using baldrige criteria to achieve performance excellence patient safety improvement at ssm health...
TRANSCRIPT
Using Baldrige Criteria to Achieve Performance Excellence
Patient Safety Improvement at SSM Health Care
The Quality Colloquium at Harvard August 27, 2003 Presented by: Andrew Kosseff, MD, FACP Medical Director of System Clinical Improvement
Agenda
SSM Health Care and MBNQA
Patient safety improvement
SSM Health Care (SSMHC)
Large Catholic health care system - St. Louis 21 Hospitals, 3 nursing homes, home health care 4 Midwestern states 5000 Physicians 23,000 Employees $2 Billion revenue / year
1990 - CQI model adopted
1995 – MBNQA criteria added
1999 – MBNQA applications
The MBNQA Effort
Strong, committed leadership Mission centered Perseverance Attention to MBNQA feedback Conviction that the pursuit made us better
The Precursors of The MBNQA
Through our exceptional health care services, we reveal the healing presence of God
SSMHC’s Mission
Attend to our mission Have goals consistent with our mission Have mature improvement processes Implement effective system improvement initiatives Use comparisons to “best in class”
What MBNQA Means to SSMHC
Safety and Clinical Improvements SSMHC Clinical Collaboratives
Safety and Clinical Improvements SSMHC Clinical Collaboratives
The SSMHC Environment and The Clinical Collaboratives
The mission The commitment to CQI
Our experience with the IHI Breakthrough Series
The Concept
By working together we can improve system clinical performance resulting in exceptional patient care
Collaboratives 85 collaborative teams
Improving the Secondary Prevention of Ischemic Heart Disease ( Secondary Prevention) - 1/99
Improving Prescribing Practices (IPP) - 5/99
Using Patient Information to Improve Care (UPI) - 11/99
Enhancing Patient Safety Through Safe Systems (EPS) - 3/00
Improving the Treatment of Congestive Heart Failure (CHF) - 11/00
Achieving Exceptional Safety in Health Care (AES) - 1/02
Start of Collaborative
DesignCollaborative
Prework
Continuous Improvement Phase
Active phase
Send out invitation
Team formation and data collection
Learning session #1
Project work and completion
Learning session #2, 3
Secondary Prevention
Data collection every 3 months
Conference calls every 2
months
CHF
AES
SSMHC’s Safety Improvement History
Pre - IOM Individual caregiver and entity efforts IHI Collaborative – medication safety SSMHC Clinical Collaboratives Post - IOM Enhancing Patient Safety Collaborative(EPS) Safety infrastructure changes Achieving Exceptional Safety Collaborative(AES)
Achieving Exceptional Safety in Health Care (AES)
Jan., 2002 .........Goal for the collaborativeTo have each entity adopt and implement 16 + recommended safety practices
3 year collaborative with 22 entities enrolled
16 + Recommended Practices1. Implement a near miss reporting system2. Eliminate dangerous abbreviations3. Design and implement an accurate patient medication list at admission and discharge and avoid "home" medication and blanket orders4. Implement an effective disclosure of unanticipated outcomes process5. Provide and use protocols for high risk medications6. Implement a fall reduction process7. Implement a sentinel event review process8. Establish an entity Safety Center Team
Achieving Exceptional Safety in Health Care (AES)
yellow - upcoming collaborative recommended practice black - recommended practice in progress
16 + Recommended Practices 9. Provide pharmacy rounding in ICU's10. Implement all recommended safety information technology advances11. Implement 24 hour pharmacy coverage12. Provide a quarterly "state of safety report"13. Develop a protocol for proper timing of surgical antibiotic prophylaxis14. Institute a needleless IV system15. Implement a protocol for glucose management of diabetic patients undergoing surgery16. Implement a surgical site marking procedure to avoid wrong limb surgery17. Effectively implement all JCAHO National Patient Safety Goals18. Improve hand washing
Achieving Exceptional Safety in Health Care (AES)
Achieving Exceptional Safety in Health Care
Good
Use of Four Dangerous AbbreviationsAve. Performance of Collaborative Entities
0%
5%
10%
15%
20%
25%
Baseline Jan02(20)
March, 02(19) June, 02(20) Sept, 02(18) Dec, 02(19) March, 03(14)
Time of data collection
Per
cent
use
of D
As
SSMHC use of DAsEliminate “QD” for dailyEliminate “U” for unitsEliminate trailing zerosUse leading zeros
Achieving Exceptional Safety in Health Care
Good
Use of "QD" Instead of DailyAve. Performance of Collaborative Entities
0%
10%
20%
30%
40%
50%
60%
70%
BaselineJan02(19)
March, 02(18) June, 02(17) Sept, 02(14) Dec, 02(13) March, 03(12)
Time of data collection
Per
cent
use
of "
QD
"
SSMHC use of DAs
Achieving Exceptional Safety in Health Care
Good
Use of "Blanket Orders" Ave. Performance of Collaborative Entities
0%5%
10%15%20%25%30%35%40%45%
Baseline 2002 (14) March '03 (16) July '03 (17)
Time of data collection
Perc
ent u
se o
f "b
lank
et o
rder
s"
SSMHC Use of blanket orders
Near Miss Reporting and Safety Process Changes
Stimulate near miss reporting Demonstrate safety process changes Magnify benefits by collaborative sharing
Achieving Exceptional Safety in Health Care (AES)
Near Miss Safety Process Changes
Pharmacy staff re-educated on placement of narcotics in Pyxis
Enforced the transfer checklist that includes the process of discarding old labels on 3ICU
Near miss involving two look alike injectables being next to each other in Pyxis led to moving one of the meds to a different drawer
Separated out the different types of insulin in Pyxis, into different bins so staff are sure to pull the right type of insulin
Reviewing process use to document patient weights; changes recommended are to remove “lbs” and use “kg” on all forms and computer systems.
Achieving Exceptional Safety in Health Care (AES)
Near Miss Safety Process Changes Liquid theophylline is available in pharmacy, as only the nonalcoholic type, to prevent the alcohol type being given to infants/pediatric patients
Orange stripe on NG tube to avoid confusion w/ IV lines
Better identification of patients in “A” bed and “B” bed
Noted confusion re: acute coronary syndrome orders and thrombolytic orders, so revision of orders and education of staff was done
Stopped the practice of staff being able to override the lockout mode on PCA pumps.
Achieving Exceptional Safety in Health Care (AES)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Time of data collection
Per
cen
t of M
I pat
ien
ts tr
eate
d w
ith L
LA
's
SSM average
Benchmark 00
Benchhmark 02
better
8 new entities join
Mehta, RH et al. Quality Improvement Initiative and Its Impact on the management of Patients with Myocardial Infarction. Arch Intern Med. 2000; 160: 3057-3062 Mehta, RH et al. Improving the Quality of Care for Acute Myocardial Infarction. JAMA 2002; 287: 1269-76.
Secondary PreventionPercent of MI patients treated with Lipid Lowering Agents (LLA's) Average Performance of Collaborative Hospitals
Core measures
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
baseline (3-01)
July, 01Dec., 01
March, 02June, 02
3rdqrt02(11)
4thqrt02(9)1stqrt03(10)
Time of data collection
% M
I pa
tie
nts
dis
ch
arg
ed
on
be
ta
blo
ck
ers
SSM averageBenchmark00
Benchmark 02JCAHO mean
Secondary Prevention Percent of MI Patients Discharged on Beta Blockers Average Performance of Collaborative Hospitals
better
Mehta, RH et al. Quality Improvement Initiative and Its Impact on the management of Patients with Myocardial Infarction. Arch Intern Med. 2000; 160: 3057-3062 Mehta, RH et al. Improving the Quality of Care for Acute Myocardial Infarction. JAMA 2002; 287: 1269-76.
Core measures
Results of SSMHC’s Collaborative Safety Improvement Efforts
Progress towards safer patient care
Recognition that patient safety is a top priority
Unexpected benefits and adventures
Andy Kosseff [email protected] 608-238-1337
For more detailed information about MBNQA: visit SSM’s website at www.ssmhc.com or contact Paula Friedman, VP of System Improvement at 314-994-7840