Last week we learned… Why influenza is specifically harmful to dialysis patients, and… Why it is important to immunize
Today we will talk about… • How to use CQI to improve vaccination rates • How to identify common barriers • How to develop strategies for overcoming the barriers
What is CQI? • Improving quality through: • Proactive approach • Optimal orientation • Process focus
What is CQI? • Improvement comes from the application of knowledge. • Any approach to improvement must be based on building and applying knowledge. • Significant, long-term, positive impact occur only when someone takes the initiative.
The CQI Cycle PLAN ACT DO STUDY The Cycle Never Ends…
ACT PLAN • What changes are to be made? • What will be the next cycle? • State the objective • Make predications • Develop a plan to carry out the cycle STUDY DO • Complete analysis • Compare data to prediction • Summarize what was learned • Carry out the plan • Document observations • Analyze data A Cycle for Learning and Improvement
The IHI Model for Improvement • What are we trying to • accomplish? • How will we know that a • change is an improvement? • What changes can we • make that will result in • an improvement? Act Plan Study Do
Understanding the Problem • Establishing a problem statement • Defining the scope of the problem • Refining the problem
Immunizations for Influenza • Where are we currently? - What does the data say? -What is the trend? • Where do we want to be? - What knowledge do we have? - What is our goal?
Where Are We Now? ESRD patients initiating therapy at least 90 days before September 1, 2005, & alive on December 31, 2005; vaccinations tracked between September 1 & December 31. illi illi lla lla USRDS ADR 2007
What Knowledge Do We Have? • Increased susceptibility of CKD patients to pneumococcal and hepatitis B (CDC) • Failure to increase rates of immunization over past 10 years (USRDS)
Where do we want to be? • Healthy People 2010 Goals • Influenza = 90% • Pneumococcal = 90% • Hepatitis B = 80% • Network Medical Review Board recommendations • CDC Guidelines
How Will We Know a Change Is an Improvement? • Identify the barriers • How do we measure that barrier? • What does improvement look like?
Identifying the Causes • Which root causes are are specific to this dialysis unit? • What barriers create this cause? • What strategies can be implemented to overcome the barriers?
Medical Prescription Technical Patient Staff-Related Education Root Cause Analysis Low immunization rates HP 2010 Goal
Planning:Key Components of a CQI Team • Multidisciplinary • Common goal • Day-to-day knowledge
Planning for Improvement • Thinking outside the box • Establishing accountability • Setting a timeframe • Evaluating results • Documenting change
REMEMBER All improvement requires change but Not all change is improvement Evaluate the results!
Rules of Creativity • Challenge the boundaries • Rearrange the order of the steps • Look for ways to smooth the flow • Evaluate the purpose • Visualize the idea • Remove “the current way of doing things” as an option
CREATIVE CHANGE • From the top down… • Support • resources • From the ground up… • Problem identification • Idea development
Implementing Change • When given a choice between two systems, one of which they understand, people will use what they know. • If you want to truly make a change, you must present an expectation and put in place a structure to effect the change. • People need information in order to change.
Resources • Immunization Tools • www.cdc.gov/vaccines/pubs/downloads/b_dialysis_guide.pdf • www.esrdnetwork6.org/STICCoalition.htm • www.esrdnet11.org/quality/immunization_coalition.asp • www.esrdnet15.org/QI.htm#stic • CQI Tools • ANNA • ESRD Networks • www.ihi.org