Sample Narrative QI Report

Important aspect of care and service:
High-risk, problem-prone area.

1. Improving quality of life standards for residents receiving enteral nutrition via gastrostomy tubes.
2. Prevention of aspiration pneumonia in residents on enteral feedings.

Indicators:

1. Presence or absence of dysphagia diagnosis by previous clinician.
2. Presence or absence of diet-specific recommendations by previous clinician.
3. Quantification of residents receiving PO intake in conjunction with enteral tube feedings.

Means to trigger evaluation: 100% compliance expected.

Collection and organization of data:

1. Data source: clinical record
2. Data collection method: retrospective
3. Sampling method: stratified probability; all residents on tube feedings

Evaluation: Conducted in _________ (month/year).

Summary of results:

 1.  Sample size: 29/34 residents on tube feedings
      (4 residents discharged; 1 chart incomplete)        
                                                                 Prior SLP             Current SLP
 2.  Presence of dysphagia diagnosis              4 (13%)              29 (100%)
 3.  Diet-specific recommendations                 8 (27%)              29 (100%)
 4.  Resident receiving PO and tube feedings   4 (13%)              13 (44%)

Problems noted/Analysis:

1. Of note, as listed above, is the lack of pertinent diagnoses and specific recommendations made by previous clinician.
2. Previous clinician initiated PO intake for 13% of tube-fed residents, whereas current clinicians have initiated PO intake for 44% of residents. This impacts on quality of life, prevention of aspiration pneumonia in tube fed patients (i.e., patients that are NPO and on tube feedings are at a higher risk for aspiration pneumonia), as well as cost factors.
3. Incomplete documentation supporting NPO status.
4. Overall, most cases presented poor or inconsistent documentation supporting tube feeding placement.
5. For 2/29 cases, the dysphagia evaluations were misfiled.
6. For 1/29 cases, the dysphagia evaluation was missing from the medical record.
7. Previous clinician recommendations for PO intake were vague in ¾ cases.
8. Access to information regarding PO diet restrictions by consistency was difficult upon chart review.

Proposed actions to improve care and service:

1. SLP to inservice nursing staff on overall dysphagia management issues.
2. SLP to continue monitoring new admissions on tube feedings, so as to conduct a dysphagia evaluation upon arrival at the facility. Formal policy to be developed with Director of Nursing.
3. Formal dysphagia management policies to be developed/revised.
4. To discuss the development of a feeding/dysphagia team with key clinical personnel.
5. Filing issues to be discussed with and addressed by Director of Nursing.

Summary:

These results present a baseline from which to build upon as the scope of speech-language pathology/dysphagia services at ABC nursing home are developed.

The above to be re-assessed in six months for all residents on tube feedings at that time.

Respectfully submitted,

XYZ, CCC-SLP

Adapted from: Lynn, D. & Riquelme, L.F. (1997). Q.I. - The Easy Way:  A Practical Guide for Developing Quality Improvement Programs. Glenmont, NY: New York State Speech-Language-Hearing Association.