1 / 17

Kelowna General Hospital AMI IMPROVEMENT TEAM

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

Download Presentation

Kelowna General Hospital AMI IMPROVEMENT TEAM

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Kelowna General Hospital AMI IMPROVEMENT TEAM Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

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

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

  14. 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

  15. 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

  16. 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

  17. Contact Information • Sherri Ellis (Registered Nurse, Cardiology) ELLS@mox.interiorhealth.ca (250) 862-4232 • Karla Waller (Registered Nurse, Cardiology) WALK2@mox.interiorhealth.ca (250) 862-4232 • Holly Morgan (Clinical QI Coordinator) holly.morgan@interiorhealth.ca (250) 862-4300 Ext 7210 Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

More Related