In the current atmosphere of closer scrutiny of healthcare practices and procedures, front-line managers and health care providers must investigate potential problems in their work environment, whether at the behest of upper management, in order to meet Joint Commission on Accreditation of Health Care Organizations (JCAHO) standards, or through their own sense that “weÆre doing something wrong.” For the investigator with limited previous experience in evaluation or research, the prospect of undertaking this kind of investigation can appear daunting, to say the least. Quality Improvement Projects in Health Care was written just for this individual. Author Eleanor Gilpatrick, a seasoned investigator and professor of health services administration, provides a review of the basic terminology and guidelines for carrying out “nuts-and-bolts” quality improvement research. She then demonstrates how such a research project can be implemented through 14 case studies involving actual health care situations. Altogether, the cases speak to a broad array of issues and potential pitfalls for the unwary investigatorŭand they show that progress can be made in even the most difficult circumstances. Quality Improvement Projects in Health Care will be of interest to students and professionals in health sciences administration, nursing, allied health, and public health.
Case 11: Compliance with Discussions and Documentation of Advance Directives in a Home Care Agency1
This case dealt with compliance regarding Advance Directives (ADs) on the part of nurses engaged in home health care. The issue of ADs and how to present them is still the subject of widespread dissatisfaction.
Proving the Problem
Background, Importance, Relevant Steps, and Operational Definitions
Kim, a registered nurse at a certified home health care agency, worked as part of a team of 14 nurse coordinators. Each nurse coordinated and administered care to about 30 patients and supervised the home health aides. Kim was concerned about the extent to which patients had discussions with nurses about ADs and whether patients’ records ...