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Plotting
Measures Over Time
A
well-run quality improvement project must determine whether
changes result in improvement by plotting measurements over
time. A project team annotates these time series graphs
with the timing of interventions; for example, when pain
as a fifth vital sign was instituted, or the beginning of
a new rotation of residents (Cook
and Campbell, 1979).
Data
are best displayed with properly prepared graphs (Cleveland,
1993; Elting, 1999).
The set of time series provides a feedback system that allows
the team to learn about the system and the effects of the
changes they are making. Here is an example of a well-presented
time series:
Figure
4.1 Percent of Inpatients with Severe Pain
(Veterans Adminstration Hospital - Tcson, AZ)
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Source:
Southern Arizon VA Health Care System, Tucson, AZ. Reprinted
with permission from Anne Gooden, RN.
This
time series was developed by the Tucson VA Hospital to track
progress toward their aim of reducing the percent of patients
with severe pain on two in-patient medical units. Their
time series is annotated with some of the key interventions
they made during this project:
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Development of a standardized pain assessment form
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Inclusion of a computer template for pain assessment form
in medical record
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Education of nurses and physicians on pain management
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Development and distribution of patient/family education
materials
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Addition of pain meds to discharge physician order sheet
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Addressing of pain in discharge planning
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