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  • QI Stories from the Field: Reducing Unnecessary Blood Tests in Detroit
    population of physicians in my institution and their laboratory orders decreased as well OS How did you identify a faculty sponsor or mentor and how did they help you succeed MC I was lucky enough to be paired with an excellent faculty mentor during the QI elective Dr Chase Coffey currently at Cedars Sinai in Los Angeles He served as my QI teacher and project coach He really pushed me during the initial phases of the project to get a solid understanding of what the problem was and what ways it could be addressed My other project mentor Dr David Paje of Henry Ford Hospital in Detroit has aided me in previous projects and fit in perfectly to help me expand this project He got me in touch with additional resources within the hospital that were essential for project growth OS What was the biggest surprise in doing the project MC The biggest surprise during the project was understanding how big a simple problem actually was and how many people it affected Laboratory orders are a seemingly simple problem But by investigating them at the ground level I saw how much nursing time technician time lab expense and potential patient harm was occurring OS What was the most gratifying part of the doing the project MC The most gratifying part of the project was seeing how focused time and effort really can make a difference in patient care in a timely fashion I had previous experience with clinical research where you would find a significant outcome but its direct effect on patients either was not clear or would not be seen for some time QI work let me see how quickly health care delivery can be improved OS What did you learn from working on an interprofessional team MC Working with other healthcare professionals who were not physicians allowed me to get a better grasp of everyone s role in patient care I also had the opportunity to meet personnel I would have not otherwise encountered if I was not on the project OS If you had the chance to start your project all over again today what would you do differently MC I would do nothing differently at the onset I learned so much and the initial phases went so well that I can t think of anything to change During my third PDSA cycle I would have made the design more QI oriented rather than setting it up as strict research design with a control I feel I lost the opportunity to impact more physicians and it limited my ability to give continued feedback during the intervention OS How will the improvements you made be sustained over time MC Sustaining the effect of the improvement over time will be difficult My project encourages changes in ordering and documentation practices which takes a large amount of buy in from the target audience of physicians I believe with the next PDSA cycle which will include a stronger feedback mechanism there

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=162 (2016-02-01)
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  • Measuring Patient Safety: How Far Have We Come?
    of care Are our clinical sy stems and processes reliable Reliability has two key components when it comes to building safer systems the reliability of the safety of critical processes and systems themselves and the capacity of staff to reliably follow critical safety procedures Standardization and simplification of processes are foundational design elements for more reliable safer systems Experience also tells us that a one size fits all process design does not ensure reliability and safety thus the approach of segmenting patients into groups enables care teams to design less complex processes that are safer and more reliably meet the needs of specific patient populations Is care safe today Teams need access to data and the capacity to monitor safety on an hourly or daily basis Vincent and colleagues refer to this as sensitivity to operations How aware are staff of daily safety issues that may arise Methods such as Patient Safety Leadership WalkRounds daily huddles and safety briefings and debriefings are helpful in identifying potential safety issues and opportunities for improvement Situational awareness that is identifying problems before they happen so they may be prevented is another crucial method for improving reliability and safety Will care be safe in the future The ability to anticipate and be prepared for problems and threats to safety is key to preventing them Case studies safety culture assessments and anticipating staffing levels and skills are all methods that help teams assess and prevent potential safety issues Are we responding and improving This question speaks to the capacity of an organization to detect analyze integrate respond and improve from safety information Aggregate analysis of safety incidents claims and complaints feedback from clinicians and identifying areas for improving safety and tracking the rate of improvement over time all help inform teams about opportunities to build safer more reliable processes and systems The framework that Vincent describes provides one possible pathway to becoming a high reliability organization There are no shortcuts to becoming a high reliability organization leaders and clinicians need to recognize that this is a journey that takes time Is 15 years too long to expect vastly safer care systems Yes Why have we not been more successful in making care safer We re looking for the quick fix rather than recognizing it s a journey Is anyone getting it right consistently To ensure system wide safety organizations must implement safe practices in all units and all sites read more in Carol Haraden s blog on The Elusive Coverage and Completeness Do you think we have made progress in making health care safer How do you know Please share your thoughts in the comments section below Tags Patient Safety Reliable Processes WalkRounds Patient Safety Leadership WalkRounds Trigger Tools Blog Home Older Average Content Rating 0 user Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments by Douglas McCarthy 3 28 2015 2 12 37 PM Frank in a series of case studies for

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=0f316db6-7f8a-430f-a63a-ed7602d1366a&ID=45 (2016-02-01)
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  • Tips for Transitioning to Bundled Payments
    teams to discuss potential new opportunities We are trying to be innovative and do things differently An example of this is our joints travel program This is an agreement that means employers pay the expenses for patients to travel to Johns Hopkins for their joints procedures This contract has been active for a year and has resulted in more volume than anyone anticipated Q How did you handle the unexpected level of interest One of the most effective things we did was create a weekly operations team meeting We would most often meet in person and hash out the areas and processes where we were not meeting the requirements of the program We worked together as a team to determine the most efficient and effective way we could organize each step of the entire process Q How did you approach breaking down the process We were participating in the IHI Joint Replacement Learning Community initiative offered by IHI and the Harvard Business School The Joint Replacement Learning Community JRLC provided us with the structure to break down the episode of care so we could look at each phase of the joint replacement process individually I think if you try to look at the entire episode of care you will have a difficult time determining where to start Q Most of the focus on bundled payments has been on reducing costs but are there also benefits to patients I think the benefit for patients is that we have streamlined and consolidated the care We also now have this very clear care plan that we articulate to patients prior to surgery so they know what to expect You will come here on this day This is what will happen You can expect the hospital to discharge you on day two You will start physical therapy the day of surgery We are also closely monitoring outcomes Q What are your top three tips for other organizations making the transition to bundled payments You have to have a physician champion who really wants to do this and change the way we deliver care I also think you need to have an integrated multidisciplinary team that is willing to look at the care process differently and work together to implement change If you have a group that s resistant to change and doesn t work well together it s not going to happen You also have to have access to some type of analytics That should include not only financial information but outcome data as well so you can evaluate cost as well as outcomes Q Why do you think it s essential to have a physician champion in particular Physicians really are the main interface with the patient Also in a physician driven organization you need the physicians on board or ch ange is not going to happen Obviously it takes more than physicians to make big changes but I think physicians have to be part of it Q How did you engage all

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=120 (2016-02-01)
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  • Meet a Regional Leader: Five Questions for Jo Inge Myhre, MD
    Leader series on this blog We started with Sarah Miano RN in the Midwest US and today we bring you five questions for Jo Inge Myhre MD who supports Continental Europe from Oslo Norway 1 Why did you go into health care Good question I m not sure to be honest My godmother was a nurse who worked in the offshore industry and I always admired her but where my fascination came from I m not really sure At one point I was considering studying botany but my biology teacher told me that it was easier to have plants as a hobby in comparison to taking care of sick people and that made sense 2 Why does quality improvement matter to you I have been working on improvement since I started medical school and for me it is a crucial part of health care Constantly improving the system we work in is an obligation for all health care professionals We can t continue making the same errors over and over again and keep working in broken systems 3 What was your best moment with the Open School community I remember when our local Chapter was invited to help with the translation of the WHO Surgical Safety Checklist into Norwegian It was such a weird moment to actually get recognition as a student for the work we had been doing I also have many Forum experiences The greatest was probably the first Asia Pacific Forum on Quality Improvement in Health Care in New Zealand were a local group of students had done an amazing job to put together a great student program The discussions we had were just amazing 4 Tell us something that most people don t know about you I have a thing for studying on public transportation In my last semester of medical school I was absolutely sure that I was going to fail so I figured I needed massive doses of traveling time This resulted in trips to San Francisco the Dominican Republic Paris and Estonia in my last five months of med school I m still positive that s what got me through in the end 5 What one piece of advice would you give a new Chapter Find some friends and if you make an event always plan for the next one If you get people interested you need to give them some sort of follow up Say hello to Jo Inge at ce ihi openschool at gmail com Tags Chapter Network Leadership Regional Open School Leader Blog Home Older Average Content Rating 0 user Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments Show More Comments Loading You are about to report a violation of our Terms of Use All reports are strictly confidential Reason Select One Contains profanity or violence Spam Defamatory Illegal Unlawful Copyright Violation Other Please select a reason for this report Add a Note Your comments were submitted successfully

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=161 (2016-02-01)
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  • Advanced Measurement Techniques in Improvement Work
    infection reduction bundle or timely administration of antibiotics prior to surgery B alancing measures provide feedback on whether the changes are resulting in unintended consequences elsewhere in the syst em For example length of stay or patient wait times Typically improvement work is informed by a well established method such as the Model for Improvement or Lean principles These approaches use rapid cycle testing e g Plan Do Study Act PDSA or Plan Do Check Act of the change ideas over time For improvement teams to know whether the changes are yielding improvement we must provide rapid feedback based on the analysis of time ordered data and measures e g run charts or control charts The measurement for improvement methods described above are greatly simplified In reality developing and applying effective improvement measurement requires discipline patience and careful coordination between improvement specialists and subject matter experts For example it can be all too tempting to do the following Suggest collecting data o n one more measure because we think it is interesting and risk overburdening the improvement team Create ambiguous measurement definitions and end up with incompatible measures across similar settings within an organization Claim success based on one month of great data and see the results regress the following month Celebrate improvement in a process measure but see no change in patient outcomes or Provide an elaborate risk adjustment measure but have teams struggle to interpret it In developing effective measurement systems for improvement here are some helpful steps Develop an aim statement Think about what you are trying to accomplish the outcome measure that best captures the aim of your improvement project the baseline level of performance on the outcome measure and how much the outcome needs to improve Develop an improvement theory Construct a driver diagram to help capture the factors that will drive improvement in your system and the changes that need to occur to achieve the aim then prioritize which drivers to work on Identify process outcomes and balancing measures You need to measure all three Measures and key terms must be defined carefully to ensure they are applied consistently over time and comparably across settings Develop a system for collecting data Data should be available for examination as soon as possible after changes have been tested so you can understand their context and what they mean The data is most useful when gathered by the people who are doing the work at the point of care Analyze and display the data Use tools like histograms Pareto charts run charts and control charts For example plotting data over time using a run chart using annotations to indicate the changes being made is an effective way to determine whether the changes you are making are leading to improvement Interpret the data Use the data to identify where successful changes can be tested more broadly or where challenges suggest the need for more small scale testing Communicate the results Share data on key measures regularly and in

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=119 (2016-02-01)
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  • Dispatches from Las Vegas: Improving Diabetes Management
    to assert their own ingenuity and creativity in serving their patients Create standardized resources and share best practices among all health coaches at Culinary Extra Clinic In my second week here I tried to better identify some of the challenges we were having with diabetes management Two medical residents who preceded me in improving diabetes care here had completed individual chart reviews analyzed diabetic population data to determine health coach and practice wide trends and interviewed health coaches and clinicians I pored over the results of their work and identified a few areas for improvement Proactive adjustment of patients insulin dosage Unlike pills insulin is prescribed in different amounts for each patient depending on their individual response Normally patients wait for weeks between appointments to have their insulin dosage adjusted Aggressive management allows patients to be on just the right amount of insulin much more quickly which mitigates the risk of end organ damage due to high sugars Transitioning uncontrolled diabetics on three oral medications to insulin which can better control their blood sugar Medication adherence plans that are sensitive to difficult work schedules Consistent and timely care for other diabetic concerns i e foot exams management of blood pressure and cholesterol vaccines etc Patient education on diabetic diets that is culturally sensitive Patient education on easy exercise and fitness strategies We ve also assembled an execution team and recruited some health coaches who have agreed to test our changes My wonderful execution team includes health coach Alejandra Sandoval Dr Ali Khan and operations coordinator Karina Bocker Some of the interventions that we will be testing in the next few weeks include Creation of a diabete s specific worry list Each health coach will manage their own list of diabetic patients that are identified as having uncontrolled diabetes and are engaged with the clinic With limited resources and so many diabetic patients the Culinary Extra Care Clinic invests in patients who have shown interest in the clinic and in improving their health Weekly diabetes office hours Providing health coaches with uninterrupted time each week that will be dedicated to calling patients and following up with medication and lifestyle management Before health coaches made these calls but didn t have dedicated time to do it Diabetes Curriculum Creation of standardized resources on important diabetes education topics that health coaches will walk through with each patient on a weekly basis Patient Diabetes Passport We re introducing this health journal to help stimulate patient engagement in the diabetes program and active management of their own diabetes This will be a centralized resource that patients can refer to as well as record positive behaviors Ultimately this tool will also provide health coaches with data on areas for improvement in patient education and behavior We have recruited three wonderful health coaches who are brave enough to join us on this beta testing journey Barbara Jeannette and Roni W e have also finalized the Diabetes Curriculum and the standardized resources for health coaches and have developed

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=160 (2016-02-01)
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  • Medication Reconciliation: New Tools and Strategies
    The tool came out of a pilot project that ran from January 2014 to July 2014 in which volunteer care transitions communities evaluated their internal anticoagulation related communication practices upon patient discharge to the next provider The tool contains audit criteria questions drawn from a range of evidence based resources It includes questions like Is there an indication for use and if the drug is used for short term therapy say for example warfarin post surgery Is there a stop and end date The hospital and the nursing homes in the pilot project demonstrated statistically significant improvement We re now going to apply this process to the rest of our care transitions communities for the rest of the scope of work and also expand to other high risk drugs like opioids and hypoglycemics and possibly antibiotics This tool is essentially to improve communication Would you talk about communication as an overarching medication reconciliation issue We want clear concise communication that not only provides information but can lead the next provider to the correct clinical steps to avoid adverse events We don t want a 50 page booklet right We aim to standardize this communication process in all of our care settings within our care transitions communities Another important part of communication is patient and family engagement For example when the patient enters the hospital ED and they have a paper artifact like their medication list or their Medical Orders for Life Sustaining Therapy MOLST what happens to that piece of paper Do you have a process for entering it into the medical record so a clinician can act upon the information in a timely manner If not you re not listening to the patient and the patient has something important to say Once you have a comprehensive medication management system and you have staff trained in the medication reconciliation process then the process will move more smoothly Organizations can solve these problems but you need intensive effort and executive level leadership to remove barriers and improve processes In some cases there is disagreement about who should ultimately be responsible for medication reconciliation How should that be determined The question is how do you determine who is responsible for medication reconciliation if nobody s responsible Some might say I don t have time for it Others might say I know it makes sense but I have to do x y z instead Organizations that do medication reconciliation well create a quality improvement program around the process The literature and resources like the MARQUIS Implementation Manual and the and the MATCH Toolkit recommend that organizations develop a charter and garner executive leadership immediately The charter should clearly delineate roles responsibilities and accountability You ll have your clinical champions who are nurses on the unit pharmacists on the unit and other clinicians You might have a social worker You ll have IT You ll have a lot of people who have clear roles and responsibilities outlined in that charter If you want to do medication reconciliation correctly you have to start with a medication management process This material was prepared by the Institute for Healthcare Improvement in collaboration with the Atlantic Quality Innovation Network IPRO The Atlantic Quality Innovation Network IPRO is the Medicare Quality Innovation Network Quality Improvement Organization for New York State South Carolina and the District of Columbia under contract with the Centers for Medicare Medicaid Services CMS an agency of the U S Department of Health and Human Services The contents do not necessarily reflect CMS policy 11SOW AQINNY TskC 3 15 08 Tags Medication Safety Adverse Drug Event ADE Medication Reconciliation Patient Safety Quality Improvement Communication Blog Home Older Average Content Rating 0 user Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments by Sandi Burkinshaw 6 1 2015 12 51 07 PM I really enjoyed this article The thing that stuck out most in my mind was the author pointing out that rather than med rec being a just check list that has to be completed with no one taking complete responsibility for it this process needs to be done by a trained professional that has received training on how to do it correctly The safety and well being of our patients depends in part on us doing a thorough med rec loading Did you find this user comment useful people found this user comment useful Report This by Sophia Galgiani 5 30 2015 3 33 09 PM I am extremely nervous about medication reconciliations In practice I have seen so many medical errors It is scary because our patients are not even familiar with the medications that they themselves are taking I am looking forward to the EHR to be implemented strictly nationwide so that we can practice safe care constantly If a patient moves or switches practitioners this would be make the transition seamless In my practice I hope to adopt an APP that my patients can download and keep an update med rec with them at all times I also would like to educate my MA s about following up with patients med lists after they have left the hospital loading Did you find this user comment useful people found this user comment useful Report This by Jana Burningham 5 30 2015 12 52 19 AM I also agree with all of the comments that have been made This article is a great way to get more people realizing the importance of medication reconciliation As the article states med rec s can reduce the rate of readmissions This can be a huge savings to a hospital with the new ACA laws about readmissions and not covering these costs It would be very prudent to do all we can to help reduce the rate of readmissions and help keep patients safer in the process loading Did you find this user comment useful people found this user comment useful Report This by Sarah Roberts 5

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=0f316db6-7f8a-430f-a63a-ed7602d1366a&ID=44 (2016-02-01)
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  • How to Minimize the Risks of the “New” Anticoagulants
    IHI Expedition on Improving Medication Safety from the Patient s Perspective We constantly search for new technologies and new medications to improve the care we deliver Warfarin the most widely used anticoagulant in the world has been around for about 60 years As beneficial as it can be warfarin also causes many adverse drug events and hospitalizations most commonly from bleeding And warfarin s interactions with other drugs and foods can negatively affect its mechanism of action Care providers must monitor patients regularly to ensure their INR short for international normalized ratio a measure of coagulation is within range The frequency of this monitoring is a burden to both patients and the health care system However without this monitoring we run the risk of either over or under coagulating patients which results in harm The search for safer anticoagulants has resulted in a new group of drugs i e Factor Xa inhibitors and direct thrombin inhibitors which are supposedly safer and do not require monitoring The new drugs claim to be less risky to patients than warfarin Yet there have been a number of reports of patients harmed while using these medications The Quality and Patient Safety Division of the Commonwealth of Massachusetts Board of Registration in Medicine recently issued an advisory on the New Anticoagulants In addition to offering case examples with lessons learned the advisory recommends five areas for which health care providers should develop processes to minimize the opportunity for harm These include Stroke and bleeding risk assessment Recommendations includ e patient engagement and communication among providers Patient characteristics and choice of anticoagulation therapy Particular attention should be paid to different modes of action and especially vulnerable patient populations Non adherence or poor medication adherence Caregivers must consider potential barriers to adherence in the outpatient setting Managing

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=0f316db6-7f8a-430f-a63a-ed7602d1366a&ID=43 (2016-02-01)
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