Improvement steps at Children's Hospital of Atlanta
| Planning Phase | Implementation Phase | |
|---|---|---|
| Multidisciplinary team | ▸ Participated in QI Workgroups ▸ Established ‘CF Academy’ | ▸ Attended weekly CF team meetings ▸ Attended monthly QI planning meetings ▸ Fostered a culture and interest in QI |
| Physicians and nurse practitioners | ▸ Established a consistent treatment plan ▸ Created a standardised order set ▸ Created outpatient to inpatient handoff form | ▸ Attended weekly inpatient multidisciplinary meetings ▸ Used new forms, tools and plans ▸ Lent overall support for QI efforts ▸ Created standard note and discharge summary templates ▸ Respected and did not interrupt ACT sessions |
| Nursing | ▸ Reviewed nursing activities and educational materials used at other institutions ▸ Established a ‘credentialed’ group of core CF nurses | ▸ Met with family on admission to discuss programme and create schedule ▸ Coordinated the schedule of all activities and therapies ▸ Acted as patient advocate and educator throughout ▸ Awarded patient tokens for observing schedule |
| Respiratory Therapy | ▸ Performed a benchmarking visit to a leading CF centre ▸ Developed standardised approaches to ACT ▸ Trained all therapists on standard ACT techniques | ▸ Attended patients on schedule ▸ Maintained standardised performance and teaching of ACT ▸ Posted sign at door during ACT to prevent interruptions ▸ Awarded patient tokens for good participation in ACT |
| Nutrition | ▸ Developed menu with caloric content of food | ▸ Educated and gave advice for high caloric intake ▸ Worked with patients on calorie counts ▸ Awarded patient tokens for good meal intake ▸ Posted daily weight charts in rooms |
| Physical therapy | ▸ Developed measurement strategy ▸ Standardised therapy visits | ▸ Set individualised plan ▸ Held PT sessions 5 days/week as scheduled ▸ Assigned unsupervised weekend activities ▸ Awarded patient tokens for participation in therapy activities |
| Child life | ▸ Established repository of prizes to be awarded for tokens | ▸ Supervised token-based incentive programme for patients ▸ Awarded prizes at end of stay |
| Patient and family | ▸ Participated in workgroups and planning | ▸ Established schedule with nurses on admission ▸ Received tokens for good participation in programme ▸ Provided feedback |
ACT, airway clearance therapy; CF, cystic fibrosis; QI, quality improvement.