Explore ideas for your own QI project.
We promote the use of the Model for Improvement when attempting a QI project. The first step is answering the question “What are we trying to accomplish?” In doing this we end up creating a project aim, in the SMART format, as the basis for everything which comes after.
The example SMART aims given here are for projects we believe could easily be undertaken by a clinician of any grade. However they should be tailored to your specific circumstances, modifying SMART components of the aim as you see fit:
Specific – Which clinical area(s)? Which patients in particular?
Measurable – What data measure is most meaningful to you in terms of achieving improvement? For example a project to reduce patient falls could look to either 1.) reduce % of patients who have at least 1 fall, 2.) reduce number of individual fall instances, 3.) increase average number of days between falls or 4.) increase time since last fall. All these measures are valid, but one would need to be selected by you as the goal.
Achievable and Realistic – What is possible depends very much on local circumstances
Timely – Having thought about the other components, what time-frame do you think you can achieve this by?
The project examples below are written in the format “To achieve [Y]… by time [X]”. This is so you can take the idea, but tailor it to your own project circumstances. In particular, it’s good practice to state the area in which you’d like to achieve this as part of your aim. We plan to continuously add more ideas to the list.
For example, the project “[Y]% of patients to have weight documented on front of drug chart within 12 hours of admission, in/by [X]”, could be taken and turned into an actual project with the aim:
“90% of patients on ward Z1 to have weight documented on front of drug chart within 12 hours of admission, by 31st Oct 2019″.
“90% of patients on ward Z1 to have weight documented on front of drug chart within 12 hours of admission, in 3 months”.
OTHER PROJECT IDEA SOURCES
If you’re looking for something more speciality-specific, the area in which you’re working will have a plethora of condition-specific guidelines (e.g. from NICE or the relevant Royal College). These are also a great source of project ideas – you can take a single recommendation and improve it, for example by increasing the percentage of relevant patients who receive that aspect of care.
Also, the journal BMJ Open Quality is dedicated to QI projects and is easy to browse through or use the search bar. There’s no reason not to take inspiration or even replicate another existing project. https://bmjopenquality.bmj.com/
GENERAL - DRUGS AND PRESCRIBING
[Y]% of patients to have weight documented on front of drug chart within 12 hours of admission, in/by [X].
In patients assessed as ‘high risk’ and no contraindications, for [Y]% to have pharmacological VTE prophylaxis prescribed, within 24 hours of admission, in/by [X].
To reduce warfarin prescription calls to out-of-hours team by [Y]% in/by [X].
[Y]% of patients with an inappropriately documented penicillin allergy (after ascertaining nature of reaction with patient and medical record) to have allergy status rectified that admission, in/by [X].
[Y]% of antibiotic prescriptions to have documented review/stop dates, in/by [X].
For [Y]% patients on NSAIDs/diuretics/antibiotics etc. to have U&Es checked every 24/48hrs etc. (as per guidelines) in/by [X].
For [Y]% of omitted drug doses documented on the chart as ‘unspecified reason’, to have a documented reason in the notes, in/by [X].
For [Y]% of patients receiving drug errors to have a duty of candour discussion documented in notes in/by [X].
For [Y]% of antibiotic choices to be compliant with the local antimicrobial formulary, in/by [X].
To reduce the omission and/or late administration of anti-Parkinson’s medication by [Y]%, in/by [X].
[Y]% of patients to have oxygen prescribed on drug charts, in/by [X].
GENERAL - PATIENT SAFETY
To reduce falls by [Y]% in/by [X].
In patients with a urethral urinary catheter, for [Y]% of catheter-days to have a daily documented consideration for removal or plan for removal, in/by [X].
For [Y]% of patients to have a completed VTE risk assessment within 24 hours of admission, in/by [X].
To reduce pressure ulcer incidence by [Y]% in/by [X].
For [Y]% of patient-days with a Central/Hickman/PICC line in situ, to have a completed line care bundle in/by [X].
GENERAL - PROCESSES
To reduce incidence of haemolysed U&E blood samples by [Y]%, in/by [X].
To reduce rejection of group and save samples due to mislabelling by [Y]%, in/by [X].
For time taken to find all venepuncture/peripheral venous cannulation equipment pre-procedure in the clean room to reduce by [Y] seconds on average, in/by [X].
For [Y]% of patients to have their TTO completed before their estimated date of discharge, in/by [X].
For [Y]% of unsuccessful attempts by phlebotomists to be communicated to clinicians, in/by [X].
For [Y]% of identified personnel to be present at handover, in/by [X]. (OR for [Y]% of handovers to have all identified personnel present, in/by [X])
[Y]% of patients admitted to the frailty unit with a fall to have a vision assessment, as per RCP guidelines, prior to discharge, in/by [X] (https://www.rcplondon.ac.uk/projects/outputs/bedside-vision-check-falls-prevention-assessment-tool)
[Y]% of patients on IV antibiotics to have blood cultures sent during their admission, in/by [X].
[Y]% of patients admitted with a diagnosis of severe community acquired pneumonia (CURB 3 and above) to have urinary pneumococcal and legionella antigens sent during their admission, in/by [X]. (https://thorax.bmj.com/content/64/Suppl_3/iii1)
[Y]% of patients admitted with a presenting complaint of syncope, falls or dizziness to have a postural blood pressure taken prior to discharge, in/by [X].
[Y]% of patients admitted with a diagnosis of decompensated heart failure to be reviewed by a heart failure specialist prior to discharge, in/by [X]. (https://www.nice.org.uk/guidance/NG106)
[Y]% of all patients admitted with a diagnosis of bacterial pneumonia to be offered a HIV test, in/by [X]. (UK National guidelines for HIV testing 2008, British HIV association; https://www.bashhguidelines.org/media/1067/1838.pdf)
[Y]% of all current inpatients with a diagnosis of acute kidney injury (as defined by KDIGO criteria) to have a urine dipstick performed in the first 24 hours of their admission, in/by [X]. (https://cks.nice.org.uk/acute-kidney-injury)
For [Y]% of patients to mobilise the day after surgery, in/by [X].
For [Y]% of female patients of childbearing age, not already thought to be pregnant, to have a pregnancy test pre-operatively in/by [X].
For [Y]% of patients with suspected/proven renal colic to have calcium and urate levels checked, in/by [X].
For y% of patients to have a MUST (malnutrition) score correctly completed on admission, in/by [X].
[Y]% of patients to attend annual asthma review within one month of invite, in/by [X].
To reduce unnecessary* MSC urine requests by [Y]% in/by [X]. (*needs defining)
To ensure [Y]% patients taking Methotrexate have monitoring blood tests every 4 months, in/by [X].
To reduce average length of stay on older adult mental health ward by [Y] days, in/by [X].
To reduce the number of violence and aggression incidents on acute mental health ward by [Y]% in/by [X].
To reduce outpatient appointment Did Not Attend rates in community mental health team by [Y]%, in/by [X].
Of new referrals with first episode psychosis, to reduce waiting time for assessment by early intervention psychosis team to less than [Y] weeks (OR proportion of patients assessed in <2weeks increased by [Y]%) in/by [X]. (https://www.nice.org.uk/guidance/qs102/chapter/Quality-statement-1-Assessment-for-a-first-episode-of-psychosis)
To reduce blood culture contamination rate by [Y]% in/by [X]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915310/
[Y]% of patients with an acute exacerbation of COPD to have a second ABG to assess impact of intervention before leaving ED, in/by [X].
In patients with DKA, to have [Y]% of further blood glucose and ketone measurements within 5 minutes of when they are due, in/by [X].
To reduce average time to first antibiotics in patients with sepsis by [Y] minutes, in/by [X].
For [Y]% of patients under care of clinician ending their shift, to have a documented handover to another clinician, in/by [X].
Reduce average pain score of patients with acute fracture on arrival to orthopaedic & trauma ward after attending ED by [Y] points, in/by [X].
For [Y]% of pneumonia/AKI/acute pancreatitis etc. care bundles to be fully completed in ED, in/by [X].
To reduce ‘door to needle time’ in patients with STEMI by [Y] minutes, in/by [X]. https://bmjopenquality.bmj.com/content/3/1/u204753.w2063.full?sid=5e9dc11b-a460-4e2e-8011-a969f19ba3
ANAESTHETICS AND CRITICAL CARE
For [Y]% of rapid sequence inductions undertaken in ED to have a documented pre-intubation RSI checklist completed, in/by [X].
For [Y]% of CVC insertions to have a completed insertion checklist with all components met, in/by [X].
For [Y]% of patients with an airway device in situ while in the recovery room, to have waveform capnography monitoring until the device is removed, in/by [X].
To reduce the percentage of patients suffering post-op shivering in recovery by [Y]%, in/by [X].
For [Y]% of patients in PACU/HDU/ICU having undergone major abdominal surgery, to mobilise day one post-op, in/by [X].
To reduce episodes of intra-operative hypotension (MAP<60mmHg) in patients undergoing repair of fractured neck of femur/laparoscopic cholecystectomy/hysteroscopy/[any other procedure] by [Y]%, in/by [X].