Transcript Tracer Methodology

Tracer
Methodology
TIPS AND STRATEGIES FOR CONTINUOUS
SYSTEMS IMPROVEMENT
Frontline Strategies to Prepare for JCI
Accreditation
Col. Dr. jamal Hommadi
CQI&PS Ditrector SR
Objectives
O Understanding Tracer
O
O
O
O
Methodology
Evolution of tracer methodology
Tracer Methodology and the
Survey Process
Tracer Methodology and its Role
in Continuous Systems
Improvement
Types of tracer methodology
process
The hypothesis is:
If we look at health care as a
series of systems and
subsystems, and identify the
“defects” within the system(s),
errors causing patients harm
will be reduced
The method is:
Method of identifying
“broken” systems
is through the use of
tracers
Introduction
O The
Joint Commission’s accreditation
process focuses on operational systems
critical to the safety and quality of care
received by those navigating the health care
system.
O The goal is to ensure that an organization is
always meeting the requirements of
accreditation by providing ongoing, highquality care at all times—not just during an
on-site survey period.
Introduction
O This represents a shift in how health care
standards are assessed.
O In the past the goal was to “ramp up” for a
survey, and got a periodic “snapshot”
picture of an organization.
O Now the focus is on continuous systems
improvement through an unannounced
survey* and Periodic Performance Review,
that incorporates tracer methodology as its
primary evaluation tool.
TRACER
METHODOLOGY
O Tracer methodology is an evaluation method
in which surveyors select a patient, resident
or client and use that individual’s record as
a roadmap to move through an organization
to assess and evaluate the organization’s
compliance with selected standards and the
organization’s systems of providing care and
services.
TRACER
METHODOLOGY: An Evolution
O Roots in science- emerged in the early twentieth
century: Used by scientific researchers.
O The tracer methodology or tracer approach in
Healthcare was introduced in the early 1970’s by
Kessener and Kalk (1973)
O In January 2004, JCAHO redesigned their
accreditation process by implementing Tracer
Methodology Shared Visions –New Pathways ®
TRACER KEY
O Flexibility is the key to the tracer process,
which typically allows the tracer to
“observe”, “walk”, “talk”, “survey”, “analyze”
and “report” that provides a “multidimensional” picture of an organization’s
processes and services; rather than a
“snapshot” picture, and a “dynamic” survey
rather than a “ramp up” survey.
Types of Tracers:
Within this methodology, surveyors conduct
the following types of tracers:
O Individual tracers
O System tracers (data use, medication
management, and infection control)
O Program-specific tracers
O Environment of care tracer (emergency
management), (for hospitals only)
Tracer Methodology
Individual Tracer
Individual tracers:
patient tracers,
resident tracers,
client tracers)
System Tracer
Program Specific Tracer
MMS Tracer
Ambulatory care
ICS Tracer
Behavioral care
DUS Tracer
Critical access
Home care
Hospital
Laboratory
Long Term
Environment Tracer
Environment of care
tracer (emergency
management), (for
hospitals only)
INDIVIDUAL TRACERS
O Individual tracers (also called
patient
tracers,
resident
tracers, or client tracers).
O To select individuals to trace,
surveyors consider the CSGs and
at least the top four priority focus
areas (PFAs) for an organization.
Tracer Conduction
To conduct the tracer, the surveyor might do the
following:
O Interview staff delivering care, treatment, and
services to the tracer individual, as needed.
O Evaluate PFAs
O Evaluate the environment, if applicable
O Review the record for clarification and
confirmation of information
O Interview the care recipient and family, if
appropriate or applicable
SYSTEM TRACERS
O The system tracer activity focuses on high-
risk processes across organizations.
O The concept behind the system tracer
methodology is to review processes at the
organization; by examining a set of
components that work together toward a
common goal.
O The surveyor can evaluate how and how well
the organization’s systems function.
SYSTEM TRACERS TYYPES
There are currently three types of
individual-based system tracers:
O Medication management system tracer.
O infection control system tracer.
O Data use system tracer.
Note: Only organizations with surveys of three days’ length or
longer will have the medication management and infection control
system tracers. For organizations with surveys of shorter duration
(such as one- or two-day surveys in ambulatory care or behavioral
health care settings),
A system tracer generally includes an interactive discussion
between a surveyor and relevant staff members. Points of
discussion can include the following:
O The flow of the process across the organization, including
identification and management of risk points, integration of
key activities, and communication among staff and units
involved in the process
O Strengths in the process and possible actions to be taken in
areas needing improvement
O Issues requiring further exploration in other survey activities
O A baseline assessment of standards compliance
O Education by the surveyor, as appropriate
Data Use
O The focus of the data use system tracer is
straightforward: How does the organization
use data to improve safety and quality of
care?
O To determine the answer to this question,
organizations can expect to discuss with
surveyors how leadership uses data to
prioritize decision making to improve quality
of care and patient safety.
Within that context, surveyors talk with organizations about the
following topics:
O Current and past performance improvement activity
O Type of analysis conducted
O Data reporting—when it occurs and to whom
O Actions taken as a result of using data
O Dissemination of findings and involvement of affected staff
O Reporting to leadership for prioritization and decision making
O Performance issues
O Approach to assessing staffing effectiveness and use of these
data and information
Médication Management
O The
objective
of
the
medication
management system tracer is to evaluate
the continuity of medication management
processes and complete a high-level
analysis of the medication management
system.
O Surveyors track medication processes and
handoff points, asking staff to explain,
“Where does the medication ‘go’?” “Why do
we do what we do?” and “What systems
touch a care recipient?”
To get a better understanding of an organization’s medication
management system, surveyors might discuss the following
topics:
O Medication processes,
O International Patient Safety Goals and the organization’s
medication use system
O Reporting of errors, system breakdowns, or near misses
O Medication education for patients and staff
O Information management related to medication management
O Data collection and analysis,
O Review of risk points, symptoms, and related issues
O Care recipient involvement as part of a medication
management team
Infection Control
O In examining how an organization addresses
its infection control and prevention,
surveyors trace a broad range of activities to
assess compliance with relevant infection
control standards.
Possible discussion topics can include the following:
O How patients with infections are identified by the
organization
O How patients with infections are considered within the
context of the infection control system
O Current and past surveillance activity—taking place in
the past 12 months
O Actions taken as a result of surveillance and the
outcomes of those actions
O Type of analysis conducted on infection control data,
including comparisons
O Reporting of infection control data—when it occurs and
to whom?
O Observation of infection control techniques (aseptic,
sterile, surgical, and so forth)
O Prevention and control activities
O Infection control data aggregation and analyses
O
O
O
O
O
O
trending
Physical facility changes that have an impact on
infection control, if applicable
International Patient Safety Goal compliance
Sterilization,
disinfection,
food
sanitation,
housekeeping, …etc.
Role and activities of the organization’s infection
control officer
Written infection control plan
How organization functions are integrated into the
infection control plan
PROGRAM-SPECIFIC
TRACERS
O As of January 1, 2007, surveyors began
conducting program-specific tracers during
on-site surveys.
O This was specifically implemented for the
ambulatory care, behavioral health care,
critical access hospital, home care, hospital,
laboratory, and long term care settings
Program-specific tracers bring a targeted focus on
important issues relevant to the following
information:
O Types of services offered by the organization
O Programs being surveyed
O The organization’s PFAs
O Centers for Medicare & Medicaid Services deemed
status/recognition requirements
TRACING THE
ENVIRONMENT OF CARE
O The EC session of the on-site survey is often
divided between group discussion on
managing risk in the organization’s
environment
(30%)
and
surveyor
observation and evaluation of the
organization’s performance in managing EC
risk (70%).
Tracer Data Form
Map of Tracer – Example on a Cardiac Stent Patient
Date: __5/19/014__________ Medical Record Number:_123456____ Hospital: _General Hospital, AZ___ Surveyor:__John Doe________
Clinical Service Group:__Cardiology__________ Rationale for Tracer Selection: _PFP identified 2 points for this CSG______________
Site (START)
Start & End at same site to recap
& validate findings with several other records
Cardiac Care
Unit
Site (END)
Cardiac Care
Unit
Standards Interface
Participants
Participants
Activity
Review open
medical record
to map-out
tracer
Charge Nurse
Attending MD
Staff nurse
Patient educator
Case manager
Cardiac Rehab RN
Attending MD
Survey Methods
- Staff interviews
- Patient interviews
- Medical Records
- Review of
educational materials
Site # 1
Site # 2
Emergency
Dept.
Cath
Lab
Standards Interface
Advance directives
Assessment
PI initiatives, ORYX
Med Use
Leadership
EC issues
Participants
Nurse
supervisor
Survey Methods
- Interviews
- Medical Record Entries
Education
Rights
Continuum
Pain management
Medication use
Assessment
EC issues
Standards Interface
Verbal orders
Informed consent
Assessment
PI initiative
Med Use
EC issues
Participants
Staff nurse
Attending MD
Survey Methods
- Interviews
- Assessment Forms
Map of Individual Tracer
1. Current Location of the Patient
Assessment and care
Medication process
Verbal orders
Screening for nutrition, rehabilitation,
fall, and skin
Pain assessment and control
Patient education
Discharge planning
Staff competency
2. Emergency Room/Preadmission
Triage Process
Assessment and reassessment
Communication with laboratory
and radiology
Medication process, especially
high-risk IVs
Hand-off process
3. Radiology: Patient Had
X-ray
Assessment and
reassessment
Communication with
laboratory and radiology
Medication process,
especially
high-risk IVs
Hand-off process
7. Physical Therapy (Patient
Rehabilitation)
Referral process
Assessment and reassessment
Goal setting (long-term, short-term,
and patient goals)
Patient and family education
Pain assessment and
documentation
Discharge planning
Patient Information
Area of Focus/Presenting Symptoms
Moist lungs, Decreased activity tolerance,
Fatigue, Shortness of breath
History
Congestive heart failure, Coronary artery disease,
Cardiac catheterization, Stent placement
Admission
To Emergency department, Intensive care unit
4. Laboratory
CBC
Data collection and trending
Chemistry profile
Critical test results
6. Pharmacy
Identification of high-risk drugs
and safety measures
Reconciliation process
Data regarding the use of
these drugs
Education regarding medications
Involvement in discharge planning
5. Intensive Care Unit (ICU)
Communication from emergency
department
Emergency department admission delays
Assessment and reassessment
Medication process
Verbal orders
Critical equipment alarms
Informed consent and education
on procedure
Conclusion
O Flexible and adaptive
O Interactive and dynamic instead of ramp up
survey.
O Multi-dimensional
picture instead
snapshot picture for the organization.
of
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