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Kelowna General Hospital AMI IMPROVEMENT TEAM. Background. KGH – very busy 333 bed Tertiary Care facility, averaging 104% capacity 191 random AMI charts from Oct. 2004 to Oct. 2005 were audited by student nurses, and showed weaknesses in: Door to Thrombolytic time

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Presentation Transcript

Kelowna General Hospital

AMI

IMPROVEMENT

TEAM

Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


Background
Background

  • KGH – very busy 333 bed Tertiary Care facility, averaging 104% capacity

  • 191 random AMI charts from Oct. 2004 to Oct. 2005 were audited by student nurses, and showed weaknesses in:

    • Door to Thrombolytic time

    • Smoking cessation counseling/ interventions

  • AMI Team evolved in response to recommendations from this study

  • Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


    Background1
    Background

    • Multidisciplinary Team from a number of areas: Emerg, Critical Care, Cardiology, Cath Lab, Cardiac Rehab/Community, QI, Pharmacy, BCAS, Health Records, etc.

    • Recommendations acted upon:

      • Triage standing order for administering ASA and ordering diagnostics

      • EHS administers ASA in the field

      • ALS EHS perform 12 lead ECG in the field

    Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


    Background2
    Background

    • Despite above modifications in practice, Avg. Time to Thrombolytic has not improved

    • Original Team experienced dissolution when Emerg Manager champion left job in early 2006.

    • New AMI Team formed in Jan. 2007 and charter written.

    Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


    Aim statements
    Aim Statements

    • Document goal of “Best Process of Care” by increasing percentage of patients receiving Perfect Care Measure by 10% by December 2007.

    • Increase percentage of patients receiving timely initiation of thrombolytics to 85% by Apr. 1, 2008.

    Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


    Aim statements1
    Aim Statements

    • Increase percentage of smokers receiving smoking cessation intervention to 95% by Apr. 1, 2008.

    • Provide Quality Improvement AMI Initiative feedback to appropriate front line staff on a monthly basis.

    Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


    Team members
    Team Members

    • Physicians

    • Cardiologist

    • Nurse Managers

    • Clinical Nurse Educators/ Patient Care Coordinators

    • Bedside Nurses

    • Clinical Pharmacist

    • Respiratory Therapist

    • Cardiac Revascularization / Cardiac Rehab Coordinators

    • BCAS Rep

    • Quality Improvement (SHN) Rep

    Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


    Changes tested
    Changes Tested

    • Concurrent audit tool (initiated by Triage RN, traveling with patient chart) developed and trialed

      • With incentive rewards

      • Without incentive rewards

    • Development/ implementation of STEMI/ NSTEMI order sets, following Best Practice guidelines (in progress)

    Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


    Changes tested1
    Changes Tested

    • Retrospective chart audits of patients receiving thrombolytics:

      • looked for variance from Best Practice

      • examined times of elements contributing to delay to thrombolytic i.e. times of:

        • Arrival

        • Triage

        • Bed

        • ECG

        • Physician exam

        • Thrombolytic administered

    Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


    Results
    Results

    • Compliance with Triage Nurse initiating concurrent audit form was about 10%, with incentive rewards. Unfortunately staff compliance for completing the audit tool disappeared with the funding for rewards.

    • Concurrent audit forms were not always accurately completed. Sometimes information was entered that would reflect more favorably on department performance.

    Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


    Results1
    Results

    • Bundle elements that were a problem two years ago remain a problem, i.e.

      • Door to Thrombolytic time

        • graph shows it is actually getting worse

      • Smoking cessation counseling/ interventions

        Limited data follows…

    Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


    Results2
    Results

    Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


    Results3
    Results

    Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


    Keys to success and lessons learned
    Keys to Success and Lessons Learned

    • Good communications at all phases are imperative. Processes that take place without adequate input from all stakeholders fail to get buy-in.

    • Incentive rewards and compensation improve participation and compliance!

    • Chart audits are time consuming. It is a non-sustainable way of obtaining data.

    Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


    Keys to success and lessons learned1
    Keys to Success and Lessons Learned

    • PDSA’s are most likely to succeed when there is a champion on the floor to engage staff, drive the process, and promote effective communications.

    • Difficult to do PDSA’s in understaffed/ grossly overcapacity ward or department. We have backed off working in ED until a project improving patient flow is completed.

    Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


    Next steps
    Next Steps

    • Add more front-line nurse champions to team

    • Focus on ways to improve smoking cessation counseling and interventions

      • proposal has been submitted to Health Canada’s Tobacco Control Program

    • Re-focus on improving Time to Thrombolytic once flow of patients through ED has improved.

    Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


    Contact information
    Contact Information

    • Sherri Ellis (Registered Nurse, Cardiology)

      [email protected]

      (250) 862-4232

    • Karla Waller (Registered Nurse, Cardiology)

      [email protected]

      (250) 862-4232

    • Holly Morgan (Clinical QI Coordinator)

      [email protected]

      (250) 862-4300 Ext 7210

    Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative


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