Transcript Achieving Exceptional Safety in Health Care (AES)

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

The MBNQA Effort
 1990 - CQI model adopted
 1995 – MBNQA criteria added
 1999 – MBNQA applications
The Precursors of The MBNQA
 Strong, committed leadership
 Mission centered
 Perseverance
 Attention to MBNQA feedback
 Conviction that the pursuit made us better
SSMHC’s Mission
Through our exceptional health care services,
we reveal the healing presence of God
What MBNQA Means to SSMHC
 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”
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
Design
Collaborative
Prework
Send out
invitation
Learning
session #1
Team
formation and
data collection
Project work
and completion
AES
Active phase
Data collection
every 3 months
Learning
session #2, 3
Continuous
Improvement Phase
Conference
calls every 2
months
Secondary Prevention
CHF
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 collaborative
To have each entity adopt and implement
16 + recommended safety practices
3 year collaborative with 22 entities enrolled
Achieving Exceptional Safety in Health Care (AES)
16 + Recommended Practices
1. Implement a near miss reporting system
2. Eliminate dangerous abbreviations
3. Design and implement an accurate patient medication list at
admission and discharge and avoid "home" medication and
blanket orders
4. Implement an effective disclosure of unanticipated outcomes
process
5. Provide and use protocols for high risk medications
6. Implement a fall reduction process
7. Implement a sentinel event review process
8. Establish an entity Safety Center Team
yellow - upcoming collaborative recommended practice
black - recommended practice in progress
Achieving Exceptional Safety in Health Care (AES)
16 + Recommended Practices
9. Provide pharmacy rounding in ICU's
10. Implement all recommended safety information technology
advances
11. Implement 24 hour pharmacy coverage
12. Provide a quarterly "state of safety report"
13. Develop a protocol for proper timing of surgical antibiotic
prophylaxis
14. Institute a needleless IV system
15. Implement a protocol for glucose management of diabetic
patients undergoing surgery
16. Implement a surgical site marking procedure to avoid
wrong limb surgery
17. Effectively implement all JCAHO National Patient Safety
Goals
18. Improve hand washing
Achieving Exceptional Safety in Health Care
Percent use of DAs
Use of Four Dangerous Abbreviations
Ave. Performance of Collaborative Entities
25%
20%
15%
10%
5%
0%
Baseline Jan March, 02(19) June, 02(20) Sept, 02(18)
02(20)
Time of data collection
Eliminate “QD” for daily
Eliminate “U” for units
Eliminate trailing zeros
Use leading zeros
Dec, 02(19) March, 03(14)
SSMHC use of DAs
Good
Achieving Exceptional Safety in Health Care
Use of "QD" Instead of Daily
Ave. Performance of Collaborative Entities
Percent use of "QD"
70%
60%
50%
40%
30%
20%
10%
0%
Baseline
Jan02(19)
March, 02(18)
June, 02(17)
Sept, 02(14)
Dec, 02(13)
March, 03(12)
Time of data collection
SSMHC use of DAs
Good
Achieving Exceptional Safety in Health Care
Percent use of
"blanket orders"
Use of "Blanket Orders"
Ave. Performance of Collaborative Entities
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Baseline 2002 (14)
March '03 (16)
July '03 (17)
Time of data collection
SSMHC Use of blanket orders
Good
Achieving Exceptional Safety in Health Care (AES)
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.
90%
80%
70%
60%
SSM average
50%
Benchmark 00
40%
30%
8 new entities join
20%
Core measures
Benchhmark 02
10%
0%
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Percent of MI patients treated with LLA's
Secondary Prevention
Percent of MI patients treated with Lipid Lowering Agents (LLA's)
Average Performance of Collaborative Hospitals
Time of data collection
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 Prevention
Percent of MI Patients Discharged on Beta Blockers
Average Performance of Collaborative Hospitals
% MI patients discharged on beta
blockers
100%
90%
80%
70%
60%
Core measures
50%
SSM average
Benchmark00
Benchmark 02
JCAHO mean
40%
30%
20%
10%
better
0%
base
l
Ju
Dec.
Marc
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h, 02 une, 02 rd qrt02( thqrt02(9 stq rt03(1
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Time of data collection
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.
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