QUALITY IMPROVEMENT

& DATA COLLECTION

How can you make data collection the “easy part”?

Naomi Erickson, BSN, MHS

Quality Improvement Consultant & MedRec Lead

Interior Health

WHY DO WE NEED DATA?

Because…

it helps us understand if a change is leading to an

improvement

it moves from subjective opinions to objective information

about a process

hospitals face pressure to report on the quality of care

provided

it engages stakeholders

(Provost and Murray, 2011;Needham et al. 2009)

DOES DATA HAVE TO BE DIFFICULT?

DATA

COLLECTION

MODEL FOR IMPROVEMENT

AIM STATEMENT

Helps us understand what we are trying to improve

Ensure your aim statement is SMART:

Time-bound

• By when would you like to accomplish your goal?

Relevant

• Does this goal matter?

Achievable

• Is this a possible goal?

Measurable

• how will we know we reached our goal?

Specific

• what is the specific improvement you are to accomplish?

AIM STATEMENT EXAMPLES

To improve compliance with MedRec by 70% in Royal Inland Hospital, by April 15, 2014.

To decrease PSLS reported medication adverse events by 30% in Kelowna General Hospital by June 30th, 2014.

To reduce the number of prescribed antipsychotics in residents by 30% in Overlander Extended Care Hospital by January 15th, 2015.

MODEL FOR IMPROVEMENT

TYPES OF MEASUREMENT

There are three types of measurements that you should

keep in mind when making an improvement

Outcome

Process

Balancing

These are the overarching end result(s) of the

improvement(s) that we are trying to achieve

OUTCOME MEASURE

OUTCOME MEASURE EXAMPLES

reduction in the number of unnecessary antipsychotics

reduction in the number of venous thromboembolisms (pulmonary

emboli and deep vein thrombosis)

reduction in the number of medication errors

reduction of adverse drug events

• Logically connected to the

outcome measure

• Often the steps or process of

achieving the outcome

• Tends to show improvement

before the outcome measure

does

PROCESS MEASURES

PROCESS MEASURE EXAMPLES

completing the Best Possible Medication History

use of the Venous Thromboembolism Pre Printed Order

number of staff educated about polypharmacy issues

number of residents who are properly screened for risk of

a fall

• Evaluate whether changes

made in one area are at the

expense of another area

• Helps us detect unintentional

consequences

BALANCING MEASURES

BALANCING MEASURE EXAMPLES

staff satisfaction with a new process

readmission rates

may decrease length of stay however, the patients are being

readmitted two days later

volume of workload

FROM THE BEGINNING

Think about what to measure right from the start of your

improvement project

what is your baseline?

is there opportunity to collect data from the Pre Printed Order Set

you develop?

When planning to collect data think about:

who, what, and how

does not have to come only from the chart

staff and patient surveys/interviews/focus groups

MEASUREMENT

Collect enough to know how the change has lead to an improvement

“just enough” data, small sequential samples (Provost and Murray, 2011; Needham et al. 2009)

this is not research sample size

keep it simple

Ministry of Health reporting requirements?

Ensure each question leads to an action

Ask the question: what will we do with this information?

If you are not doing anything with it….don’t collect it

MEASUREMENT

Create clear audit instructions and tools

Ensures everyone is collecting data in the same way (Needham et al.

2009)

Be aware of who is collecting the data (clinical and/or non clinical)

Involve stakeholders as able

Unit or site audit champions

Provides peer to peer learning

Engages individuals in the project

DATA COLLECTION TOOLS

Paper

Excel spreadsheets

Apps

MEASUREMENT EXAMPLE (1)

Fiscal Period

BPMH

Completed

Unit

BP

MH

Req

uir

ed

BP

MH

Fo

rm

On

Ch

art

Med

icat

ion

veri

fica

tio

n

HM

R

Med

icat

ion

Sec

tio

n

Co

mp

lete

Ver

ifica

tion

Com

plet

e *

Ph

ysic

ian

Ord

ers

Ph

ysic

ian

Sig

nat

ure

s

Ord

ers

Com

plet

e*

12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes no no no FALSE no no FALSE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg no TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg no yes TRUE yes yes TRUE12 (Mar 2- med surg yes no no no FALSE no no FALSE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes no no no FALSE no no FALSE12 (Mar 2- med surg yes no no no FALSE no no FALSE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes no no no FALSE no no FALSE12 (Mar 2- med surg yes yes no no FALSE no no FALSE

14 14

MEASUREMENT EXAMPLE (2)

Simple yes/no

answers Just enough to

know a change

is an improvement

HOW OFTEN?

You and your team can decide what is appropriate

flexible depending on your project and who is able to collect the

data

Ministry of Health may dictate reporting timelines

Think about:

more frequently at the start

once goal is reached how often do you need to collect for

sustainability?

HEART AND THE MIND

Impact to the patient/client/resident and family

SHARE THE DATA

Share the data with stakeholders

Display it where stakeholders can view their progress

Take opportunities to celebrate success

Simple is okay

Great Work Everyone

DISPLAYING DATA Quality Improvement and Patient Safety

Engage ~ Inspire ~ Empower ~ Celebrate

Detailed audit results from November, 2013: (n = 26)

How we're doing over time:

RIH Med Rec Monthly Report - Nov, 2013

81%

54% 50%

92% 92%

0%

20%

40%

60%

80%

100%

BPMH on chart VerificationComplete

HMR Complete Physician OrdersComplete

SignatureComplete

Med Rec Completion - Nov, 2013

0%

20%

40%

60%

80%

100%

Nov

-12

Dec

-12

Jan

-13

Feb-

13

Mar

-13

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep-

13

Oct

-13

Nov

-13

% w/ Signature Complete

0%

20%

40%

60%

80%

100%

Nov

-12

Dec

-12

Jan

-13

Feb-

13

Mar

-13

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep-

13

Oct

-13

Nov

-13

% w/ Physician Orders complete

0%

20%

40%

60%

80%

100%

Nov

-12

Dec

-12

Jan

-13

Feb-

13

Mar

-13

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep-

13

Oct

-13

Nov

-13

% w/ Verification complete

0%

20%

40%

60%

80%

100%

Nov

-12

Dec

-12

Jan

-13

Feb-

13

Mar

-13

Apr

-13

May

-13

Jun

-13

Jul-

13

Aug

-13

Sep-

13

Oct

-13

Nov

-13

% w/ HMR Complete

QUESTIONS

REFERENCES

Needham et al. (2009). Improving data quality control in quality

improvement projects. Retrieved from

http://intqhc.oxfordjournals.org/content/21/2/145.full.pdf+html

Provost, L. and Murray, S. (2011). The health care data guide: Learning from

data for improvement. San Francisco: Jossey-Bass.