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Ada Ibe Offurum Assistant Professor
Univ. of Maryland Medical Center
Focus on patients Identify value for the patient ◦ Get rid of everything else
Minimize time by improving efficiency ◦ Reduce duplication of efforts
Continuous improvement
Identify the problem Understand the current state Develop the goal statement/target state Perform root cause/gap analysis Brainstorm solutions Implement solution plan Confirm results and share insights
BOX 1: REASON FOR ACTION
Problem Statement:
Scope:
Objective:
BOX 2: CURRENT/INITIAL STATE
BOX 3: FUTURE/TARGET STATE
BOX 4: GAP ANALYSIS
BOX 5: SOLUTION APPROACH
BOX 6: RAPID EXPERIMENTS
BOX 7: COMPLETION PLAN
BOX 8: CONFIRMED STATE
BOX 9: INSIGHTS
TITLE
Start Date - Current
Team Members:
In 2005, MMCIP (Maryland Medicine Comprehensive Insurance Program) lost several medical pulmonary embolism malpractice cases.
Pulmonary embolism deaths soon after discharge.
Multiple departments using various VTE prophylaxis regimens.
No evidence based guidance on risk assessment and prophylaxis options.
Standardized template for calculating VTE risk and choosing regimen.
Evidence based. Multidisciplinary for continuous improvement
and hospital-wide spread.
Departments operating in silos. Lack of standardized, evidence based tools
for risk level and prophylaxis choice. No mechanism for reporting adverse events
or auditing compliance. No collaboration between physicians, nurses
and pharmacists. No executive leadership buy-in. Lack of education and awareness of VTE in
general.
Hospital leadership buy-in and involvement. Multidisciplinary group Evidence based, standardized risk
assessment tool with prophylaxis based on risk level.
Frequent chart auditing and compliance data reports
Hospital wide in-services for nurses, physicians and ancillary staff.
Approve standard guidelines for VTE prophylaxis hospital-wide.
Institute methods to achieve 100% compliance.
Implement adequate patient education upon discharge of at-risk patients
Use best practice standards and stay current with advances in VTE Prophylaxis
CMO of University of Maryland Medical Systems present
Designate physician and nursing champions and liaisons
IT involvement Create a VTE risk assessment and regimen
tool Implement discharge educational package for
higher risk patients.
Compliance reports Data presented at QI meetings and Clinical
Chief’s meetings Monthly steering committee meetings Modify based on ACCP guidelines
Reported to Maryland Health Care Commission. VTE Prophylaxis in first 24 hrs of admission ICU VTE Prophylaxis within 24 hrs of admission VTE treatment with Anticoagulation Overlap Therapy VTE patients receiving unfractionated heparin (UFH)
with dosages/platelet count monitoring by protocol Venous Thromboembolism discharge instructions Incidence of potentially preventable venous
Thromboembolism
0/101/13
4%0%8%8%Incidence of Potentially-Preventable ThromboembolismVTE-6
9/133/9
81%70%76%33%Venous ThromboembolismDischarge InstructionsVTE-5
11/1813/1
3
99%61%97%100 %
Venous ThromboembolismPatients receiving Unfractionatedheparin with Dosages/Platelet Count Monitoring by protocol or nomogramVTE-4
21/2113/1
5
95%100%96%87%
Venous ThromboembolismPatients with Anticoagulation Overlap TherapyVTE-3
13/1314/1
4
95%100%94%100%
ICU Venous ThromboembolismProphylaxisVTE-2
23/2637/4
2
90%89%89%88%Venous ThromboembolismProphylaxisVTE-1
TJC observed 2nd
qtr 2012Jan-13
TJC observed 3rd
qtr 2011
Jan-12Venous Thromboembolism (VTE)
0/101/13
4%0%8%8%Incidence of Potentially-Preventable ThromboembolismVTE-6
9/133/9
81%70%76%33%Venous ThromboembolismDischarge InstructionsVTE-5
11/1813/1
3
99%61%97%100 %
Venous ThromboembolismPatients receiving Unfractionatedheparin with Dosages/Platelet Count Monitoring by protocol or nomogramVTE-4
21/2113/1
5
95%100%96%87%
Venous ThromboembolismPatients with Anticoagulation Overlap TherapyVTE-3
13/1314/1
4
95%100%94%100%
ICU Venous ThromboembolismProphylaxisVTE-2
23/2637/4
2
90%89%89%88%Venous ThromboembolismProphylaxisVTE-1
TJC observed 2nd
qtr 2012Jan-13
TJC observed 3rd
qtr 2011
Jan-12Venous Thromboembolism (VTE)
1/340/12
3%10%0%Incidence of Potentially-Preventable
ThromboembolismVTE-6
37/4013/13
92%73%100%Venous Thromboembolism Discharge Instructions
(Coumadin)VTE-5
65/6528/28
100%96%100%
Venous Thromboembolism Patients receiving Unfractionated heparin with Dosages/Platelet Count Monitoring by protocol or nomogramVTE-4
62/6322/24
98%92%96%Venous Thromboembolism Patients with
Anticoagulation Overlap TherapyVTE-3
39/4121/21
95%91%100%ICU Venous Thromboembolism ProphylaxisVTE-2
132/13948/50
95%83%96%Venous Thromboembolism ProphylaxisVTE-1
Oct-Dec 2013
Hospital Compare 3rd qtr 2012 to 2nd qtr
2013Jan-14Venous Thromboembolism (VTE)
1/340/12
3%10%0%Incidence of Potentially-Preventable
ThromboembolismVTE-6
37/4013/13
92%73%100%Venous Thromboembolism Discharge Instructions
(Coumadin)VTE-5
65/6528/28
100%96%100%
Venous Thromboembolism Patients receiving Unfractionated heparin with Dosages/Platelet Count Monitoring by protocol or nomogramVTE-4
62/6322/24
98%92%96%Venous Thromboembolism Patients with
Anticoagulation Overlap TherapyVTE-3
39/4121/21
95%91%100%ICU Venous Thromboembolism ProphylaxisVTE-2
132/13948/50
95%83%96%Venous Thromboembolism ProphylaxisVTE-1
Oct-Dec 2013
Hospital Compare 3rd qtr 2012 to 2nd qtr
2013Jan-14Venous Thromboembolism (VTE)
Monthly meetings were key Constant executive leadership engagement Continuous feed back and hospital wide
education plans were essential 90% standardized, 10% customized for Ortho,
Shock Trauma and Neurosurgery Ever changing regulatory landscape were
challenging Next steps: Spread to other sister hospitals
from flagship hospital