Session Code: M3 The presenters have nothing to disclose Reducing opioid-related harm and building quality improvement capability in New Zealand: a national formative collaborative John Kristiansen Prem Kumar 5 December 2016 10:00 am #IHIFORUM
The future we want P2 All New Zealanders live well, stay well, get well, in a system that is people-powered, provides service closer to home, is designed for value and high performance, and works as one team in a smart system. Minister of Health. 2016. New Zealand Health Strategy: Future direction. Wellington: Ministry of Health. See: www.health.govt.nz/publication/new-zealand-health-strategy-2016
New Zealand health system P3 1. Ministry of Health. 2014. The New Zealand Health and Disability System: Organisations and Responsibilities: Briefing to the Minister of Health. Wellington: Ministry of Health. See: www.health.govt.nz/system/files/documents/publications/new-zealand-healthand-disability-system-organisations-responsibilities-dec14-v2.pdf 2. Health Quality & Safety Commission: The New Zealand Triple Aim framework. See: www.hqsc.govt.nz/about-the-commission
HQSC role and purpose P4 To lead and coordinate work across the health and disability sector for the purposes of: monitoring and improving the quality and safety of health and disability services helping providers across the health and disability sector to improve the quality and safety of health and disability services Shining the light on variation, and key areas for improvement Being an intelligent commentator and advocate for change Lending a hand by making expert advice, guidance and tools available Health Quality & Safety Commission. See: www.hqsc.govt.nz/about-the-commission/our-role
The problem with opioids P5 Opioids are essential medicines for treating pain but are the most common class of medicines that cause harm to inpatients Harms range from life-threatening over-sedation and respiratory depression to less severe, such as constipation There is no universally accepted bundle of evidencebased interventions to reduce harm from opioids This was the impetus for the safe use of opioids national formative collaborative 1. Seddon, ME, Jackson A, Cameron C et al. The Adverse Drug Event Collaborative: a joint venture to measure medication-related patient harm. NZMJ 25 January 2013, Vol 126 2. Institute for Safe Medication Practices (ISMP). ISMP s List of High-Alert Medications. 2012. See: www.ismp.org/tools/highalertmedications.pdf
Collaborative aim and goals P6 The national aim was to reduce opioid-related harm by 25% in participating areas of hospitals by April 2016 The goal of the collaborative was to: Develop care bundles to reduce opioid-related harm Increase the capability of participating teams to use quality improvement tools and methods Create a reusable clinical network across New Zealand for further medication safety work
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P8 What did we achieve? #IHIFORUM
Results - capability building P9 Learning session attendees knowledge of improvement science methodologies I guess from a professional point of view, learning about PDSA cycles and the methodology. It s been really useful for me a different way of thinking. (DHB 1) I came into it not really understanding PDSAs and to the extent to the formalisation that they (the Commission) were talking about, so I guess [not knowing] the science behind [it] I learned a lot. (DHB 6) Nearly all (98%) survey respondents reported that they would use the improvement tools, knowledge and methods they gained during the collaborative in the future.
Results - care bundles P10 This composite care bundle reflects the key interventions that were tested to support a reduction in opioid-related harms in hospitals Three individual harm bundles were also created
Results - harm reduction P11 20 teams were eligible for the collaborative: 17 actively participated; 5 were excluded from the analysis because a baseline was not established. Of the remaining teams: 7/12 hospitals (58 percent) showed greater than 25 percent relative reduction in opioid related harm, with 6/12 (50 percent) exhibiting a special cause in SPC chart 2 hospitals showed a 0 25 percent relative reduction (one with special cause) 3 hospitals showed a relative increase in harm (no special cause) Examples of analysis
Execution theory Drivers of change Strong leadership and governance Measurement Reduction in harm Collaborative model and methodology Support Partnership Co-design Example of a team s assessment Sector engagement
Collaborative model and methodology P13 Collaborative model - IHI breakthrough series Underpinned by Model for Improvement Inter-professional team, aim statement, driver diagram, and measurement plan were created for each DHB Project sponsor and clinical lead identified for each team
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Co-design and partnership P15 Commission s national team kept DHB teams involved in all decision-making Consumers were involved in testing the interventions Responsiveness to Māori cultural appropriateness Key documents were co-designed with DHB teams (eg, care bundles and measures Improvement advisors from DHBs were involved in teaching at the learning sessions Harm areas were chosen by DHB teams
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Measurement P17 Teams identified their measures, developed a data collection plan and manually collected data on a weekly basis for their identified outcome, process and balancing measures DHB monthly reports were shared with the Commission and national dashboards were created Data was analysed using three methods: two sample test of proportions, statistical process control (SPC) charts and relative percentage change from baseline
Infrastructure and support P18 Four national learning sessions and four regional meetings Monthly national teleconferences Visits by national team to each DHB; one-on-one coaching Connections with DHB clinical leads and project sponsors International support (IHI), and connecting with other counties Common platform to file all materials (shared workspace) Newsletters and webinars Muffins
Leadership and governance P19 Expert faculty Steering group National team (project manager, improvement advisor, content specialist, clinical lead, and project sponsor) Invitation letters sent to DHB executives Presentations at DHB meetings Consumers were involved in governance at a national and DHB-level
Lessons learnt from execution P20 Co-design, partnership and relationships key elements for success at a national level Formative nature teams were asked to develop interventions while learning improvement science; many struggled with the notion of building the plane, while flying it Team work successful teams had an inter-professional structure with strong project sponsor support Measurement teams needed explicit direction regarding baseline data requirements Methodology teams needed help with the practical use of PDSA in their clinical settings, especially small- versus large-scale testing Bundle creation not easy! Shared learning national learning sessions were effective for bringing the teams together to share and learn from each other
Thank you P21 Prem.Kumar@hqsc.govt.nz John.Kristiansen@hqsc.govt.nz www.hqsc.govt.nz Learning session 2 Christchurch, NZ June 2015