Organizational accountability
This presentation is the property of its rightful owner.
Sponsored Links
1 / 21

Organizational Accountability PowerPoint PPT Presentation


  • 103 Views
  • Uploaded on
  • Presentation posted in: General

Organizational Accountability. Creating and Sustaining the Culture of Change Darla Belt, RN. Just the Facts. The IOM estimates that as many as 98,000 people die each year in US hospitals due to medical injuries.

Download Presentation

Organizational Accountability

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Organizational accountability

Organizational Accountability

Creating and Sustaining the Culture of Change

Darla Belt, RN


Just the facts

Just the Facts

  • The IOM estimates that as many as 98,000 people die each year in US hospitals due to medical injuries.

  • The Centers for Disease Control and Prevention estimate that two million patients suffer hospital-acquired infections each year. 


The facts cont

The Facts Cont.

  • The US spends the most money on health care of all (advanced) industrialized nations [1], but it performs more poorly than most on many measures of health care quality [2].

    [1] Reinhardt UE, Hussey PS, Anderson GF. US health care spending in an international context. Health Affairs. 2004;23(3):10-25.

    [2] Blendon RJ, Schoen C, DesRoches CM, Osborn R, Zapert K, Raleigh E. Confronting competing demands to improve quality: A five-country hospital survey. Health Affairs. 2004;23(3):119-135.


The metrics

The Metrics

  • Goal – Lives Saved: Number of staffed beds divided by 4

    • Rationale: 1 life per 4 beds should be saved

    • Example: 600 staffed beds/4 = 150 lives saved


Strategies

Strategies

  • Deploy Rapid Response Teams…at the first sign of patient decline

  • Deliver Reliable, Evidence-Based Care

  • Prevent Adverse Drug Events (ADEs)…by implementing medication reconciliation

  • Prevent Hospital Acquired Infections…by implementing a series of interdependent, scientifically grounded steps called “Bundles”

  • Prevent Surgical Site Infections…by reliably delivering the correct perioperative care

  • Physician Accountability…The role of today’s Medical Executive Committee


Medical response team

Medical Response Team

  • Staff member is worried about the patient

  • Acute change in heart rate

  • Acute change in systolic BP

  • Acute change in respiratory rate

  • Acute change in O2 saturation

  • Acute change in level of consciousness

Dedicated Number

Dedicated Staff


Bundles

Bundles

  • A bundle is just that, a bundle or grouping of best practices that have been individually proven to improve quality in an area.

  • Evidence-based protocols and practices that have been tried and tested to improve outcomes. Not theory.


Central line bundle

Central Line Bundle

  • MD and all staff assisting with insertion must disinfect hands before procedure.

  • MD must wear mask, sterile gown, sterile gloves and cap.

  • All personnel assisting with procedure must wear gloves and mask. Patient should also don mask.

  • Prep site with Chlorahex prep stick.

  • Drape site with sterile drape.

  • Dress site immediately with CVC sterile dressing kit and apply bio-patch medicated disc to site.


Ventilator bundle

Ventilator Bundle

  • HOB 30 Degrees

  • PUD Prophylaxis

  • DVT Prophylaxis

  • Mouth care Q2H

  • Sedation Vacation Q24H

  • Is patient ready to wean?


Urinary tract infection bundle

Urinary Tract Infection Bundle

  • Can urinary catheter be removed?

  • Change out catheter if pt having symptoms, insert silver coated catheter

  • Drainage bag must be kept lower than pt’s bladder at all times

  • All urinary catheters must be secured to decrease movement of catheter

  • Strict hand washing

  • Peri-care daily and after each bowel movement


Nosocomial infection rates fiscal year 2001 fiscal year 2006

Nosocomial Infection RatesFiscal Year 2001-Fiscal Year 2006

3 VAP’s in 24 Months

1 Symptomatic UTI in 24 months


Icu alos per episode

ICU ALOS Per Episode


Improving ami care

Improving AMI Care

  • Crucial Care – Concept of using multidisciplinary rounding and concurrent data collection to facilitate compliance with core measures, spread bundles, and improve patient outcomes.


Role of the crucial care medical directors

Role of the Crucial Care Medical Directors

  • Daily multidisciplinary rounds

  • Protocol maintenance

  • “Bundles Compliance” (Spread)

  • Staff education

  • Physician communication

    We had 21 physicians signed up to do two week rotations in this role!


Crucial care team

Crucial Care Team

  • Rotating Medical Director

  • Charge Nurse

  • Patient’s Nurse

  • Case Manager

  • Pharm D

  • Social Worker

  • Dietician

  • Core Measure Data Collectors

  • Nurse Educator


Ami percent of perfect care

AMI Percent of Perfect Care


Sip and scip

SIP and SCIP

  • Procedure based protocols and standing order sets

  • Assigning bottom line accountability

  • Automatic stop orders

  • Differentiating between prophylaxis and treatment


Medical staff compliance

Medical Staff Compliance

  • Protocols are “opt out” vs. “opt in”

  • Variation among populations is discouraged

  • Compliance is enforced

    • Protocol noncompliance without documented, approved rationale is subject to the disciplinary process


Disciplinary process

Disciplinary Process

  • Protocol variances should be considered an unusual occurrence

  • Three instances of protocol noncompliance generates mandatory referral to MEC

  • MEC orders focus chart review

  • Further infraction results in 14 day suspension of privileges


Lessons learned

Lessons Learned

  • Board Support

  • Senior Leader visibility

  • Create a culture where rapid cycle change is the norm

  • Disseminate the information

  • Execution is Everything

  • Celebrate your success


Words to live by

Words to Live By

“A Quality Leader’s job is never done until the Medical Staff and the Line Staff can stand up and speak for organizational quality with the same effectiveness that you can.”


  • Login