Congratulations to the winners of the 2010 ACH Quality Improvement Awards! The winners were recognized at a luncheon on Jan.12 by ACH President and CEO Gary Carnes and Dr. Michael Epstein, Sr. Vice President of Medical Affairs.
Departmental Quality Improvement Award
Emergency Center - Procedural Pain Improvement Project
The Emergency Center identified an opportunity to improve and standardize procedural pain and anxiety for procedures, starting with lumbar punctures (LP).
The Emergency Center was targeted as trial study intervention area since 40% of LPs are completed there. The goal was to improve the use of local anesthesia and increase the use of sedation for patients one year of age and greater.
The multidisciplinary team reviewed department data and best practices on pain control for lumbar punctures. They developed a reference document for analgesia and sedation recommendations for LP procedures and educated medical and nursing staff on the importance of providing these measures.
A key to success was the implementation of the Lumbar Puncture checklist and providing ongoing feedback to physicians and nurses on the progress of the improvement.
Families were involved in the discussions about the use of local anesthetic to help numb the pain of the LP procedure and assured that staff was doing everything possible to help control pain. This was truly a culture change related to pain management in the EC.
Results of the improvement are impressive!
- Improved Local Anesthetic use from 39% to 92% (statistically significant improvement at p<.001).
- Improved Sedation use from 69% to 77% for patients one year of age and older.
Hospital-Wide Quality Improvement (Co-Winners)
Revitalizing Bedside Care Collaborative
In 2009-2010 All Children's participated in the CHCA Collaborative on Revitalizing Bedside Care. This project mirrored national projects, such as the Robert Wood Johnson Foundation's "Transforming Care at the Bedside" that has identified specific actions that can be taken to increase time spent in direct patient care.
The goal of the project was:
- To increase the amount of time bedside caregivers spend in direct patient care on 8N from 39.5% to 44.5%
- Engage "front line" to identify issues, areas of concern and improvement opportunities
- Focus on four areas proven to transform care:
- Lean processes to increase efficiency and decrease waste (5 S's, streamline processes)
- Improve teamwork
- Create family centered care experience
- Improve patient safety and Just Culture
The interdisciplinary team made up of nursing, case management, respiratory therapy, and Quality held monthly conference calls with other CHCA hospitals to learn and test best practices. Data collection was key to comparing processes from the old hospital to the new, including measuring the number of steps taken using pedometers, and measuring time spent in direct patient care.
The team exceeded their goal by increasing the percent of time in direct patient care from 39.5% to 52.3%. Through the implementation of lean processes (e.g. bedside carts) nursing steps per hour decreased from average of 716 to 520. There has been improved teamwork and involvement of families through family centered rounds. Many of these initiatives are spreading to other units in the hospital.
Safe Medication Practices Improvements (ISMP)
In the fall of 2009, an interdisciplinary team of consultants from the Institute for Safe Medication Practices (ISMP) performed an onsite system review of medication use at All Children's Hospital. From their visit, the ISMP provided ACH with a list of recommendations to help us to pursue perfection in Medication Safety. An interdisciplinary team was formed and the recommendations were prioritized based on Safety Impact, Time/Effort, and Cost/Resources.
Improvements have been made in both systems and processes including prescribing, procurement, dispensing, administration, and monitoring. Of the 42 Interim ISMP Action Plan items, 57% were implemented. Of the 191 Comprehensive ISMP Action Plan items, 28% are in progress and 23% are implemented. The Safe Medication Team will continue to implement recommendations currently in progress as we maintain our focus on patient safety!
Honorable Mention - Departmental Project Category
Imaging Improvement Project - Reducing Radiation Exposure
The goal of this project was to establish MRI as alternative for CT for reduction in CT radiation exposure. It improved anatomical imaging and direct muliplanar imaging and compared imaging times between MRI and CT. The project also provided the ability to schedule an MRI in a timely manner.
Through the diligent efforts of the imaging team, the many more patients receive MRIs now (which has a radiation dose of 0). The average time to perform and complete MRI Rapid compared to CT Brain was equal or less than CT turn around time.
Also, as a result of the above Quality Improvement:
- MRI has expanded its hours.
- Modified MRI brains are being performed in place of CT
- Brains for other clinical history to reduce radiation and sedation risks.
Protocol is being designed to r/o appendicitis, which is currently being evaluated by CT.
View photos of the awards presentation