PLAN standards and writing to patients: quality improvement by audit

AimsThis quality improvement project aimed to assess the adherence of a hospital psychiatric liaison team's documentation of assessments to the Psychiatric Liaison Accreditation Network (PLAN) standards framework; to identify areas of improvement; to identify barriers to and improve adherence.MethodData were extracted from 27 randomly selected patient assessments from 01/07/2020 to 31/08/2020 and then 27 assessments from 01/10/2020 to 30/11/2020 for re-audit.Quantitative data was collected by calculating the percentage of assessments which documented each specific aspect of PLAN standards.Qualitative data including attitudes specifically towards writing to patients was gathered from 1:1 discussions with members of staff.Interventions between rounds of audit:Presentation of results of 1st data collection to team in November 2020 followed by discussionEmailed instructions to create a template based on PLAN standards for assessments to staffLobbied for Cerner access at liaison team office to facilitate use of aboveResultQuantitative – overall improvements were seen in adherence to all aspects of documentation of assessments including collateral history (from 23% to 67%) past medical history (30% to 70%) and acknowledging the patient/carer perspective (46% to 74%). Some improvement was seen in offering written correspondence to patients (0% to 20%).Qualitative – the majority of comments regarding writing to patients were positive, with no staff members opposing the standard (“it is best practice”, “should become a habit”). However, some barriers were identified including increased workload (“requires more editing”, “could take a lot more time”).ConclusionTeam adherence to PLAN standards for documentation of assessments was improved through low intensity interventions. Overall adherence was high, however certain areas leave space for improvement. The audit facilitated conversations around writing to patients on discharge, both in the form of formal gathering of qualitative data and informal discussions between staff. Attitudes towards writing these letters were positive and some improvement was seen between audits. Ongoing audit activity aims to further improve adherence and monitor improvements.

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Assessing Nurses’ Knowledge of Noise in the Intensive Care Unit: An Educational Intervention Project

10.28971/532021fj114 ◽

2021 ◽

Author(s):

Jennifer Fortes

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Quality Improvement ◽

Educational Intervention ◽

Quality Improvement Project ◽

Minimal Risk ◽

Improvement Project ◽

Staff Members ◽

Nurses Knowledge

Noise in the intensive care unit (ICU) has been studied for over thirty years, but it continues to be a significant problem and a top complaint among patients. Staff members are now reporting detrimental health effects from excessive noise. One of the significant factors of inadequate noise control in the ICU is that nurses have insufficient awareness regarding the hospital noise issue and its negative impact on health status. The level of knowledge of clinical staff on the topic of noise is not known. A quality improvement project to explore noise in the ICU could facilitate better understanding of the phenomenon and formulation of new ways to continue to reduce noise at a community hospital in Massachusetts. The purpose of this quality improvement project was to evaluate nurses’ knowledge of the potentially harmful effects of noise on patients as well as on nurses, to identify opportunities for improvement of the environment, and to conduct an educational intervention aimed at reducing noise in the intensive care unit. The methodology for this project included a pre-test, followed by an educational session, and completion of a post-test. The participants included registered nurse staff members in the Intensive Care Unit (ICU) and the Critical Care Unit (CCU). Exclusion criteria included staff members who are not registered nurses. The project posed minimal risk. No identifying or biographical data was collected, and results included analysis of aggregate data. Descriptive statistics were used to assist with analysis. Results were disseminated to the staff of the ICU and CCU, posted on a bulletin board in the critical care area, presented as a poster presentation at the Spring RIC MSN Symposium, and available as a manuscript on the RIC Digital Commons.

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Managing Access by Generating Improvements in Cannulation: A national quality improvement project

The Journal of Vascular Access ◽

10.1177/1129729820939334 ◽

2020 ◽

pp. 112972982093933

Author(s):

Catherine Ann Fielding ◽

Scott William Oliver ◽

Alison Swain ◽

Alayne Gagen ◽

Sarah Kattenhorn ◽

...

Keyword(s):

Quality Improvement ◽

Best Practice ◽

Quality Improvement Project ◽

Practical Implementation ◽

Improvement Project ◽

The United Kingdom ◽

National Quality ◽

Arteriovenous Access ◽

Structure Improvement ◽

Improvement Method

Cannulation is essential for haemodialysis with arteriovenous access, but also damages the arteriovenous access making it prone to failure, is associated with complications and affects patients’ experiences of haemodialysis. Managing Access by Generating Improvements in Cannulation is a national UK quality improvement project, designed to improve cannulation practice in the United Kingdom, ensuring it reflects current needling recommendations. It uses a simple quality improvement method, the Model for Improvement, to structure improvement to cannulation practice. It assists units in the practical implementation of the British Renal Society and Vascular Access Society of Britain and Ireland needling recommendations, ensuring actual cannulation practice reflects what is defined as best practice in cannulation. An eLearning package and awareness materials have been developed, to assist units in changing their cannulation practice. The Kidney Quality Improvement Partnership provides a structure for Managing Access by Generating Improvements in Cannulation that promotes development and dissemination. It is hoped that Managing Access by Generating Improvements in Cannulation will raise an understanding about the cannulation of arteriovenous access and change behaviours and beliefs around correct cannulation practice, to ensure longevity of this lifeline.

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Norris Cotton Cancer Center (NCCC) neuro-oncology glioma tumor quality improvement project.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.137 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 137-137

Author(s):

Evelyn Schlosser ◽

Camilo E. Fadul ◽

Jennifer Snide ◽

Karen Homa

Keyword(s):

Quality Improvement ◽

Best Practices ◽

Poor Performance ◽

Individual Case ◽

Primary Brain Tumor ◽

Tumor Board ◽

Cancer Center ◽

Improvement Project ◽

Staff Members ◽

The Individual

137 Background: Glioma patients represent 30% of the primary brain tumor population at NCCC, and often require surgical intervention prior to medical management. In order to ensure coordinated, comprehensive and timely care, reliable referral to the neuro-oncology program is needed. Earlier quality improvement efforts identified 10 best practices designed to facilitate referral into the neuro-oncology program, though over the years these practices lapsed. A manual record review of 2010 cases revealed 43 glioma patients, of which compliance with best practices ranged from 29% to 93%, and none of the patients had all best practices when indicated. Additionally, the percentage of 9 out of the 10 best practices (excluding post-operative order sets) completed for all consecutive patients from January 2010 to May 2011 was 63%. Methods: A project was chartered by leadership and a multidisciplinary team was convened twice a month from May to October 2011. The team was organized into three groups (entry into the system, surgical, and post-op care, and continuing care) and assigned a coach with instructions to flowchart the current processes and identify factors that contributed to poor performance. The three process maps were then combined to create one system map by which the team brainstormed improvement ideas to pilot. Results: Concurrent review of the individual case-level data during the project team meetings was helpful in identifying process weaknesses as changes were being piloted. Performance of best practices improved significantly when measured several months following completion of the project; furthermore, best practices completed for consecutive patients from June 2011-May 2012 was 87%. Conclusions: The team was challenged to identify changes in process that were not dependent upon individual providers/staff members and that took advantage of a newly implemented electronic medical record. Manual chart abstraction was replaced by electronic data abstraction. Sustained measurement and reporting of performance is essential and has been incorporated into the Neuro-Oncology Tumor Board meetings on a quarterly basis.

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Abstract 267: A Single-page Best Practice Algorithm Reduces Stroke Risk and Improves Arrhythmia Management Decisions in Patients With Acute Atrial Fibrillation: A Quality Improvement Project

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.11.suppl_1.267 ◽

2018 ◽

Vol 11 (suppl_1) ◽

Author(s):

Edd Maclean ◽

Shreena Patel ◽

Olaminposi Joseph ◽

Daniella de Block Golding ◽

Samantha Maden ◽

...

Keyword(s):

Atrial Fibrillation ◽

Quality Improvement ◽

Best Practice ◽

Stroke Risk ◽

International Standards ◽

Quality Improvement Project ◽

Management Decisions ◽

Improvement Project ◽

Management Algorithm ◽

Arrhythmia Management

Objectives: In response to a serious incident involving an atrial fibrillation (AF) associated stroke, a quality improvement project was established to examine and abrogate unnecessary thromboembolic risk in patients presenting with acute AF to London’s North Middlesex University Hospital (NMUH). Methods: The presenting complaint was examined for 2,105 consecutive medical admissions to identify 100 patients (4.7%) with acute AF. For each patient, 36 indices and performance indicators were collected and analysed against international standards and the collective best practice of the local Cardiology team. Deficiencies were identified throughout the inpatient experience, including documentation, risk stratification, anticoagulation and arrhythmia management decisions. With cross-specialty collaboration, a single-page AF management algorithm was subsequently established using sequential PDSA methodology, and following its introduction a further 100 consecutive patients with acute AF were analysed prospectively. Results: Algorithm implementation significantly reduced the proportion of patients exposed to unnecessary stroke risk (30% -> 4%, p<0.0001); improved identification and documentation of thromboembolic potential (50% -> 88%, p<0.0001), reduced incorrect drug decisions (12% -> 2%, p=0.01), reduced contraindicated rhythm control (8% -> 0%, p=0.007), and increased direct oral anticoagulant (DOAC) prescribing (38% -> 86%, p<0.0001) over warfarin. There was a trend towards reduced mean inpatient stay (4.7 -> 3.5 days, p=0.11). Conclusions: Using established quality improvement methodology and cost-neutral multi-disciplinary expertise, this novel management algorithm has significantly improved the quality and safety of care for patients with acute AF at NMUH. Prospective analysis of long-term adverse outcomes is now required to establish morbidity or mortality benefit.

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Abstract 34: Kentucky Stroke Encounter Quality Improvement Project Statewide Collaboration to Improve Alteplase Utilization, Decrease Door to Needle Times, and Impact Outcomes: A 10 Year Review

Stroke ◽

10.1161/str.51.suppl_1.34 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Kari D Moore ◽

Lynn Hundley ◽

Polly Hunt ◽

Bill Singletary ◽

Allison Merritt ◽

...

Keyword(s):

Quality Improvement ◽

Best Practices ◽

Best Practice ◽

Systems Of Care ◽

Quality Improvement Project ◽

Complication Rates ◽

Improvement Project ◽

Face To Face ◽

Data Tracking ◽

Stroke Systems Of Care

Background: Evidence shows systems change interventions improve care and outcomes for stroke patients. Geopolitical boundaries have been a barrier to improving regional systems of care. Despite efforts nationally, regionally, and locally alteplase use for ischemic stroke has remained low and door to needle (DTN) times exceeded 60 minutes. Kentucky created the Stroke Encounter Quality Improvement Project (SEQIP) in 2009 to share best practices and improve stroke systems of care across the Commonwealth. Purpose: The aim was to utilize and share best practice models among 23 SEQIP hospitals in KY to improve tPA utilization, decrease DTN times, and improve outcomes. Methods: Hospitals implemented a statewide quality improvement plan focused on identifying barriers, removing barriers, and implementing best practice strategies regarding thrombolytic therapy. Accountability was achieved with ongoing GWTG data tracking, teleconferences, and face to face meetings from January 2009 through December 2018 sharing strategies and solutions for best practice. Results: SEQIP’s participating hospitals achieved significant improvement in thrombolytic administration over 10 years. The percent of all AIS patients receiving tPA increased from 4.61% in 2009 to 8.80% in 2018 (OR=2.0, p <0.0001). Alteplase use in eligible patients arriving by 2 hours and treated by 3 hours improved from 59.6% to 88.5% (OR=5.2, p <0.0001). Alteplase use in eligible patients arriving by 3.5 hours to 4.5 hours increased from 24.9% to 55.1% (OR=5.0, p <0.0001). Median DTN times decreased from 74 minutes to 49 minutes (p<0.0001). Complication rates of symptomatic hemorrhage were consistent with NINDS data and < 6% from 2009-2018. The tPA in-hospital mortality rate in 2009 was 11.7% and by 2018, decreased to 3.6% (p=0.00016). In 2009, 28.4% of tPA patients were discharged home and by 2018, that had increased to 47.9% (p <0.00001). In 2009, 32.1% of tPA patients were able to walk independently at d/c and by 2018 had increased to 43.6% (p = 0.00359). Conclusions: Geopolitical boundaries can be overcome and collaboration can be sustained among competing hospitals through sharing of best practices to safely increase utilization of tPA in eligible patients, decrease DTN times, and improve outcomes.

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MON-117 Reducing Unnecessary Repeat Vitamin D Testing at a Large Ambulatory Hospital: A Quality Improvement Initiative

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1160 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Olexandra Koshkina ◽

Miranda Boggild ◽

Felicia Tai ◽

Geetha Mukerji

Keyword(s):

Vitamin D ◽

Quality Improvement ◽

Best Practice ◽

Quality Improvement Initiative ◽

College Hospital ◽

Improvement Project ◽

Repeat Testing ◽

Hydroxyvitamin D ◽

Practice Advisory ◽

25 Hydroxyvitamin D

Abstract Background: With the increasing interest in the importance and potential benefits of vitamin D, there has been a significant rise in unnecessary vitamin D testing. The aim of the project was to reduce unnecessary repeat vitamin D testing at Women’s College Hospital by 50% by May 30th 2020. Methods: The Model for Improvement framework was used in the design of the quality improvement project to reduce unnecessary repeat vitamin D testing. Problem characterization was conducted to design the intervention to address root causes and iterative Plan-do-Study-Act cycles were used to develop an intervention that incorporated a best practice advisory (BPA). The primary outcome measure was unnecessary vitamin D testing. Unnecessary repeat testing was defined as: repeat 25-hydroxyvitamin D testing within 3 months or repeat 25-hydroxyvitamin D testing after a normal result (>75 mmol/L) in the preceding 12 months. Secondary outcomes which included BPAs generated, as well as the number of BPAs that resulted in no test being ordered were tracked. Paper-based orders were also tracked as a balancing measure. Results: It was identified that 12.7% of vitamin D testing (n= 289/2276) between July 2017 and July 2018 was related to unnecessary repeat testing. Following our cause and effect analysis and problem characterization, it was noted that providers ordered repeat vitamin D testing due to being unaware of prior normal results, as well as due to a knowledge gap of current testing recommendations. If the 25-hydroxyvitamin D order was identified as unnecessary at the time of order entry, a BPA was generated at the point of care. The BPA was implemented on February 4th, 2019. As of August 31st, 2019 based on the analysis of the number of BPAs generated and the number of tests not ordered as a result, there has been a 26% reduction in the number of inappropriate repeat vitamin D orders. Conclusions: Based on the preliminary data, a best practice advisory alert for vitamin D testing can be an appropriate QI intervention to reduce unnecessary vitamin D testing. Ongoing data analysis will be conducted to assess the long-term impact and sustainability of this intervention. Next steps include consideration of implementation of force function to reduce inappropriate repeat vitamin D testing.

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The development of a quality improvement project to improve infection prevention and management in patients with asplenia or hyposplenia

BMJ Open Quality ◽

10.1136/bmjoq-2019-000770 ◽

2020 ◽

Vol 9 (3) ◽

pp. e000770

Author(s):

Natalya Elizabeth O'Neill ◽

Jillian Baker ◽

Richard Ward ◽

Colleen Johnson ◽

Linda Taggart ◽

...

Keyword(s):

Quality Improvement ◽

Best Practice ◽

Tertiary Care ◽

Clinic Visit ◽

Quality Improvement Project ◽

Care Centre ◽

Tertiary Care Centre ◽

Improvement Project ◽

Vaccination Rates ◽

Fever Management

Asplenia and hyposplenia (a/hyposplenia) are associated with increased morbidity and mortality from complications including infection. The recommended measures to reduce the risks associated with infection include patient education, vaccination and early initiation of antibiotic therapy for fever. Despite these recommendations, there is poor adherence to best practice management of patients with asplenia or hyposplenia (PWA/H). We present the development methodology and pilot data of a quality improvement project that explored whether a programme involving a novel medical alert card together with a patient and healthcare provider educational booklet increased vaccination rates and improved awareness and understanding of the infectious implications of a/hyposplenia. Our aim was to increase the proportion of those appropriately vaccinated and the proportion of patients with proper understanding of fever management by twofold in 18 months. Questionnaires were used locally as a root-cause-analysis to confirm the need for education and evaluate the effectiveness of the programme, as well as patient satisfaction. An interdisciplinary team developed a toolkit composed of a medical alert card and booklet. The toolkit was distributed to PWA/H who presented for a haematology clinic visit at a tertiary care centre. A separate set of questionnaires was then used to evaluate satisfaction and obtain feedback from patients and practitioners receiving the toolkit for the first time. Changes suggested by patients and practitioners with unanimous agreement among study investigators were made to the toolkit. The pilot study showed an increase in vaccination rates and awareness of vaccination status and appropriate fever management. The majority of the patients and practitioners found the information provided by the toolkit helpful. Given these promising single-centre findings, the intervention is being extended to another tertiary care centre with a large red blood cell disorders programme to evaluate its generalisability. The next step will be to expand the scope to paediatric PWA/H.

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Pump Early, Pump Often: A Continuous Quality Improvement Project

The Journal of Perinatal Education ◽

10.1891/1058-1243.24.3.160 ◽

2015 ◽

Vol 24 (3) ◽

pp. 160-170 ◽

Cited By ~ 21

Author(s):

Diane L. Spatz ◽

Elizabeth B. Froh ◽

Jessica Schwarz ◽

Kathy Houng ◽

Isabel Brewster ◽

...

Keyword(s):

Quality Improvement ◽

Critically Ill ◽

Continuous Quality Improvement ◽

Best Practice ◽

Medical Intervention ◽

Quality Improvement Project ◽

Critically Ill Children ◽

Improvement Project ◽

Continuous Quality ◽

Delivery Unit

ABSTRACTResearch demonstrates that although many mothers initiate pumping for their critically ill children, few women are successful at maintaining milk supply throughout their infants’ entire hospital stay. At the Garbose Family Special Delivery Unit (SDU) at the Children’s Hospital of Philadelphia, we care for mothers who have critically ill infants born with complex cardiac and congenital anomalies. Human milk is viewed as a medical intervention at our institution. Therefore, nurses on the SDU wanted to ensure best practice in terms of pumping initiation. This article describes a continuous quality improvement project that ensured mothers pumped early and often. Childbirth educators can play a key role in preparing mothers who are anticipating an infant who will require hospitalization immediately post-birth.

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1580 Introduction of Dedicated Boarder’s Bleep and Registrar for Improved Clinical Communication, Management, And Care of Boarder Surgical Patients

British Journal of Surgery ◽

10.1093/bjs/znab259.782 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

J S Khan ◽

N Ekpete ◽

M Elsllabi ◽

C Payne

Keyword(s):

Quality Improvement ◽

Patient Care ◽

Qualitative Data ◽

Surgical Patients ◽

Surgical Team ◽

Communication Management ◽

Clinical Communication ◽

Staff Members ◽

Framework Approach ◽

Improving Patient Care

Abstract Aim Surgical patients are often placed within non-surgical wards due to shortage of beds, however the care of these patients remains under the parent surgical team. Unfortunately, patients outwith surgical areas can frequently feel neglected, with staff often unsure who to contact for reviews. This project aims to improve communication between boarding wards and the surgical team, as well as improving patient care and management. Method This prospective study was based on the Model for Improvement Framework approach to quality improvement. Data was gathered using questionnaires from various staff members on non-surgical wards. Outcomes were measured on a qualitative basis. Results Qualitative data was collected from 45 nursing staff (NS). Prior to introduction of a designated boarder’s bleep, 25% of NS felt they knew who to contact for queries and reviews, whereas 46% contacted the parent ward and 29% contacted the on-call surgical registrar. Only 46% of boarded patients received daily reviews. Following introduction of a dedicated surgical registrar for boarders, 62% of NS felt they knew who to contact with 48% aware of surgical boarder’s bleep. Daily reviews of patients increased to 65% over the course of the cycles of this project. Conclusions Bed shortages can play a vast role in patient care and treatment. This study has effectively demonstrated an improvement in provision of patient care, demonstrating an increase in NS knowing who to contact, as well as a 19% increase in daily patient reviews. Introduction of a dedicated boarder’s bleep-holder has shown improvement in clinical communication and management.

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Improvements in Communication and Coordination of Care in a Hemophilia Treatment Center

Acta Haematologica ◽

10.1159/000515350 ◽

2021 ◽

pp. 1-6

Author(s):

Christopher J. Ng ◽

Nancy Spomer ◽

Rick Shearer ◽

Audra LeBlanc ◽

Sharon Funk ◽

...

Keyword(s):

Quality Improvement ◽

Clinical Staff ◽

Quality Improvement Project ◽

Treatment Center ◽

Coordination Of Care ◽

Improvement Project ◽

Staff Members ◽

High Satisfaction ◽

Patient Reported ◽

Communication And Coordination

Introduction: In response to the increasing complexity of care for patients with bleeding disorders, we established new clinical teams for our hemophilia treatment center (HTC). Aims: We undertook a quality improvement project to improve the coordination and communication with our patients by establishing primary assignments of clinical staff to individual patients (primary teams). Methods: A quality improvement project group was formed that established the goals and assignment of primary teams. Patients were surveyed for their knowledge of their primary teams as well as their ability to schedule and contact their primary providers. As a measure of the effects on clinical staff, a balancing survey was also conducted among providers impacted by the clinical assignment of teams. Results: Our results demonstrate improvements across both coordination and communication as reported by patients. Additionally, the assignment of primary teams was met with high satisfaction and improvement in coordination and communication as reported by the clinical staff members of the HTC. Conclusions: Initiation of a quality improvement project and the creation of a primary team system were feasible at a large HTC and resulted in improvements in both patient-reported and staff-reported outcomes of coordination and communication of care.

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