Developing a quality improvement process: Impacting patient outcomes and achieving ambulatory accreditation
Colleen Elizabeth Nappi
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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Date of Graduation
Doctor of Nursing Practice (DNP)
School of Nursing
Jeannie Corey, DNP, RN, NEA-BC
Colon cancer is the second leading cause of cancer deaths in the United States (US) and colonoscopy is the best method for screening and detecting cancer before symptoms are present. A colonoscopies' ability to detect precancerous lesions or identify colorectal cancer (CRC) relies on patients having a high-quality bowel preparation. The US Multi Society Task Force (USMSTF) on colorectal cancer set quality standards for colonoscopy including bowel preparation quality, adenoma detection, and cecal intubation times. As a private gastroenterology practice in Northern Virginia was preparing for re-accreditation with the Accreditation Association for Ambulatory Health Care (AAAHC) it was determined that there was no standardized documentation process for recording the patient bowel preparation quality. AAAHC requires benchmarking studies to improve patient care. The purpose of the quality improvement project was to create a standardized process for recording bowel preparation quality. A documentation process was implemented in the Electronic Health Record (EHR) to consistently document results in the colonoscopy record. The quality improvement project utilized a pre-implementation phase to assess the organization’s documentation practices, identify deficiencies and conducted a feasibility study to explore the organization’s commitment to proposed changes and change efficacy. A standardized process was implemented using a template scoring the bowel preparation quality with the Aronchick Bowel Preparation Scoring (ABPS) tool. The standardized process allowed the organization to record, gather, and analyze the data on bowel preparation quality and compare the results to recommended standards set by the USMSTF. Four Plan Do Study Act (PDSA) cycles were utilized to assess the adoption of the process by physicians at the organization and measure the bowel preparation quality. The feasibility study demonstrated organizational readiness and commitment to change. Consistent compliance with the documentation process was adopted at the end of the second PDSA cycle. The organization was found to exceed the national standards for bowel preparation quality set by the USMSTF with preparation quality ≥ 96% or better in all four PDSA cycles. The results were utilized to meet the benchmarking initiatives required for re-accreditation by the AAAHC in September 2022. The Ambulatory Surgery Center gained re-accreditation through 2025.
Keywords: Colorectal cancer, Colonoscopy, Indicators, quality metrics, Quality improvement
Nappi, Colleen, "Developing a quality improvement process: Impacting patient outcomes and achieving ambulatory accreditation" (2022). Doctors of Nursing Practice (DNP) Final Projects, 2020-current. 25.