Successfully Using Six Sigma to Improve Nursing Quality Indicators

Objectives: 1) Describe how Six Sigma can be used to improve nursing quality indicators, and     2) Describe how the DMAIC process identified the critical steps surrounding the incidence or pressure ulcers.

Purpose: To share the performance improvement strategies our organization undertook to reduce the incidence of hospital acquired pressure ulcers.

This session demonstrates how using a structured, evidence-based approach like Six Sigma, coupled with our NDNQI data, helped us to identify and address the underlying causes of errors and inefficiencies related to skin care to improve patient-care.

Summary:  In 2001, Heritage Valley Health System began to look beyond the traditional health care process improvement techniques to offset the issue facing it and much other health care organization. In the last 5 years, Heritage Valley has successfully transformed an improvement methodology traditionally liked to manufacturing to health care with a strong focus in improving patient care. Six Sigma is a problem solving methodology that has a strong metric component; is data driven;

and reduces variation so that acceptable performance falls within Six Standard Deviations (6 s).

A review of NDNQI data showed The Medical Center's rate for hospital acquired pressure ulcers was higher than the national mean. In July 2005, a Six Sigma team was sanctioned to improve the hospital's incidence of hospital acquired pressure ulcers. Using the DMAIC process, the team identified the critical x's surrounding the incidence or pressure ulcers, looked at the data collection process, developed new processes, utilized FMEA and implemented the following improvements:

1. Revision of measurement process

2.       Revision of Skin Care Protocol to reflect evidence based practice. Included easy to follow tables on equipment and products  

3. Reorganization of the Skin Care Committee with newly defined charter and purpose

4. Revision of documentation forms to include risk assessment and staging
5. Education of nursing staff
6. Delineation of the role of the CWOCN

7. Incorporation NDNQI data on our Nursing Balanced Scorecard.

Once we started looking at pressure ulcers as an area of opportunity, we used Six Sigma methods and FMEA to design a better process that would allow us to improve patient outcomes. The FMEA assisted us in developing processes to prevent and mitigate those instances that escaped the initial process.  The project results so far have been impressive:

-         Reduction in hospital acquired pressure ulcers from 6.9 to 3.7 (Sigma level from 2.9 to 3.3)

-         Incorporation of risk assessment from “on admission” to daily with an improvement in documentation of risk assessment from 50% to 99%.

Implications for practice:  Incidence of pressure ulcers remains a significant problem in most hospitals. Using a six sigma problem solving approach within nursing can identify and eliminate barriers nurses face in caring for their patients.