The Role as an MBSCR & MBS Coordinator Wearing Two Hats

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1 The Role as an MBSCR & MBS Coordinator Wearing Two Hats Linda Trainor, RN, BSN, CBN., MBSCR Bariatric Coordinator, Compliance Specialist Beth Israel Deaconess Medical Center 330 Brookline Avenue Boston, MA Tel:

2 Location: Boston, Massachusetts Teaching Hospital: Harvard Medical School Biomedical Research Funds $229.8 million annually 651 Licensed beds A full range of emergency services, including a Level 1 Trauma Center and roof-top heliport 2016: 40, 217 Inpatient Discharges 56,959 Emergency Department Visits 638,449 Outpatient Visits 348, 183 Radiology Visits 1,250 Physicians on Active Medical Staff most of these physicians hold faculty appointments at Harvard Medical School Weight Loss Surgery: Comprehensive Center Two Surgeons, Gastroenterologist Staff: Bariatrician, Bariatric NP, Registered Dietitians (2), RN, MSW, Exercise Physiologist, Nurse Coordinator/MBSCR, Administrative Director bariatric surgeries per year 15 Balloon Endoscopies

3 Our Bariatric Team at 2015 MBSAQIP Accreditation for Comprehensive Bariatric Center

4 NO Disclosures Disclosures

5 Wearing Two Hats MBS Coordinator M B S C R The Role as an MBSCR & MBS Coordinator

6 Wearing Two Hats

7 ANALYSIS of Role : (MBS Coordinator) Metabolic & Bariatric Surgery (MBS) Coordinator MBS Coordinator Reports and assists the MBS Director Assists in the Centers Development Manages the accreditation process Ensures Continuous compliance with MBSAQIP requirements NOTE: MBS Coordinator may fulfill the role of MBS Clinical Reviewer as long as this individual does document in the patient s chart.

8 ANALYSIS of ROLES: (MBS Coordinator) Metabolic & Bariatric Surgery (MBS) Coordinator (cont d) Maintains: 1. Relevant policies and procedures 2. Patient education 3. Outcomes data collection 4. Quality improvement efforts 5. Education of relevant staff in the various aspects of the metabolic and bariatric surgery patient with focus on Patient Safety & Positive Outcomes Supports the Development of Written Protocols and Education of Nurses: Detailing the rapid communication and basic response to critical vital signs that is specifically required to minimize delays in the diagnosis and treatment of serious adverse events. Serves as a Liaison: between the facility and all surgeons performing metabolic and bariatric surgery at the center and general surgeons providing CALL coverage. ASSISTS: in maintaining the documentation of the call schedule provided by all covering surgeons. NOTE: MBS Coordinator must have the authority and resources to fulfill all the listed duties

9 PROCESS for MBS COORDINATOR STANDARDS MANUAL V2.0 Resources for Optimal Care of the Metabolic and Bariatric Surgery Patient 2016 Print Copy from ASMBS site SHARED DRIVE UPDATE INFORMATION DO NOT WAIT for date to re-apply for re-accreditation INTRANET (IT Department) CHECKLISTS (MBSAQIP Committee) EDUCATIONAL TRAININGS: (HR, IT, Managers) MY PATH place educational trainings on line for All Staff who care for the Bariatric Surgical Patient per required years for staff to be trained and re-trained. Bariatric Coordinator

10 PROCESS for MBS COORDINATOR TEAM WORK:ESTABLISH RELATIONSHIPS with MBS Director, Surgeons, Nurse Managers, Dept. Managers, Anesthesia, Administrators, MBSAQIP. Enthusiasm, Validation & Value of various staff roles = Vested Interest with Staff MBS Coordinator COMMUNICATION: ONGOING WITH TEAM

11 Solutions: MBS Coordinator COORDINATOR: Update Nursing Guidelines Review Guidelines at Next MBSAQIP QA Meeting Contact Intensive Care Unit Nurse Manager Attend Peri-Operative Grand Rounds Meet with Surgeon Champion, Meet with Nurse Manager, clinical RN, NP For Quality Improvement Project Schedule QA Meeting MBSCR: Check Lock Dates New Cases Complete 6 month F/U CHECK LISTS White Board in Office Shared SHARED DRIVE Drive

12 Solutions: MBS Coordinator SAMPLE: CHECK LIST 2.1 STANDARD Description of Standard Notes: BIDMC MBSAQIP COMMITTEE CHECK LIST Define Members of MBSAQIP Committee MBSAQIP Committee: Dr. Daniel Jones, MBS Director, Dr. Benjamin Schneider, Surgeon, Dr. Edward Hatchigian (Bariatrician), Linda Trainor, CBN, MBSCR, MBS Coordinator, Leigh Ann Burke, Bariatric NP, Kristen Almechatt, Administrative Director. Date Completed 12/1/2014 Continued Review 2.1 Documentation of Three MBSAQIP Meetings per year with Sign In Sheets for Attendance at Meetings (Note Members required to attend depend on subject matter presented). AFFILIATE MEMBERS: John Tumolo, BIDMC QA Manager, Marybeth Cotter, NSQIP Manager, Mary Ward, NSQIP Surgical Case Reviewer, John Ryan, Nurse Manager, Farr 9 PROCESS for MBS COORDINATOR Please reference Blue Folders for agendas, sign in sheets for MBS Meetings for meeting dates. 2/28/2014 3/5/2014 5/28/2014 6/4/ /5/2014 4/29/15 7/22/15 Next meeting planned for 9/23/15 to review next SAR report 2.2 Provides Proof that MBS Director is attending minimum requirement of MBSAQIP Committee Meetings per year. Please reference sign in sheets for MBS Director in Blue QA Folders 2/28/14 3/5/14 5/28/14 6/4/14 12/5/14 4/29/15 7/22/15

13 MBS Coordinator: Solutions INTRANET

14 MBS Coordinator: CREATING A VISION PATIENT SAFETY & POSITIVE OUTCOMES

15 MBS Coordinator: Creating a Vision OBESITY TASK FORCE Bari-Buddies BIDMC On Line Wellness & Weight Loss Newsletter= 3,500 precipitants

16 Dual Roles: MBSCR & MBS Coordinator Bariatric Coordinator MBSCR The Bariatric Coordinator & MBSCR must work closely together to ensure timely submission of outcome data. The center s organizational framework must incorporate the MBS Coordinator position and the MBS Coordinator must have the authority and resources fulfill listed duties

17 Analysis of Role as: MBSCR Flipping the Switch with HATS M B S C R PRIMARY GOAL is to ensure Timely and accurate data to ensure Quality improvement that will ultimately enhance patient safety. Time MGMT

18 Analysis of Role as: MBSCR Enter Data: MBSAQIP Data Registry Platform Training and Recertification Long-term follow-up Reports for analysis Communication Note: MBSCR not approved to be supervising patient care or documenting patient care in charts. The number of Full Time Equivalents (FTE s) needed to fulfill all required MBS Clinical Reviewer must be commensurate to the center s annual case and follow-up census. Please see MBSAQIP website at facs.org/mbsaqip for information

19 MBSCR: Process Work Environment: Setting Up For Success: Chapter 3 Operation Manual T E A M E F F O R T MBS Director Surgeons Administrative Director Nursing Managers Administrative Staff, f/u schedule of patients appts. MBSAQIP Staff: Clinical and Technical Support Where Is the DATA? Documentation is For successful MBSCR workflow & Data Abstraction

20 Solutions: Documentation & TEMPLATES Date Height Pre-op Weight Bariatric Screening Examples of Documentation & Templates Bari Weight Wt. Change Ttl Wt Change Bari BMI % TWL % EWL BP Fill Volume O 2 Satur ation% Heart Rate Pain Score Action lbs/29 days Her medical history is significant for: 1) COPD/asthma with no recent flares or prednisone taper 2) hyperlipidemia 3) obstructive sleep apnea on CPAP 4) history of gout after her pregnancy 5) bilateral carpal tunnel syndrome 6) history of HPV ) allergic rhinitis 8) hepatic steatosis by ultrasound study 9) tobacco dependence 10) likely borderline type 2 diabetes with hemoglobin A1c 6.3% and estimated glucose average 134 Her medications include: 1) rosuvastatin 20 mg daily for hyperlipidemia 2) sertraline 50 mg daily for mood/depression 3) albuterol (ProAir) 2 puffs as needed for wheezing (does not use) 4) beclomethasone (Qvar) 1 puff twice daily for wheezing 5) varenicline (Chantix) 0.5 mg daily for smoking cessation 6) melatonin 5 mg taken as needed for sleep 7) multivitamin daily for nutritional supplementation 8) cholecalciferol (vitamin D3) 1000 units daily supplementation 9) ibuprofen 600 mg 3 times daily with food as needed for pain (patient will stop using following sleeve gastrectomy

21 MBSCR: Solutions DOCUMENTATION ACTUAL Example of Surgeons OP NOTE: FINDINGS: 1. A 36-French bougie based sleeve. 2. No evidence of hiatal hernia. 3. Gastric division site 6 cm from pylorus 4. Staple Reinforcement: Seam guard buttress material used throughout the staple line. 5. No Over sew 6. Leak test was negative. 7. NO Drain DISCHARGE: Brief Hospital Course: 1. Operating Room:? Adverse Events?Extubated 2. Post Anesthesia Care Unit (PACU) 2. Transferred to Ward 4. Discharge Note Neurology Cardio Vascular Pulmonary Infectious Disease HEMATOLOGY: Prophylaxis:?Heparin discharge on Lovenox Summary: Pertinent Results:

22 Workflow: USE ALGORITHMS Rule In Rule Out Useful guideline MBSAQIP Resource

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24 MBSCR: Solutions/TIPS CONSULT WITH SURGEONS regarding ADVERSE EVENTS: Prior to Lock Dates Case Abstraction: after post-operative day Complete 30 Day Follow-up, Co-Signatures Follow-Up 6 Months, Yearly: Templates for Surgeons for Comorbidities Auxiliary Staff: Follow-up Telephone Calls & Letters Sample Template: Note Date: 05/12/17 Note Type: Telephone Note Title: Follow Up Patient Contact Management Patient contacted via telephone to schedule bariatric follow-up appointment with Bariatric Surgery Program. [x] Talked to patient, appointment scheduled for 06/08/17 [] No Answer. Left message for patient to return call at xxx-xxx-xxx. [] Patient refused to schedule appointment. [] Talked to patient and they declined to make an appointment at the current time. They will call back when their schedule permits. [] Talked to family member/significant other, left message for patient to return telephone call at (#). [] Patient unreachable/phone # not is service SAMPLE TEMPLATE Patient was seen in the Bariatric clinic today, denies all of the following within 30 days of the Sleeve Gastrectomy: Any hospital readmission's. Any re-operations. Any adverse events. Any emergency room visits not resulting in a readmission. Any IV fluid replacements in an out-patient setting.

25 MBSCR: Creating a Vision All Staff who care for bariatric Surgical Patient Anesthesia Emergency Department Patient Safety Nurse Managers Keep Your MBS Coordinator Administrators Surgeons Administrative Manager MBSCR MBS Director The PRIZE

26 MBSCR : VISIONS The Problem, Aim/Goal, The Team, Interventions, The Results, Progress M B S C R Decrease 30 Day Readmission Rate for Bariatric Surgery Procedures Readmissions Type 7/1/12-6/30/13 1/1/13-12/31/13 7/1/13-6/30/14 All Cause 19.61% 16.33% 8.82% Lap Roux-en-Y Gastric Bypass Related 14.29% 8.82% All Cause 6.25% 6.96% 5.83% Lap Sleeve Gastrectomy Related 5.22% 4.17% All Cause 8.24% 6.35% 7.89% Lap Gastric Band Related 3.17% 5.26%

27 MBSCR : Visions SAR REPORTS Semiannual Report: Site Summary Site Number? As Expected, Exemplary, Outlier

28 MBS Coordinator s & MBSCR s