QUALIS HEALTH HONORS WASHINGTON HEALTHCARE PROVIDERS

Transcription

1 LEADERSHIP IN IMPROVING HEALTHCARE Harborview Medical Center Code Sepsis: Improving Survival in Sepsis with Early Identification and Activation of a Critical Care Team Sepsis, one of the highest causes of death in the U.S., is a key driver of inpatient death and produces substantial clinical and economic costs for hospitals. Harborview Medical Center data collected from June 2009 to October 2010 revealed 72% of patients with sepsis presented in Septic Shock. Harborview s overall mortality was 13%; lower compared to recent published outcome data ranging from 28-40% (Seymour 2010, Otero 2006, Rivers 2001). Using Systemic Inflammatory Response Syndrome screening criteria and Goal-Directed Sepsis Resuscitation Therapy; Harborview has developed a Code Sepsis process for screening emergency department patients aimed at early identification, activation of aggressive treatment and early critical care team involvement. In result, Harborview exceeded the three-hour international guideline recommendation for antibiotic administration, reduced mortality by 32%, decreased hospital length of stay by 30% and decreased cost by 43%. Contact: Paula Minton-Foltz at pfoltz@uw.edu Virginia Mason Medical Center Improving the Safety, Efficiency & Effectiveness of the Medication Administration Process Approximately 40% of medication errors occur at the patient s bedside. Virginia Mason Medical Center (VMMC) implemented Collaborative Alliance for Nursing Outcomes (CALNOC), amedication administration accuracy survey to eliminate errors and prepare for implementation of barcode medication administration (BCMA). In 2010, over 70 trained nurse observers collected uniform data on more than 5,000 medication doses across 13 inpatient units. Baseline measures were benchmarked against results from like-sized, CALNOC hospitals to identify areas for improvement. Workshops involving teams of RNs, patient care technicians, pharmacists, dieticians, physicians and patients targeted gaps in medication administration processes with standard work, visual control and mistake-proofing. Monthly, observers measured the effectiveness of process improvements across all inpatient units. By year-end, overall unsafe medication administration practices had been cut in half with a reported 59% reduction in wrong time errors, 57% reduction in wrong technique errors and 40% reduction in distractions/interruptions. VMMC s efforts have laid a stronger foundation for patient safety and BCMA-adoption in Contact: Joan Ching, RN, MN, CPHQ at joan.ching@vmmc.org

2 LEADERSHIP IN IMPROVING HEALTHCARE University of Washington Medical Center Infection Control Breakthrough Goal Project: A Systems-Level Approach to Eliminating Healthcare-Acquired MRSA, CLABSI, Respiratory Virus Infections, VAP and CAUTI To achieve sustainable reductions in healthcare-associated infections, staff at University of Washington Medical Center (UWMC) implemented a systematic collaborative process. Five multidisciplinary teams addressed healthcare-acquired Methicillin-resistant Staphylococcus aureus (MRSA), central line associated bloodstream infections (CLABSI), respiratory virus infections, ventilator associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTI). The goal is to eliminate healthcare-associated infections among UWMC inpatients by In the first 18 months CLABSI decreased 72% and MRSA decreased 36%. Compliance with targeted interventions has been strong with 100% adherence to the VAP bundle, 97% compliance with hand hygiene and 98% compliance with influenza vaccinations. Strategic underpinnings of the project include: strong executive leadership; multidisciplinary project teams; ownership by all staff and providers; evidence-based solutions; no option to opt out ; standardized, accessible infection prevention supplies; partnership with patients and families and real-time data to assess outcomes and compliance with targeted interventions. Contact: Donna Henderson, BSN, MHA at matkaz@u.washington.edu LEADERSHIP IN IMPROVING OUTPATIENT CARE Columbia Basin Health Association Improving Tdap Vaccinations in Postpartum Patients Pertussis, also known as whooping cough, is highly contagious and spreads easily through coughing and sneezing. Washington State has experienced multiple localized outbreaks of pertussis in recent years. One outbreak reported in Grant County, within Columbia Basin Health Association s service area, resulted in the death of an infant. The team at Columbia Basin Health Association implemented a project aimed at improving Tdap (tetanus, diphtheria, pertussis) vaccination rates for postpartum mothers. Newborn infants are particularly at risk for contracting pertussis since the vaccination series for pertussis does not begin until they are two months old. At the start of the project, the Tdap vaccination rate for postpartum patients was just 2.4%. Six months later the rate had improved drastically and was at 82% and then by October 2009, the rate had increased to 98%. In November 2010 the team celebrated the first month at 100% of postpartum moms vaccinated for Tdap. Contact: Dulcye Field at dulcyef@cbha.org

3 LEADERSHIP IN IMPROVING LONG TERM CARE Puget Sound Healthcare Pressure Ulcer Reduction Puget Sound Healthcare implemented a pressure ulcer reduction project after its current skin program was identified as a high risk area during a quality performance improvement review. The project focused heavily on staff education and training and involved collecting data, reviewing the current skin and wound program, identifying the source(s) of the program breakdown, analyzing the root cause for the breakdown and formulating a plan to restructure and improve the program by developing measurable outcomes. The facility reduced in-house acquired pressure ulcer numbers from 6.19% to 4.12% in the first month of the program. Puget Sound Healthcare continued to show improvement month to month, and by December 2010, was at 1.8% for in-house acquired pressure ulcer rate. The facility s goal to decrease the pressure ulcer percentage to less than the state average of 5% was met. Contact: Mark Trangsrud at mtrangsrud@extendicare.com Group Health Cooperative Medication Reconciliation by Ambulatory Clinical Pharmacists Post Hospital Discharge Group Health Cooperative s (GHC) Pharmacy Administration team implemented a post-discharge medication reconciliation process that had positively impacted readmissions, financial savings and medication discrepancies. Patients identified as high-risk for readmission received a phone call from a pharmacist 3 7 days post-discharge for medication reconciliation. Through electronic health records, readmission reports and by tracking patients, a Data Collection Tool captured discrepancies. The intervention decreased readmissions at 14, 30 and 60 days. Savings per 100 patients who received intervention totaled $35,621. Discrepancy rates were lower with the intervention, with the most common being discontinued medications (48%), dose changes (45%) and medication omissions (44%). The data supports the hypothesis that medication reconciliation can decrease readmissions and provide savings and is an integral step for high-risk patients in transition from hospital to home. Contact: Meg Kilcup, PharmD at kilcup.m@ghc.org

4 Providence Regional Medical Center Everett Implementation of Antimicrobial Therapy Monitoring Service Evidence exists that programs targeting appropriate use of antimicrobial agents can significantly improve quality of care. In late 2008, the Providence Regional Medical Center Everett s pharmacy and infectious diseases departments co-created the Antimicrobial Therapy Monitoring Service (ATMS). The ATMS targeted weekday patient rounds by a dedicated pharmacist, who meets with the infectious disease physician to review which cases have potential for improvement, at which point, the prescribing physician is contacted to modify therapy. Data collected one year after implementation of the ATMS, demonstrated that 2,787 interventions had a 95% acceptance rate by the medical staff, a declining trend in Clostridium difficile infection rates and a $492,000 decrease in annual antimicrobial drug purchases. Contact: Preston Simmons, FACHE at preston.simmons@providence.org or Eric Werttemberger at eric.werttemberger@providence.org Swedish Health Services Reducing Sepsis Mortality through Improved Patient Transitions from Emergency Department to Intensive Care Unit Staff at Swedish Health Services recognized that many of the patients identified as having sepsis are admitted through the emergency department (ED), making it clear that early life saving therapy should begin in the ED followed by a new process for rapid transition to the intensive care unit (ICU). Antibiotics were often not started prior to admission, long waits for ICU beds were not unusual and life saving volumes of fluids didn t begin until patients arrived in the ICU. New processes developed through interdepartmental collaboration were necessary to quickly intervene and ensure timely transitions for improved patient care and safety. Mortality for patients was reduced from 75% to 20% during the pilot phase, 100% compliance with best practice sepsis interventions was achieved in the ED and a Code Sepsis process was developed, allowing for rapid transition of patients from the ED to the ICU. Contact: Alta Ballard, MHA at alta.ballard@swedish.org

5 Yakima Valley Memorial Hospital Outpatient Infusion Care - Throughput Workout Yakima Valley Memorial Hospital s Infusion Care program provides skilled nursing, pharmacy and dietitian services. Growth in inpatient and outpatient volumes had led to the need to serve a greater number of patients by providing efficient, cost-effective care and an outstanding patient experience, while preventing outpatient procedures occurring on at-capacity inpatient units. Memorial has implemented a quality improvement program called Q+. Using Lean and Six Sigma strategies, the program empowers staff to form multidisciplinary teams to develop change ideas, test on a pilot scale with Rapid Cycle Tests, measure results to determine statistical significance and implement process changes. The result is improved efficiency, increased capacity and enhanced patient experience. During this workout, the Chair to Infuse times were reduced from to minutes. Length of stay times dropped from to minutes, creating capacity for four additional patient visits per day or 1,040 visits per year. The percentage of patients who felt they received timely care increased from 66% to 87%. Contact: Russ Myers at russmyers@yvmh.org or Sandy Dahl at sandydahl@yvmh.org For a full list of the nominees, click here.