Quality Improvement Project Report

Transcription

1 Quality Improvement Project Report Homeward Bound November 28, 2012

2 Define What process did we look at? The current referral process for mother/baby transition from hospital (MCCU) to community (Public Health Nursing. The referral process is cumbersome, involves all mothers and newborns, increases workload, causes frustration for staff and has potential to cause risk to clients.

3 Define The main goal of the project is to improve the communication process among staff and with clients across the continuum of service (MCCU and PH Nursing). The project includes: an identification of the current process; an analysis of that process through the capture of team identified measures; improvements through the reduction of inefficiencies to minimize risk for clients; and to ensure a safe transition from hospital to community for mothers and babies.

4 Measure 1) Date and time babies born and discharged 2) Time required to complete PHN referral form 3) Time required to complete screen for risk/discharge form 4) Report MCCU RN to PHN time of day & length of report 5) Number of mothers not visited by PHN in hospital 6) Time screen for risk/ discharge form received at PHN office noting missing information 7) Mother/Baby referral missed and noting reason why 8) Pages made to PHN by MCCU staff

5 Baseline Data Summary In July/August - 34 babies were born in a 25 day period In Oct./Nov. 18 babies were born in a 16 day period In July/ August, MCCU completed a Referral Form and a Screen for Risk/Discharge form at two separate time periods during the stay. There was not a clear process as to who completed the forms and when. Often data points were missing and time spent searching for information. PHN visited at 1 pm but at this time, Mom s had often already been discharged. 32 percent of mothers were not visited by the PHN prior to discharge.

6 New Information In consultation with the Health PEI Privacy and Information Access Co-ordinator it was determined: It is Best Practice to have a separate form for information specific to the mother & one for information specific to the baby This information directed our piloting of the British Columbia Community Liaison Records Postpartum and Newborn

7 Improve - AIMS To make a 50 percent improvement in the completion and transfer of referral information by November 13 (50 percent reduction in the amount of missing data). To make a 50 percent improvement in the number of mothers seen by the PHN prior to discharge by November 13.

8 Improve PDSA 1 Replace the current Referral Form and Screen for Risk Discharge Form with the BC Community Liaison Records- Postpartum and Newborn PDSA 2 Change the time of the public health nurse visit PDSA 3 Develop an Algorithm which identifies the process for transition of care - hospital to community

9 Minutes 1800 Comparison Time to Complete Referral & Discharge Form & Maternal & Newborn Liaison Forms July - August 89 percent improvement in the time to complete information for transfer October - November Pre Pre-Median Post Post- Median

10 Missing Data - July/August as compared with October/November 30.0% 25.0% 20.0% 26.6% 67.9% decrease in the amount of missing data 15.0% 11.3% 10.0% 5.0% 5.6% 1.8% 0.0% Pre Top Ref Pre Bottom Ref Pre Discharge Post/Liaison Form Combined Jul/Aug Oct/Nov

11 12 Time of Discharge for Mothers from MCCU for Babies Born July 12 (0800 hrs)- August 6, 2012 (1600 hrs) October 29 (0001 hrs)- November 13, (1600 hrs) Count - August Count - November :00-10:00 10:01-11:00 11:01-12:00 12:01-13:00 13:01-14:00 14:01-15: :01-16:00 16:01-17:00 17:01-18:00 18:01-19: :01-23:00 0 Missing

12 9 Number of Missed Mothers by PHN in Hospital Prior to Discharge by Date and Day of Week - July/ August in Comparsion to Oct./Nov % Change 82.7% decrease in the number of mothers not seen by the PHN in hospital in Nov. compared to Aug. 5 4 Number of mothers missed (pre) Number of Mothers missed (post) Monday Wednesday Friday

13 Summary The team developed two aims following the initial measurement period. Not only were the aims achieved, results exceeded expectations. 89 percent improvement in the time to complete information for transfer. 68 percent improvement in the amount of missing data. 67 percent of mothers are going home before 1300 hrs With PHN visiting at ~0900 hrs, only one mother was not seen in hospital. 83 percent decrease in the number of mothers not seen by PHN in hospital

14 Considerations There were no pages recorded during the measurement period. Feedback that Algorithms are helpful Processes needing consideration included: Time of day that s are sent to PHN (prior to 1500 hrs) Look at how forms are scanned to mother/baby pairs together Process for notifying Lennox Island nurse of mother/ baby discharge On-call PHN checking account when working on holidays More education: with PHN on how to interpret and follow-up with the Liaison Records received with MCCU staff on completion of the Liaison Records and process for transfer

15 Control PDSA 1: Change in form template Fundamental Change Standard Work Visual Controls The number of missing data points will be measured by PHN for the first 5 discharges received each month for 6 months. PDSA 2: Change the time of (PHN) visit, format of report & add confirmation process (compare with CIS discharge report). Fundamental Change Standard Work Mistake proofing The number of mothers not seen by PHN prior to discharge will be measured by PHN for the first 5 discharges received each month for 6 months.

16 Control PDSA 3: Develop Algorithms which clearly identify the process for transition of care from Hospital to Community Standard Work Visual Controls Any situations where a patient is missed will also be captured by Incident Reporting.

17 Lessons Learned Was a lot of work - worth it - should have been done sooner Measures were difficult at times but provided concrete information about pre & post situation Need to be mindful of messaging shared with staff important to hear concerns & comments from staff throughout the process Important to believe in the work & be positive to sell it to staff Support of the Team made it easier to go forward Helpful to have great facilitators People were open & honest at Team meetings Frustration levels have decreased & relationships are rebuilding Increased understanding & appreciation for roles & responsibilities of all Team members Comments: - PHN Liaison more productive with time at PCH - less disruption to work flow at PCH MCCU unit

18 Next Steps/Spread Spread Homeward Bound Lean project findings: - Team members will present to the Maternal Child Quality Team meeting December 5, to discuss provincial standardization. - Brenda Worth, Director of Nursing at PCH, will invite Mary Harris, Director of Nursing at QEH & Kathy Jones, Director of Public Health Programs - Team members will present to Staff meetings at PCH - Dec. 13 th & 20 th - Team members will present to Staff meeting at PHN - Dec. 17 th - Initiate the process to obtain permission/templates for Liaison Records from Perinatal Services BC Diane - Meet with Liaison nurses in the Charlottetown office to provide overview of Project work to date and information on interpretation of Liaison Forms Arlene & Diane

19 Next Steps/Spread What next QI project is our organization going to be doing next? MCCU Will conduct a 5S review of the Bulletin Boards in the Med Room - to complete by the end of December PHN Will conduct a 5S review of the Front Office Work Space - to complete by the end of December

20 The Team!