ORIENTATION FOR STUDENTS

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ORIENTATION FOR STUDENTS

• PATIENT SAFETY
• PERFORMANCE IMPROVEMENT
• Quality Risk

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RISK MANAGEMENT, PERFORMANCE IMPROVEMENT,
PATIENT SAFETY

• An organizational QUALITY PERFORMANCE program
  exists to
• Evaluate and improve processes that enhance
  patient safety and result in quality service
• Educate and involve staff in processes
• Identify events and other opportunities that
  allow for process review and improvement

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WHAT IS PERFORMANCE IMPROVEMENT?

• Performance Improvement is EVERY staff persons
  concern
• It is the assessing of how things are done or
  turn out and how to make them better
• No matter what your job, you play an important
  role in helping OMH provide safe quality patient
  care.
• Performance Improvement is vital to our
  organization and your departments goals!
• IT IS HOW WE ARE JUDGED!!!

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What is the Current Climate?

• Public trust at an all time low
• Institute of Medicine Reports (12/99 3/01)
• Headlines about fraud / medical mistakes
• Increased co pays and denials / decreased access
• Legislation
• Staffing shortages heavily reported
• Patient / family expectations increasing as to
  clinical and non clinical services

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PATIENT SAFETY QUALITY - EXAMPLE ACTIVITIES
SOURCES

• Application / Credentialing
• Orientation
• Job Descriptions
• Evaluations
• Continuing Education
• Policies / Procedures
• Regulatory Compliance
• (Environmental) Safety

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• Documentation
• External Alerts / Guidelines -reviewed
• Third party reports
• Complaints
• Infection Control
• Internal Surveys
• Occurrence Reporting
• Monitors / Screens / Profiles
• Peer Review

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JCAHO Patient Safety Goals

• Focus on previously reported Sentinel Events
• Are surveyed as an all or none
• Can change every year
• Evidenced - based and require culture change
• Seven goals / 13 aspects

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2003-04 Patient Safety Goals

• Patient identification
• Use of 2 unique identifiers
• Use of time out prior to invasive procedure
• Effective communication
• Read back on verbal / phone orders
• Standardize abbreviations / list those not to be
  used

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• Safe use of high-alert medications
• Remove concentrated electrolytes
• Standardize / limit drug concentrations
• Eliminate wrong site, patient, procedure surgery
• Pre-op verification process
• Site marking

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• Safe use of infusion pumps
• Free-flow protection
• Effectiveness of clinical alarm systems
• PM and testing of systems
• Settings - parameters, audible for
  distance/competing noise
• Nosocomial Infections reduced and Monitored
• CDC Guidelines adopted and implemented
• Tracking of serious injury / death related to
  nosocomial infection

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DO THE RIGHT THINGAt 99

• 2 airplanes will crash during landing at OHare
  airport per day
• 1 new hire a year will have falsified their
  application
• One Xray study each day will be done wrong or
  misread
• 17 Lab studies would be reported incorrectly each
  day

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Measuring Performance Improvement Safe Care

• It is important to objectively know we are doing
  a good job
• Measuring where we are and that we have done to
  improve must be done using data
• Data comes from lots of sources.. Sometimes even
  you !
• Data then is analyzed (interpreted)
• And then changes are sometimes made and re
  measured

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STRIVE FOR 100 QUALITY Because at 99

• The wrong procedure would be performed in surgery
  once a week
• Every two months a baby would be dropped to the
  floor at delivery
• 8 bills a day will be for too much and contain
  errors
• One EMS call each week would fail to meet EMTALA
  regulations

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Plan, Do, Study Act

• Oconee Memorial
• Hospital
• utilizes the
• PDSA
• methodology to continuously measure, assess,
• and improve processes
• and outcomes.

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Plan the improvement and the data
Do the improvement and the data collection
2
Study the results of the implementation
Act to hold the gain and continue improvement
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3
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OMH SPECIFIC ACTIVITIES ADDRESSING PI / PATIENT
SAFETY

• Organization-wide initiative - MISSION
• Routine monitoring of outcomes / events
• Timely reporting and evaluation of events /
  complaints with process the focus
• Use of external information as a source for
  process change
• Departmental initiatives to enhance processes

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COMMON PATIENT SAFETY ISSUES

• Medication orders-prescribing, dispensing,
  administering, verbal/phone orders
• Recognition / knowledge of patient condition
  failure to respond to information on patient
  status
• Communication breakdown with patient or staff
• Procedure error- skill, appropriate application

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Other Issues

• Confidentiality Other Patients Rights Issues
• Documentation
• Regulatory Compliance
• Workplace Safety
• Equipment / Product Usage
• Appropriate Communication

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COMMON BARRIERS to GOOD PI / PATIENT SAFETY

• Lack of consistency
• Lack of knowledge / understanding
• Lack of commitment
• Not involving staff in the process evaluation
• Lack of willingness to change
• Failure to admit to mistakes
• Lack of communication

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Examples of OMH Patient Safety Initiatives

• Medication Safety
• Fall Prevention
• External Information as resource
• Patient Confidentiality (HIPAA)
• Policy Revisions
• Universal Protocol for correct surgery
• Patient Identification
• Disclosure

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NOTHING WILL CHANGE UNLESS YOU CHANGE IT

• SAFETY IS AN INDIVIDUAL COLLECTIVE
  RESPONSIBILITY