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Ada Ibe Offurum Assistant Professor Univ. of Maryland Medical Center

Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

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Page 1: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

Ada Ibe Offurum Assistant Professor

Univ. of Maryland Medical Center

Page 2: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

Focus on patients Identify value for the patient ◦ Get rid of everything else

Minimize time by improving efficiency ◦ Reduce duplication of efforts

Continuous improvement

Page 3: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

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

Page 4: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

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:

Page 5: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

In 2005, MMCIP (Maryland Medicine Comprehensive Insurance Program) lost several medical pulmonary embolism malpractice cases.

Pulmonary embolism deaths soon after discharge.

Page 6: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

Multiple departments using various VTE prophylaxis regimens.

No evidence based guidance on risk assessment and prophylaxis options.

Page 7: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

Standardized template for calculating VTE risk and choosing regimen.

Evidence based. Multidisciplinary for continuous improvement

and hospital-wide spread.

Page 8: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

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.

Page 9: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

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.

Page 10: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

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

Page 11: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

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.

Page 12: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation
Page 13: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

Compliance reports Data presented at QI meetings and Clinical

Chief’s meetings Monthly steering committee meetings Modify based on ACCP guidelines

Page 14: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation
Page 15: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

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

Page 16: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

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)

Page 17: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation
Page 18: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation
Page 19: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

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)

Page 20: Ada Ibe Offurum Assistant Professor Univ. of Maryland ... · PDF fileNo executive leadership buy-in. ... Hospital wide in-services for nurses, ... VTE treatment with Anticoagulation

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