Which of the following is most important when developing a continuous quality improvement program?

A. Institutional Support

CQI takes time and financial resources. This effort must have the sustained support of top program leadership.

B. Program Leadership

Members of the CQI team should represent various members of the health-care team including clinical, nursing, front office, health education, finance, and other administration, and patients. Strong team leadership and team building increase the chances of success.

C. Obtain Baseline Measurements

It is essential to compile baseline measurements of existing care processes and clinical outcomes such as the incidence of prematurity and low-birth-weight outcomes.

D. Identify Interventions/Process Measurements

The team collaborates on how to improve and modify existing care processes. Data collection tools to measure adherence to the new care processes are developed, and mechanisms to compile these measurements are implemented.

E. Enact Plan/Do/Study/Act Cycle

Process measurements are collected and disseminated to the team members on an ongoing basis. On the basis of this feedback, the CQI can institute additional refinements and improvements to the care model. Ultimately, the incidence of premature and low-birth-weight babies will determine the overall effectiveness of the model.

37. How should peritonitis be prevented and treated?

A team-based, multifaceted approach to continuous quality improvement with regular audit of infection rates and outcomes is essential to improving peritonitis rates. Training and retraining of both patients and nurse patient-educators is a cornerstone of this effort.

A number of peritonitis episodes are the result of direct extension of an infection associated with the exit site, in particular when the infecting organism at the exit site is either S. aureus or P. aeruginosa. All BDPs in reducing exit site infections will decrease peritonitis episodes. Another measure to reduce peritonitis is “flush before fill” connectology, a technology that washes any bacteria introduced at the tubing–catheter interface during an exchange into the drainage bag rather than into the patient’s peritoneum. Avoidance of constipation reduces the risk of peritonitis by attenuating transmigration of enteric bacteria across the bowel wall.

Observational studies have suggested benefits in draining the peritoneum dry and providing appropriate prophylactic antibiotics prior to dental, gastrointestinal, and genitourinary procedures. Adequate 25-hydroxyvitamin D levels have also been associated with lower peritonitis rates.

Once a presumptive diagnosis of peritonitis is made, prompt treatment with antibiotics capable of covering both gram-negative and gram-positive organisms is implemented. Although antibiotics can be given orally or intravenously, intraperitoneal (IP) administration has the benefit of providing immediate delivery of bacteriocidal concentrations of antibiotics. PD fluid culture results should then help narrow the spectrum and guide the duration of antimicrobial therapy. Attention to achieving a consistent mean inhibitory concentration (MIC) of antibiotics in the PD fluid, particularly if the patient is receiving APD or if intermittent antibiotic therapy is being used, is critical to successful treatment. Continuous rather than intermittent antibiotic therapy should ensure that a therapeutic MIC is achieved. While intermittent vancomycin dosing appears to be acceptable, it is prudent to obtain serum levels to ensure adequate MIC levels, particularly in the presence of significant RKF. Serum vancomycin levels should be kept >15 mmg/mL.

The signs and symptoms of peritonitis usually resolve within 48 hours after appropriate antimicrobial therapy. Persistent pain, cloudy fluid, and elevation of peritoneal fluid white blood cell (WBC) count should prompt reevaluation of the infectious cause and whether antibiotic therapy is suitable. Peritonitis refractory to treatment, defined as failure of the effluent to clear within 5 days of appropriate antibiotic therapy, should result in removal of the catheter. The ISPD has published guidelines for the prevention, diagnosis, and treatment of peritonitis.

What is the focus of a continuous quality improvement program quizlet?

Which of the following principles applies to continuous quality improvement in an organization?

Which of the following should a quality Council provide to best ensure success of performance improvement teams?

What is the primary purpose of an organization's quality improvement Qi strategic plan?