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BEYOND THE AUDIT: MEASURING FOR IMPROVEMENT
Kim Streitenberger, Project Leader, ISMP CanadaMaryanne D’Arpino, Patient Safety Improvement Lead, CPSI
Paula Pickard, Patient Safety Consultant – Horizon - Fredericton & Upper River Valley AreaJohn Thomas Glidden, Patient Safety Consultant, Horizon - Miramichi Area
Diane Beaulieu, Patient Safety Consultant, Horizon - Saint John AreaAlex Titeu, Project Coordinator, Central Measurement Team, Safer Healthcare Now!
Lynn RileyMedication Safety Specialist and Educator, ISMP Canada
Today’s Facilitator
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Welcome to our francophone attendees
Bienvenue à nos participants francophones
Hélène RiverinConseillère en sécurité et en améliorationSafety Improvement Advisor
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Pour nos participants francophones..
Pour accéder aux diapositives français:
-Cliquez sur l'onglet "FRENCH"
OU
-Envoyer un courriel à [email protected]
Suivre la boîte «Chat» pour les commentaires du
conférencière traduit en français
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Where to find our webinars…
1. Recap of 2015 MedRec audit month data that identify potential opportunities for improvement – ISMP Canada
2. Review QI principles as it relates to measuring for quality improvement – Maryanne
3. Hear from local teams of how they use measurement for MedRec quality improvement.- John, Paula, Diane
4. Review how to enter data into the Patient Safety Metrics System and create run charts – CMT
Objectives
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Please complete our poll
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Today’s Speakers
Kim Streitenberger Maryanne D’Arpino Diane Beaulieu
John Thomas Glidden Paula Pickard Alex Titeu
KIM STREITENBERGERISMP Canada
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Outline
Provide brief summary of 2015 audit month results– March 31st presentation handouts available at
http://ismp-canada.org/medrec/#webinars
Discuss opportunities for Improvement
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Oct. 2013 Feb. 2015
Sites 103 173
Patients / Residents 2340 5201
Audit Participation
Performance of MedRec
80% 98%
n = 4745+443
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Quality of MedRec Performed
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Element Acute Care(% of patients)
LTC(% of residents)
BPMH based on > 1 source 69% 70%
Med use verified by patient/caregiver 66% 54%
Each med w/name, dose, route, etc. 88% 83%
Meds on BPMH are accounted for 80% 81%
Prescriber documented rationale 69% 76%
QUALITY BPMH
QUALITY RECONCILIATION
35%
n=4825
30%
Percentage of Patients by Quality Score
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Average MedRec Quality Score2013 vs. 2015 by Sector
2013 (n) = 19452015 (n) = 4825
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Percentage of MedRec Performed x Score
30%
40%
n=4210
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Compliance w/ BPMH elements by “Admit via”
n=2393
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Measurement for Continuous Improvement
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1-9 Data Submissions
53%
10-17 Data Submissions
47%
Data Submissions since MRQA Month 2013*
• 88% of sites who participated in the 2013 MedRec Quality Audit Month continued to submit data to Patient Safety Metrics
Measure your MedRec processes consistently over time and submit your data to Patient Safety Metrics
Use your own organizational data to drive your quality improvement efforts.– Improve the performance of MedRec for all patients– Improve the quality of MedRec performed
Summary of Opportunities for Improvement
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How Are You Using Your Data for Improvement
We Are Actively Making Changes
Based On Our Data
We Are Planning Improvements Based On Our
Data
We Haven’t Started to Use Our Data Yet
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MARYANNE D’ARPINOCanadian Patient Safety Institute (CPSI)
QI Principles: Measurement for Improvement
Knowing why you need to improve Having a way to get feedback to let you know if
improvement is happening Developing an effective change that will result in
improvement Testing a change before attempting to implement Implementing a change
Langley, G. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed., p. 490). San Francisco, California: Jossey-Bass.
5 Fundamental Principles of Improvement
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QI Measurement is Different Than Accountability or Research
Improvement Accountability ResearchWHO?Audience
Internal External Science community
WHY?Purpose
Process knowledge,change monitoring
Comparison New knowledge
WHAT?ScopeMeasuresTime PeriodConfounders
LocalFew, easyShort, currentRarely
Local & otherFew, complexLong, pastTry to measure
UniversalComplexLong, pastMeasure
HOW?MeasuresSample SizeCollection
InternalSmallSimple
ExternalLargeComplex
ExternalLargeComplex
Source: Solberg, et al. (1997). The Three Faces of Performance Measurement. Jt Comm J Qual Improv.;23(3):135-4723
Why IS Measurement Important?
What does "better" look like?
How will we recognize better when we see it?
How do we know if a change is an improvement
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How Can We Depict Data?
STATIC VIEW
Descriptive StatisticsBar graphs/Pie charts
DYNAMIC VIEW
Run ChartControl Chart(plot data over time)
Source: Lloyd, R. & Scoville, R. (2010). Simplifying the Selection & Use of Shewart Charts. Institute for Healthcare Improvement [IHI] Forum.
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WEEK 4 WEEK 11
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Measuring over time – the value of a run chart
To understand baseline performance and identify opportunities for improvementTo determine if a change
resulted in improvementTo determine if we are
holding the gains made by our change
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Use audit results as your baseline Identify where there is opportunity for
improvement Identify the measures you will use to
monitor your improvement efforts over time Measure consistently over time
Beyond the Audit: Measuring for Improvement
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Leadership Support Aligns with organizational strategy QI Lead & Team QI Culture
QI Implementation Fundamentals
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JOHN THOMAS GLIDDEN PAULA PICKARD DIANE BEAULIEU
Horizon’s Approach to Using Med RecMeasurement for Improvement
A little about us…
“Areas”
Moncton* Saint John Fredericton/Upper River Miramichi
(12 Hospital Facilities)
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Accountability breeds “response-ability”.
Stephen R. Covey, Beyond the 7 Habits
Measurement for Improvement –Accountability
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Quantity
Horizon Med Rec Dashboard• % of patients receiving MedRec on Admission• % of patients receiving MedRec at Discharge
Measurement
• Quarterly Data• Clinical Network, Facility, & Unit-Level Data• Trend Analysis
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QualitySHN! Patient Safety Metrics
• % MedRec performed • Quality Bundle
BPMH has > 1 sourcePatient/caregiver as a sourceEach med has all information requiredEach med is accounted for & rationale included
Measurement
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Engage frontline staff Communicate results to all levels Display results creatively Acknowledge & celebrate successes Evaluate quality of processes Evaluate small tests of change & identify
action plans
Using the Data
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Measurement PDSA cycle
The focus of measuring data is
Using PDSA cycle for Process Improvement
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Horizon Experience with PDSA
Low compliance in Quantity Data
Implement Quality Audits; Team Meetings
Resolving Medication Discrepancies
Modify MedRec Form; Quality Audits
Resources, Support & Commitment Accountability Framework Current Data Limitations Engagement Creativity Acknowledgement
Reporting and Learning:Lessons Learned
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HOW TO GET YOUR RUN CHARTSPatient Safety Metrics
Alex Titeu
You need an account for PSMetrics to access your data and reports If you do not have an account, please
email [email protected]– Your First and Last Name– Your Phone Number– Name of the site(s) you want to access
reports
Patient Safety Metrics (PSMetrics)
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1. On the “Report” tab 2. Click on the “MedRec Quality” sub-tab3. Click on one of the following reports:
– Quality Audit Bundle Compliance at Admission in Acute Care (MedRec-Acute 12)
– Quality Audit Bundle Compliance at Admission in Long Term Care (MedRec-LTC 7)
Organization Run Chart
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1. On the “Data” tab 2. Click on the “MedRec-Acute” or “MedRec-
LTC” intervention3. Scroll to the “Measurement Worksheets” table4. Look for measures “MedRec-Acute 12” or
“MedRec-LTC 7” for your “Unit”5. Click “View/Add data” link6. Click “Compliance Run Chart” Button
Unit-level Run Charts
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LYNN RILEYISMP Canada
Discussion/Questions
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Improving the quality of MedRec processes is our responsibility. Measurement and improvement are
possible. Identify the root cause before making
changes. Be creative in developing solutions. THINK OUTSIDE THE BOX!
Key points to remember…
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Resources
IHI Open Schoolhttp://www.ihi.org/education/ihiopenschool/Pages/default.aspx
Improvement GSKhttp://www.saferhealthcarenow.ca/EN/shnNewsletter/Pages/Improvement-Frameworks-Getting-Started-Kit-guides-system-change.aspx
MedRec GSKs and One Pagers http://www.saferhealthcarenow.ca/EN/Interventions/medrec/Pages/default.aspx
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Upcoming MedRec Webinars
September 2015 Home Care new MedRec GSK and the link to Acute Care and Long Term Care
November 2015 Accreditation Canada new MedRec ROPs for 2016
February 2015 to be determined
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Beginning September 2015
MedRec Open Mike- Need help with MedRec…stay on the line
after each national webinar
- Submit your questions prior to the Open Mike session to [email protected] or ask them live
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MedRec Communities of Practice Post your questions Respond to questions Share tools and
resources
http://tools.patientsafetyinstitute.ca/Communities/MedRec/default.aspx
Online Community Dedicated to MedRec
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Please complete our poll
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We are here to help!
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For Audit forms and Data QuestionsCPSI Central Measurement Team [email protected] Flintoft - 416-946-8350Alexandru Titeu - 416-946-3103
For MedRec Content (MedRec Intervention Lead)Institute for Safe Medication Practices Canada (ISMP Canada)[email protected]
CPSI Patient Safety Intervention LeadMaryanne D’Arpino [email protected]
