Incorporating Clinical Outcomes. Plan. Barbara S. Prosser, RPh V.P. Clinical Services, Critical Care Systems. Kevin L.

Transcription

1 Incorporating Clinical Outcomes into a Performance Improvement Plan Barbara S. Prosser, RPh V.P. Clinical Services, Critical Care Systems Kevin L. Ross, RN, BSN

2 Top 5 Things to Know for CE: Make sure your BADGE IS SCANNED each time you enter a session, to record your attendance. Carry the Evaluation Packet you received on registration with you to EVERY session. If you re not applying for CE, we still want to hear from you! Your opinions about our conference are very valuable. Pharmacists, Pharmacy Technicians and Nurses need to track their hours on the Statement of Continuing Education Certificate form as they go. FOR CE: At your last session, total the hours and sign both pages of your Statement of Continuing Education Certificate form. Keep the PINK copies for your records. Place the YELLOW and WHITE copies in your Evaluation packet. Make sure an evaluation form from each session you attended is completed and in your Evaluation packet (forgot to pick up an evaluation form at a session? (Extras are available in an accordion file near the registration desk.) Put your name and unique member ID number (six digit number on the bottom of your badge) on the outside of the packet, seal it, and drop it in the drop boxes in the NHIA registration area at the convention center.

3 Disclosures Barbara Prosser and Kevin Ross declare no conflicts of interest or financial interest in any service or product mentioned in this program. Cli i l t i l d ff l b l ill t b Clinical trials and off-label uses will not be discussed during this presentation.

4 Objectives List steps for targeting clinical outcomes to be incorporated into the Performance Improvement Plan Describe how to incorporate the use of a common denominator when reporting clinical outcomes Explain sources for benchmarking clinical outcomes to identify areas of risk for your business

5 Benefits Demonstrates commitment to quality care/service Increases appeal to payers Meets licensure and accreditation requirements Reduces risk Improved perception of care (patient satisfaction) Establish Best Practices

6 Outcomes to Consider Hospital readmissions ER visits related to home infusion complications Missed doses and/or interruption of therapy Central line related infections Patient status at time of discharge Reason for stopping a therapy/medication

7 Finding the Data Clinical progress notes Catheter tracking logs Infection logs On-call logs Incident reports Discharge note/summaries Patient assessments

8 Clinical i l Progress Notes Outcome data Hospital readmissions/reason ER visits/reason it Interruption of therapy/reason Patient interventions Labs SE/ADR management

9 Catheter Tracking Log Outcome data Catheter type Tunneled, PICC, etc. Catheter infections Confirmed or suspected Blood cultures Tip culture Site infection Bloodstream infection

10 Outcome data Infection Log IV access related infection Other infections acquired after admission i i.e. post op surgical wounds, MRSA, URI Influenza

11 Outcome data ER visits/reason On Call Log Missed dose or interruption ti of therapy/reason Catheter complications Patient re-education

12 Outcome data Event Reports Hospital readmissions ER visits it Interruption of therapy Catheter events Infection Catheter t breaks Catheter occlusion Catheter migration

13 Discharge Note/Summary Outcome data Patient status upon discharge Goals of therapy met Clinical deterioration New manifestations (unrelated) Patient death Unanticipated Expected

14 Medication i Events Adverse drug events Side effects Errors Mis-administrations Pump issues

15 Data Collection Use consistent methods to collect data Only collect data on processes that are in your control Use statistically significant data pools Build your operating system to support your data Build your reports to support your data

16 Use of a Common Denominator Promotes consistent data comparison Allows for consistent data reporting Allows for benchmarking with other providers regardless of size Evidence based medicine

17 Examples Per 1000 catheter dwell days Calculated by counting the total number of dwell days for all central catheters over a given period of time Reporting central line catheter infections Reporting other catheter t events» Occlusion» Catheter breakage» Catheter migration

18 Examples Per 1000 patient days Calculated by counting number of days of service for all patients over a given reporting period Reporting hospitalization readmissions Reporting number of ER visits Reporting missed doses or interruption ti of therapy

19 Now What? Don t collect data and then do nothing. Dig down into the data. Compare office to office, therapy to therapy, month to month, quarter to quarter, year over year ( Benchmarking)

20 Benchmarking Data is your friend befriend it. Compare internal components: Office to office Therapy to therapy Protocol to protocol External comparisons Published industry standards Evidence-based medicine

21 What to Benchmark? Identify key measures important to your organization: Patient ae cae care Clinical outcomes Productivity Reimbursement Financial Don t limit best practices to the clinical areas; nothing happens in a silo.

22 Benchmarking Include all aspects of your organization. Avoid silos. Post and share the data. Everyone has ideas. Share the responsibility of collection, review, and analysis. Data collection should not be a chore.

23 Benchmarking Use common denominators to equal the playing field. Per 1,000 days Apples to apples: Collect and report data consistently across the organization and the industry. Patient numbers vs. patient % vs. patient days

24 DATA ASSESSMENT Number of statistical tools that are used to evaluate data: run charts, pareto charts, control charts and pie charts 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

25 Metrics Know your baseline numbers Establish expected threshold Create a Dashboard

26 Thresholdsh Thresholds - Thresholds are assigned to each criteria to provide a trigger point for action. Carefully determine threshold levels, referring to standards d of practice or industry standards. Set realistic thresholds, rarely can 100% be achieved when external variables exist.

27 Focus Monitors With the use of indicators, focus monitors are used in areas chosen for more intensive evaluation or specific auditing. Indicators are the suggested method for monitoring i and evaluating a problem, however other methods of data collection and threshold h setting are acceptable.

28 Process Improvement Team approach to process review Make sure all relevant players are represented Is the process working? Has the process changed? Outline the process (Visio, fishbones) Determine change or a new process

29 PERFORMANCE IMPROVEMENT Shewhart PLAN/DO/CHECK/ACT cycle provides the basis for the improvement process. Cycle guides the development of new processes and dinnovations. Represents the four stages in the evolution of a new process

30 PDCA Source: JWS Solutions Ltd. Available at: Accessed on 3/11/10.

31 What is a Best Practice? Processes/practices that result in consistent positive patient outcomes Processes/practices that can be duplicated / replicated Efficiency Proven cost-effectiveness

32 Definition i i Methods and techniques that have consistently shown results superior than those achieved with other means, and which are used as benchmarks to strive for. BusinessDictionary.com. Available at: Accessed 3/6/10.

33 Definition i i Best Practice is a superior method or innovative practice that contributes to the improved performance of an organization, usually recognized as "best" by other peer organizations. It implies accumulating and applying knowledge about what is working and not working in different situations and contexts, including lessons learned and the continuing process of learning, feedback, reflection, and analysis (what works, how and why). Visitask. Best practice. Available at: Accessed 3/11/10.

34 The Best? Who has the best documented outcomes? Who is seeing an upward trend? Who is sustaining i a consistent t threshold? It may be a combination of people and places.

35 The Best? Consistent positive patient outcomes - What do they do that makes it consistent? Processes/practices that can be duplicated / replicated - What tools are they using? Efficiency What have they streamlined? Proven cost-effectiveness ti - How do they contain costs?

36 What does a Best Practice look like? Policy and procedures Standards of practice Clinical i l protocols Clinical pathways

37 Source: Available at: Accessed on 3/11/10.

38 Questions?