JECT 2017 PBMS Review Course IBBM PBMS Review Course The Job, Quality, and Data Jeff Riley MHPE, CCP Portland OR October 21, 2017 1
1996 ABCA-Sponsored Job Analysis 1996 demographics for PMBT Rating scales (task categories) Content areas for competency exam 56 tasks surveyed Task frequency vs. criticality 43 tasks both frequent and critical Informed by: American Psychological Association Standards for educational and psychological tests Equal Employment Opportunity Commission Uniform guidelines on employee selection procedures Task and Legal Hierarchy Analysis Credentialing Issues in Perioperative Blood Management aabb, AmSECT 2007 Cognitive Domain PABMS [RN+CCP] CCP MD RN + Others PABMS Legal Standing CMS? SABM JC SCA STS ICEBP AATS AABB PABMS PABMT Scope of Practice Re-discover and expand our practice scope and cognitive domain Professional = voluntarily profess to meet a standard AmSECT (ICEBP) (IBBM) ACVT 2
Review Outline: The Job Patient Blood Management Specialist Job Description Duties of a Perioperative PBMS How the literature defines PBM Exam Content Domains Role of Subject Matter Experts (SMEs) Distribution of questions in content domains Knowledge, Skills, Abilities (KSAs), and Critical Incidents Specific review topics Administrative and organizational duties Quality and reporting, data manipulation The Perioperative PBMS Job Description Participates in data collection, quality control, data reporting, and quality improvement projects related to inpatient perioperative transfusion experiences Contributes to the adoption of principles for inpatient perioperative autologous blood conservation and collection including intraoperative autotransfusion techniques Coauthors high reliability evidence-based hospital policies and procedures for patient blood conservation and transfusion care perioperatively Is familiar with the installation, user-qualifications, and procedures for the use of medical equipment and supplies for autologous blood collection and allogeneic blood administration Has knowledge of methods and pharmacology to avoid and treat anemia perioperatively 3
The Perioperative PBMS Job Skills Able to read and apply the current scientific publications related to perioperative patient transfusions and blood conservation in the perioperative phases of care. Apply quality control principles and six sigma quality improvement methodologies. Exhibits knowledge of perioperative autologous blood salvage methodology. Working knowledge of principles of monitoring coagulation and the drugs that affect coagulation. Working knowledge of equipment used for blood collection and administration in the perioperative phase of inpatient care. Author evidence-based patient care guidelines and plans. Team player/leader who can provide a clear direction and vision for the team, while listening and providing support to the team members. Study Guide PBMS Review Course Study Guide (2017) 1. Environment 1. Leadership and administration 2. Change management for patient blood management 3. Regulatory issues for medical practice 4. Regulatory issues for laboratory practice 2. Quality Improvement 1. Internal and external data registries 2. Statistical quality measures 3. Quality improvement: DMAIC 4. Data collection 3. Patient Care 1. Writing blood management procedure guidelines 2. Blood administration indications, safety, and contraindications 3. Evidence-based, consensus standards, recommendations, and guidelines 4. Physiology and pharmacology body of knowledge 4. Critical Incidents 1. Team response to critical incidents in patient blood management 2. Multidisciplinary team response to complications 3. Diagnose, troubleshoot and report critical incidents 4. Coagulation, anemia and oxygen delivery body of knowledge 4
Three Pillars of PBM Three Pillars of PBM 5
Three Pillars of PBM https://www.blood.gov.au/system/files/documents/pbm-3-pillars.pdf In conclusion, mirroring those of other noneuropeancountries 19,20, European governments should intervene directly, issuing regulatory actions and recommendations and providing resources to implement PBM programmeseffectively. The Italian regulatory guidelines may represent an excellent model for inspiring how to pursue this objective. Blood Transfus2017; 15: 292-3 6
April 2015 7
The Exam Plan Perioperative Patient Blood Management Specialist PBM Specialist Job Domain Analysis Theoretical, Hierarchical Construct for KSAs for Competency Exam Environmental Factors 41 Leadership, Administration, finance, and quality in patient blood management (1.5) 14 Change management, Integration of patient blood management into medical care planning (1.4) 8 Inter-team member communication and patient rights and privacy (1.3) 4 Data/Quality Improvement 30 Participation in internal and external PBM data registries (2.5) 4 Application and statistical presentation of data for quality measure (2.4) 8 Statistical analysis and interpretation of data for quality review (2.3) 5 Patient Care Procedures 69 Suggest changes to anesthesia and surgical advanced practice guidelines (3.5) 8 Follow guidelines for blood administration, safety, contraindications and exceptions (3.4) 13 Follow guideline indications for use, pre-op and intra-op care (3.3) 11 Critical Incidents 59 Design and practice team response to critical incidents (4.5) 4 Communication with multidisciplinary teams during complications and critical incident (4.4) 5 Respond correctly to critical incidents and emergencies (4.3) 9 Hospital administrative structure and vocabulary of blood management practices (1.2) 8 Principles of quality improvement, measurement and record keeping (2.2) 8 AABB, OSHA, FDA, TJC and professional organization evidencebased standards (3.2) 10 Diagnose, troubleshoot and report critical incidents in anesthesia, surgery and obstetrics (4.2) 17 Rules for regulatory laboratory and medical practices (1.1) 7 Understanding and evaluating data sources and methods (2.1) 5 Body of medical knowledge: physiology, pharmacology (3.1) 27 Body of medical knowledge: coagulation, anemia and O2 delivery (4.1) 26 Increasing complexity, proficiency and difficulty Updated 11-12-2016; 10-20-2017 8
Score Total exam and section scores are presented as fractions (i.e.: 0.850 = 85.0%). Examinees may use the exam plan content section scores to compare themselves to the group and to identify areas of strength and areas for CME opportunity. For more information, go to http://www.intbbm.org/ or contact the IBBM office. Examinee All Examinees Exam # 627 Score 70 Total Items 100 Fraction 0.70 Mean = 0.746 Rasch Measure 1.09 SEM = 0.006 Status Pass Score by Exam Plan Section All Examinees Exam Plan # Items Section Label Examinee Average 1.1 7 Regulatory lab and medical rules 0.86 0.870 1.2 8 Hospital administrative structure 0.75 0.785 41 1.3 4 Inter team member communication 0.50 0.667 1.4 8 Change and blood management 1.00 0.825 1.5 14 Leadership, quality, administration 0.88 0.746 2.1 5 Understand and evaluate data 0.736 2.2 8 Principles of quality improvement 0.761 30 2.3 5 Statistical analysis and interpretation 0.742 2.4 8 Data and quality measurement 0.832 2.5 4 Participation in PBM data registries 0.813 3.1 27 Physiology and pharmacology 0.723 3.2 10 Organization standards 0.823 69 3.3 11 Indications for peri-op care 0.833 3.4 13 Contraindications for peri-op care 0.619 3.5 8 Changes to practice guidelines 0.637 4.1 26 Medical knowledge, anemia 0.801 4.2 17 Diagnose critical incidents 0.423 59 4.3 9 Respond correctly 0.678 4.4 5 Communication multiple discipline 0.890 4.5 4 Design team critical response 0.780 Total items 100 * See http://intbbm.org/certification/preparing-for-the-pbmt-examination/ Continuous Quality Improvement: DMAIC 9
Continuous Quality Improvement: DMAIC aabb CQI: Flow Charts and Fishbones 10
CQI: Flow Charts and Fishbones Statistical Process Control Chart Chest Tube Drainage ml Contrast CQI versus QAP 11
Statistical Process Control Chart Chest Tube Drainage ml Statistical Process Control Chart Chest Tube Drainage ml 12
Statistical Process Control Chart Chest Tube Drainage ml Statistical Process Control Chart Chest Tube Drainage ml 13
Measures of Central Tendency Mean = sum of all values divided by number of values Median = middle value when the data are arranged in order Mode = most common value in a set of data Q1, Q3 = quartiles: 25 th and 75 th percentiles Q3-Q1 = interquartile range (IQR) Whiskers = min, max values Outliers = Observations outside whiskers Box Plot Rating Evidence: Quality of Evidence 14
Rating Evidence: Quality of Evidence Clinical Procedure Guidelines 1. Title 2. Purpose 3. Relates to 4. Key Points 5. Definitions 6. Policies 7. Procedures 8. Clinical Notes 9. References 10. Approval 11. Dates for review Enroll in AmSECT University CPG Course! 15
10/21/2017 Clinical Procedure Guidelines 1. Title 2. Purpose 3. Relates to 4. Key Points 5. Definitions 6. Policies 7. Procedures 8. Clinical Notes 9. References 10. Approval 11. Dates for review Clinical Procedure Guidelines 1. Title 2. Purpose 3. Relates to 4. Key Points 5. Definitions 6. Policies 7. Procedures 8. Clinical Notes 9. References 10. Approval 11. Dates for review 16
Critical Incidents in PBM Contamination of sterile field and circuit components Set-up contamination Contamination during cell processing Bacteremia (1) Record keeping errors Record entry error Record entry omission Mis-label autologous blood product Quality indicator failure (2) Hemolysis Wrong cell wash solution Wrong heparin drip solution Inadequate de-airing of anesthesia red cell infusion bag Accidental venous air infusion Medication errors Wrong anticoagulant drug Wrong anticoagulant drug dose Wrong anticoagulant drip solution Allergic reactions Anaphylactic reaction (3) Equipment failure Cell washing devices Platelet concentration devices Rapid infusion devices Blood warming devices Circuit disposable component failure Shed blood reservoir Cell washing bowl or chamber Circuit blood line separation Blood spray Blood loss Special patient management requirements Partial cell washing bowl volume (2, 4) Massive red blood cell and platelet loss (5) Massive plasma protein and clotting factor loss Pediatric patients (6) Jehovah Witness (7) Cancer patient (8) Cesarean patient (9, 10) Liver transplant patient Review Summary Patient Blood Management Specialist Job Description Duties of a Perioperative PBMS How the literature defines PBM Exam Content Domains Role of Subject Matter Experts (SMEs) Distribution of questions in content domains Knowledge, Skills, Abilities (KSAs), and Critical Incidents Specific review topics Administrative and organizational duties Quality and reporting, data manipulation Shander A, Isbister J, Gombotz H. Patient blood management: the global view. Transfusion. 2016 Mar;56 Suppl 1:S94-102. 17
Additional Reading Thank You! rileyjb@gmail.com 18