ihi expedition: preventing obstetrical adverse events · 2012-08-15 · 8/8/2012 1 ihi expedition:...
TRANSCRIPT
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IHI Expedition: Preventing Obstetrical Adverse Events
Deb Bell-Polson, MSN, RNC-OB
Peter Cherouny, MD
These presenters have nothing to disclose
Expedition Coordinator
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Kayla DeVincentis, Project Coordinator, has
worked at IHI since 2009, starting as an intern in
the Event Planning department. Since then, Kayla
has contributed to the STAAR Initiative, the IHI
Summer Immersion Program, and the IHI
Expeditions. Kayla obtained her Bachelor’s in
Health Science from Northeastern University and
brings her interest in health and wellness to IHI’s
Health and Fitness team.
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Our Expedition Director
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Sue Leavitt Gullo, RN, BSN, MS, Managing Director,
Institute for Healthcare Improvement (IHI), brings 30
years of health care experience to her current roles,
which include work in IHI's national and international
patient safety work, and IHI's faculty for leadership and
patient safety. She is the Director of the Perinatal
Improvement Community and The Safer Patient Project
in Denmark. Prior to joining IHI, Ms. Gullo was the
Director of Women's Services at Elliot Hospital in New
Hampshire. Her prior nursing roles included experience
in the frontline clinical areas of maternal-child health,
oncology, and medical-surgical nursing. Ms. Gullo has
also been active as national faculty in obstetrical care
for the last 15 years. Her involvement with IHI dates
back to 1995 as a participant in the IHI Breakthrough
Series on Improving Maternal and Neonatal Outcomes
and continued as IHI faculty until she joined the IHI staff
in 2005.
Ground Rules
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• We learn from one another – “All teach,
all learn”
• Why reinvent the wheel? - Steal
shamelessly
• This is a transparent learning
environment
• All ideas/feedback are welcome and
encouraged!
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Schedule of Calls
Session 1 – Introduction to Obstetrical Adverse Events
Wednesday, May 30, 1:00 PM – 2:30 PM ET
Session 2 – Structure and Process for System Redesign
Date: Wednesday, June 13, 1:30 PM – 2:30 PM ET
Session 3 – Executing Oxytocin Bundles
Date: Wednesday, June 27, 1:30 PM – 2:30 PM ET
Session 4 – Designing Reliable Processes
Date: Wednesday, July 11, 1:30 PM – 2:30 PM
Session 5 – Using the Perinatal Trigger Tool to Identify System Harm
Date: Wednesday, July 25, 1:30 PM – 2:30 PM
Session 6 – Results Report-out and Advanced Bundles
Date: Wednesday, August 8, 1:30 PM – 2:30 PM7
Expedition Objectives
At the end of the Expedition, participants will be able to:
• Describe two reasons to eliminate elective deliveries prior to 39 weeks confirmed gestation.
• Identify the components of the IHI Perinatal Care Bundles.
• Define reliability and give an example of components that will achieve different levels.
• Describe the Model for Improvement and the need for small scale testing.
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Faculty
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Deb Bell-Polson, MSN, RNC-OB, is a Masters
prepared Perinatal Nurse with 22 years of experience.
Most recently has worked as a Clinical Nurse Manager
leading a multidisciplinary team that has had great
success in the IHI Perinatal Community. We had proven
results in changing culture for quality and safety and
achieving 95% compliance on the Elective Induction and
Augmentation bundles as well as the Vacuum Bundle.
Also serves on a regional Quality and Safety Network
guidelines team that is working to set regional standards
for care in the Northern New England region. Is most
recently a part of a state wide Committee to review
cases of Sudden unexplained infant Deaths and work to
prevent them in the future. When not working I keep
busy with my family of three sons and a wonderful
husband.
Faculty
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Peter Cherouny, MD, Professor of Obstetrics and
Gynecology, University of Vermont College of Medicine,
has strong clinical interests in obstetric health care
quality improvement and is currently serving as Chair of
the Institute for Healthcare Improvement's Perinatal
Improvement Community. He was also the lead author
of the IHI white paper, "Idealized Design of Perinatal
Care." He has been Chair of Quality Assurance and
Improvement and Credentialing for the Women's Health
Care Service of Fletcher Allen Heathcare for the last 15
years. His recent research and work in obstetric quality
improvement is as Chair of the March of Dimes
collaborative, "Improving Prenatal Care in Vermont,"
and as co-investigator of the MedTeams project.
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Agenda
• Volunteer Report-Out
─The Royal Commission Medical Center
─ IUH University Hospital
• How to Manage Change
• Obstacles and Resistance
• Closing and Follow-up
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Storyboard Report-Out
• The Royal Commission Medical Center
─Dr. Nada (Obstetrician)
─Ms. Nabissah (L&D Nurse)
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BACKGROUND
• RCMC would like to maximize the approach in overall safety in Obstetrics and Gynecology Department that would reduce the rate of adverse outcome thus improve patient safety, decrease patient injury and decrease liability losses.
• Through IHI Expedition, RCMC staff will initiate clinically based practices, collecting data for perinatal trigger tool and create a comprehensive and standard protocols and guidelines.
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FACILITY DESCRIPTION
DEMOGRAPHIC
Royal Commission Medical Center(RCMC) is located in Yanbu Al-Sinaiyah, also known as “TheIndustrial City” having a 4-storeybuilding with 361 beds capacity. TheOb-Gyne Department situated in the1st floor secured by all automatedlocked door.
RCMC holds the prestigious JointCommission International (JCI)accreditation standard. Thisinternationally recognized standardreflects the organization’scommitment to provide the highestquality patient care.
SYSTEM CHARACTERISITIC
Ob-Gyne Department offers a wide range maternity & newborn care such as :
� Pre & Post Natal Care� Gynecology� Newborn � Referral to Medical-Surgical Professional� Equipped with the highest standard of technology� Investigation and treatment of recurrent Abortion
Ob-Gyne Team composed of highly trained healthcare professionals, as follows:
� Obstetricians� Anesthesiologist� Neonatologist� Pediatrician� Nutritionist� Social Workers� Registered Nurses & Midwives
To provide such services, they render a :� 24/7 On-call Consultant Obstetric &
Anesthesiologist� Emergency support for potential complications� Onsite Neonatal Intensive Care Unit� Newborn Nursery� Rooming In� Maternity Clinic for out patient services� Emergency Room is working round the clock
PICTURESTHE MEETINGS…..
THE DATA COLLECTORS
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Team Leader & Members
Team Leader: Dr. Issam Ben Ali –
Acting Chief, Ob-Gyne Dept.
Facilitator: Dr. Ahmed El-Gamal –QI Officer
Members:Dr. Mostafa Ghalwash – QI Director
Dr. Mohammed Eshmawi – Manager, Pharmacy Dept.
Dr. Basam Hejeli – Senior Registrar, Ob-Gyne Dept.
Dr. Nada Ahmed – Registrar, Ob-Gyne Dept.
Ms. Hadeel Haleem Daqeeq – Nursing Instructor, Nursing Education Dept.
Ms. Harjit Kaur Singh - Nursing Instructor, Nursing Education Dept.
Ms. Nabeesah Mohammed – Head Nurse, L& D Unit
Ms. Marylew Deicker Pascua – RN-RMW, L&D Unit
Ms. Ms. Sherlly Visitacion – RN1, OB-Gyne Ward
Ms. Charmaine Grace Gaa-ng - RNMW, OB-Gyne Ward
Mr. Yassser Al-Ghamdi – Pharmacist, Pharmacy Dept.
Ms. Hadeel Al-Harbi – Pharmacist, Pharmacy Dept.
Ms. Mary Ann Loren – QI Coordinator
AIM
The Ob-Gyne Expedition Team initiated this quality improvement project intended to all patient and staff of Ob-Gyne Dept. to:
� Reduce the adverse events noted during review of trigger tool.� Revised all unit protocols, policies & algorithm according to
evidence based theory.� Adopt the SBAR technique for communication and NICHD
Terminology during documentation.� Generate related forms for obtaining consent and, prescribing
medication and physician’s order.� Ob-Gyne staff must have a regular meeting to review fetal heart
rate monitoring strips.
Consequently, this improvement strategy will maintain to ensure staff dedication in providing safety practices at all times.
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GOAL• 31st May 2012 - All members joined and participated the IHI
Expedition entitled “Preventing Obstetrical Adverse Events.”
• 3rd June 2012 – The first meeting takes place; delegation of task was given to all participants; review the process in Ob-GyneDepartment to identify the defect and established the areas for improvement, such as:� Review of fetal monitoring strip in a weekly & monthly basis� Revision of Oxytocin administration� Generate a standard Physician’s Order Sheet � Adopt the Tachysystole Algorithm� Standardize the Clinical Algorithm for management of
indeterminate/abnormal FHR patterns� Utilization of SBAR (Situation, Background, Assessment,
Recommendation) technique for communication� Generate informed consent form for Oxytocin Administration� Updated statistic for induction /augmentation procedures
SURVEY FORMStructure Yes No N/A % Yes
1. Interdisciplinary Fetal Monitoring Education √ 100%
2. Documentation tools consistent with NICHD (National Institute of Child Health and Human Development) Terminology
√ 0%
3.Weekly fetal monitoring strip and case reviews or (#4)√
0%
4. Monthly fetal monitoring strip and case reviews √ 0%
5. Standard mixture and policy for oxytocin administration √ 50%
6. One standard administration order set √ 0%
7. If provider opts out of standard order set, system in place to identify and address when standardized dosage is not followed
√ 0%
8. Team definition for tachysystole √ 25 %
9. Clinical algorithm for identification and management of tachysystole
√ 0%
10. Clinical algorithm for management of indeterminate/abnormal FHR pattern (NICHD 2009)
√ 50%
11. RN empowered to call cesarean team (not to diagnose the need for cesarean, but to activate the team)
√
12. RN empowered to call neonatal team √ 100%
13. Consistent handoff tool {SBAR, etc} specify √ 0%
14. Informed Consent for oxytocin administration √ 0%
15. Individual Provider data published about induction/augmentation rates?
√ 0%
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OXYTOCIN- Elective Induction Bundle Composite
Data Collection ToolElements:
□ Gestational Age 39 weeks or >. Documented prior to initiation of oxytocin. Per ACOG definition in ACOG Practice
Bulletin Number 107, August 2009{Induction of Labor}.
Team Definition: >39 weeks of Gestational Age at the time of Induction
□ Normal Fetal Status: See NICHD September ’08 Tier Recommendations. Assessed and documented prior to initiation
of oxytocin and during administration.
Team Definition: Fetal weight of > 2.5 and < 4.0 k and Reassuring CTG
□ Pelvic Assessment: This element includes documentation of a complete pelvic assessment with cervical examination
(dilation, effacement, station of the presenting part, cervical position and consistency; Bishop’s Score), clinical
pelvimetry (acceptable is “adequate pelvis”) and an assessment of the fetal presentation.
Team Definition: Bishop Score of > 7; Documented as adequate clinical pelvis and assessment of the fetal
presentation/ position
□ Tachysystole: Recognized and management throughout the administration of oxytocin. NICHD September ’08
Definition- >5 contractions in 10 minutes, averaged over a 30 minute window. If present, it is recognized and
treated.
Team Definition: >5 contractions in 10 minutes, averaged over a 30 minute window
Instructions: Review 5 charts each week where oxytocin was used to electively induce labor.
N: Total number of individual components in place (5 charts X 4 elements= 20)
D: Total number of elective induction components possible in 5 charts reviewed(20).MR # Gestational Age Score Normal Fetal Status Score Pelvic Assessment Score Tachysystole Score Total
AUGMENTATION BUNDLE
Chart 1 Chart 1 Chart 1 Chart 1 Chart 1 TOTAL
EFW
Reassuring FHR
(not Category III)
Pelvic Exam
Tachysystole
TOTAL
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GESTATIONAL AGE RELIABILITY
Confirmation of Term Gestation Individual Tool*Collect data on all scheduled deliveries, inductions and cesareans
Current ACOG recommendations (ACOG Number 107, 2009) for determination of term gestation:
Criteria met for scheduling elective delivery? YES □ NO □ NOT SURE □
Information obtained from prenatal record □ prenatal office staff □ other □ _________
*If NO or NOT SURE, (next action step is a local decision) escalation policy:
1. Deny scheduling, notify Chief/Medical Director of OB for case review and approval □
2. Schedule case and note as pending final approval from Chief/Medical Director of OB□
*Local team will want to keep data on scheduling practices in order to provide feedback and learning where needed if cases do not meet ACOG criteria.
Report weekly the summary (N) of yes answers, and the summary of scheduled cases (D)
• Ultrasound measurement at less than 20 weeks of gestation supports gestational age of 39 weeks or greater.
• Fetal heart tones have been documented as present for 30 weeks by Doppler ultrasonography.
• It has been 36 weeks since a positive serum or urine human chorionic gonadotropin pregnancy test result.
N= Number of scheduled deliveries for which there is documentation of data that is considered optimal criteria
D= Total number of scheduled deliveries
PLAN• To implement the weekly Fetal Monitoring Review
among Ob-Gyne Physicians (Minutes of meeting must be documented).
• To update the clinical guidelines for Oxytocinadministration and to utilize the Informed Consent prior oxytocin administration.
• To develop a Clinical algorithm for identification and management of tachysystole.
• To monitor continuously the data concerning induction/augmentation rates.
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BRAINSTORMING
• Team definition for Oxytocin Elective
Induction Bundle Composite
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DO
• Revision of Clinical Guideline for OxytocinAdministration
• Review of fetal monitoring strips done by the Ob-Gyne physicians in a daily and weekly basis
• Formatted and implemented the Oxytocin Consent Form and Pre-Induction Checklist
• Adopted the IHI Tachysystole Algorithm
• Continuously data collection for Augmentation, Induction of Labor and Perinatal Trigger Tool
CHECK
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Table 1:NEWBORN TRIGGER TOOL
0
500
1000
1500
2000
2500
3000
3500
4000
Number of
Newborn
Delivered in
RCMC
Apgar Score <7
@ 5 minutes
Newborn
Admitted to
NICU
Newborn
Admitted to
NICU > 24H
2010
2011
2012
Table 2: PERINATAL TRIGGER TOOL
3464
85
2310
145
1802
163
1174
163
0
500
1000
1500
2000
2500
3000
3500
4000
Number of
Deliveries
T7 T17 P5
2011
2012
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Table 3: NUMBER OF PATIENT ADMITTED
IN RCMC WITH GESTATIONAL DIABETES
0
5
10
15
20
25
30
JAN FEB MAR APR MAY JUNE JULY AUG SEPT OCT NOV DEC
Series 1
Series 2
Series 3
Table 4: BLOOD UTILIZATION (PRBC) IN
LABOR & DELIVERY UNIT
0
2
4
6
8
10
12
14
16
2010
2011
2012
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Table 5: NUMBER OF CASES OF
POSTPARTUM HEMORRHAGE
0
5
10
15
20
25
30
IMMEDIATE PPH DELAYED/SECONDARY PPH
2010
2011
2012
Table 6: NUMBER NEWBORN SUFERRED FROM
SHOULDER DYSTOCIA
0
0.5
1
1.5
2
2.5
JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC
2010
2011
2012
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Table 7: NUMBER OF CASES RELATED
TO BIRTH INJURY
0
5
10
15
20
25
30
2010
2011
2012
IOL & INDUCTION BUNDLE
0%
20%
40%
60%
80%
100%
120%
Induction of Labor Augmentation
3rd Week of June
4th week of June
1st week of July
2nd week of July
3rd week of July
4th week of July
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ACT
• Change the Structure compliance from 2
points into 8 points.
• Agreeing on team definitions & Policies
• Putting Consent in action
• Orienting staff
• Continuous Evaluation of practices
TESTIMONIESDr. Essam Bin Ali (Head of Ob-Gyne Department) “Routine daily work that we thought of as “Perfect”, turned to have many opportunities for improvement.”Dr. Nada Hussein (Registrar, Obstetrician) “Perinatal Care Knowledge was there, but the project has put everything in clear frames.”Dr. Nagla Hussein (Resident, Obstetrician) “My Impression is that this project changes practices into better ones, however, prompt implementation is still a challenge.”Ms. Harjit Kaur Singh (Nursing Clinical Instructor) “Awareness of such practices increase patient safety culture & makes processes more friendly & more simple; It will be incorporated in our CNE activities.”Ms. Charmaine Grace Gaang (MW, OBW) “Documentation of pelvis assessment needs improvement, We will do it as a TEAM.”Ms. Emma Baladad (MW, L&D Unit) “We practised the gestational age verification & it was a good experience.”Ms. Marylew Deicker Pascua (RN, L&D Unit) “I really liked that we reached Team Definitions, as we had various definitions when we started the project. It was difficult to implement the Oxytocin consent & we had some challenges with the Pelvis assessment documentation. Trigger tool initiated a scientific discussion in the department & we are willing to implement the new guidelines.”Ms. Hadeel Al-Harbi (Pharmacist) “Although this expedition didn’t affect my practices directly, yet I learned about the IHI & managing changes.Dr. Mohammed Eshmawy (Pharmacy Manager) “It was a very Educational opportunity, I learned about Oxytocin & medical practices. I think I’ll use the PDCA methodology afterwards in my practice”Dr. Ahmed AlGamal (Quality Improvement Officer) “After the 1st session, we measured our structure against the IHI requirements & we found that we were only complying to only 2 points, now we are almost complying with 8 points. This project really helped to build good team dynamics. Because of time difference, my colleagues used to come to the hospital on their afterhours to attend. It also enhanced the culture of using guidelines”Ms. Mary Ann Loren – Quality Improvement Coordinator “Healthcare professionals awareness of this project is very essential for it to succeed”
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IHI EXPERIENCE
Generally speaking….
“We learned that even if our practices were good, yet they were not documented.
The Oxytocin Induction Consent was a really good idea that helped us to maintain patient rights & protect staff practices.
Furthermore the main challenge will be is how to disseminate the information & total involvement of all Ob-Gyne Staff.”
CONCLUSIONA scrupulous review exhibiting RCMC approach in overall safety in Obstetrics and Gynecology which focuses on measuring
adverse events on Induction and Augmentation of Labor resulted to a conclusion that our procedures mostly being done in respect to the knowledge and experience of our physicians and not following the written protocol.
Based on weekly Fetal Monitoring Review among Ob-Gyne Physicians, we came to know that their documentations needs improvement.
With weekly data collection for Induction of Labor using the Oxytocin - Elective Induction Bundle Composite, RCMC has leaped a 10% improvement from baseline 65% to 75% in one month window period. Meanwhile, Augmentation Bundle exhibited on the month of July form 60% to 100%.
Each graphical representation vividly depicts data on the course of Perinatal Trigger Tools.
T1 implies to newborn with Apgar of < 7 in first 5 min of life; in Table 1, 2010, 2011 and 2012, sum total of delivered newborns were 3243, 3475 and 1794. Apgar Score ranges to 26%, 25% and 25%, however newborn admission to NICU was 27%, 28% and 22% respectively.
As T7 denotes 3rd or 4th degree lacerations while T17 entails Administration of Oxytocic Agents, Table 2, illustrates 3464 deliveries in 2011 and 1802 deliveries halfway of 2012. Figuratively, there is only a less than 1% T7 reported cases for both years. However, a colossal number of Oxytocin 65% of the latter receives >20 units after immediate postpartum period while the former were 61%.
Table 4, portraying T9 for Blood Transfusion markedly doubled in numbers from 2011 to 2012.
Moreover, T15 which is pertaining to Estimated Blood Loss; Table 5 there has been 24 cases of 3464 deliveries for 2011 and, 23 out of 1802 in midyear of 2012 reported.
T18 Instrumented Delivery: 85 cases of instrument deliveries in 2011 and 45 instrument deliveries halfway of 2012.
Gestational Diabetes as T21 shows that there are reported cases as 9% and 12% out of total deliveries for 2011 and midyear of 2012 as depicted in Table 5.
Divulging on above apropos inference, RCMC has revised the Clinical Guidelines for Oxytocin Administration, formulated an Informed Consent prior to Oxytocin Administration and Pre-Induction Checklist, and adopted the Clinical Algorithm for Identification and Management of Tachysystole by the IHI.
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Storyboard Report-Out
• Indiana University Health University
Hospital
─Elizabeth Spoor
─Kerista Hansell
─Ginette Budreau
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Questions?
Raise your hand
Use the Chat
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Preventing OB Adverse
Events Expedition
Team Storyboard
Team: IUH University Hospital
Indiana University Health University Hospital
• This unit cares for obstetric patients throughout their pregnancy from antepartum complications, intrapartum and delivery, postpartum care, and bereavement care. This unit cares for acute, progressive, and critical care needs. There are three triage beds offering ER services to obstetric patients, ten L&D rooms, two operating rooms, and a PACU. The patient population is comprised of both high-risk and low-risk patients. Our unit is supported by Maternal-Fetal Medicine physicians as well as OB/GYN physicians. We are the hub of the MFM practice and approximately half of our patient population is transferred from other facilities for care.
• 800+ deliveries per year
• Level 3 Special Care Nursery
• Part of an AHC with another delivering facility and a level 3 NICU.
• Part of a health system that includes 10 delivery sites
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Who is on Your Team?
• Ginette Budreau, RN, MA, MBA - Director, Nursing Operations
• Betsy Spoor, RN, BSN, – Clinical Nurse Manager, OBICU
• Kerista Hansell, RN, CNS – Perinatal Clinical Nurse Specialist
• Lee A. Learman, MD, PhD, Medical Director, Women's Health Services IU Health University & The Indiana Clinic
• Men-Jean Lee, MD – Chief of OB/GYN
• Amy Nethery, RN, BSN – Nurse Safety Analyst
• Alexis Neal, RN – Director of Women’s Service Line
IUH Team Survey
StructureStructureStructureStructure YesYesYesYes NoNoNoNo N/AN/AN/AN/A % Yes% Yes% Yes% Yes1. Interdisciplinary Fetal Monitoring Education 2 7 - 22
2. Documentation tools consistent with NICHD terminology 5 4 - 55
3. Weekly fetal monitoring strip and case reviews (or #4) 0 8 1 0
4. Monthly fetal monitoring strip and case reviews 0 8 1 0
5. Standard Mixture and policy for oxytocin administration 8 1 - 89
6. One standard administration order set 8 1 - 89
7. If provider opts out of standard order set, system in place to identify and address when standardized
dosage is not followed.
4 5 - 44
8. Team definition for tachysystole 6 3 - 67
9. Clinical algorithm for identification and management of tachysystole 4 4 ? 44
10. Clinical algorithm for management of indeterminate/abnormal FHR patterns 0 7 ? 0
11. RN empowered to call c/s team (not to diagnose, but to activate) 7 2 - 78
12. RN empowered to call neonatal team 7 1 - 78
13. Consistent handoff tool (SBAR, etc.) (specify: ________) 5 4 - 55
14. Informed consent for oxytocin administration 0 8 1 0
15. Individual provider data published about induction/augmentation rates? 0 8 - 0
In Progress
Have – need education
Secondary Priority
First Priority
Unsure if MDs want
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Journey to your AIM…
1. Education for our team regarding processes in place (yellow rows)
2. Fine tune project in progress (green rows)
3. Benchmark against other IU Health facilities to learn about their progress/processes already in place
4. Focus on first priority rows (blue)
1. Clinical algorithm for identification and management of tachysystole
2. Clinical algorithm for management of indeterminate/abnormal FHR patterns
3. Individual Provider data published about induction/augmentation rates
• Does our physician team want this/find this useful??
Aim
The IUH University Hospital interdisciplinary team is focused on improving communication, safety, and quality outcomes surrounding oxytocin administration. Our team intends to accomplish the following:
1. Identify and implement a clinical algorithm for identification and management of tachysystole by December 2012.
2. Identify and implement a clinical algorithm for management of indeterminate/abnormal FHR patterns by December 2013.
3. Explore with MD leadership whether or not there is a desire to publish individual provider data about induction/augmentation rates by December 2012.
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Tests of Change
Final Word
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Questions?
Raise your hand
Use the Chat
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Mindful Practice
“It is not enough to do your best
you must know what to do
and then do your best”
W. Edwards Deming
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First Critical Step
• Be able to explain the “WHY”
53
How do we view others?
• Do others resist change?
• Or do they resist being changed?
54
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How do we view others?
• Do others resist change?
─We respond by attempting to overcome that resistance to change
─We end up creating resistance
─70% of change efforts fail
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How do we view others?
• Do others resist being changed?
─ You can’t trick people into changing.
─ Allow them control as long as the outcome is acceptable.
─ Allow them to make decisions.
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Engaging Improvement Methods
• Define the outcome you want.
• Suggest a path to achieve it.
• Allow people to reject your path as long
as they choose an alternate route to the
same destination. Remember the “Why”.
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Engaging Improvement Methods
• Don’t sell, which requires “buy-in”
• Identify and raise disagreement
• Allowing changes creates accountability
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Engaging Improvement Methods
Self motivation vs micromanaged
Energized alignment vs passive resistance
Inspired collaboration vs frustrating exhaustion
Engaging Improvement Methods
1. Standardize what is standardizable, no more.
2. Generate light, not heat, with data (use data sensibly and use it for learning not judgment)
3. Make the right thing easy to try. End paralysis by analysis
4. Make the right thing easy to do.
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Attributes of the Change
• Relative advantage - compared to current method (evidence from testing)
• Compatibility - with the current system and current values
• Simplicity - both the change and transition
• Trialability - how easy is it to test the change
• Observability - ability to observe the change and its impact
Adopter Categorization on the Basis of Innovativeness
Late Majority
34%
Early Majority 34%
Early
Adopters
13.5%
Laggards
16%2.5%
+ 1sd- 1sd- 2sd
0
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Matching Activities to Key Adopter
Categories
• Early adopters -Search for successful sites -Create pull through communication
-Change agents need a plan for sites that come forward -Focus on influencers as messengers -Make the work of early adopters observable
• Early majority-Allow for peer-to-peer contact with early adopters -Communicate local successes
• Late majority-Peer pressure is necessary -Communicate adoption of the changes is inevitable
Try and Get People to Test
• Make it less frightening
• Allows people to try it on
• Legitimizes feedback
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Usual Responses
• ‘There is no problem’- share data
• ‘The change won’t work’- share results
• ‘The change isn’t valid’- share science
• ‘You don’t understand my work’- have a
colleague speak with them
• ‘I don’t have time’- very small test
65
Questions?
Raise your hand
Use the Chat
66
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Follow up
• The listserv will remain active.
─To use the listserv, address an email to [email protected].
• A manual with instructions to receive
Continuing Education Credits will be sent
with the follow-up email for today's session.
• Please take 5 minutes to complete the
Expedition evaluation survey.
Coming Soon!
How-To Guide: Prevent Obstetrical Adverse
Events
68
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Thank you!