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1 Use of Tracers as a Leadership Tool Slide 2 2 Creating the Opportunity for Excellence in Patient Care Slide 3 3 Objectives Upon completion of this presentation, the participant should be able to: Articulate an overview of the process used when tracing the care of a patient Identify how to use tracers as a method of improving quality and patient safety within the organization Articulate how to use tracers as a leadership tool in this organization Slide 4 4 The hypothesis is: If we look at health care as a series of systems and subsystems, and identify the defects within the system(s), errors causing patients harm will be reduced Slide 5 5 Method of identifying broken systems is through the use of tracers Slide 6 6 Systems The new way of thinking Slide 7 7 Accreditation and Systems Consensus definition of system: A group of interacting, interrelated, or interdependent components that form a complex, unified whole Slide 8 8 Accreditation and Systems (cont.) The accreditation process is a system Overall quality and safety of patient care and the patient environment are measured by: Standards and measurable elements International Patient Safety Goals International indicators Slide 9 9 What is a Tracer? Slide 10 10 An individual patient tracer follows the experiences of a patient throughout the health care system. An individual-based system tracer examines high-risk processes (medication management, infection control, data) across the organization Slide 11 11 Using Tracer Methodology in the Survey Process Slide 12 12 Tracers in the Survey Process Gradual introduction into the survey process in 2006; official part of survey and accreditation decision process in 2007 Comments are positive focus on the process of caring for the patient and their environment Changes in survey process are not significant Slide 13 13 Changes include: New Patient system focus Patient is the center of activity visits focus on the contacts the patient has or will have Standards compliance based on review of systems and process unified, relationship to the whole Old Department function focus The departments is the focus scheduled visits to each department Standards compliance based on department functions without examining the relationship to the whole Slide 14 14 Changes continued: New Patient system focus Interviews focus on systems and processes (medication management, infection control, data/ quality, and competency) Bottom line is how you care for your patients and their environment each day Old Department function focus Interviews focus on questions and answers Slide 15 15 Bottom-line Focus How the care is delivered to the patients, and how their environment is maintained each day You can learn more in 8 hours of tracing than in 20 hours of chart review! Slide 16 16 Performing Successful Tracers Slide 17 17 Tracer Varieties Individual patient tracer Performed by those who have a broad organizational perspective Slide 18 18 Tracer Varieties (cont.) Individual-based system tracer Theme-based tracer Hospitalwide issues, such as medication management, infection control, or data Typically performed by chapter teams or key organizational personnel Unit-based tracer Tracing or monitoring issues at the unit pain assessment, advance directives, medication administration, etc. Slide 19 19 Getting Started Dont expect it to go perfectly at first Be willing to modify your process Frame all communication around patient safety and quality improvement Slide 20 20 Selecting a Patient to Trace Use patient census as an organization you will be asked to provide census with patient admission date, location, diagnosis For focused tracers such as a patient with an infection, you may be asked to compile a list this usually will not be the first tracer Consider using the top diagnosis or top procedures performed Slide 21 21 Approach Initial review of the record to determine: Care experience of the patient being traced (nursing care, diagnostic testing, treatments, etc.) The staff caring for the patient The medications ordered Process Interview staff delivering care, treatment and services Evaluate the environment Interview the patient and family, if appropriate Slide 22 22 Start the process Patient Information Area of Focus/Presenting Symptoms Moist lungs, Decreased activity tolerance, Fatigue, Shortness of breath History Congestive heart failure, Coronary artery disease, Cardiac catheterization, Stent placement Admission To Emergency department, Intensive care unit Slide 23 23 Departments Visited: Discussion Points 1. Current Location of the Patient Assessment and care Medication process Verbal orders Screening for nutrition, rehabilitation, fall, and skin Pain assessment and control Patient education Discharge planning Staff competency Slide 24 24 Departments Visited: Discussion Points 2. Emergency Room / Preadmission Triage Process Assessment and reassessment Communication with laboratory and radiology Medication process, especially high-risk IVs Hand-off process Slide 25 25 Departments Visited: Discussion Points 3. Radiology: Patient Had X-ray Assessment and reassessment Communication with laboratory and radiology Medication process, especially high-risk IVs Hand-off process Slide 26 26 Departments Visited: Discussion Points 4. Laboratory CBC Data collection and trending Chemistry profile Critical test results Slide 27 27 Departments Visited: Discussion Points 5. Intensive Care Unit (ICU) Communication from emergency department Emergency department admission delays Assessment and reassessment Medication process Verbal orders Critical equipment alarms Informed consent and education on procedure Slide 28 28 Departments Visited: Discussion Points 6. Pharmacy Identification of high-risk drugs and safety measures Reconciliation process Data regarding the use of these drugs Education regarding medications Involvement in discharge planning Slide 29 29 Departments Visited: Discussion Points 7. Physical Therapy (Patient Rehabilitation) Referral process Assessment and reassessment Goal setting (long-term, short-term, and patient goals) Patient and family education Pain assessment and documentation Discharge planning Slide 30 30 Map of Individual Tracer 2. Emergency Room/Preadmission Triage Process Assessment and reassessment Communication with laboratory and radiology Medication process, especially high-risk IVs Hand-off process 1. Current Location of the Patient Assessment and care Medication process Verbal orders Screening for nutrition, rehabilitation, fall, and skin Pain assessment and control Patient education Discharge planning Staff competency 3. Radiology: Patient Had X-ray Assessment and reassessment Communication with laboratory and radiology Medication process, especially high-risk IVs Hand-off process 5. Intensive Care Unit (ICU) Communication from emergency department Emergency department admission delays Assessment and reassessment Medication process Verbal orders Critical equipment alarms Informed consent and education on procedure 6. Pharmacy Identification of high-risk drugs and safety measures Reconciliation process Data regarding the use of these drugs Education regarding medications Involvement in discharge planning 7. Physical Therapy (Patient Rehabilitation) Referral process Assessment and reassessment Goal setting (long-term, short-term, and patient goals) Patient and family education Pain assessment and documentation Discharge planning 4. Laboratory CBC Data collection and trending Chemistry profile Critical test results Patient Information Area of Focus/Presenting Symptoms Moist lungs, Decreased activity tolerance, Fatigue, Shortness of breath History Congestive heart failure, Coronary artery disease, Cardiac catheterization, Stent placement Admission To Emergency department, Intensive care unit Slide 31 31 Tips for Tracing Trace the patient, not the department Ask open-ended questions Listenthe answer youre expecting may not be the answer you get! Be ready to show documents and policies or to demonstrate a process Validate discrepancies from policy, good practice, or system failures Include more people than just the nurse (dieticians, physicians, therapists, clerks, etc.) Stay staff-focused, not leadership-focused Slide 32 32 Tips for Tracing Survey for environmental compliance Go into patient rooms, medication rooms, supply rooms Scan for unsafe situations in the environment Include a facilities or safety person on teams Note equipment models and serial numbers Do a competence assessment Check human resources, competency, medical staff, and allied health files Slide 33 33 Benefits Patients Safety, Quality, Systems flow, Interest Staff Team building, Systems thinkers, Understanding of each others jobs Organization Happy patients, Systems improvement, Team focus among staff Slide 34 34 Therefore, as leaders, lets focus on systems and processes as we continually strive for quality and safe care for our patients.