analyzed. 7.          Describe the role of clinical governance in the prevention of the problems that occurred in this scenario? 8.          Provide information about tools, resources and other Quality Improvement(QI) strategies that could be used to improve services monitoring and evaluation in this organization.           Credit:ivythesis.typepad.com

1. Describe Berwicks theory of continuous improvement and how it applies to this scenario. Which of Deming’s obstacles agrees with this theory?

Clinical Scenario: Mrs. Grambal( aged 73) presented at emergency department at 4pm with a bad headache accompanied by her husband. The...