MedStar St. Mary’s Hospital Pioneers In Quality Presentation Presenter: Elizabeth Ballard, MSN, RN & Dawn Yeitrakis MS, RN, CEN 1
MedStar St. Mary's Hospital (MSMH) Mission & Vision • Our Mission – MedStar St. Mary’s Hospital is a community hospital that upholds its tradition of caring by continuously promoting, maintaining and improving health through education and services while assuring high quality, patient safety, and fiscal integrity • Our Vision – To be the trusted leader in caring for people and advancing health 2
Population Served • St. Mary’s County – 110,000+ residents • Median household income - $82,529 • 7.7% below poverty • Median age - 36 years • 14K military veterans + family members (40K in region) • HPSA/MUA • 80% White, 14% Black/African American, 2.7% Hispanic, 2.2% Asian • Naval Air Station, Patuxent River - 22,000 population • Department of Defense Contractors • Farmers • Watermen • Amish & Mennonite Communities • > 6,000 College Enrolled Students • Largest PhD Population per capita in 3 Maryland
MSMH Stroke Care Committee • Stroke Medical Director • Stroke Coordinator • Executive Leads • Clinical and Ancillary Department Leaders and Clinical Coordinators – Emergency Department, Intensive Care Center, Telemetry, Medical Surgical Pediatrics, Rehabilitation, Imaging, Laboratory, Organizational Learning and Research, Population and Community Health, Pharmacy, Nutritional Services and PI/HIM 4
MSMH Stroke Team • MedStar Stroke Services • MedStar SITEL • Health Connections • Stroke Team Associates – License Independent Practitioners – RNs – Physical Therapist – Occupational Therapist – Speech Language Pathologists – Respiratory Therapists – Diagnostic Imaging Technologists – IT Support Staff 5
The MSMH Approach • Early Adoption of Technology • EHR Optimization • Meeting and Exceeding Standards 6
FADE/Change Management Process • F ocus on the problem/change • A nalyze the situation • D evelop a plan • E xecute and E valuate the plan 7
FADE/Change Management Process 8
Project Tactics • Developed Team approach – Code Stroke Team – Real time monitoring of process • Concurrent chart reviews • Overlay IT components 9
Hardwiring Change • Communication – Newsletters – Department Meetings – Safety Huddles • Education – On-boarding – Annual Competency – Ongoing remediation – Simulation • Partnership with MedStar SITEL 10
MSMH Stroke Committee Focus Areas Discharge Stroke Measures CY 2014 CY 2015 100% 92% 90.40% 87.40% 90% 83.90% 80% 70% Compliance Rate 60% 50% 38.5% 40% 30% 20% 10% 4.8% 0% Discharge Atrial Fib Anticoagulation Therapy Documented Modified Rankin Score at Discharge Cholesterol Reducing Drugs at Discharge 11
Arrival • PowerPlans ED Stroke/TIA – Less than 8 hours since Last Known Well ED Stroke/TIA – Greater than 8 hours since Last Known Well ED Stroke Alteplase Decision Stroke/TIA • Quality Measures, Stroke order 12
Thrombolytic Therapy Decision 13
Time Management 14
Quality Measures Dashboard 15
Quality Measures MPage Component • Acts as checklist for quality measure-related documentation. • Component retrieves data from the clinical workflow, such as ordering, medication administration, documentation of allergies and problems, or other structured documentation. • As documentation occurs, tasks that are completed move to the Complete section. Incomplete tasks remain in view at the top of the component. 16
Clinicians InterActive View 17
Discharge Triggers Built Discharge Alerts for: – Stroke Anticoagulation Discharge Medication – Stroke Antithrombotic Discharge Medication – Stroke Statin Discharge Medication Evoking Triggers – Discharge order – >18 years of age Logic – Observation and Inpatient encounter status – Order find: Quality Measures, Stroke – Rule looks for completed ordered of specific type of medication – Rule looks for completed PowerForm with reason for not ordering medication at discharge Action – Message to provider to consider ordering stroke discharge medications 18
CPOE Of Discharge Order 19
Nursing Depart Process 20
Ongoing Process Improvement Outcomes Discharge Stroke Measures CY 2014 CY 2015 CY 2016 CY 2017 98.63% 95.92% 100% 92% 90.91% 90.40% 87.40% 90% 84.62% 83.90% 83.33% 80% 70% 60.38% Compliance Rate 60% 50% 38.5% 40% 30% 20% 10% 4.8% 0% Discharge Atrial Fib Anticoagulation Therapy Documented Modified Rankin Score at Discharge Cholesterol Reducing Drugs at Discharge 21
Sustaining Actions Next Steps • Continue monthly • Education Committee meetings • Partnering with • Concurrent reviews System resource to educate (SiTEL) • Outlier reviews • Link to post acute – Real time follow up care • Ongoing education 22
Questions? • Presenter Contact Information: – Elizabeth Ballard at Elizabeth.Ballard@medstar.net – Dawn Yeitrakis at Dawn.M.Yeitrakis@medstar.net 23
Recommend
More recommend
