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QI project

  1. 1. QI Projects Tamer Gharaiybah, RN, MSN Risk Management and Patient Safety Coordinator Al-Ahsa Hospital CQI Department
  2. 2. Objective • To discuss Emergency Room (ER) Project • To discuss Troponin I project • To discuss Prevent Falling Down Project CQI Department 2
  3. 3. Emergency Room (ER) Project • The overall goal of the project was to compose health care in ER fit with hospital mission and vision. • FOCUS PDCA has been adapted to improve health care in ER.
  4. 4. CQI Department 4 Find • problem in ER mostly related delaying in health care provided in ER which is directly increases the boarding time more than 3 hours.
  5. 5. CQI Departemnt 5 Organize • Organized team was being formed in ordered to review the process and identify the reason of delaying
  6. 6.  Clarify • Clarifying existed problem by comparing the expected outcome with actual performance. CQI Departemnt 7
  7. 7. 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% mar apr may jun jul aug sept oct nov dec Boarding Time indicator in ER 2015
  8. 8. Understanding • study conducted over one month to evaluate the waiting time and summarize the problems in ER as well validated data. CQI Departemnt 9
  9. 9. 0 1000 2000 3000 4000 5000 6000 Figure 1: Trend of ER visit number per month 2014-2015 Series 1
  10. 10. Selecting • To prioritize the performance improvement in ER, we matched the problem with priority matrix of indicators. • 1. Minimize rate of patients wait more than 3 hours • 2. Reporting urgent and emergent lab and radiology result • 3. Adherence to policy triage cases and physician documentation.
  11. 11. PLAN • The overall goal of the project was to compose health care fit hospital mission and vision. • to reform ER structure and extend number of beds. CQI Departemnt 12
  12. 12. DO Supportive services director was responsible to achieve the objective. Redesign ER structure to fit the extension number of beds. 4 beds were added to be totally 11 beds. Also pediatric clinic is opened in ER at time off OPDs CQI Departemnt 13
  13. 13. CHECK • After expansion, the waiting time indicator showed decrease in percentage to the half. For instance, in January and February the percentage of waiting time indicator was 6.6 and 7.39, respectively. • Regarding patient complain, it showed decrease in 1st quarter in 2016 comparing with 4th quarter 2015. CQI Departemnt 14
  14. 14. Act • The project has been already finished • It is under monitoring
  15. 15. Point of Care-Troponin I Find • Data obtained from CAREWARE system showed that turnaround time was more than 1 hour for patient coming to ER. CQI Departemnt 16
  16. 16. Organize • The team involved from head of LAB, ER, head nurse, supportive maintenance, and CQI. CQI Departemnt 17
  17. 17. Clarifying • existed problem by comparing the expected outcome for TAT with actual performance • The expected outcome should match hospital policy to reflect hospital vision and mission. According to hospital policy (LAB-QM-POST-7), the expected TAT is 1 hour. CQI Departemnt 18
  18. 18. 0 10 20 30 40 50 60 70 80 90 10-2015 11-2015 12-2015 01-2016 02-2016 03-2016 percentage of sample taken more than 1 hour
  19. 19. Understanding • Collected specimens were sent to lab without prioritizing Troponin I. In lab, the technician did not know which sample should be prioritize as it is emergent. CQI Departemnt 20
  20. 20. CQI Departemnt 21 PLAN • The overall goal of the project was to compose health care fit hospital mission and vision. • Objective: to avoid delay in result and to report panic value within 1 hour for troponin
  21. 21. DO CQI Departemnt 22 • In the literature, the easiest method is applying Point of Care (POC) in EMS to avoid result delaying. For instance, study showed that the result of troponin was available on average in 15 versus 83 minutes for the laboratory result (A.J., J., J., & J., 2005).
  22. 22. • Supportive maintenance was responsible to provide POC kit. • Head of laboratory revised POC policy. • Lab technician will educate ER nursing staff how to use the kit. CQI Departemnt 23
  23. 23. prevent Fall Down Project CQI Departemnt 24  To do a comprehensive assessment for all patient admitted  To prevent patient fall during hospitalization  Improvement done using FOCUS PDCA. • Find • Received OVR Monthly regarding patient fall down, and this is against target indicator. • should be no incidence as it is one of international patient safety goal.
  24. 24. CQI Departemnt 25
  25. 25. Organized team.  CQI director  Risk mngt & PT coordinator  ICU head nurse  ECU head nurse  Nursing Educator Radiology supervisor Physiotherapy supervisor CQI Departemnt 26
  26. 26. Clarifying • Morse Scale was revised carefully. • There was error in printed scale which mean the result scale for patient at high risk for fall will be low risk and vice versa. • Morse scale lacking assessment for change in elimination status which is the most reason leading for fall. CQI Departemnt 27
  27. 27. CQI Departemnt 28
  28. 28. • In pediatric scale; error in printing humpty dumpty scale. • There is no process to check equipment may cause fall for reason such as wheel chair, IV stand, or beds. • Medications may cause fall integrated in the Morse scale without sensitivity consideration. CQI Departemnt 29
  29. 29. Understanding • Lack proper Assessment as well no clear intervention to prevent fall is the major cause of fall in the hospital. CQI Departemnt 30
  30. 30. PLAN To Implement valid fall assessment tool To implement comprehensive fall prevention program involving intervention CQI Departemnt 31
  31. 31. DO Fall prevention policy completely changed to new comprehensive program. Assessment tool was changed from Morse scale to Johns Hopkins Fall risk Assessment Tool (JHFRAT). (CQI Director). Educate the staff how to implement JHFRAT (Nursing educator) Set comprehensive intervention for scale (Head nurses). Prepare checklist for equipment checking (OPD head nurse) Check equipment either daily or weekly (Nurses and end users). CQI Departemnt 32
  32. 32. CQI Departemnt 33
  33. 33. CQI Departemnt 34

Notas

  • Why this is important lecture, well, at first you know that after 2 month we will face JCI. So, one of the question may ask you is, tell me about 1 project in hospital. Or tell me about your departmental project.
    So, thru this presentation, you will know what is hospital project as well you will learn how to do project in your department.
  • Mainly, thru this lecture we will present 3 project in the hospital.
  • The hospital mission emphasize the commitment hospital to improve quality by providing excellent preventive and curative medical service to patients through adopting national and international standards.
    FOCUS-PDCA it is a simple, logical, and systematic approach to accomplish incremental improvement of an existing process, or to redesign an existing process or design an essentially new process or in problem solving.
  • And this is against hospital policy. In particular policy #EMS.2 “Holding patient for observation” according to this policy it is clearly stated that observation hours for patient in ER should not exceed 3 hours.
  • from head of ER, head nurse, supportive maintenance, administrative, and CQI.
    - The purpose of project explained in detail to members. They enhanced to be logical, creative, and empowered to make contribution.
    Each member has a unique role in the project. For example: the role of head nurse was to provide Data regarding the total number of patient have visited ER per month. Supportive maintenance restructures the design of ER. CQI represent facilitate the team member requirement.
  • The expected outcome should match hospital policy to reflect hospital vision and mission.
    This graph shows the percentage of patient waited time exceeded 3 hours.
  • - submitted data by the ER head nurse.
  • Reviewing the trend of visiting ER showed increasing numbers of patient from month to month.

    increasing number of patients visit ER at the same time the availability of beds just 7 beds definitely that will impact waiting time.
    And Increasing in waiting time definitely will impact other aspect of health care.

    For instance, starting from triage room, we found non-adhere to hospital policy in triaging patient. Non-adherence to policy could be result from increasing patients’ numbers coming to ER. Deficiency in physician’s note was significant in triage form. Moreover, our study showed that delay in urgent and emergent lab result as well radiology report
  • As I mentioned before the goal of this projects was……………..
    And to achieve this goal we set our objective which is ………………………..
  • Second project conducted based on data from ER study and also , it was received 3 OVRs for delaying to release + Troponin I result. One of these OVRs, patient signed DAMA and discharged without treatment which mean it is affect patient safety.
  • Exceed more than 1 hours indicates that delay in proper intervention could impact lifesaving.
  • chart shows the percentage of sample taken duration more than 1 hour to release the result.
  • Under this circumstance, delay to analyze the result definitely will delay of releasing result and that will impact patient safety, in particular for urgent and emergent patient.
  • Point of care is small machine through it you can test troponin beside the patient, it is almost the same process of taken Glucocheck
  • All members were responsible to achieve the objective and each member has unique role.
  • As you see in this figure, the number of fall higher than expected
  • The scale which used to assess the patient was revised carefully.
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