1) I had expected to learn more quality improvement
strategies during this unit.
2) I actually learned a great deal how not to confuse Common
Causes with Special Causes. According to
our lecture video provided from the Mayo Clinic (2012) which presents Edward Deming’s
theories of profound knowledge, reacting to common causes is like scraping
burnt toast. One might ask what a common cause is? A Common Cause is an
occurrence that is constantly active within a system (Mayo Clinic, 2012). It is predictable. A
Special Cause, on the other hand, is the new, unanticipated, emergent or
previously neglected occurrence within a system (Mayo Clinic, 2012). Special Causes are
unpredictable. Deming stated not to react to common causes, because they are
already going to be present in a system, and it will only make things worse. For
example, a Common Cause is the burnt toast produced by a poorly designed
toaster. Continually scraping the burnt toast to make it look better only makes
things worse and doesn’t fix the problem. In contrast, a Special Cause is the
toaster. If the heat is turned down on
the toaster, burnt toast will no longer be produced.
Quality
Improvement teams need to remember not
to react to Common Causes, because they will always be present in a system—there
is no point in scraping burnt toast. The focus should be fixing the Special
Causes in a system. Ways to recognize the Special Causes is through collection
of data and creation of a control chart with upper and lower controls. A
sequence of seven or more points continuously moving upward or downward is
considered a “trend.” A clump of eight points above or below the upper/lower
control limits is called a “run.” These runs are the Special Causes that must
be paid attention to in a system. They are unpredictable and need fixing to
produce better outcomes.
3) I enjoyed the team discussion on our burn victim patient
that had second and third degree burns on 75% of his body. Our burn victim had
a poor nutritional status with a decreased appetite. One member of my team brought up research
about the caloric needs for victims with a burn covering 25% of total body
surface area (TBSA). Caloric needs can exceed 5,000 calories per day. Our group
discussion focused on possible reasons why this patient had a decreased appetite
and ways to increase his nutritional status.
We
concluded that pain was likely a large contributing factor to this patient’s
decreased appetite. Dehydration secondary to his burns likely increased his
feelings of nausea and compounded his poor appetite too. We also assumed the patient
may be depressed from trying to cope with this disfigured body, and those
feelings of depression were possibly reasons why he may not feel like eating as
well.
We decided
the healthcare team needed to focus their efforts on increasing his appetite
via pain control, ensuring adequate hydration via intravenous fluids and oral
intake, beginning tube feedings with a high-calorie/high-protein formula, make
snacks readily available for the patient, and administer anti-nausea
medications and appetite stimulant medications such as marinol to help meet
this patient’s nutritional needs and stimulate his appetite. The nurse would
include the patient’s family in encouraging him to eat high
calorie/high-protein snacks throught the day as well. We concluded that these
efforts implemented by the healthcare team would increase his nutritional
status allowing for better wound healing to take place and for his immune
system to be improved.
4) I plan to utilize the information I have learned in my
nursing practice by trying to recognize common causes in our process improvement
systems, and not react to them. They are predictable and will always be present
in a system. I will, however, recognize the special causes and try to fix them,
so process improvement plans can carry on, and lead to better patient outcomes.
5) I enjoyed the material covered. I want to become more
familiar with statistical analysis, variation, data collection and research in
my nursing practice. This way I can use statistical tools such as flow charts,
diagrams, or control charts (Sollecito & Johnson, 2013, p. 77-116) to help analyze
and improve processes.
References
Mayo Clinic
(April 2012). Common cause and burnt
toast. Retrieved online from https://www.youtube.com/watch?v=ctn1JFsNiCE&list=PLUuOgSK-0gzHmArwz4iwLy0zz_EeP0JSN
Sollecito, W. A.,
& Johnson, J. K. (2013). Mclaughlin
and Kaluzny's continuous quality improvement in health care. Burlington, MA: Jones & Bartlett Learning.
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