Improving Safety In the ICU - PowerPoint

Document Sample
Improving Safety In the ICU - PowerPoint Powered By Docstoc
					Saints Medical Center
  Cross-Continuum Team


  MASSACHUSETTS STAAR
   October 11-12, 2011
STAAR Cross-Continuum Team


 Our Experience Re-Convening a
 Cross-Continuum Team

 Development and Use of a Handoff
 Communication Quality Improvement Tool
      Saints Medical Center

• 157-bed Community Hospital

• Serves Greater-Lowell and Merrimack
  Valley since 1839

• Primary and Acute care services to
  315,000 residents from 25
  communities
            Readmissions

• In 2009
  ─Heart Failure Readmission Rate
    27.9% (among highest in nation)

  ─Joined STAAR September, 2009
  How-to-Guide: Convene a Cross-
   Continuum Improvement Team

─Implementing change
     –   Conduct Small Tests of Change
     –   Don’t wait until it’s perfect
     –   Dive in
     –   Do it today

─ Membership - Who?
   SNF and HHA Liaisons


─ Monthly meetings December, 2009 – June 2010
 Through the Eyes of an Early Cross-
     Continuum Team Member

• Staff level involvement

• Liaisons happy to participate

• Shared information with administration

• As clinical leader, felt need to participate
 Through the Eyes of an Early Cross-
     Continuum Team Member

• First meetings
  ─Getting to know each other
  ─Group Assessment
     Tools, Processes

     Educational Materials

     Best Practices, Standards of Care

     Regulatory Reporting Requirements
 Through the Eyes of an Early Cross-
     Continuum Team Member

• By June, 2010

  ─ Recognized need to standardize care


    HHA – Hospital to Home Pathway

    SNF - INTERACT
           Tests of Change

• Plan: split into HHA and SNF subgroups
• Re-evaluate appropriateness of team
  membership
• Blow it up and start over

• “Moving into the next phase”
  ─Membership to include Administrators and
   Clinical Leaders that could impact change in
   their facilities
    STAAR Cross-Continuum Team
Community Partners
•   Elder Services of Merrimack Valley - Mary DeRoo,      •   Wingate at Lowell - Diane Tessier-Efstahiou,
    Home Care Director                                        Adminstrator
•   Home Health VNA - Patricia Finocchiaro, Clinical      •   Heritage Nursing Care Center - Elizabeth Rozzi,
    Director                                                  Administrator
•   VNA of Greater Lowell - Irene Sommers, Director of    •   Palm Manor - Frank McGuire, Administrator
    Clinical Services
                                                          •   Willow Manor - Robin Fortin, Administrator
•   CareTenders - Michael Guarnieri, Executive Director
                                                          •   Radius Northwood HeathCare Center – Michele
•   Blaire House of Tewksbury - Paula J. Drelick, RN          Desmarais, Executive Director
    NHA
                                                          •   Life Care Center of Merrimack Valley - Colleen
•   D’Youville Senior Care - Cynthia Thornton, RN,            Lovering, Executive Director
    Director of Nursing                                   •   NEQCA – Tufts - Jennifer Mercier, RN
•   Fairhaven Healthcare Center – Alex Struzziero,
                                                          •   Amedisys HHA – Kimberley Brown, RN
    Administrator


Saints Medical Center
•   Debbie Staniewicz, RN Day-To-Day Leader STAAR,           Dr. S. Ramya, Hospitalist, Executive Leader
    Dir. Nursing 3E, 4A                                       STAAR
•   Deborah McCrady, Dir. Case Management                    Helene Thibodeau, CNO, VP Q&PS, Executive
                                                              Leader STAAR
•   Ellen Scott, RN Dir. Nursing ICU, Telemetry, 5P
                                                             Judith Casagrande, COO
•   Janet Liddell, RN Day-To-Day Leader STAAR,
    Quality Improvement Coordinator                          Jennifer Braga, Dietician
•   Kim Richardson, RN, Dir. Outpatient Satellites           Lisa Conte, RN, Nurse Manager, Dialysis
STAAR Cross-Continuum Team

New Team Composition:
 ─Great Attendance and Meeting Participation
 ─Needed working group
    Formed a Sub-Committee

    Enhanced Teaching and Learning

    Quickly Accomplished Objectives
STAAR Cross-Continuum Team

• July 2011 Team’s Priority Work
  ─TJC and Health Care Proxy
  ─Full Code vs. DNR
  ─Revised HF Teach Back w/ weights
  ─Insurance Contract requirements
    Sub-Committee

    Handoff communication

    QI Tool
                 Handoff Communication QI Tool
                                                                           Cross-Continuum Quality Improvement Monitor: Transitions in Care

                                                                                                         Date (of review)       Date         Date                         Date         Date

Month:_______________________________

                                                                                    Patient Identifier


                                                                           Date of Hospital Discharge

                                                        (HHA) Date of Initial Post-Hospital Encounter                                                                                                    Totals

       Hospital Discharge Materials                                        Did you receive?                             Y/N            Y/N               Y/N                     Y/N          Y/N   Total Yes/Total Reviews

                                                                                          example:                          Y          N                  N                      Y            Y              3/5
Enhanced Assessment

Teach Back Document with Weights/PCP appt.

Completed Health Care Proxy Form
Code Status/ DNR Paperwork
Documented Palliative Care Consult

Medication Reconciliation                            (HHA) Next Dose Due
(SNF) Last Dose Given

(HHA) Page 1, 2, 3 Referral
D/C Summary (physician)

                                  (HHA) Two-Week Assessment                                                             Y/N            Y/N               Y/N                     Y/N          Y/N   Total Yes/Total Reviews
Primary Learner Identified
Hospital-to-Home Pathway Utilized
Medication Reconciliation Completed

Disease Specific Teaching Initiated
Daily Weight Log Maintained
Patient able to Teach Back Heart Failure Zones
Primary Care Appointment Kept
(HHA) Telehealth Implemented
1st Two week visit Frequency 2 - 3 x / week
(SNF) Date of NP/MD face-to-face medical encounter




Conclusion: ___________________________________________________________________



Action Plan: ___________________________________________________________________


Manager's Signature: _______________________________________                                                                                 Date: ____________________
   Handoff Communication QI Tool
                                                                                                        Date (of review)
Month:_______________________________
                                                                                   Patient Identifier

                                                                         Date of Hospital Discharge

                                                       (HHA) Date of Initial Post-Hospital Encounter



             Hospital Discharge Materials                             Did you receive?                                     Y/N

                                                                                          example:                         Y
Enhanced Assessment

Teach Back Document with Weights/PCP appt.

Completed Health Care Proxy Form

Code Status/ DNR Paperwork

Documented Palliative Care Consult

Medication Reconciliation                       (HHA) Next Dose Due
(SNF) Last Dose Given


(HHA) Page 1, 2, 3 Referral

D/C Summary (physician)


                                     (HHA) Two-Week Assessment                                                             Y/N
Handoff Communication QI Tool

• Used by HHA and SNFs

• To assess patient information sent to next
 care provider

• Conducted case reviews at HHA
                 Findings

• Highlighted processes that were working
  ─Medication reconciliation
  ─Scheduled MD appointment

• Uncovered inconsistencies and
  discrepancies
  ─missing documents i.e., health care proxy,
   discharge summaries, teach back with
   weights
       Plan, Do, Study, ACT

• Tested the tool
• Presented findings at sub-committee and
  revised tool
• Led to major areas of interest and
  opportunity for focus within the hospital
  and across the continuum to improve
  handoff communication and transitions in
  care.
                   Contact Information
Janet Liddell, MSN/MBA, RN, QI Coordinator
Saints Medical Center
One Hospital Drive, Lowell, MA 01852
(978) 458-1411 x4089
jliddell@saintsmed.org

Patricia Finocchiaro, RN, MS, Director Clinical Services
Home Health VNA
(978) 552-4124
pfinocchiaro@homehealthfoundation.org

Heidi Landers, RN, BSN, MHA, Lowell Branch Manger
Home Health VNA
(978) 569-1704
hlanders@homehealthfoundation.org

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:6
posted:10/5/2012
language:Latin
pages:18