Here - Jefferson Hospital

Allegheny Health Network Quality Improvement Initiative
Jefferson Hospital Team Leaders
Initiatives
Jefferson Team Leaders
Readmissions
Pam Gnora
Core Measures – Acute Myocardial Infarction
Lexi Robinson
Core Measures – Congestive Heart Failure
Jim Monack
Core Measures – Pneumonia
Gabby Thomas
Core Measures – Immunization
Barb Wyvratt
Core Measures – Stroke
Britney Gratton
Core Measures – Surgical Care
Dana Mariano
Core Measures – Venous Thromboembolism
Adam Rothschild, MD
HCAHPS
Joy Peters
ED Throughput
Diana Allman Pehanich
Infections: Central Line Bloodstream
Beverly Flannery
Infections: Catheter-Associated Urinary Tract Infection
Cindy Andrews
Infections: C. difficile
Beverly Flannery
SSI
Rob McCoy
Pressure Ulcers
Hilary Johnson
Falls
Michele Jones
Medication Errors
Terri Riskey
Never Events
Michele Jones
Work Injuries
Angela Sowerby
ACA/Stars
Steve Kelly
Here are summaries of some of the initiatives submitted by Jefferson Hospital’s team
leaders of the AHN Quality Improvement Initiative.
Initiative: AHN Surgical Care Improvement Project (SCIP)
Dana Mariano, Manager, Nursing, Intraoperative Services
SCIP is a national partnership of organizations committed to improving the safety of surgical
care through the reduction of postoperative complications. These complications can adversely
affect a patient’s health and safety as well as extend their postoperative stay.
My role in the project with AHN is ensuring the success of our program by educating our staff
and instituting network-based best practices in our facility. Through successful implementation
of the SCIP measures, our patients achieve the best surgical outcomes possible, utilizing
recognized evidenced-based care.
Initiative: Pneumonia
Joy Peters, Vice President, Patient Care Services and CNO (AHN)
Gabby Thomas, Performance Improvement Specialist (Jefferson)
I am leading the AHN system-wide initiative for the core measure of Pneumonia. The initiative
includes represents from all seven hospitals. The measures for scoring are as follows: blood
cultures obtained on arrival for ICU patients and an appropriate initial antibiotic selection for the
ICU and non-ICU patients. There are more than 75 different choices of antibiotic combinations
that are considered acceptable to meet this measure. Each hospital has an electronic or paper
order set/pathway with choices of antibiotics to guide practice. It is important to select an
approved choice or document why a different antibiotic was chosen. The plan is to standardize
antibiotic selection across the network for the treatment of pneumonia patients and develop an
educational tool to complement the decision.
Initiative: Core Measures: Acute Heart Attack Care (AMI)
Lexi Robinson, Director of Cardiology
The core measure for AMI ensure that each patient presenting to a hospital experiencing a heart
attack is treated with a standard of evidence-based care and that this care works to ensure optimal
outcomes for the patient’s health.
The measures are as follows:
• Aspirin within 24 hours of arriving at hospital
• If experiencing a STEMI heart attack, receiving their coronary intervention within 90
minutes
• Aspirin at time of discharge
• A beta blocker drug at time of discharge
• A statin(lipid lowering drug) at time of discharge
• An ACE/Arb drug at time of discharge
All of these treatments are not required for all patients; treatment is individualized depending on
the patient’s condition. My role as part of a six-member team appointed by AHN is to work to
standardize processes to achieve our core measures care 100 percent of the time.
Initiative: ED Throughput
Diana Allman Pehanich, Director, Emergency Department, EMS
I am the lead for the ED throughput committee and initiative. This initiative is important in that
we are optimizing our resources, decreasing our Emergency Department wait times and length of
stay while still providing excellent care to our patients in the community. The ED throughput
initiative will not just impact our Emergency Department patients; it will also have an impact on
the throughput of patients in the hospital.
This committee allows us to not only see where the ED bottlenecks are, but also where the
roadblocks to discharging patients in house occur. Throughput of patients will benefit Jefferson
Hospital and our community by maximizing the use of our resources and providing safe and
efficient services. Reducing the length of stay has a positive impact on patients’ social, emotional
and physical wellbeing by returning them to their home environment.
Initiative: Work Injuries
Angela Sowerby, Manager, Employee Health
I’m currently an active participant on our network’s WorkSAFE Committee, where we
collaborate with our network colleagues on employee injury prevention strategies. Some
initiatives include injury problem solving, the Safety Champion program and daily injury calls.
The key to injury problem solving is determining the root cause of why the injury occurred and
identifying corrective actions to prevent it from reoccurring.
This information is shared during daily Call to Care huddles, in our hospital’s Workplace Safety
Committee, and on a daily network-wide injury call. The calls are an opportunity to share
information and ideas for injury prevention, and a safety quick tip is generated from injury trends
which is sent to facility leadership and Safety Champions. Safety Champions are an exciting
recent addition, and are going to be vital in our ongoing efforts to create and maintain a safe
workplace. They perform monthly safety rounds in their departments to proactively identify
hazards and follow up on their repairs. We are committed to providing a safe workplace, and
look forward to working together moving forward on this quality improvement.
Initiative: Congestive Heart Failure Core Measures
James Monack Jr., Manager, Nursing, CVU and PCCU
I am a part of a network initiative to maintain 100 percent compliance with heart failure Core
Measures. Our goal is to standardize processes to eliminate outliers. This statistic verifies that we
deliver evidence-based care to all of our heart failure patients.
Initiative: Stroke
Brittney Gratton, Patient Care Manager
Being a part of the Stroke quality improvement initiative, I have had the opportunity to work
with the other network hospitals to improve processes for the stroke patients. By collaborating,
we have been able to share educational opportunities which in the future will give nurses and
physicians an opportunity for more education sessions offered regularly.
Initiative: Patient Fall Prevention
Michele Jones, Patient Safety Officer
I am working with the network to develop best practices that can be used network-wide to
prevent falls. Each hospital is evaluating their fall program to see where improvements can be
made. Working together, we can make a safer environment for our patients. We have developed
a network tool for a post-fall Huddle to ensure that we are addressing all fall prevention issues.
We are in the process of putting a bed alarm in all of the acute care area rooms to have readily
available for our fall-risk patients. Thank you for all that you have done to make Jefferson the
leader in fall prevention.
Initiative: Never Events
Michele Jones, Patient Safety Officer
We are working on a network policy to define never events. We are evaluating our root cause
analysis policy. The goal that the network is working toward is to complete a root cause analysis
within 10 days of a never event. We are also working to develop a tool for follow-up after an
event.
Initiative: Reducing Infections
Beverly Flannery, Manager, Infection Control and Prevention
I represent our hospital on AHN collaborative teams to reduce infections related to central
intravenous catheters (CLABs), foley catheters (CAUTIs), surgical site infections and
Clostridium difficile diarrhea. There are other members from our hospital on some of these
teams. We use established criteria from the Centers for Disease Control and Prevention to
determine infection in patients. Each team is working toward standardizing the best practices
(both internal and external) from AHN hospitals and integrating those practices in each
individual hospital.
•
Central Line Associated Bloodstream Infections (CLABs) – Central intravenous lines are
used when veins in the arms cannot be used for many reasons. There are eight entrance sites for a
central line, either side of the neck, either side of the collar bone, either blood vessels in the
elbow area (PICC lines) and either groin. Central lines in the groin must be removed as soon as
possible and never exceeding five days. This area generally contains many more bacteria than
other areas of the body. PICC lines can stay in for months. The neck and collar bone area lines
must be changed before day 7. At Jefferson, we went eight months in a row with no central line
blood stream infections throughout the hospital. Diane Destephano, RN, from the PICC team
also participates in this group.
•
Catheter Associated Urinary Tract Infections (CAUTIs) – Foley catheters drain urine
from the bladder and are to be used for very specific reasons and removed as soon as possible.
Each AHN hospital was using a different type of urinary catheter. Part of the responsibility of
the team is to standardize to one product. Right now the team is developing a nurse-driven
protocol for the removal of these devices as soon as possible. Cindie Andrews, RN, from
Infection Prevention participates in this group.
•
Surgical Site Infections – Our group started by using Jefferson as a model for distributing
chlorhexidine soap to surgeon’s offices. We did this several years ago because we believe that
everyone has bacteria and most often the surgical site infections that patients develop are caused
by their own skin bacteria. Bathing with chlorhexidine soap has been shown over and over in
studies to decrease surgical site infections. It is important to bathe the night before and the
morning of surgery with this soap. Rob McCoy, RN, Director of Surgical Services, participates
in this group.
•
Clostridium difficile – C. difficile is a spore forming bacteria that we probably all have in
very low numbers in our GI tract. When we take antibiotics, the good bacteria in our GI tract dies
and this organism overgrows and causes severe diarrhea. It can be very debilitating. We have a
multi-disciplinary group internally working on more effective ways to reduce transmission
within the hospital. “Do we feed it to patients when we don’t clean the electronic thermometer?”
are among questions we are asking to see how we can do routine tasks safely. You will be seeing
an article in the near future designed by this group to begin educating everyone on how to help
limit transmission called “C the Diff”. Cindie Andrews, RN, Infection Prevention, is part of this
team.
Initiative: Medication Errors
Terri Riskey, Director of Pharmacy
Medication errors are defined as any failure in the medication process beginning from the
physician order through administration to the patient. An estimate of one medication error
occurs per patient per day in the hospital. A 2006 Institute of Medicine (IOM) report estimates
that 1.5 million preventable adverse drug events occur in the U.S. per year. Each day of
hospitalization increases the risk for a medication error to occur. Our goal is to improve patient
safety by continually reviewing processes to minimize and/or eliminate medication errors.
A team of pharmacy, nursing, education, patient safety and performance improvement staff
review reported events or near misses on a weekly basis. Evaluations are done of each event to
identify the cause and any process improvement opportunities that exist. We are also focusing
our efforts related to medication errors by communicating with the other AHN hospitals to share
information and identify trends. These ongoing efforts are an example of how we want to ensure
a safe environment to our patients and employees at Jefferson Hospital.
Initiative: Quality Initiative, Pressure Ulcer
Hilary Johnson, Wound Care Nurse
I represent the Pressure Ulcer Quality Initiative for the network with daily 30 minute calls on
Tuesday through Friday. Our focus in the group is looking at standardizing the policies,
procedures and care plans for wound care throughout the system. We are standardizing products
and assisting to build the epic wound care charting piece. We are also looking at ways to work
on continuum of care, so that Inpatients, Outpatient Clinics, and Home Care are all intertwined
with better communication and standardization of care. We do a weekly round table discussing
hospital-acquired events. I am on this initiative with all the WOC nurses within the network.
Jefferson Hospital will benefit from the initiative as we will be following the same standards of
care as the rest of the network. All patients will be receiving the same treatments regardless of
which facility they use to seek care.
Initiative: Readmissions, Quality Blue Readmissions
Pamela Gnora, Manager, Case Management
Arleen Yoest, Patient Care Manager
Reducing avoidable hospital readmissions is an opportunity to improve quality, reduce costs and
improve patient satisfaction. All health care providers play a vital role in reducing readmissions.
Initiatives that have been implemented to reduce readmissions include:
•
Early discharge planning by the multidisciplinary team rounds that includes assessment
of the patient’s support system and post-acute care needs (Durable medical equipment and home
care services).
•
Medication and discharge instructions/transition of care education utilizing the teachback method.
•
Early physician follow-up appointment post-discharge.
•
Collaborative efforts with physician practices, palliative care services, skilled nursing
facilities, and post-acute care community services.
•
Health Coaching initiatives with the Allegheny County Area Agency on Aging,
(Community Care Transition Program) and the Community Care Network collaborative program
with Washington & Jefferson College students.
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