Continuous Quality Improvement and Risk Management

Brenda Quint-Gaebel

▪ INTRODUCTION

Continuous quality improvement (CQI) in the health care environment is the constant examination of processes and patient outcomes with the objective of making incremental improvements in the care provided to patients and the effectiveness of resources used. Resources include time, staffing, equipment, and supplies. Simply put, the goal of CQI is to improve patient outcomes and reduce health care costs. Another term that has been used in health care and many other industries is “quality assurance.” The American Society for Quality (ASQ) defines assurance of quality as the “planned and systematic activities implemented in a system so that quality requirements for a product or service will be fulfilled.” In other words, quality assurance is a process that is in place to achieve a certain level of quality. Health care organizations, in order to provide quality care and meet regulatory requirements, must have a quality assurance program in place. Organizations such as the Joint Commission and the Centers for Medicare & Medicaid Services require programs in place for the continual improvement in the quality and safety of patient care. This chapter focuses on the added value of CQI and risk management to a quality assurance program.

▪ RISK MANAGEMENT

Risk management is a process an organization undertakes to reduce the risk of liability. In health care, risk management attempts to reduce or prevent patient injury or other negative patient experiences. In addition, an important component of risk management is what to do when a negative event does occur. Quick recognition of an event and an appropriate response is critical to the successful management of risk. A timely response can reduce injury and improve eventual outcomes by interrupting ongoing events and providing appropriate treatment for the injury. Risk management involves not only treating the injury but also timely communication by the clinician and/or management staff with the patient and the family. Finally, risk management can reduce future risk by introducing the event into the CQI process where the root cause of the event can be analyzed. Such an analysis may lead to policy or procedure changes to reduce the likelihood of similar injuries in the future. It is important to note that risk management involves not only events that can or have injured patients but also injuries to the workers themselves.

▪ WHAT IS THE ANESTHESIA TECHNICIAN’S ROLE IN CQI AND RISK MANAGEMENT?

Anesthesia technicians (ATs) are an integral part of the perioperative team. As such they contribute to the care of every patient who receives anesthesia by helping to provide a safe, clean, well-functioning anesthesia work environment. The AT can also play an important role in CQI and risk management by awareness of, response to, and reporting of perioperative events. The following activities are listed to highlight some common areas that ATs can participate in and even lead in CQI and risk management.

Infection Prevention

The AT plays a key role in reducing the chances of a patient developing a postoperative infection every time anesthesia equipment and the work area are cleaned and set up for an incoming patient. Having a formal protocol to follow for removing all contaminated items, cleaning surfaces and equipment, and setting up for a new
case reduces the chances of missing a key step in the process. An evaluation of the room turnover process may identify opportunities for improvement (i.e., CQI) in the cleaning and setup process. Consider if there are pieces of equipment that are not currently included in the cleaning protocol such as computer keyboards, mouse, track ball, and/or computer screen. Could they be a source of cross-contamination and infection?

Equipment

Another important area for both CQI and risk management is anesthesia equipment. Operating room (OR) staff using patient care equipment should be properly trained before using the equipment. Inappropriate or incorrect usage of equipment is a common source of patient injury. Investigations of equipment-related injuries frequently find that personnel were inadequately trained or not trained at all on the piece of equipment in question. Some of this responsibility lies with management; however, each individual AT should strive to be trained on all equipment that he or she uses and to remain current on product information. In addition to cleaning and restocking, following a protocol for setting up and checking of equipment before use can reduce patient injury. Routine checking for signs of leaks, wear, damage, and malfunction can identify issues before they can cause a problem.

What steps should be taken when defective or malfunctioning equipment is involved in a patient care event or is suspected to have caused an injury to a patient? If the equipment is in use, the anesthesia provider will first assess patient needs, ensure patient’s safety, and prevent injury or further injury (see also Chapter 45). The equipment should be immediately removed from service. If possible, leave the equipment “as is.” If there are supplies or accessories involved, leave them attached to the device and store the entire setup in a secure place. Include all supply packaging if available. Avoid changing any setting or connections. Preserving the equipment in this way will enable the medical equipment technician and risk management team to evaluate the equipment and its potential contribution to any patient injury. In addition, properly preserved equipment may need to be returned to the manufacturer or even a regulatory agency for further investigation (e.g., the Food and Drug Administration). Consult with your risk management department to identify equipment issues that should be reported to regulatory agencies.

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