Our Quality Improvement Framework
Our Nursing Department supports the hospital's strategic quality movement by continuously promoting and cultivating a learning culture for quality improvement among the nurses. We believe that with every improvement we make to our quality of nursing care, we can play an important role in ensuring better safety and patient experience
The Nursing Quality Improvement (NQI) Framework that the Nursing Department has adopted since 2005 aims to achieve the following objectives:
- Provide a coordinated Quality Improvement (QI) programme for nurses
- Ensure nursing services delivered are monitored for quality and appropriateness of care
- Establish monitoring and feedback mechanisms for evaluation and continuous improvement to service delivery
- Promote evidence-based nursing practice
- Promote a strong culture of QI among nurses
Under this framework, we have established committees to plan and oversee the implementation of the nursing quality movement. It emphasises a "bottom-up" approach in encouraging ownership and participation by nurses in quality improvement and patient safety initiatives.
At every level, our junior and senior nurses are actively involved in quality improvement activities and working in collaboration with key stakeholders.
We continue to equip our staff with Quality improvement training such as Leading NST (Nursing Standards Team, 6S, RCA (Root Cause Analysis), starting your NUHSWAY project, CPIP (Clinical Practice Improvement Programme), risk management and patient safety workshops, etc.
To ensure that the quality initiatives are effectively implemented, the respective patient care units perform regular audits for compliance and to identify areas for improvement. Audit results are shared to create awareness and action plans are formulated to address areas identified for improvement.
Under the Nursing Strategic Scorecard, KPIs (Key Performance Indicators) such as inpatient fall rates and hospital-acquired pressure ulcer rates are measured and monitored to evaluate the effectiveness of the quality improvement strategies. The clinical outcome of these indicators are trended, discussed and shared at the various nursing forums and meetings across Nursing and with our nurses on the ground.
We organise monthly Quality Improvement (QI) Rounds to help spread the quality message and share useful quality-related information with all nurses. This forum provides an excellent platform for them to keep abreast of the latest developments in quality and patient safety initiatives... Nurses are constantly encouraged to share and adopt best practices.
Our nurses’ works are constantly recognized through Quality improvement awards, poster and oral presentation at conferences, both locally and internationally.
Nurse leaders conduct rounding regularly to encourage and motivate teams on their quality improvement works.
EPEEP is a structured nurse 2 hourly rounding. EPEEP acronym stands for explain (E), pain/position (P), elimination/toileting (E), environment (E) and plan to return (P). During patient contact, nurses explain their contact events, ensure patients are free of pain and comfortable, offer help in toileting needs, place patients’ personal items within their reach and lastly, inform patients on the next nursing activities or EPEEP round.
EPEEP was piloted in 4 wards from June – Sep 2013 and was progressively rolled out to all general wards from October 2013 to March 2014. We achieved 90% of EPEEP compliance rates for all wards. For areas with consistent EPEEP, the number of callbells per patient per day reduced by 30 %, from 2.52 to 1.69 patient days (Sep 2014). The time saved helped nurses to spend more time at the bedside.
Both nurses and patients reaped the benefits from the EPEEP process. EPEEP creates a controlled environment for our nurses to work in as interruptions are decreased with reduced callbells. Patients are informed of the regular rounding by nurses. The proactive rounding helps build rapport with the patient/family, as well as teamwork, thereby elevating the staff and patient satisfaction level.
Transforming Care at the Bedside (TCAB)
Since January 2011, we embarked on a journey to Transform Care At the Bedside (TCAB). The intention of the TCAB is to improve the Quality and Safety of patient care; increase the vitality and retention of nurses; engage and improve the patient’s and family members’ experience of care and improve the effectiveness of the entire care team.
A series of 7 Rapid Improvement Events (RIEs) were completed to streamline and improve care processes related to TCAB. Through TCAB, we have improved our Total Direct Patient Contact Time from 31% to 51%. The results sustained at 49% since August 2011 till June 2012. Moving forward, we aim to work towards 60% of nurse-direct patient contact time.