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Kelowna General Hospital AMI IMPROVEMENT TEAM

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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
slide1
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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