Aligning Opioid Prescribing Pathways

There is a drug epidemic sweeping the State of Maine and it continues to worsen each passing year. In 2017, the Maine legislature passed Public Law Chapter 488 to strengthen the controlled substance prescription monitoring program. An outpatient pharmacy, located in a large acute care hospital, created a performance improvement project to clarify opioid prescription and resolve any non-compliance with Chapter 488. After a root cause analysis, several KPIs were established to include tracking the number of phone calls made by pharmacists to non-compliant providers to clarify scripts, provide one on one education and ultimately resolve non-compliance. Repeat offenders were also tracked and individually counseled. Since hardwiring the new approach, a significant decrease in the percentage of opioid prescriptions requiring follow-up was achieved. Ongoing monitoring is planned to make sure compliance is maintained

Improving Type And Screen Specimen Collection Prior To Elective Surgery

To avoid delays in the availability of compatible blood for elective surgery patients requiring transfusion, a type and screen specimen should be completed at least 24 hours prior to surgery. Baseline metrics in an acute care inpatient blood bank demonstrated a significant number of cases with no type or screen completed. The objective of this KPI was to prevent any delays in providing compatible blood products to scheduled surgical patients. Several internal and external system issues were identified as a result of a root cause analysis and a number of actions were initiated. Outcomes have been positive. Data collection post KPI implementation has demonstrated a significant increase in type and screens completed within the 24 hour window mandate. To further streamline the process, work is ongoing to develop a master surgical list of procedures requiring type and screen into the workflow

Identification Strategies For The Very High Fall Risk Patient In An Acute Inpatient Psychiatric Unit

Patients falling as a result of geriatric and psychiatric impairments are at a much higher risk than the average patient population. An acute care inpatient psychiatric team used baseline metrics to demonstrate increasing fall rates per month that surpassed the unit’s target number. As a result, a quality improvement project around falls was felt to be warranted. The overall goal of this study was to improve patient safety by reducing falls for their very high risk fall population. A root cause analysis determined that this population was not being properly identified and several tools were developed and employed to better assess and visually identify this group of patients. Post KPI implementation, the unit reported a 95% reduction in falls of those patients deemed very high fall risk. Next steps involve hard wiring the countermeasures to obtain outcome sustainment

Strategies To Improve Control Of Blood A1C In Diabetics

A1c monitoring is an important aspect of controlling the health of a diabetic patient. An adult internal medicine clinic noted that the percentage of their diabetic patients who had an A1c higher than 9 or no reading within the past year exceeded the national average. As a result, operational excellence methods were implemented with the overall goal to reduce their percentage to 18% or less. A root cause analysis identified several deficiencies to includelack of essential equipment, variations in staff education and the absence of daily reminders. Post KPI implementations, an overall decrease in the percentage of patients with poorly controlled diabetes was attained. Next steps include ongoing monthly reviews of patients with A1c \u3e9 or have not been seen in 12 month

Improving Cardiology Patient Flow In Nuclear Medicine

At baseline, a nuclear medicine department found it difficult to complete cardiac stress tests within scheduled times. Using the performance improvement process, a nuclear medicine department looked to improve patient experience related to wait times for this test. Two goals were identified and a root cause analysis was initiated. After identifying some process issues, two KPIs were developed to address them. A root cause analysis identified some processing issues and two KPIs were instituted to address them. As a result, one outcome was to hire an additional physician assistant to address the barrier of inadequate cardiology coverage. Next steps include continued auditing of delays to discern what other barriers might exist to completing cardiac stress tests in the scheduled time frame

Communication Of Medication Side Effects In An Acute Care Hospital

COMMUNICATION OF MEDICATION SIDE EFFECTS IN AN ACUTE CARE HOSPITAL Effective patient education of prescribed medication side effects improves patient safety and reduces overall risk. On an acute care hospital unit, nursing staff felt previous attempts at this education had been ineffective as demonstrated by their HCAHPs scores for communication about medications. A root cause analysis demonstrated some flaws and several countermeasures were instituted. The goal of this KPI project was to attain a higher than national average for the specific HCAHPs score. Post KPI inception, the unit’s HCAHPs data showed steady improvement. Within one month, the goal of an above national average score was attained. Next steps involve hardwiring newly developed procedures in staff orientation and partner with doctors in the process

Strategies To Improve Interdisciplinary Communication In An Acute Care Inpatient Pediatric Unit

Interdisciplinary patient rounding has been shown to improve patient and family satisfaction as well as reduce patient length of stay and readmission rates. In an acute care inpatient pediatric unit, baseline metrics demonstrated that 100% of the time, nursing was not included in these rounds thus resulting in sub optimal communication. The goal of this performance improvement project was to attain increased nursing participation. Data collection demonstrated several reasons for lack of participation and corrective actions were instituted. After undertaking this KPI goal and utilizing operational excellence, 95% of the time, nurses were called to morning rounds with the medical staff team. Continued auditing of nursing attendance will help reinforce this best practice measure until it is a consistent part of the care environmen

Interdepartmental Rounding

STRATEGIES FOR IMPROVING COMMUNICATION BETWEEN DOCTORS AND NURSES IN AN ACUTE CARE HOSPITAL Effective interdisciplinary communication is imperative for safe patient care in an acute care hospital environment. A surgical unit used their HCAHPs scores to assess how often patients perceived there was good communication between different doctors and nurses during their hospital stays. The data demonstrated that this occurred 22% less often than the national average. As a result of a root cause analysis, a number of countermeasures were initiated with the goal of achieving scores greater than the national average. Post KPI inception in the second quarter of 2016, the goal was met by the first quarter of 2017. Next steps are to make sure that interdisciplinary care is hardwired through ongoing audits

Delirium Reduction Strategies For The Critically Ill

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients. Patients with delirium have longer hospital stays and a lower 6-month survival rate than do patients without delirium. Preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge. In a large acute care hospital, the cardiac intensive care staff became interested in mitigating their unit’s high delirium rate of ventilated patients. At baseline, many members of the healthcare team did not believe that delirium could be prevented and the predominant view was that critically ill patients were too ill to mobilize. An extensive literature review suggested that early mobilization was extremely beneficial in delirium reduction. As a result, the goal of this performance improvement project was to reduce the prevalence and severity of delirium through progressive mobilization. Several barriers to preventing delirium were identified through a root cause analysis. Using improvement measures of operational excellence, a number of countermeasures were established. Several positive outcomes of this project were realized to include the development of an early mobility pathway and a bedside mobility assessment tool. Next steps include a prospective study of the effect this KPI might have on decreasing duration of ventilation days as well as overall length of hospital stay

Getting There Safely: A Review of Car Seat Safety Through the Years

Date of Presentation: November 10th, 2022 Presented By: Haley Pelletier DO, PGY-3 Pediatric Resident, The Barbara Bush Children’s Hospital at Maine Medical Center CME available for 1 year after presentation CME Text Code: 79296https://knowledgeconnection.mainehealth.org/pediatrics_gr/1009/thumbnail.jp