DNP 835 Reflecting on the “IHI Module QI 202: Addressing Small Problems to Build Safer, More Reliable Systems,” describe how your direct practice improvement project achieves clinical improvement

The IHI module QI 202: Addressing Small Problems to Build Safer, More Reliable Systems reflects on minor problems in healthcare systems and how to overcome these small problems to build safer systems. Steve Spear used various examples to make the readers understand the concept of small loopholes and workarounds which distract the employees resulting in mistakes, and sometimes these mistakes become catastrophes (Institute for Healthcare Improvement, 2022b). The “IHI” also highlighted eight steps for systems to support quality and safety, how to support the teams and how to support the patients and families. Each of these three highlighted sections in the module demonstrates a systems approach across the continuum of care to improve patient quality and safety. The direct practice improvement project achieves clinical improvement by reducing the number of adverse events that occur in the patient population.

My DPI project addresses the relationship between adherence to fluid and diet restrictions and interdialytic weight gain among ESRD patients undergoing hemodialysis. Previous studies have shown that a positive dialysate-to-plasma sodium gradient is associated with increased thirst and interdialytic weight gain among ESRD patients (Jalalzadeh et al., 2021). However, there is a need for further studies on the effect of patient education on fluid and diet restrictions on patient adherence to the set restrictions. End-stage renal disease adults require kidney transplants or hemodialysis to help them stay alive. The primary role of maintenance hemodialysis (HD) is the extracellular fluid volume (ECV) balance, which makes sodium balance possible between interdialytic sodium intake and sodium removal during HD sessions. The problem addressed in the project is the relationship between adherence to fluid and diet restrictions and interdialytic weight gain among ESRD patients undergoing hemodialysis. Previous studies have shown that a positive dialysate-to-plasma sodium gradient is associated with increased thirst and interdialytic weight gain among ESRD patients (Jalalzadeh et al., 2021). However, there is a need for further studies on the effect of patient education on fluid and diet restrictions on patient adherence to the set restrictions. Interdialytic weight gain can lead to several adverse health outcomes for ESRD patients. Fluid overload can increase the workload on the heart and lead to heart failure, while weight gain can exacerbate other underlying health conditions such as hypertension and diabetes (Weiner et al., 2017). Additionally, maintaining an appropriate weight through adherence to fluid and diet restrictions can improve the overall quality of life for ESRD patients.

The widespread change would be affected if the project were implemented in a country with universal health care (UCH). The health outcome would be impacted because patients would have access to healthcare regardless of race, color, or creed due to the benefits of UHC. After all, universal health coverage means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It covers essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.  The health outcome would be impacted because patients would be less likely to experience an adverse event. After all, UHC covers essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.  According to the World Health Organization (WHO), to make health for all a reality, all people must have access to high-quality services for their health and the health of their families and communities. To do so, skilled health workers providing quality, people-centered care; and policymakers committed to investing in universal health coverage are essential. Universal health coverage requires vital, people-centered primary health care. Sound health systems are rooted in the communities they serve, and they focus not only on preventing and treating disease and illness but also on helping to improve well-being and quality of life (WHO). Hopefully, this project will also contribute to an overall improvement in healthcare quality in the United States. The project’s contribution to bettering the country’s healthcare system will have a ripple effect on society.

Institute for Healthcare Improvement. (2022b, August). QI 202: Addressing small problems to build safer, more reliable systems. IHI. https://education.ihi.org

Jalalzadeh, M., Mousavinasab, S., Villavicencio, C., Aameish, M., Chaudhari, S., & Baumstein, D. (2021). Consequences of Interdialytic Weight Gain Among Hemodialysis Patients. Cureus, 13(5), e15013.