CONTINUOUS QUALITY IMPROVEMENT IN INPATIENT CLINICAL NUTRITION SERVICES

Defining quality patient care is a complex and often confusing issue. This article describes one hospital's experience in applying quality i mprovement theories to inpatient clinical nutrition practice. The key to measuring quality was the use of standardized practice guidelines. In this article, terms such as continuous quality improvement are clar ified and fundamental assumptions such as ''quality is defined as conf ormance to requirements'' are discussed. We review a working model for the 10-step plan of the Joint Commission on Accreditation of Healthca re Organizations (JCAHO) and its application in practice, including th e indicators and measurement tools used. Actual results from ongoing q uality improvement efforts are addressed and compared to the JCAHO nin e components of quality patient care. Because of preexisting nutrition practice guidelines at the Yale-New Haven Hospital, improvements in t he delivery of patient nutrition care could be demonstrated; these inc luded enhanced efficiencies in screening and intervention. Continuous quality improvement initiatives do work, and practitioners can use the practice experience presented here as a conceptual framework to justi fy or validate the quality of patient nutrition care in their own inst itutions.