Patient Safety Collaborative: Measured Success in Improving Care

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Patient Safety Collaborative Measured Success in
Improving Care

• Sue Currin RN, MS, Chief Nursing Officer, San
  Francisco General
• Sandra Kissoon RN, MS, VP Patient Care,
• San Mateo Medical Center
• Sue Bartlett RN, MBA, VP Quality Initiatives,
  Beacon Collaborative

September 10, 2008
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• Beacon, the San Francisco Bay Area Patient
  Safety Collaborative, is a leading patient safety
  effort dedicated to ending inadvertent harm to
  hospitalized patients through education,
  training, and peer-to-peer sharing and exchange
  between health professionals. Beacon is funded
  by the Gordon and Betty Moore Foundation.

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What is BEACON?
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Programming
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Attributes of the Collaborative
Create a sense of urgency and competition
Create a sense of community and support
Everybody teaches/everybody learns
Action-oriented
Results-oriented/accelerate improvement
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The Journey at San Mateo Medical Center

• Sandra Kissoon RN, MS

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Patient Safety CollaborativeMeasured Success in
Improving Care

• Sandra Kissoon, RN, MS, CNA-BC
• San Mateo Medical Center

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The story of SMMCs Med-Recon

• Leadership of the Director of Quality Management
• Involvement with IHI in 2005
• Patient Safety Initiative Decrease medication
  errors and improve patient safety

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Barriers Faced Heads On

• Loss of MD champion
• Finding the right MD champion
• Changes in Nursing Leadership
• Changes in Pharmacy Management/Leadership

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Persistency

• Constant focus to meet compliance
• Reaching out for support from administration,
  getting stakeholders energized
• Partnership with all level of staff

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Med-Recon at SMMC

• Using FOUR FAILURE RULES
• Make It Obvious
• Make Failure Impossible
• Make Failure Easy-to-fix
• Make It a Priority

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Making it Obvious

• Get all stakeholders to participate
• Educate Staff
• Marketing and Communication
• Unit staff involvement
• Implement small test of change

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Making Failure Impossible

• Simplifying the process
• Process
• Form
• Avoid work around
• Standardize the form
• Sharing information with all levels of staff

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Making Failure Easy to Fix

• Started small, focusing on inpatients only
• Rolling out to other departments in the
  organization
• Targeted discussion with the Surgeons through
  Medical Staff Surgical Committees

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Making it a Priority

• Patient Safety Initiative weekly meetings Joint
  Commission Standards
• Regular meetings of the Med-Recon Committee
• Active participation on Beacon Collaborative
  quarterly attendance of key players
• Standing agenda item on Patient Safety Committee

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The Importance of Nursing Leadership

• Continue to keep open dialogue with key
  stakeholders
• Share results with all levels of staff
• Open dialogue with staff during Nursing
  Leadership Rounding

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Lessons Learned

• One process does not fit everyone
• Include Medical Staff early in the leadership
  process
• Re-evaluate a systems change
• Look to incorporate processes as new technology
  is introduced
• One size does not fit all

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The Journey at San Francisco General Hospital

• Sue Currin RN, MS

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Medical Emergency Response Team SFGHs
Experience with Beacon

• Sue Currin, RN, MS
• Chief Nursing Officer
• Senior Hospital Associate
• San Francisco General Hospital Trauma Center

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SFGH and Beacon

• SFGH has participated in the Bay Area Patient
  Safety Collaborative through
• Taking an active role in quarterly meetings
• Providing Quality and Patient Safety training for
  staff through Beacon classes and consultation
• Becoming a Platinum
• member in 2007
• Stroke
• Sepsis

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Selecting a Project MERT

• Early participation in Beacon was a priority for
  SFGH leadership
• Using the sharing aspect of Beacon was
  invaluable for launching our medical emergency
  response team MERT
• In 2006, we identified a champion, Leslie Dubbin,
  RN to participate in Beacon and glean knowledge
  from local experts

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Defining the Medical Emergency Response Team Role

• Respond to emergencies that do not meet code blue
  criteria
• Assist in maintaining patients in a stable
  clinical condition at their current level of care
• Follow-up on code blues in an attempt to identify
  missing triggers
• Guide, support, and mentor nurses in the practice
  of professional role based nursing

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Philosophy of M.E.R.T.

• Goal
• Assist nurses to focus on big picture of
  disease process
• Link the medical and nursing plans of care
• Why are we doing this?
• What are the nursing implications?
• What nursing tools can we use to move the pt
  along the continuum of care?

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Early Challenges

• Resistance from physicians (you dont need a
  MERT, just call me)
• Resistance from nurses (everything is just fine
  on the unitwe dont need a MERT)

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Overcoming the Challenges

• Taking MERT to the next level by creating a
  Professional Role Based MERT Program on 1
  Med/Surg Unit
• Increasing the understanding of the professional
  RN role
• Increasing clinical competence
• MERT staff served as role models
• Relationship building between staff RNs and MERT
  staff

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Overcoming the Challenges

• Developed a collaborative plan for preemptive
  rounds and improved communication
• CNs spent time shadowing the MERT RN
• Implemented the 9-step decision making process
• Change of shift hand-off focuses
• on the stability of the patient
• the comprehensive assessment of the patient, and
• evaluation of the plan of care

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ORourke Stability of the Patient Condition
Professional Practice Decision Making Model
Indirect
Indirect
Indirect
Direct
Direct
Direct
9 Care Coordination
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MERT Activity Comparison of Years 2006, 2007
MERT Calls, 2006 170 MERT Calls, 2007 496
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MERT Rounds 2007
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The overall number of code blues within the MERT
coverage area (med-surg and acute psychiatry) has
decreased by 8 since 2006. The average length of
stay (ALOS) in the MERT coverage area has
increased by 17 and the average daily census
(ADC) has increased by 10.
MERT Calls, 2006 170 MERT Calls, 2007 496
Increase 10
228
213
207
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Is the MERT having an Impact on the number of
Codes Outside of Critical Care?
79 / 10980 X 1000
79 / 11437 X 1000
73 / 10908 X 1000
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Codes, Intubations, and Deaths during MERT Call
2006, 2007
MERT Calls, 2006 170 MERT Calls, 2007 496
13/170
12/170
25/496
19/496
2/170
3/496
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Reason for MERT Call
hypoglycemia seizures oversedation
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Disposition of Patient Following MERT Call
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MERT Activity on 5D, 2007
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Final Thoughts

• Beacon has
• transformed SFGHs performance improvement and
  patient safety internal capacity as
  demonstrated through MERT
• promoted sharing and transparency between Bay
  Area health care organizations which is the trend
  of the future and
• energized SFGH staff towards accelerating
  performance improvement.

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Beacon Patient Safety Collaborative Progress

• Composed of 39 Hospitals in 5 Counties
• How are we performing?
• Progress over time

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Central Line BSI
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VAP
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Central Line Lives Saved
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VAP Lives Saved
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Infections Reduced 3/08
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Lives Saved 3/08
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Lives Saved Assumptions

• Beacon Hospitals were similar to NHSN hospitals
  when the collaborative started
• Did not include improvement before data was
  submitted
• CLI BSI attributable mortality 18
• Berenholtz SM, Pronovost PJ, Lipsett PA. Crit
  Care Med. 2004322014-2020.
• VAP attributable mortality 40
• Making Health Care Safer A Critical Analysis of
  Patient Safety Practices. AHRQ. Evidence
  Report/Technology Assessment Number 43.
  2001185-204

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Conclusions
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