1. Section Editor(s): Alexander, Mary MA, RN, CRNI(R), CAE, FAAN

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I'm sure every nurse has heard about Quality Improvement. It's an essential feature of infusion nursing; in fact, it should be one of the central features of every nursing specialty. But how will it fare in the new and changing health care environment?

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The advent of the Affordable Care Act in January 2014 means that quality will be more important than ever for health care professionals. Organizations will be scrutinized as never before, and nurses' performance will be more frequently assessed and measured against patient outcomes.


We hear the term quality used in different contexts in health care: quality of life; quality of care; quality improvement; quality management; quality control; quality measurement; and quality assurance. So what can nurses do to identify and maintain quality in every practice setting?


There are initiatives on quality in which nurses can participate. The Robert Wood Johnson Foundation funds the Quality and Safety Education in Nursing Institute, which addresses the challenge of preparing future nurses with the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the health care systems in which they work.1 The National Quality Forum (NQF) is a nonprofit, nonpartisan, public service organization committed to transforming our health care system to be safe, equitable, and of the highest value. NQF reviews, endorses, and recommends use of standardized health care performance measures.2 The mission of the Nursing Alliance for Quality Care (NAQC) is to advance the highest quality, safety, and value of consumer-centered health care for all individuals-patients, their families, and their communities.3


The Infusion Nurses Society (INS) is a member of both NQF and NAQC. We have the opportunity to provide feedback on the issues affecting quality patient care, offer input on quality measures, and support and endorse our nurse colleagues for panel appointments.


These top-notch organizations support nurse leaders who work to establish a culture of quality in their facilities. I realize, of course, that not every nurse has the time or inclination to take part in their work. But every infusion nurse can (and should) provide quality care, even without taking formal courses. So what can we do? First, by not settling for "good enough" patient care, we can aim for the best care. Second, by advocating for safe patient care, we can share our knowledge and skills to increase positive patient outcomes throughout our facilities. Third, by becoming familiar with the Infusion Nursing Standards of Practice, we can apply the standards to clinical practice.


Patients should be part of quality measurement, as well. No longer satisfied to simply do as they are told by the health care professional, patients are becoming savvy consumers who know what they want and what they should expect in a health care facility. They can answer questions about their care, communication with health care professionals, and even the food and cleanliness of their rooms. Patient-reported outcomes (PROs) allow health care teams to process information about patients, as told directly by the patient, without interpretation. The collection of that information, PROM, is performed by tools such as questionnaires. And finally, the information is aggregated into a reliable measure of performance (PRO_PM).4


I've advocated for evidence-based practice on these pages, and that is one of the definitions of quality in health care. Every infusion nurse can incorporate research into her or his practice, and by demonstrating to others what works to improve outcomes, each nurse promotes quality.


For many of us, integrating quality into our practice is second nature. Let's continue to ensure that quality care is not singled out and is embedded in all we do. Only then will we know quality when we see it!


Mary Alexander




1. QSEN Institute Web site. Project overview. Accessed September 30, 2013. [Context Link]


2. National Quality Forum Web site. Who we are. Accessed September 26, 2013. [Context Link]


3. Nursing Alliance for Quality Care Web site. Mission. Accessed September 25, 2013. [Context Link]


4. National Quality Forum. Creating valid and reliable patient-reported outcome measures. Fast Forward: Briefs on New Work by NGF. Washington, DC: NQF; 2013:1-2. [Context Link]