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Quality Improvement for Infection Prevention
Meghan Kwiatkowski, MAIO, CPHQ
June 10, 2019
In partnership with Comagine
Oregon HAI Prevention Network Webinar Series
Oregon Patient Safety CommissionJune 10, 2019
Quality Improvement (PDSAs) for Infection Prevention
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Today’s agenda and presenter
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Meghan A. Kwiatkowski, MAIO,
CPHQSenior Practice Transformation Analyst
• Identify foundations for QI
projects▪ Using PDSA to address problem
area(s)
• Maintaining changes post-
project▪ Creating an action plan
▪ Monitoring results
© 2018 American Medical Association. All rights reserved.
First things first…
Form your team!
• Ensure that you have a cross-functional team
• Team will vary in size/composition, depending on practice needs• Clinical leaders
• Technical expertise
• Day-to-day leadership and workers
• Project sponsor
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© 2018 American Medical Association. All rights reserved.
What are your concerns?• Prompted by patients
• Patient safety problem or risk• Complaints from patients
• Prompted by staff• Complaints from physicians or other employees• Employee shortages• Facility space• Routine extraordinary efforts by employees to
keep things working
• Prompted by process• Systems that routinely require re-working• Workflow issues – breakdowns, bottlenecks,
waiting• Inventory challenges – too much or never enough
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© 2018 American Medical Association. All rights reserved.
What do we want out of this?
• Develop your aim• What does my practice want to accomplish?• Why is this a priority? • What current process is my practice changing?• What does the new process look like?• Who will enact the changes?
• Outline SMART goals• Specific• Measurable• Attainable• Relevant• Time-bound
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© 2018 American Medical Association. All rights reserved.
Basis for a quality improvement projectCollect your data by asking these questions
• How often?
• When does it occur?
• Where does it occur?
• Who is involved? • Identifying who should be involved
• Who is affected at the end of the process?
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Reference: SL2 webinar: “Where to start: prioritizing and scoping QI projects”, presented July 26, 2017
© 2018 American Medical Association. All rights reserved.
Test and implement improvement ideasYou’ve identified problems
Evaluated the data
Developed ideas for improvement
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Project types
• “I plan to:”
• “I hope:”• Measureable goal
• What did you observe?
• What did you learn? Did you meet your measurement goal?
• What did you conclude from this cycle?
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https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool2b.htm l
© 2018 American Medical Association. All rights reserved.
PDSA
Plan
• State the objective or purpose• Where is your practice less
efficient/improve patient care?
• Make a prediction of what will happen and why• “If X…then Y…” statements
• Develop a plan to test the change • What do you think needs to
happen and how?
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© 2018 American Medical Association. All rights reserved.
PDSA
Do
• Test the change on a small scale• One patient, one unit, one
shift, one hour
• Document what happened• Were there problems?
Other observations?• Discuss the new process
as it goes on
• Data analysis on the outputs of the change
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© 2018 American Medical Association. All rights reserved.
PDSA
Study
• Complete data analysis• What have you learned so far?
• Compare data to predictions • Measure success against your
benchmarks• Run charts are often used to
visualize changes over time
• Summarize learnings and think about meaning• What impact do the results
have?
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© 2018 American Medical Association. All rights reserved.
Mind the gaps
Screen the possibilities
• Review for gaps between the current and expected or desired performance
• The cause of the problem is not known or is poorly understood
• The solution is not predetermined nor readily apparent
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© 2018 American Medical Association. All rights reserved.
PDSA
Act
• Adopt, adapt, abandon the change based on results of the test• Were your results wildly
inaccurate? • Unanticipated adverse
events?
• Prepare plan for next test • Are you starting a new
project? A new cycle of the current one?
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© 2018 American Medical Association. All rights reserved.
Evaluate the outcome
• If the problem is complex, how well do existing processes cope, and how much will they need to change?
• Do you have the skills and expertise needed?• Consultants? External
training and/or in-services?
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© 2018 American Medical Association. All rights reserved.
Observations are keyOperationalize criteria
• What are the benefits of making changes?
• What is the level of feasibility?
• What will be the lesson learned/strategic benefit?
• Evaluate remaining projects and select best candidate
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UTI reduction
• Communication improves safety of patients
• AHRQ: Use of educational bundles • Hand hygiene
• Equipment and environment
• Standard and transmission-based precautions
• Catheter care and use • Is training or re-training needed?
• Urine cultures • How often is appropriate?
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https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/education-bundles.html
© 2018 American Medical Association. All rights reserved.
Sustainable changes
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© 2018 American Medical Association. All rights reserved.
Measurement
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Project impact measurement• Audit• Survey• EHR data• Software timestamps
Sustain, sustain, sustain
• Name the new process(es)
• Reinforce with checklist, workflow diagram
• Follow measured changes from baseline to post intervention
• Survey of staff• Survey of patients
• Share where there has been improvement
• Not everything will work• No failures• Problem-solving/learning process can be
celebrated instead
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© 2018 American Medical Association. All rights reserved.
Sustainability
• Develop an action plan• If there was a complete and total turnover in
practice staff – what would happen?
• Written commitment from team and leadership• Mission, goals• Living document
• Roles• Responsibilities
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© 2018 American Medical Association. All rights reserved.
Action plan
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https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/sustainability.html
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© 2018 American Medical Association. All rights reserved.
Choose and implement successful, sustainable change• Determine if it eases the work burden for those
who deliver care
• Confirm that it will improve patient care
• Confirm that a revenue stream will support the change
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© 2018 American Medical Association. All rights reserved.
Questions?
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© 2018 American Medical Association. All rights reserved.
References
• Share, Listen, Learn webinar: July 26, 2017 - Where to start: prioritizing and scoping QI projects
• STEPS Forward™ modules: Select Sustainable Change Initiatives, Quality Improvement Using Plan-Do-Study-Act
• The Six Sigma Way Team Fieldbook: An implementation guide for process improvement teams. Peter S. Pande, Robert P. Neuman, Roland R. Cavanaugh. 2002.
• Mometrix CPHQ Study Exam Guide. 2017.
• Plan-Do-Study-Act (PDSA) Directions and Examples. Content last reviewed February 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool2b.html
• Quality in Healthcare. American Society for Quality. http://asq.org/healthcare-use/why-quality/case-studies.html
• Toolkit To Reduce CAUTI and Other HAIs in Long-Term Care Facilities. Content last reviewed May 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/index.html
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Thank you!
Today’s Presenter
Meghan Kwiatkowski| MAIO, CPHQ
American Medical Association
Oregon Patient Safety Commission Staff
Suzanne Wood | Patient Safety System Analyst
503.477.8280
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Access recorded webinars and register for upcoming webinarshttps://oregonpatientsafety.org/qi-initiatives/oregon-hai-prevention-network/
Infection Prevention Consultation/Assessmenthttps://oregonpatientsafety.org/qi-initiatives/Infection-Prevention-Consultation/
On Demand Infection Control Training for Nursing Homeshttps://www.train.org/cdctrain/training_plan/3814
Oregon HAI Prevention Network Webinar Series
In partnership with Comagine
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