# Presentation: 002437

## Quality Factors: Seeking Opportunities For Improvement through Audit & Analysis 

- Chris Hunter, RN, BSN
- Nurse Consultant
- Management & Training Corporation

## Objectives

- Participants will understand the importance of Continuous Quality Improvement.
- Participants will understand methods of obtaining feedback from students.
- Participants will understand methods of evaluating and improving services based on student feedback.
- Participants will understand methods of evaluating and improving services and compliance based on chart audits

## Continuous Quality Improvement

- “The process of ongoing evaluation of services in order to assess needs for improvement and then making changes based on the evaluation.”

## What does the PRH say about CQI?

- “Center health staff shall seek feedback from students, employ mechanisms to document quality of care provided, and document quality improvement activities.”
- PRH 6.12, R15

## Student Feedback

- Quarterly National Student Satisfaction Surveys
- Center Student Satisfaction Surveys
- Center Wellness Committee
- Focus Groups

## Student Feedback (cont.)

- Why is student feedback important?
- Students are our customers!
- Students’ perceptions are their reality.
- There is usually at least some truth to their perception.
- Adolescents have a way of seeing our faults!  We should not give them any reason to call us on our imperfections!
- We need to change their perception.......

## Quarterly National Student Satisfaction Surveys

- “I was treated with care and respect by the medical staff on center.”
- Question #36:  Job Corps’ National Student Satisfaction Survey

## Quarterly National Student Satisfaction Surveys 

- Challenge wellness staff to rank higher than the national average.
- Offer positive feedback and/or rewards when your students rank your wellness staff higher than the national average.
- Make the results of question #36 a part of your employees’ performance evaluation if possible.

## Center Student Satisfaction Surveys

- Surveys should be conducted _at least_ biannually on center.
- Survey results should be compiled.  Results should be evaluated and compared to the previous results to determine whether progress is being made. (Graph the results, if possible to be able to see at a glance your progress.)
- You must have wellness staff’ input and “buy-in” in order to make successful changes.  Solicit their help to implement a quality management plan.

## Center Student Satisfaction Surveys

***The Tale of  “Grumpy Granny”***

## Wellness Committee

- Can be formed from SGA representatives or any student that is interested in wellness issues.
- Meet with HWM or other wellness representative monthly.
- Dual purpose:
- Obtain valuable input on wellness services from the student body.
- Educate committee members on DOL and center policies and wellness issues.  Encourage the members to share the information with other students on center.  (Solicit their “buy-in” to the “Wellness to Employability” concept.)

## Focus Groups

- Conduct focus groups with a random sample of students periodically throughout the year.
- Have set questions that are asked and then solicit questions/concerns from the group.
- Allow students to voice concerns, but keep order.
- Do not allow one “disgruntled student” to dominate the group.
- Let students know that you take their comments seriously and show efforts to improve wellness services based on their concerns.

## Feedback to Students

- Monthly Newsletter
- Publish health and/or nutrition tips.
- Publish minutes from the most recent wellness committee meeting.
- Publish latest survey results.
- Announce wellness activities.

## Chart Audits

**Entry chart audits**
- Should be conducted within first 48 hours of student entry to assure all of the 48 hour requirements are met.
- Should be conducted again before day 14 to assure that the 14 day requirements are met.
- Dental should audit new inputs before their 75th day to ensure the IDE is conducted within the required timeframe.

## Chart Audits (cont.)

**Random 10% monthly chart audits**
- Should focus on all visits that have occurred since the 14 day audit (walk-ins, follow-up appointments, TEAP, mental health referrals).
- Should also re-check to assure that _all_ entry requirements were met (pay attention to timeframes).

## Chart Audits (cont.)

**Focused audits**
- Mental Health:  audit those files of students that have had a mental health referral.  Check that the assessment has been conducted in a timely manner, a management plan has been developed, and written feedback has been offered to the referring source.  (TAG D, 2.4.1.3 , p. 17)

## Chart Audits (cont.)

**Focused audits (cont.)**
- TEAP:  audit charts of students who were drug positive on entry.  Look for lab results, documentation of assessments, group attendance, follow-up lab results, etc.....

## Chart Audits (cont.)

**Focused audits (cont.)**
- Dental:  Check that the initial cursory exam was conducted within 48 hours, the IDE was conducted between the student’s 45-75th day on center, the visit was prioritized by the dentist, x-rays are secured in the chart, etc....

## Progress Note (SF-600) Audit

- All visits to health and wellness center should be documented.
- Documentation should be in chronological order with the most recent date on the top.
- Staff should be using the “SOAP” format.
- All documentation should be legible, signed, and dated.
- Treatment guidelines should be referenced when used.
- Treatment guidelines should be followed.  Any deviance from the guideline requires a doctor’s order.
- There should be no blank lines between documentation.
- All pages should include identification information.

## Charting Format

- SOAP format
- S = Subjective (what symptoms are described by the student?)
- O = Objective (what signs are detected upon physical examination?– vitals, etc.)
- A = Assessment (what is the nursing/medical diagnosis?)
- P = Plan (which TG is to be followed? what are the next steps?)

## Who should audit?

- Daily
- Any user of chart
- Weekly
- Center Physician (review charts of students seen)
- 1st week input files
- 2nd week input files
- Monthly
- HWM/Nursing staff should conduct random chart audits (recommend at least 10% of OBS).
- Other disciplines can also conduct audits of their section of the chart (TEAP, CMHC, Dental).

## What should I do with data?

- Track and trend student satisfaction surveys and change services based on student feedback.
- Summarize findings from chart audits.  Develop corrective action plans with input from all appropriate staff.

## What should I do with data? (cont.)

- Present findings of all surveys and audits to the Health and Wellness team.
- Evaluate the effectiveness of changes and whether or not improvements are being made on an ongoing basis.

## Questions??/Comments!!