1. SCENARIO ONE: You have been appointed as Director QualityImprovement in a large Skilled Nursing Facility. Recent data has shown an increase incidence of bed sores or pressure ulcers in patients admitted to your facility for long term care. The rate is now 12% of your Nursing Home Residents developing Bedsores.

Bed sores are injuries to the skin and underlying tissue resulting from prolonged pressure on the skin. Most often occurs on skin covering bony areas of the body such as heels, ankles hips and tail bones. Approximately 11% of Nursing home residents have pressure ulcers in the U.S.

It is now your responsibility toproceed with improving the Quality within your organization. How will you proceed with reducing the pressure ulcer (bed sore) rates? Please use examples and references in support of the steps you would take. Your focus must be on using CQI strategies.You may also include pertinent information from the lectures, text book and your discussion papers. Discuss and focus on the tools and strategies you may use. Please do not spend time in discussing pressure ulcers and its pathology at any great length. You may mention the importance of improving pressure ulcer rates very briefly.Please focus more on the Quality Improvement strategies. This scenario may be written in two double spaced pages.

2. Answer the following 3 questions (Each Question about ¾ to 1 page): (Please note Improvement strategies requested below may include FOCUS PDSA, Six Sigma, Lean Principles. Within the improvement strategies components also include other tools such as Root Cause Analysis, DMAIC that goes with Six Sigma etc). Explain your choices with references :

a. Wait times for patients visiting the Eastwood Hospital ER are on an average 4 hours. With the result hospital is losing clients and revenues. What strategy would you consider to improve the wait times? What is the reason for selecting your strategy?

b. Below is a chart analyzing and tracking Medication errors over a period of 12 months. These errors need to be reduced and eliminated since they are responsible for creating safety issues for patients. Interventions are noted at various times on this chart. Please explain the type of chart and describe components of this chart. In addition also discuss what happened in December 1998? Please note the interrupted line (dashes) below is the goal line. What improvement strategy may have been used here?

c. Below is a control chart analyzing and tracking defects over a period of 20 weeks. These defects need to be reduced and eliminated since they are responsible for creating safety issues for patients. Please describe the components of this chart. In addition also discuss what happened at week 11 and onwards? What strategy may have been used in reducing the defects?

3. SCENARIO TWO: Admission Process- Description( Minimum length one and a half pages with Chart)

Current Process for patient being admitted as an inpatient:
• Upon arrival to the hospital, the patient reports to the hospital registration or admitting area. (Please note, patient is not going through the ER)

• The patient completes paperwork and provides proof of insurance, if insured.

• An identification bracelet including patient's name and doctor's name is placed around the patient's wrist.

• Patient is requested to sign a consent form before any services are provided. If patient is not feeling well a family member or care giver may help patient complete the admission process.

• Patient then waits to be admitted. Wait time is based on bed availability in the unit patient needs to be admitted

The hospital Quality Improvement professional has been requested to exploreany areas of improvement in this process. This requires the professional to developtwo aims and select two measures that would helpwith analyzing and making improvements to the admission process described above.

(Hint: Please focus on this process only as written above and not any admission process in general)

Answer all three issues listed below based on this scenario:

a. What are the two Aimsyou would select for improving process above? Explain your aims.

b. Select two specific measures you have identified to evaluate the AIMs you selected forthis particular admission process only as described above. Explain your measures

c. Draw a run chart or control charttracking progress for only one of the admission process measures you have selected above. The chart must show the baseline and then results after intervention. You may use fictitious data for your chart. Be sure to describe your chart.