Prototype 2: Trusted and Empathic Smoking Cessation Processes. Northside Health Center Team

Transcription

1 Prototype 2: Trusted and Empathic Smoking Cessation Processes Northside Health Center Team Cradle Cincinnati Learning Collaborative Learning Session 3 Breakout Session

2 Learning Objectives for Each Prototype Identify key drivers for the Prototype Understand at least two best practice PDSAs for the Prototype Create a customized KDD for the Prototype with my teammates Plan out for my team at least 2 PDSA cycles or 1 Ramp for Prototype

3 Smoking Cessation Initiative Cincinnati Health Department Northside Health Center Rocco Rossi, MD Sue Comte, CNM Stephanie Deimling, CNM Eva Miller, RN M keva Ferguson, MA Learning Objectives Designing Process Improvement The Importance of Tracking Data

4 Revision Date: 10/23/16 (v1) GLOBAL AIM Eliminate all tobacco use in pregnant women at NSHC SMART AIM Increase the % of patients who receive the Ask and Assist steps from 64% (baseline for NSHC) to 90% by December 31, 2016 Northside Health Center Key Driver Diagram (KDD) KEY DRIVERS WHAT 1. Administer the 5A s too all pregnant patients 2. Administer assist to all smoking patients 3. Ask all patients if they use tobacco at their first prenatal visit 4. Ask all smoking patients if they are still smoking at 28 weeks of gestation. INTERVENTIONS HOW Create smoking cessation pathway for all providers and nurses to follow USE STANDARDIZED PROGRAM (e.g. 5A s) TO HELP MOMS QUIT SMOKING PRE-CLINIC HUDDLE to review daily plan for how many need to complete ASK / ASSIST (e.g.. USE QUIT LINE) CHW-HV CO-MANAGE with CASE MANAGER to ensure PT S BASIC NEEDS are MET CHW-HV MEETS PATIENT AT OB OFFICE for 1 st Visit QI WEEKLY HUDDLE TO REVIEW DATA & ANALYZE FAILURES

5 Northside Health Center ASSIST Chart NSHC goal is to increase ASSIST step above 64% for 8 consecutive months Baseline Median 64% (centerline)

6 09/16 08/16 07/16 06/16 05/16 04/16 03/16 02/16 01/16 12/15 11/15 10/15 09/15 08/15 07/15 06/15 05/15 04/15 03/15 02/15 01/15 Cradle Cincinnati Learning Collaborative % New OB Patients Received ASK Step at First OB Visit CCLC Baseline Median 94% (centerline) # New patients received ASK step at first OB visit # New patients received first OB visit Measure Value 100% 98.3% 98.4% 100% 100% 100% 83.1% 93.9% 94.2% 94.7% 83.8% 92.0% 95.0% 100% 99.3% 98.0% 97.5% 91.9% 94.0% 94.4% 95.1% # of Sites scoring >= 100% # of Sites Reporting

7 09/16 08/16 07/16 06/16 05/16 04/16 03/16 02/16 01/16 12/15 11/15 10/15 09/15 08/15 07/15 06/15 05/15 04/15 03/15 02/15 01/15 Cradle Cincinnati Learning Collaborative % Patients Received ASSIST Step at First OB Visit CCLC Baseline Median 50% (centerline) # Patients received ASSIST step at first OB visit # Smokers at first OB visit Measure Value 54.6% 39.1% 42.1% 48.3% 61.1% 38.7% 52.0% 50.0% 61.5% 53.3% 50.0% 37.5% 47.4% 50.0% 59.5% 58.3% 55.9% 39.3% 66.7% 51.4% 69.2% # of Sites scoring >= 90% # of Sites Reporting

8 09/16 08/16 07/16 06/16 05/16 04/16 03/16 02/16 01/16 12/15 11/15 10/15 09/15 08/15 07/15 06/15 05/15 04/15 03/15 02/15 01/15 Cradle Cincinnati Learning Collaborative % Patients Smoking at 28 Week Visit CCLC Baseline Median 29% (centerline) # Patients smoking at 28 week visit # Patients completed 28 week visit Measure Value 50.0% 26.7% 35.7% 33.3% 75.0% 36.8% 25.0% 19.4% 33.3% 36.4% 21.1% 27.3% 47.4% 30.4% 21.4% 27.8% 15.6% 26.7% 20.0% 14.7% 41.7% # of Sites scoring <= 5% # of Sites Reporting

9 CURRENT FAILURE MODES INTERVENTIONS PROCESS Patients Receiving the ASK & ASSIST Steps at 1 st OB Visit Include ASK Step on Intake Form (smoking pathway) Record Pt. s ASK response Make smoking status a mandatory field Include smoking status with other vital data Call Quit Line during Visit Include ASSIST Step in Intake Process Include ASSIST status with vital data Use sticky notes to document ASSIST action Step 1: Ask if Patient is Smoking Step 2: Document Smoking on Pt. Record Step 3: Supply Quit Assistance/ Material during Visit Step 4: Document ASSIST Action on Pt. Record ASK process step not standard Different intake processes do not include ASK Step ASK Step is missed Smoking Status is not asked during visit Don t know where to document smoking status Smoking status is not documented Smoking status documentation is not accessible to all Staff lacks quit information or material ASSIST Step is missed / forgotten Failed Attempt to reach Quit Line Patient rejects Quit Assistance ASSIST Step is not done during visit Don t know where to document ASSIST information ASSIST Step documentation is not accessible to all

10 Questions To Ponder What barriers do you see to administering the 5A s? Is your clinic staff on board with the program? How do you record your progress? How do you continually improve?

11 A Vignette