Please don t put us on HOLD

Transcription

1 Please don t put us on HOLD If you need to step away Use the MUTE button on your phone or You can use *6 to place the call on MUTE and *6 to come off of MUTE

2 Welcome OPQC NEO ACTION PERIOD CALL May 20, :00-3:00pm ET

3 Please don t put us on HOLD If you need to step away Use the MUTE button on your phone or You can use *6 to place the call on MUTE and *6 to come off of MUTE

4 Introductions and Roll Call NEO Faculty Michele Walsh, MD (Lead) Laurel Bookman, MD Edward Donovan, MD, Consultant QI Faculty Carole Lannon, MD, MPH Heather Kaplan, MD MSCE OPQC Project Team Barb Rose, RN, MPH, Program Director Pat Heinrich, RN, MSN Neo Quality Improvement Consultant Alyson Roeding, Project Manager Myia Marcum, Project Specialist Mariea Taylor, Coordinator Dan Jeffers, Data Manager Josh Watring, Project Specialist Susan Ford, RN Beacon Quality Improvement Coordinator NEO TEAMS 1 Akron Children's at Summa Health System 2 Akron Children's Hospital 3 Akron Children's Hospital at St. Elizabeth Health Ctr 4 Aultman Hospital NEO TEAMS cont. 5 Cincinnati Children's Hospital Medical Center 6 Cleveland Clinic 7 Dayton Children's Medical Center 8 Fairview Hospital 9 Good Samaritan Hospital 10 Grant Hospital 11 Hillcrest Hospital 12 Mercy St. Vincent Medical Center 13 MetroHealth Medical Center 14 Miami Valley Hospital 15 Mount Carmel East Hospital 16 Mount Carmel West Hospital 17 Nationwide Children's Hospital 18 Nationwide Grant Medical Center 19 Nationwide Riverside Hospital 20 Nationwide St. Ann's Hospital 21 Promedica Toledo Children's Hospital 22 OSU Wexner Medical Center 23 University Hospital - Cincinnati 24 University Hospital - Cleveland - Rainbow Babies

5 Who are you cheering for?

6 Agenda 2:00 Welcome and Roll Call Pat Heinrich 2:05 Review of Data Dr. Laurel Bookman 2:20 Feedback from LS 1 Challenges and Opportunities Session Pareto Chart 2:30 Focused Team Sharing 2:45 Open Team Sharing and Discussion & Lessons Learned (from PDSA tests of change since LS 1) Susan Ford Dayton Children's Med Ctr Fairview Hospital Mercy St. Vincent Med Ctr Wexner Med Ctr All Teams 2:55 Next Steps Pat Heinrich

7 OPQC Neonatal Key Driver Diagram

8 Human Milk KDD Eliminate late onset (>72hrs) bacterial blood stream and CSF infections in infants in Ohio NICUs Practice Changes Aim SMART AIM By June 2013 we will reduce late onset (>72 hrs) blood stream/csf infections in infants weeks gestational age to < 10% in Ohio NICUs For all infants weeks GA: 1)HM begun within 72 hrs. in >80%. 2) 100 ml/kg/day of HM by 21 days of life >95%) - MOM maximized - DM minimized - Formula eliminated Key Drivers Maternal education about the benefits (for both mother and infant) of HM Care practices that promote adequate supply of human milk Administrative/Leader and staff education to promote and support HM Optimize feeding practices to promote initial and persistent human milk feeds Use of donor milk when mother's milk not available or inadequate in volume All pregnant women should be informed of the benefits of human milk Antenatal consult (NICU MD and Lactation Consultation) on admission for high risk mothers (admitted for preterm labor or other complications) including Benefit and importance of human milk as first feedings Importance of early pumping for adequate and sustained milk supply Use of donor milk if no maternal milk is available Encourage Kangaroo care All Mothers should be shown (by LC or trained nursing staff) how to express their milk (both pumping and by hand expression) Early initiation of pumping (within 6 hours of delivery) Presentation of business case for human milk Leadership commitment to communicate project goals (as they relate to the organizational strategic objectives) and support team by removing barriers to achieving them Develop unit specific feeding guidelines/policies, to promote initial and persistent human milk feed Policies to encourage use of donor mild from a certified milk bank, if MOM NA

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19 # of responses Opportunities 30 L&D, PP, and OB support, education, and collaboration 14 Maternal education 9 Prenatal education at OB visits or on L&D in preterm labor 7 Appropriate usage and adequate numbers of Lactation Consultants 7 Increase use of Kangaroo care 7 Initiation of early (hand) pumping 6 Strong dedicated passionate group that believes human milk is best 5 Strong Administrative support 5 Adequate amount & availability of breast pumps 4 Ability to use donor milk 3 Inclusion of MD OB order to initiate breast feeding

20 Opportunities Opportunities for Human Milk Usage Number % 14 45% 55% 62% 69% 76% 82% 88% 93% 100% 90% 80% 70% 60% 50% 40% 30% % % 0 0%

21 Challenges (which are also really opportunities for improvement) Labels Total Responses 165 Lack of RN (L&D,PP) and MD OB support and education 38 Inadequate Lactation Consultant coverage, lack of dedicated LC in NICU 21 Inadequate amount and access to breast pumps 20 Challenges related to mom being at an outlying hospital 15 Inadequate number of data collectors 13 Maternal feelings, cultural views & family support related to breast feeding 10 Inadequate privacy for mom to pump 9 Maternal illness and instability; mom in an ICU 9 Slow initiation of first pumping (> 6hours) 6 Restrictive NICU feeding protocols (specifically ELBW mentioned) 6 A need for MD/RN culture change towards breast feeding 5 Lack of Administrative support 4 Decreased maternal milk supply 4 Neonate too unstable for Kangaroo care (UVC/UAC lines mentioned) 3 Lack of support for Prolacta 1 Residents in the NICU rotate/change every 28 days 1

22 Challenges (which are also really opportunities for improvement)

23 Let s Poll Have you completed one PDSA test of change since LS 1?

24 Let s Poll What is the most important activity a team can do immediately after a Learning Session to assure they accomplish their AIM by the end of a Collaborative? A. Send a report of the meeting to their Senior Leader B. Collect the data they forgot to send prior to the meeting C. Complete one PDSA cycle D. Hold a team meeting to update the other staff who didn t attend in person

25 Answer THE MOST IMPORTANT ACTION IS: X Send a report of the meeting to their Senior Leader X Collect the data they forgot to send prior to the meeting Complete one PDSA cycle X Hold a team meeting to update the other staff who didn t attend in person

26 What is a PDSA Test? Putting a change into effect on a temporary basis, measuring it s effect & learning about its impact

27 P-D-S-A? Plan What is the objective of the test? population? What tasks are necessary in order to conduct the test? Develop the action plan of tasks who, when, what How will you measure the impact of the test? What do you predict will happen? Do--test the change Study What were the results from the test? Was your prediction correct? What do you need to do next? Act Adapt do you need to make revisions & re-test? Adopt do you need to scale up a successful test? Abandon did your test fail but you were able to learn from it?

28 Plan Act Do Study PDSA Worksheet PDSA WORKSHEET Team Name: Date of test: Test Completion Date: Overall team/project aim: What is the objective of the test? PLAN: Briefly describe the test: DO: Test the changes. Was the cycle carried out as planned? Yes No Record data and observations. How will you know that the change is an improvement? What did you observe that was not part of our plan? What driver does the change impact? STUDY: Did the results match your predictions? Yes No What do you predict will happen? Compare the result of your test to your previous performance: PLAN List the tasks necessary to complete this test (what) Plan for collection of data: Person responsible (who) When Where What did you learn? ACT: Decide to Adopt, Adapt, or Abandon. Adapt: Improve the change and continue testing plan. Plans/changes for next test: Adopt: Select changes to implement on a larger scale and develop an implementation plan and plan for sustainability Abandon: Discard this change idea and try a different one

29 #1 Challenge/Opportunity Lack of RN (L&D,PP) and MD OB support and education Discussion of education related PDSAs Dayton Children's Med Ctr Fairview Hospital Mercy St. Vincent Med Ctr Wexner Med Ctr

30 Team Sharing and Learning Harvard School of Education

31 Next Steps If you have not yet done so, please send your AIM and PDSA worksheet (with both sides completed) to the OPQC box submit February data Continue to collect data and submit March data April 5, 2012 Keep testing changes - PDSAs Join the April Action Period Call (date/time TBA) to share your teams results and learn from other teams