Environmental sampling
- not usually recommended
- routine dialysis water and dialysate testing and biological monitoring of sterilization processes
- rarely helpful in outbreak investigation
Relative risk ratio
- used in cohort studies, e.g., patients with a central line
- prospective (starts at 0 and continues into the future, begins before event occurs)
- asks “What is risk of developing disease if exposure to identified risk factor”?
Odds ratio
- used in case control studies
- compares those with disease with those who do not have disease
- retrospective (disease already present)
- not appropriate with chronic diseases
- asks “if disease is present, what is risk of being exposed to risk factor?”
Research use
- findings statistically significant?
- sample size large enough?
- groups being compared truly similar?
Relative risk calculation
- use 2x2 table
- relative risk (RR) = [a/(a+b)]/[c/(c+d)]
2x2 table
Disease No disease total
Factor present A B A+B
Factor not present C D C+D
total A+C B+D A+B+C+D
Odds ratio calculation
-use 2x2 table
Negative predictive value
- percentage of negative tests when disease not present
- use 2x2 table
- d/(c+d) x 100
Root cause analysis
- retrospective review of adverse outcomes
- used to discover basic and contributing causes for undesired outcome
Positive predictive value
- Percentage of positive tests when disease present
- use 2x2 table
- a/(a+b) x 100
Gap analysis
- list characteristics of present situation
- list characteristics of future situation, e.g. CMS standards
- Identify difference between current state and desired state
Cause & Effect diagram
- Ishkawa, fishbone or tree diagram
- used to display contributing factors
- used to identify key elements
- Looks backwards, asks “why”
Failure modes effect analysis (FMEA)
- Proactive, preventative identification of potential failures and opportunities for error
- Prioritizes and addresses possible process failures that might lead to adverse outcome
Multi-voting
-Prioritizes large list of topics to final selection for process improvement
Strategic plan
- Prioritize risks of undesired events
- Set goals based upon prioritized risks
- Describe activities to achieve goals
- Describe goal achievement evaluation process
SWOT analysis
-Identifies strengths, weaknesses, opportunities and threats
PDSA
- Plan: identify risks, goals and activities to achieve goals
- Do: implement strategies
- Study: analyze data for improvement outcomes
- Act: Continual change to achieve goals and stay abreast of new expectations
Outcome measure
-Indicates results, e.g., VAP rates
Process measure
-Indicates compliance rate to desired process, e.g. VAP bundle
Cognitive learning domain
- Intellectual abilities
- Recall, application and analysis
Psychomotor learning domain
- New skills
- New ways of acting or doing
Adult learner
- Prefer knowledge that they need and can apply vs. academic knowledge
- Value relationship between knowledge content and personal experience
- Problem-centered
- Immediate application enhances retention
- Expects respectful & self-directional methods
Affective learning domain
- Learning involves new attitudes, beliefs, values, etc
- Caring, respectful relationship enhances learning
Learning objectives
- Specific
- Measurable
- Achievable
- Relevant to content
