A PRACTICAL GUIDE TO QUALITY IMPROVEMENT FOR BURN CARE in Low-Resourced Settings
Driver diagram – These diagrams help us plan what improvement activities we might to work on. The diagram starts with the overall aim of the project and works backwards into primary drivers (these are the big areas that we will need to work on to achieve the aim), secondary drivers (sometimes there are other things that we would need to put in place to make sure What are y ur int rim milestones?
the primary drivers work well) and change ideas (these are the ideas that we would test to see if they help move towards the overall aim by influencing the primary and secondary drivers). When you put all these ideas together, the driver diagram helps the users come up with a catalogue of changes that start to help form a project plan.
Example of a driver diagram from Ziphilly and Olive for their project on fluid and vital sign monitoring.
This is a driver because in order to achieve the aim the staff must know how the HDU forms should be completed.
• Continuous supportive supervision • Appoint HDU Champion • Develop a checklist • Orientation to new nurses on observation charts and guidelines Ordering monitoring equipment; equipment to measure vital signs; observation charts; burets and perfusers • Put up guidelines and policies and checklists • Have ward meeting and remind nurses about documentation • Provide assessment cards for nurses • Have orientation pack for new nurses on observation charts.
Improving vital signs and fluid balance monitoring for the High Dependence Unit (HDU) burn patients from 40% to 90% between September 2019 and January 2020.
• Staff compliance. • Adequate knowledge on fluid monitoring. • Availability of monitoring equipment.
Guidelines, policies and standards availability.
In the interventions they list the concrete actions that will help to achieve the Drivers that are identified. For example, there are several ways to remind nurses of the guidelines and policies during their work.
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