scholarly journals Implementation of a Pharmacist-Led Antimicrobial Time-Out for Medical-Surgery Services in an Academic Pediatric Hospital

2021 ◽  
Vol 26 (3) ◽  
pp. 284-290
Author(s):  
Christopher R.T. Stang ◽  
Preeti Jaggi ◽  
Jessica Tansmore ◽  
Katelyn Parson ◽  
Kathryn E. Nuss ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Audit And Feedback ◽  
Quality Improvement Initiative ◽  
Pediatric Hospital ◽  
Pediatric Medicine ◽  
Statistical Process ◽  
Quality Improvement Team ◽  
Time Out ◽  
The Mean ◽  
Improvement Team

OBJECTIVE This report describes a quality improvement initiative to implement a pharmacist-led antimicrobial time-out (ATO) in a large, freestanding pediatric hospital. Our goal was to reach 90% ATO completion and documentation for eligible patients hospitalized on general pediatric medicine or surgery services. METHODS A multidisciplinary quality improvement team developed an ATO process and electronic documentation tool. Clinical pharmacists were responsible to initiate and document an ATO for pediatric medicine or surgery patients on or before the fifth calendar day of therapy. The quality improvement team educated pharmacists and physicians and provided ATO audit and feedback to the pharmacists. We used statistical process control methods to track monthly rates of ATO completion retrospectively from October 2017 through March 2018 and prospectively from April 2018 through April 2019. Additionally, we retrospectively evaluated the completion of 6 data elements in the ATO note over the final 12-month period of the study. RESULTS Among 647 eligible antimicrobial courses over the 19-month study period, the mean monthly documentation rate increased from 54.6% to 83.5% (p < 0.001). The mean ATO documentation rate increased from 32.8% to 74.2% (p < 0.001) for the pediatric medicine service and from 65.0% to 88.1% for the pediatric surgery service (p = 0.006). Among 302 notes assessed for completeness, 35.8% had all the required data fields completed. A tentative antimicrobial stop date was the data element completed least often (49.3%). CONCLUSIONS We implemented a pharmacist-led ATO, highlighting the role pharmacists play in antimicrobial stewardship. Additional efforts are needed to further increase ATO completion rates and to define treatment duration.

scholarly journals Feedback Frequency in Competence by Design: A Quality Improvement Initiative

2020 ◽  
Vol 12 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Neil Arnstead ◽  
Paolo Campisi ◽  
Susan Glover Takahashi ◽  
Chris J. Hong ◽  
Florence Mok ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Head And Neck ◽  
Control Charts ◽  
Neck Surgery ◽  
Completion Rate ◽  
Head And Neck Surgery ◽  
Audit And Feedback ◽  
Quality Improvement Initiative ◽  
Statistical Process ◽  
Electronic Assessment

ABSTRACT Background Otolaryngology–head and neck surgery is in the first wave of residency training programs in Canada to adopt Competence by Design (CBD), a model of competency-based medical education. CBD is built on frequent, low-stakes assessments and requires an increase in the number of feedback interactions. The University of Toronto otolaryngology–head and neck surgery residents piloted the CBD model but were completing only 1 assessment every 4 weeks, which was insufficient to support CBD. Objective This project aimed to increase assessment completion to once per resident per week using quality improvement methodology. Methods Stakeholder engagement activities had residents and faculty characterize barriers to assessment completion. Brief electronic assessment forms were completed by faculty on residents' personal mobile devices in face-to-face encounters, and the number completed per resident was tracked for 10 months during the 2016–2017 pilot year. Response to the intervention was analyzed using statistical process control charts. Results The first bundled intervention—a rule set dictating which clinical instance should be assessed, combined with a weekly reminder implemented for 10 weeks—was unsuccessful in increasing the frequency of assessments. The second intervention was a leaderboard, designed on an audit-and-feedback system, which sent weekly comparison e-mails of each resident's completion rate to all residents and the program director. The leaderboard demonstrated significant improvement from baseline over 10 weeks, increasing the assessment completion rate from 0.22 to 2.87 assessments per resident per week. Conclusions A resident-designed audit-and-feedback leaderboard system improved the frequency of CBD assessment completion.

scholarly journals A Quality Improvement Initiative to Reduce Bronchopulmonary Dysplasia in a Level 4 NICU—Golden Hour Management of Respiratory Distress Syndrome in Preterm Newborns

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 301
Author(s):  
Andrew M. Dylag ◽  
Jamey Tulloch ◽  
Karen E. Paul ◽  
Jeffrey M. Meyers
Keyword(s):  
Quality Improvement ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Control Charts ◽  
Fluid Management ◽  
Delivery Room ◽  
Quality Improvement Initiative ◽  
Statistical Process ◽  
Golden Hour ◽  
Surfactant Administration

Background: Prevention of chronic lung disease (CLD) requires a multidisciplinary approach spanning from the delivery room to Neonatal Intensive Care Unit (NICU) discharge. In 2018, a quality improvement (QI) initiative commenced in a level 4 NICU with the goal of decreasing chronic lung disease rates below the Vermont Oxford Network (VON) average of 24%. Methods: Improvement strategies focused on addressing the primary drivers of ventilation strategies, surfactant administration, non-invasive ventilation, medication use, and nutrition/fluid management. The primary outcome was VON CLD, defined as need for mechanical ventilation and/or supplemental oxygen use at 36 weeks postmenstrual age. Statistical process control charts were used to display and analyze data over time. Results: The overall CLD rate decreased from 33.5 to 16.5% following several interventions, a 51% reduction that has been sustained for >18 months. Changes most attributable to this include implementation of the “golden hour” gestational age (GA) based delivery room protocol that encourages early surfactant administration and timely extubation. Fewer infants were intubated across all GA groups with the largest improvement among infants 26–27 weeks GA. Conclusions: Our efforts significantly decreased CLD through GA-based respiratory guidelines and a comprehensive, rigorous QI approach that can be applicable to other teams focused on improvement.

Improving the Timely Delivery of Antihypertensive Medication for Severe Perinatal Hypertension in Pregnancy and Postpartum

2021 ◽  
Author(s):  
Patrick Schneider ◽  
Patricia Ann Lee King ◽  
Lauren Keenan-Devlin ◽  
Ann E.B. Borders
Keyword(s):  
Quality Improvement ◽  
Postpartum Period ◽  
Care Team ◽  
Quality Improvement Initiative ◽  
Elevated Blood ◽  
Statistical Process ◽  
Pregnancy And Postpartum ◽  
Blood Pressures ◽  
The Impact ◽  
Timely Delivery

Objective Sustained blood pressures ≥160/110 during pregnancy and the postpartum period require timely antihypertensive therapy. Hospital-level experiences outlining the efforts to improve timely delivery of care within 60 minutes have not been described. The objective of this analysis was to assess changes in care practices of an inpatient obstetrical health care team following the implementation of a quality improvement initiative for severe perinatal hypertension during pregnancy and the postpartum period. Study Design In January 2016, NorthShore University HealthSystem Evanston Hospital launched a quality improvement initiative focusing on perinatal hypertension, as part of a larger, statewide quality initiative via the Illinois Perinatal Quality Collaborative. We performed a retrospective cohort study of all pregnant and postpartum patients with sustained severely elevated blood pressure (two severely elevated blood pressures ≤15 minutes apart) with baseline data from 2015 and data collected during the project from 2016 through 2017. Changes in clinical practice and outcomes were compared before and after the start of the project. Statistical process control charts were used to demonstrate process-behavior changes over time. Results Comparing the baseline to the last quarter of 2017, there was a significant increase in the administration of medication within 60 minutes for severe perinatal hypertension (p <0.001). Implementation of a protocol for event-specific debriefing for each severe perinatal hypertension episode was associated with increased odds of the care team administering medication within 60 minutes of the diagnosis of severe perinatal hypertension (adjusted odds ratio 3.20, 95% confidence interval 1.73–5.91, p < 0.01). Conclusion Implementation of a quality improvement initiative for perinatal hypertension associated with pregnancy and postpartum improved the delivery of appropriate and timely therapy for severely elevated blood pressures and demonstrated the impact of interdisciplinary communication in the process. Key Points

Results of a Regional Effort to Improve Warfarin Management

2016 ◽  
Vol 51 (5) ◽  
pp. 373-379 ◽  
Author(s):  
Adam J. Rose ◽  
Angela Park ◽  
Christopher Gillespie ◽  
Carol Van Deusen Lukas ◽  
Al Ozonoff ◽  
...  
Keyword(s):  
Quality Improvement ◽  
New England ◽  
Audit And Feedback ◽  
Quality Improvement Initiative ◽  
Veterans Health ◽  
Health Administration ◽  
Process Of Care ◽  
Processes Of Care ◽  
Anticoagulation Control

Background: Improved anticoagulation control with warfarin reduces adverse events and represents a target for quality improvement. No previous study has described an effort to improve anticoagulation control across a health system. Objective: To describe the results of an effort to improve anticoagulation control in the New England region of the Veterans Health Administration (VA). Methods: Our intervention encompassed 8 VA sites managing warfarin for more than 5000 patients in New England (Veterans Integrated Service Network 1 [VISN 1]). We provided sites with a system to measure processes of care, along with targeted audit and feedback. We focused on processes of care associated with site-level anticoagulation control, including prompt follow-up after out-of-range international normalized ratio (INR) values, minimizing loss to follow-up, and use of guideline-concordant INR target ranges. We used a difference-in-differences (DID) model to examine changes in anticoagulation control, measured as percentage time in therapeutic range (TTR), as well as process measures and compared VISN 1 sites with 116 VA sites located outside VISN 1. Results: VISN 1 sites improved on TTR, our main indicator of quality, from 66.4% to 69.2%, whereas sites outside VISN 1 improved from 65.9% to 66.4% (DID 2.3%, P < 0.001). Improvement in TTR correlated strongly with the extent of improvement on process-of-care measures, which varied widely across VISN 1 sites. Conclusions: A regional quality improvement initiative, using performance measurement with audit and feedback, improved TTR by 2.3% more than control sites, which is a clinically important difference. Improving relevant processes of care can improve outcomes for patients receiving warfarin.

scholarly journals Doctor Who? A Quality Improvement Project to Assess and Improve Patients' Knowledge of Their Inpatient Physicians

2016 ◽  
Vol 8 (2) ◽  
pp. 197-201 ◽  
Author(s):  
Kathleen Broderick-Forsgren ◽  
Wynn G Hunter ◽  
Ryan D Schulteis ◽  
Wen-Wei Liu ◽  
Joel C Boggan ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Audit And Feedback ◽  
Quality Improvement Initiative ◽  
Clinical Learning Environment ◽  
Improvement Project ◽  
Business Card ◽  
Quality Patient Care ◽  
White Board ◽  
White Boards ◽  
The Impact

ABSTRACT  Patient-physician communication is an integral part of high-quality patient care and an expectation of the Clinical Learning Environment Review program.Background  This quality improvement initiative evaluated the impact of an educational audit and feedback intervention on the frequency of use of 2 tools—business cards and white boards—to improve provider identification.Objective  This before-after study utilized patient surveys to determine the ability of those patients to name and recognize their physicians. The before phase began in July 2013. From September 2013 to May 2014, physicians received education on business card and white board use.Methods  We surveyed 378 patients. Our intervention improved white board utilization (72.2% postintervention versus 54.5% preintervention, P &lt; .01) and slightly improved business card use (44.4% versus 33.7%, P = .07), but did not improve physician recognition. Only 20.3% (14 of 69) of patients could name their physician without use of the business card or white board. Data from all study phases showed the use of both tools improved patients' ability to name physicians (OR = 1.72 and OR = 2.12, respectively; OR = 3.68 for both; P &lt; .05 for all), but had no effect on photograph recognition.Results  Our educational intervention improved white board use, but did not result in improved patient ability to recognize physicians. Pooled data of business cards and white boards, alone or combined, improved name recognition, suggesting better use of these tools may increase identification. Future initiatives should target other barriers to usage of these types of tools.Conclusions

scholarly journals Quality improvement initiative to reduce adverse effects associated with parenteral nutrition overfeeding

2018 ◽  
Vol 10 (1) ◽  
pp. 67-71 ◽  
Author(s):  
Andrew J Franck
Keyword(s):  
Quality Improvement ◽  
Amino Acid ◽  
Parenteral Nutrition ◽  
Outcome Measures ◽  
Liver Dysfunction ◽  
Bloodstream Infections ◽  
Quality Improvement Initiative ◽  
Refeeding Syndrome ◽  
The Mean ◽  
The Impact

ObjectiveParenteral nutrition (PN) overfeeding is a potential risk factor in the development of infections and other complications including hyperglycaemia, refeeding syndrome and liver dysfunction. This study was conducted to evaluate the impact of a quality improvement initiative to reduce PN overfeeding.DesignRetrospective cohort study of a quality improvement initiative.SettingA health system comprised of two US Department of Veterans Affairs medical centres.PatientsPatients receiving PN.InterventionsMethods to reduce overfeeding included the use of standardised PN products with lower dextrose to amino acid ratios, reduced use of intravenous lipid emulsion (ILE), and use of adjusted body weights or guideline-recommended predictive equations for energy requirements.Main outcome measuresThe primary outcome measures were the doses of kilocalories, amino acids and ILE in each cohort. The proportions of patients developing complications before and after the intervention were evaluated.ResultsThe mean maximum total daily kilocalorie dose was 30.2 kcal/kg/day in the preintervention group (n=86) vs 23.4 kcal/kg/day in the postintervention group (n=62) (p<0.001). More patients in the postintervention group received reduced ILE during the first week of PN therapy compared with the preintervention group (p<0.001). The mean maximum total daily amino acid dose in each group was not significantly different. Significantly fewer cases of central line-associated bloodstream infections, hyperglycaemia and liver dysfunction were observed in the postintervention group.ConclusionsA quality improvement initiative to reduce PN overfeeding was effective in reducing kilocalorie and ILE doses while maintaining similar amino acid doses. Observed complications were reduced following the intervention.

Use Of Prothrombin Complex Concentrates In Warfarin Anticoagulation Reversal In The Emergency Department: A Quality Improvement Study Of Administration Delays

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4824-4824
Author(s):  
Simon Bordeleau ◽  
Daniele Marceau ◽  
Julien Poitras ◽  
Patrick Archambeault ◽  
Carolle Breton
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Action Plan ◽  
Blood Bank ◽  
Audit And Feedback ◽  
Chart Audit ◽  
Improvement Project ◽  
Administration Time ◽  
The Mean ◽  
Timely Administration

Introduction In some bleeding situations, quick reversal of warfarin anticoagulation is important. In the event of a major life-threatening bleeding event, the anticoagulation reversal delay can have an impact on mortality. This study aimed to improve the administration delay when using Prothrombin Complex Concentrate (PCC) for the emergent reversal of warfarin anticoagulation in the emergency department. Methods An audit and feedback quality improvement project was conducted in three phases: a retrospective audit phase, an analysis and feedback phase and prospective evaluation phase. The charts of all eligible patients in a single Emergency Department (ED) in Québec, Canada, who received 4-factor PCC since the introduction of this product in 2009 until October 31, 2011 were retrospectively audited with pre-planned evaluation criteria. The administration delay of PCC was calculated from the time of prescription to the time of administration. After this retrospective chart audit, we determined where improvements could be attained, gave feedback to the ED and the blood bank, and we created an action plan to ensure the timely administration of PCC. The action plan was then implemented in practice to reduce the administration delay. Finally, a six-month prospective evaluation study was conducted to determine if our action plan was followed and improved the administration delays. Results Seventy-seven charts were reviewed in the retrospective chart audit. The mean administration delay was 73.6 minutes (STD [34.1]) with a median of 70.0 minutes (25-75% IQR [45.0-95.0]). We found that this delay was principally due to the following barriers that prevented timely administration of PCCs: communication problems between the ED and the blood bank and reconstitution and delivery inefficiencies. In order to address these barriers, we developed an action plan that involved the following elements: a flowchart to remind all clinicians how to order PCCs and a new delivery method from the blood bank to the ED. During the 6 months following the implementation of our action plan, 39 patients received PCCs and the mean administration time decreased to 33.2 minutes (STD [14.2]) (p<.0001) with a median of 30.0 minutes (25-75% IQR [24.3-38.8]). Conclusion This audit and feedback quality improvement project involving the development and the implementation of an action plan comprising of a flowchart and a new delivery process reduced the administration time of PCC by more than half. Future studies to measure the impact of implementing a similar audit and feedback process involving an action plan in other centers should be conducted before this type of improvement process is implemented on wider scale. Disclosures: No relevant conflicts of interest to declare.

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