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Systems and technology that support the collection and dissemination of healthcare information improve service levels, enhance quality, and improve continuity of care. The delivery of patient care is changing rapidly because sophisticated clinical information systems are providing fast, organized access to large amounts of patient information (Ornstein et al., 1997). The Carl T. Hayden Veterans Affairs Medical Center in Phoenix developed and implemented a computerized process for interdisciplinary assessment and treatment of patients. This was accomplished within the framework of a recent reorganization into service lines and the initiation of a computerized medical record system. Traditional frameworks for change management often include a methodical picture of the required steps or phases of the change process. The rapid rate of change, both technologically and in the healthcare system, however, defies the application of some aspects of traditional change theory. A model for change that considers realistic change strategies, including good planning and identification of barriers, was used to facilitate the move to computerized interdisciplinary assessment (Daly, Button, Prophet, Clarke, & Androwich, 1997).

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Assessing clinical performance is difficult. Members of the Nursing Service Clinical Practice Committee at the Carl T. Hayden Veterans Affairs Medical Center in Phoenix developed a comprehensive program of competency assessment based on performance measures. This article describes the committee's process of developing and implementing the program and includes a blueprint for competency assessment and selected performance measures for all nursing staff who provide patient care. The approach to competency assessment includes performance measures specific to patients' ages.

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The education of patients and their families can support positive patient healthcare outcomes. Patient and family education is an essential component of the healthcare delivery process, but it often is fragmented, with individual disciplines providing information without coordination. At the Carl T. Hayden VA Medical Center in Phoenix, AZ, a team reviewed the facility's process for providing patient education. As a result of this review, interdisciplinary process and documentation forms that improved both the quality of education provided and the documentation of that education in the medical record were developed.

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Collaborative interdisciplinary patient care is enhanced as healthcare professionals in special care units work to implement Joint Commission on Accreditation of Healthcare Organizations' standards for improving organizational performance. This second part of a two-part article provides a practical approach to developing a process action team to review the care of patients receiving mechanical ventilation. As a follow-up to the development of one special care unit committee, this was an important step in the transition from multidisciplinary, discipline-specific care to interdisciplinary, collaborative care.

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Quality improvement (QI) activities in special care units can serve as a model of interdisciplinary problem identification and resolution for organizations that are moving from service-specific QI activities to organizational-wide activities. The transition from distinct unit-based QI activities to an interdisciplinary collaborative model at the Carl T. Hayden Veterans Administration Medical Center began with recognition of problems that were identified during a Joint Commission survey of the special care units. Process improvements were made that resulted in improved interdisciplinary collaboration between the special care units, and a successful follow-up Joint Commission survey.

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With the revision of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) nursing standards in 1991, a new emphasis has been placed on the nursing standards of patient care and the standards of nursing practice (Claflin, 1990). These standards provide the basis for nursing care and the foundation for nursing's contributions to an interdisciplinary quality improvement program. This article will describe how nursing standards of patient care and standards of nursing practice have been developed and integrated into a nursing department's documentation plan and quality improvement program.

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In 1991, the Joint Commission's nursing services standards scoring guidelines went into effect. Nancy Claflin discusses the changes in the nursing process needed to meet these revised standards under the rubrics of assessment, planning, intervention, and evaluation. She then presents an extensive implementation plan for integrating this revised nursing process into a nursing QI program. The focus of this article is both on the principles of quality improvement and the exigencies of aspects of care, standards of nursing practice, and indicators.

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Monitoring and evaluating the quality and appropriateness of patient care in the special care unit is the basis for quality assurance activities. To make the monitoring and evaluation process helpful, health care professionals in special care units must be involved in each step of the process. The focus must be on patient care, specifically on clinical aspects of care rather than on structural specifications or technical processes. In addition to assisting the special care unit to meet accreditation requirements, ongoing monitoring and evaluation assist that unit to assure high-quality care. Monitoring and evaluation activities also assist the special care unit manager in responding to demands of state and federal regulators by providing an objective assessment of the care provided to Medicare and Medicaid patients. These activities also can provide assistance in responding to concerns about lawsuits involving alleged negligence in provision of special care; and in meeting pressures from third-party payers to reduce costs associated with unnecessary treatment in special care units. This chapter describes how the ten-step monitoring and evaluation process can be used to help assure high-quality patient care in the special care unit.

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The American Association of Critical-Care Nurses (AACN) has developed education standards for critical care nursing. These structure and process standards can be used as part of the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) ten-step process for monitoring and evaluating critical care education programs. This chapter discusses the application of the monitoring and evaluation process, based on education standards, for critical care education programs.

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In the critical care unit setting, a quality assurance program is based on the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) ten-step model for monitoring and evaluation. The addition of nursing standards of patient care and standards of nursing practice to that ten-step model provides the vital link between patient expectations, staff performance, and quality assurance in that unit.

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