MedStar St. Mary s Hospital Pioneers In Quality Presentation. Presenter: Elizabeth Ballard, MSN, RN and Dawn Yeitrakis MS, RN, CEN

Transcription

1 MedStar St. Mary s Hospital Pioneers In Quality Presentation Presenter: Elizabeth Ballard, MSN, RN and Dawn Yeitrakis MS, RN, CEN 1

2 MedStar St. Mary's Hospital (MSMH) Mission & Vision Our Mission MedStar St. Mary s Hospital is a community hospital that upholds its tradition of caring by continuously promoting, maintaining and improving health through education and services while assuring high quality, patient safety, and fiscal integrity Our Vision To be the trusted leader in caring for people and advancing health 2

3 Population Served St. Mary s County 110,000+ residents Median household income - $82, % below poverty Median age - 36 years 14K military veterans + family members (40K in region) HPSA/MUA 80% White, 14% Black/African American, 2.7% Hispanic, 2.2% Asian Naval Air Station, Patuxent River - 22,000 population Department of Defense Contractors Farmers Watermen Amish & Mennonite Communities > 6,000 College Enrolled Students Largest PhD Population per capita in Maryland 3

4 MSMH Stroke Care Committee Stroke Medical Director Stroke Coordinator Executive Leads Clinical and Ancillary Department Leaders and Clinical Coordinators Emergency Department, Intensive Care Center, Telemetry, Medical Surgical Pediatrics, Rehabilitation, Imaging, Laboratory, Organizational Learning and Research, Population and Community Health, Pharmacy, Nutritional Services and PI/HIM 4

5 MSMH Stroke Team MedStar Stroke Services MedStar SITEL Health Connections Stroke Team Associates License Independent Practitioners RNs Physical Therapist Occupational Therapist Speech Language Pathologists Respiratory Therapists Diagnostic Imaging Technologists IT Support Staff 5

6 The MSMH Approach Early Adoption of Technology EHR Optimization Meeting and Exceeding Standards 6

7 FADE/Change Management Process Focus on the problem/change Analyze the situation Develop a plan Execute and Evaluate the plan 7

8 FADE/Change Management Process 8

9 Project Tactics Developed Team approach Code Stroke Team Real time monitoring of process Concurrent chart reviews Overlay IT components 9

10 Hardwiring Change Communication Newsletters Department Meetings Safety Huddles Education On-boarding Annual Competency Ongoing remediation Simulation Partnership with MedStar SITEL 10

11 MSMH Stroke Committee Focus Areas Discharge Stroke Measures CY 2014 CY % 90% 92% 83.90% 87.40% 90.40% 80% 70% Compliance Rate 60% 50% 40% 30% 20% 38.5% 10% 0% 4.8% Discharge Atrial Fib Anticoagulation Therapy Documented Modified Rankin Score at Discharge Cholesterol Reducing Drugs at Discharge 11

12 Arrival PowerPlans ED Stroke/TIA Less than 8 hours since Last Known Well ED Stroke/TIA Greater than 8 hours since Last Known Well ED Stroke Alteplase Decision Stroke/TIA Quality Measures, Stroke order 12

13 Thrombolytic Therapy Decision 13

14 Time Management 14

15 Quality Measures Dashboard 15

16 Quality Measures MPage Component Acts as checklist for quality measure-related documentation. Component retrieves data from the clinical workflow, such as ordering, medication administration, documentation of allergies and problems, or other structured documentation. As documentation occurs, tasks that are completed move to the Complete section. Incomplete tasks remain in view at the top of the component. 16

17 Clinicians InterActive View 17

18 Discharge Triggers Built Discharge Alerts for: Stroke Anticoagulation Discharge Medication Stroke Antithrombotic Discharge Medication Stroke Statin Discharge Medication Evoking Triggers Discharge order >18 years of age Logic Observation and Inpatient encounter status Order find: Quality Measures, Stroke Rule looks for completed ordered of specific type of medication Rule looks for completed PowerForm with reason for not ordering medication at discharge Action Message to provider to consider ordering stroke discharge medications 18

19 CPOE Of Discharge Order 19

20 Nursing Depart Process 20

21 Ongoing Process Improvement Outcomes Discharge Stroke Measures 100% 90% 92% 83.90% 83.33% 90.91% CY 2014 CY 2015 CY 2016 CY % 87.40% 90.40% 95.92% 98.63% 80% Compliance Rate 70% 60% 50% 40% 38.5% 60.38% 30% 20% 10% 0% 4.8% Discharge Atrial Fib Anticoagulation Therapy Documented Modified Rankin Score at Discharge Cholesterol Reducing Drugs at Discharge 21

22 Sustaining Actions Continue monthly Committee meetings Concurrent reviews Outlier reviews Real time follow up Ongoing education Next Steps Education Partnering with System resource to educate (SiTEL) Link to post acute care 22