Let the Patient Discharge Follow-Up Call Data Do the Talking!

Abstract Category: Practice Innovation / Performance Improvement (PI) Purpose: The purpose of this initiative was to review the Patient Discharge Follow-Up Call (PDFC) Data, point out its importance and identify the issues presented in order to bring awareness to key stakeholders and continue to monitor the impact on patient outcomes. Methods: In mid-February of 2018, based on the collected PDFC Data, the PI Director, PI Coordinator, Statistician and Quality Assurance Nurse (QAN) identified opportunities to educate Nursing, Hospitalists, Pharmacy, and Leadership on the issues related to discharge medications potentially leading to a return visit to the Emergency Department (ED), possible readmission and adverse patient outcomes. In early March of 2018, this team presented information for awareness purposes, gathered an Interdisciplinary team to review data and worked on opportunities. Findings: All patients discharged from West Kendall Baptist Hospital (WKBH) receive a follow-up phone call from the QAN within 24-48 hours. Out of the 3,897 PDFC in the period of September 2017-February 2018 approximately 70% of patients were reached. Of those patients that reported issues (2.7%), the majority (63%) reported issues related to discharge medications. Discussion: In as much as the majority of the patients reported no issues, the small percentage who had problems with medications related to prescribing warranted an intervention to prevent possible readmissions and reduce adverse patient outcomes. The team decided to address the medication issues by implementing the following: Address verification of accuracy of preferred pharmacy during Interdisciplinary Rounds Emphasize Hospitalists to communicate with RN or AP when printing prescriptions Hospitalists and Case Management/SWS to start processing medications that need preauthorization prior to the day of discharge Bring awareness to Pharmacy & Hospitalist teams - to be cognizant of patients on Nebulizer and switch to inhaler upon discharge Bring awareness to interdisciplinary team members of impact of PDFC data on their practice Implications for Practice: Completion of the process related to medication upon discharges plays a vital role for improved patient outcomes, can reduce both return visits to the Emergency Department and readmission rates and can maintain higher standards of clinical practice and service excellence, thereby promoting a culture of patient safety. Future plans include: pharmacy and nursing verifying accuracy of patient’s preferred pharmacy during daily rounds, pharmacy tracking and reviewing specific medication cases, Case Management/Social Work Services (SWS) assisting in following-up on medications that need preauthorization and the data being presented at Nursing Operations and Hospitalist Meetings

Let the Patient Discharge Follow-Up Call Data Do the Talking!

Abstract Category: Practice Innovation / Performance Improvement (PI) Purpose: The purpose of this initiative was to review the Patient Discharge Follow-Up Call (PDFC) Data, point out its importance and identify the issues presented in order to bring awareness to key stakeholders and continue to monitor the impact on patient outcomes. Methods: In mid-February of 2018, based on the collected PDFC Data, the PI Director, PI Coordinator, Statistician and Quality Assurance Nurse (QAN) identified opportunities to educate Nursing, Hospitalists, Pharmacy, and Leadership on the issues related to discharge medications potentially leading to a return visit to the Emergency Department (ED), possible readmission and adverse patient outcomes. In early March of 2018, this team presented information for awareness purposes, gathered an Interdisciplinary team to review data and worked on opportunities. Findings: All patients discharged from West Kendall Baptist Hospital (WKBH) receive a follow-up phone call from the QAN within 24-48 hours. Out of the 3,897 PDFC in the period of September 2017-February 2018 approximately 70% of patients were reached. Of those patients that reported issues (2.7%), the majority (63%) reported issues related to discharge medications. Discussion: In as much as the majority of the patients reported no issues, the small percentage who had problems with medications related to prescribing warranted an intervention to prevent possible readmissions and reduce adverse patient outcomes. The team decided to address the medication issues by implementing the following: Address verification of accuracy of preferred pharmacy during Interdisciplinary Rounds Emphasize Hospitalists to communicate with RN or AP when printing prescriptions Hospitalists and Case Management/SWS to start processing medications that need preauthorization prior to the day of discharge Bring awareness to Pharmacy & Hospitalist teams - to be cognizant of patients on Nebulizer and switch to inhaler upon discharge Bring awareness to interdisciplinary team members of impact of PDFC data on their practice Implications for Practice: Completion of the process related to medication upon discharges plays a vital role for improved patient outcomes, can reduce both return visits to the Emergency Department and readmission rates and can maintain higher standards of clinical practice and service excellence, thereby promoting a culture of patient safety. Future plans include: pharmacy and nursing verifying accuracy of patient’s preferred pharmacy during daily rounds, pharmacy tracking and reviewing specific medication cases, Case Management/Social Work Services (SWS) assisting in following-up on medications that need preauthorization and the data being presented at Nursing Operations and Hospitalist Meetings

Impact of educational campaign on the timely initiation of mechanical venous thromboembolism prophylaxis

Introduction: The effectiveness of mechanical prophylaxis for the prevention of venous thromboembolism (VTE) incidence are methodically described in recent randomized controlled trials. Nurses are pivotal in the immediate application and maintenance of sequential compression device (SCD) therapy especially in those with pharmacological therapy contraindications. The Centers for Medicare and Medicaid Services (CMS), no longer reimburses for this cumulative cost of VTE since it is a preventable event. The Purpose of this IRB-approved study was to determine the impact of educational intervention on mechanical VTE prophylaxis. Methods and Study Design: In this pre/post quasi-experimental study, a retrospective chart re-view of patients admitted for an acute medical condition from August 1st to December 31st 2017 (pre-educational campaign) and from July 1st to November 30th 2018 (post-educational campaign) was generated from MIDAS with a total of 924 patient charts meeting the eligibility criteria. The patients’ data were collected through Cerner which included: age, reason for admission, type of VTE prophylaxis ordered, time to initiation of VTE prophylaxis, contraindications, and the total number of reminder calls to nurses who failed to apply the mechanical VTE prophylaxis admitted to one of the following hospital floors: ICU, 4 South, 3 South, 3 North, and Observation. An educational intervention on the mechanical VTE prophylaxis using the PowerPoint or hand-outs, was implemented for 2 weeks (June 17-30, 2018) for day and night shift nurses working two or more shifts per week caring for patients in the same hospital floors. A survey that included the nurses’ demographics and their barriers to the timely initiation of mechanical VTE prophylaxis was concurrently conducted prior to the educational intervention. A high participation rate of 91% of the total nurses\u27 population completed the research survey. The objectives included: to compare the number of reminder calls on the timely initiation of mechanical VTE prophylaxis among patients admitted pre-and post-educational campaign; and to explore the direct patient care nurses’ barriers to implementing VTE prophylaxis within 24-hours of a patient’s admission. Results: The study showed that the greatest barriers to adherence are: mechanical devices were not available to use (n=101); no physician order (n=89); patients\u27 refusal to wear SCDs (n=82), and lack of standardized protocol (n=39). The majority of the sample had SCD ordered (n = 800, 87.6%). A total of 32 patients (3.5%) did not have a VTE ordered by the attending physician but still had an SCD placed before discharge by a nurse who initiated the process post- intervention. A Mann-Whitney U independent test was conducted for the number of calls and time to VTE in minutes by unit. The number of calls and time to VTE in minutes was significantly associated with the intervention group (alpha = 0.05). Conclusion: A statistically significant improvement on the VTE reminder call logs after the educational intervention was noted. We demonstrated that a combination of educational campaign which includes institutional data on the nurses’ barriers to adherence and standardized methods of mechanical VTE prophylaxis ensure a substantial change in our practice and preventing VTE incidence