Quality Improvement Tools

A Quick Introduction to Quality Improvement

The use of tools on a regular basis forms part of the Quality Improvement Methodology, which considers;

  • Systems – ensuring the environment and the processes within it are conducive to preventing errors and promoting safety in practice;
  • Reliability – ensuring whatever is meant to happen, happens the right way every time.
  • Testing change – all improvement will require change but not all change results in improvement therefore changes to a system or process must be tested using PDSA cycles (Plan, Do Study Act)
  • Measurement – The Tools enable the application of effective Infection Prevention systems and processes to be measured.

(Further information is available on the What is Quality Improvement Methodology' page). 

Both Process Improvement Tools (PITs)  and Rapid Improvement Tools (RITs) are available for clinical practice and care settings.

  1. Clinical Practice Improvement Tools measure specific clinical practices.  They can be used in any care setting where clinical practice is performed - for example, the ‘Asepsis’ clinical practice tool may be used in all care settings.
  2. Care Setting Improvement Tools are specific to care settings such as Endoscopy, theatres, acute in-patient facilities and care homes. 

Each Quality Improvement Tool can be printed out for use as a paper copy to record the outcomes in the practice setting and then entered onto the database, or handheld devices can be used to record the audit electronically.

Process Improvement Tools (PIT)

These are tools designed for detailed measurement of all aspects of practice/environment. (E.g. ward, outpatient dept, operating theatre etc) or a specific clinical practice (e.g. hand hygiene, insertion and care of peripheral vascular devices etc).

These tools can be used to measure baseline compliance with standards and identify areas for improvement work.  Guidance is provided against the criteria in each standard to ensure objective assessment.  They will identify the extent of overall compliance with evidence based criteria required to prevent/reduce the risk of infection.  These tools are very comprehensive and will give a good overall indication of how well the areas are doing and should not need repeating frequently.

In care settings where there is a specialist Infection Prevention and Control Team, these tools may be used by the team but the guidance allows use by others without specialist knowledge, e.g. matrons, ward managers, home managers and link practitioners.  The tools are very detailed and therefore simultaneous use is not advised.

Each criterion should be marked Yes/No or Not applicable (N/A).  Some criteria cannot be marked as N/A because these criteria reflect national evidence based standards and are considered to be always applicable

Once a base line assessment has been made using a PIT, the PIT may be used infrequently, for instance bi-annually, frequency of use is for local determination.   The person using the improvement tools should provide verbal feedback immediately.

Then:

  • Plans should be made to achieve the improvement required,
  • Realistic time frames should be set to achieve the improvement
  • Regular assessment should be made to determine whether improvement work is successful, this could be done by using the Rapid Improvement Tools (RIT).

Such improvement work may be undertaken using quality improvement tools and techniques such as the PDSA cycle.  A specific section of the PIT may be used depending on where improvement is required, or more frequent measurement in this context may be more practical using the shorter Rapid Improvement Tool designed for this purpose.

Care Setting tools available:

Clinical Practice Tools available:

Care Homes
Care Homes [Word Doc] 

Asepsis 
Asepsis [Word Doc] 

Endoscopy – Decontamination
Endoscopy – Decontamination [Word Doc] 

Central Venous Catheter (CVC) Continuing Care
Central Venous Catheter (CVC) Continuing Care [Word Doc]

Endoscopy – Environment
Endoscopy – Environment [Word Doc] 

Central Venous Catheter (CVC) Insertion
Central Venous Catheter (CVC) Insertion [Word Doc]

ECT Treatment Suite Mental Health
ECT Treatment Suite Mental Health [Word Doc] 

Isolation Precautions 
Isolation Precautions [Word Doc] 

GP Surgery/Health Centre
GP Surgery/Health Centre [Word Doc]

Enteral Feeding
Enteral Feeding [Word Doc] 

Hydrotherapy/Swimming Pool
Hydrotherapy/Swimming Pool [Word Doc]

Hand Hygiene Environment
Hand Hygiene Environment [Word Doc] 

In & Out Patient Area Departments
In & Out Patient Area Departments [Word Doc] 

Hand Hygiene Observation Tool (5 moments) (use RIT)

Inpatient/care home Mental Health/Learning Disabilities
Inpatient/care home Mental Health/Learning Disabilities [Word Doc]

Hand Hygiene technique
Hand Hygiene technique [Word Doc]

Day/Resource Centre Mental Health/Learning Disabilities
Day/Resource Centre Mental Health/Learning Disabilities [Word Doc] 

Peripheral Vascular Device (PVD) Continuing Care
Peripheral Vascular Device (PVD) Continuing Care [Word Doc]

Operating Theatres
Operating Theatres [Word Doc]

Peripheral Vascular Device (PVD) Insertion
Peripheral Vascular Device (PVD) Insertion [Word Doc] 

Outpatients Mental Health/Learning Disabilities
Outpatients Mental Health/Learning Disabilities [Word Doc] 

Scrub Procedures 
Scrub Procedures [Word Doc]  

Transportation of Specimens 
Transportation of Specimens [Word Doc] 

Standard Precautions
Standard Precautions [Word Doc] 

Vaccine Storage and Transportation
Vaccine Storage and Transportation [Word Doc] 

Theatre Asepsis
Theatre Asepsis [Word Doc] 

Vehicles 
Vehicles [Word Doc]  

Urinary Catheter Insertion
Urinary Catheter Insertion [Word Doc]

 

Urinary Catheter Daily Care
Urinary Catheter Daily Care [Word Doc]


Rapid Improvement Tools                                                                      

Rapid improvement tools (RITs) cover clinical areas (e.g. ward, outpatient dept, operating theatre etc) and clinical practices (e.g. hand hygiene, insertion and care of peripheral vascular devices etc).

These tools are shorter and intended to be used on a frequent basis. They are an effective means of identifying infection risks and areas for improvement and to assess whether planned changes have been implemented successfully to achieve improvement. Guidance is provided against the criteria in each standard to ensure objective assessment.  They will identify the extent of overall compliance with evidence based criteria required to prevent/reduce the risk of infection.

In care settings where there is a specialist Infection Prevention and Control Team, these tools may be used by the team but the guidance allows use by others without specialist knowledge, e.g. matrons, ward managers, home managers and link practitioners.  The tools are very detailed and therefore simultaneous use is not advised.

Each criterion should be marked Yes/No or Not applicable (N/A).  Some criteria cannot be marked as N/A because these criteria reflect national evidence based standards and are considered to be always applicable. The person using the improvement tools should provide verbal feedback immediately.

Then:

  • Plans should be made to achieve the improvement required,
  • Realistic time frames should be set to achieve the improvement
  • Regular assessment should be made to determine whether improvement work is successful.

Such improvement work may be undertaken using quality improvement tools and techniques such as the PDSA cycle (see methodology menu item). 

It is recommended that if practice is persistently poor as measured by the RIT, despite improvement efforts, that a more detailed assessment using the PIT is undertaken.

Specific Guidance for the Hand Hygiene RIT Observation Tool

The hand hygiene observation tools directly reflect the World Health Organisation (WHO) 'My 5 Moments for Hand Hygiene' (WHO 2009) and focus on ensuring observations in practice reflect hand hygiene performed at the right times to improve patient safety.

 The WHO 'My 5 Moments for Hand Hygiene' (2009) state that hand hygiene should occur:

  1. Before touching a patient
  2. Before a clean/aseptic procedure
  3. After body fluid exposure risk
  4. After touching a patient
  5. After touching a patient’s surroundings.

 

This WHO concept and the associated tools have been tried and tested globally and represent a robust, validated and reliable approach to hand hygiene monitoring. They have been developed through discussions between IPS, researchers at the Royal Free and University College London Medical School who led and published on the Hand Hygiene Observation Tool research in England and Wales (McAteer et al 2009), and the National Patient Safety Agency ‘cleanyourhands’ team. The outline of the tools also draws on tools produced by Health Protection Scotland which are also based on WHO recommendations.

Monitoring of the 5 Moments is presented as a Rapid Improvement Tool and it is recommended that it is undertaken on a regular basis.

The RIT can also be used to monitor an individual ‘moment’.  Monitoring of individual moments is only recommended when the 5 Moments have been reported against and it is known that specific rapid improvement is required, for example in an intensive care unit when it is clear that Moment 2 (before clean/aseptic procedure) is consistently not being adhered to prior to central line insertion.

 

Care Setting tools available:

Clinical Practice Tools available:

Care Homes
Care Homes [Word Doc]

Asepsis 
Asepsis  [Word Doc]

Endoscopy – Decontamination
Endoscopy – Decontamination [Word Doc]

Central Venous Catheter (CVC) Continuing Care
Central Venous Catheter (CVC) Continuing Care [Word Doc]

Endoscopy – Environment
Endoscopy – Environment [Word Doc]

Central Venous Catheter (CVC) Insertion
Central Venous Catheter (CVC) Insertion [Word Doc] 

ECT Treatment Suite Mental Health
ECT Treatment Suite Mental Health [Word Doc]

Isolation Precautions
Isolation Precautions [Word Doc] 

GP Surgery/Health Centre
GP Surgery/Health Centre [Word Doc] 

Enteral Feeding
Enteral Feeding [Word Doc]

Hydrotherapy/Swimming Pool
Hydrotherapy/Swimming Pool [Word Doc]

Hand Hygiene Environment
Hand Hygiene Environment [Word Doc] 

In & Out Patient Area Departments
In & Out Patient Area Departments [Word Doc]

Hand Hygiene Observation Tool (5 moments)
Hand Hygiene Observation Tool (5 moments) [Word Doc] 

Inpatient/care home Mental Health/Learning Disabilities
Inpatient/care home Mental Health/Learning Disabilities [Word Doc] 

Hand Hygiene technique
Hand Hygiene technique [Word Doc] 

Day/Resource Centre
Day/Resource Centre [Word Doc]

Peripheral Vascular Device (PVD) Continuing Care
Peripheral Vascular Device (PVD) Continuing Care [Word Doc]

Operating Theatres
Operating Theatres [Word Doc] 

Peripheral Vascular Device (PVD) Insertion
Peripheral Vascular Device (PVD) Insertion [Word Doc] 

Outpatients Mental Health/Learning Disabilities
Outpatients Mental Health/Learning Disabilities [Word Doc] 

Scrub Procedure
Scrub Procedure [Word Doc] 

Transportation of Specimens
Transportation of Specimens [Word Doc]

Standard Precautions
Standard Precautions [Word Doc] 

Vaccine Storage and Transportation 
Vaccine Storage and Transportation [Word Doc]  

Theatre Asepsis
Theatre Asepsis [Word Doc] 

Vehicles
Vehicles [Word Doc]

Urinary Catheter Insertion 
Urinary Catheter Insertion [Word Doc] 
 

Urinary Catheter Daily Care 
Urinary Catheter Daily Care [Word Doc]