Surgical Care Improvement Project

1
Surgical Care Improvement Project
UNIVERSITY MEDICAL CENTER Quality
Management July 15, 2008
2
Challenges

• Medical and Nursing Staff
• Lack of knowledge
• Poor documentation
• Abstraction
• Complex
• Frequent guideline changes

3
Challenges

• Processes
• Patient flow
• Surgical patients
• Departmental segregation
• Surgical Clinics/Ambulatory Surgery Department
• Floor Nurses/OR personnel
• Surgical Staff/Anesthesia department
• UMC/other LSU facilities

4
Success

• Leadership backing
• Pre-printed Pre-Operative Orders
• Pre-printed Post-Operative Orders
• Posted prompts and reminders to facilitate
  documentation
• Medical Staff departmental education
• Nursing Staff education through MC Strategies

5
Success

• Antibiotics given in OR
• Literature given to surgeons supporting
  antibiotic selection and discontinuing
  antibiotics within 24 hours.
• Post-Op order sets revised for antibiotic
  duration not to exceed 24 hours

6
Success

• Nurse for Concurrent Review
• Reviews surgical charts for compliance with
  indicators
• Good rapport with surgeons and nursing staff
• Intervenes with Medical Staff if indicator not
  met
• Intervenes with Nursing Staff if indicator not
  met

Our Most Successful Strategy
7

8
(No Transcript)
9
SCIP Checklist Any contraindication must have a
reason documented by MD/APN/PA.
10
Our Progress SCIP 2006-2007
Pre-Printed Orders in place
Concurrent Review in place
11
Questions???