109H Are You Ready for Patient Tracers

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109H Are You Ready for Patient Tracers?

• Shirley Simons RN, MSN, CPHQ
• CQI/Readiness Director
• VA Midwest Health Care Network (VISN 23)

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109H - Are You Ready For Tracers?

• This is 1.5 Hours Hands-On class
• Restrooms are located
• Cell Phones
• Please turn off or change to vibrate.
• If you must answer a call, please leave the room.

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109H - Are You Ready For Tracers?

• Please,
• No questions during the presentation (except
  instructional)
• Questions written on the 3X5 cards will be
  answered at the conclusion of the presentation
• For questions not answered during the session,
  both questions and answers will be available on
  the web

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109H - Are You Ready For Tracers?

• If you get lost, raise your hand.

There are room assistants to help you.
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109H - Are You Ready For Tracers?

• Priority Focus Process (PFP)
• Priority Focus Areas (PFA)
• Process, system, or structure that significantly
  impacts the quality safety of care
• Clinical Service Groups (CSG)
• Categories of patients/residents/clients or
  service for which data are collected

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109H - Are You Ready For Tracers?
Priority Focus Areas

• Assessment care/services
• Communication
• Credentialed Practitioners
• Equipment Use
• Infection Control
• Information Management
• Medication Management

• Organizational Structure
• Orientation Training
• Rights Ethics
• Physical Environment
• Quality Improvement
• Patient Safety
• Staffing

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109H - Are You Ready For Tracers?

• Examples of Clinical Service Groups
• Cardiology
• Internal Medicine
• Urology
• General Surgery
• Dialysis
• Behavioral Health
• Long Term Care
• Residential Care

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109H - Are You Ready For Tracers?

• 2007 Top Joint Commission Findings
• MM.2.20 Medication Storage
• REQ.2C Critical Test Results
• REQ.8A Medication Reconciliation
• REQ.9B Fall Reduction Program
• REQ.7A Hand Hygiene
• REQ.3D Labeling of Medications
• HR.1.20 Staff Qualifications

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109H - Are You Ready For Tracers?

• Top Joint Commission Findings 2008 1st Quarter
• REQ.2C Critical Test Results
• PC.8.10 Pain Assessment
• EC.5.20 Life Safety Code
• REQ.8A Medication Reconciliation
• UP.1.C Time Out
• REQ.7A Hand Hygiene

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109H - Are You Ready For Tracers?

• OIG Findings FY08 FYTD
• Data Trending, Analysis Reporting
• Improvement Based on Data
• Hand-Off Communication
• Medication Reconciliation
• Medication Refrigerator Temperatures
• Medication Storage

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109H - Are You Ready For Tracers?

• SOARS Findings FY07
• Medication Reconciliation
• Hand-Off Communication
• Medication Refrigerator Temperatures
• Medication Storage
• Information Security

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109H - Are You Ready For Tracers?

• Common Findings
• Medication Reconciliation (4)
• Medication Storage (3)
• Hand-Off Communication (2)
• Medication Refrigerator Temps (2)
• Critical Test Results (2)
• Hand Hygiene (2)

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109H - Are You Ready For Tracers?

• The Added Value of Tracers
• Readiness Tool
• Focuses on Care/Service to Patient
• Utilizes the Expertise of Front Line Staff
• Assesses deployment
• Identifies opportunities for improvement in care
  processes
• Provides additional feedback to the facility and
  validates perceptions
• Educational for staff

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109H - Are You Ready For Tracers?

• Elements of a Tracer
• Observation of care processes
• Care/Treatment Planning
• Medication Management
• Infection Prevention/Control
• Communication/Interaction
• National Patient Safety Goal implementation
• Discussion of data used for improvement
• Medical record review
• EOC observations

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109H - Are You Ready For Tracers?

• Tracer Process
• Choose a patient to trace
• PFA/CSG Complete tracer
• Following a specific topic (NPSG, Medication
  Management)
• Meet with the nurse providing care to the patient
• General information about the patient
• Open CPRS for care and document review (nurse is
  the driver)
• 30-60 minutes with the front line care staff
• Discuss data related to patient care processes

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109H - Are You Ready For Tracers?

• Summary
• Find out how your facility is using the tracer
  process for readiness
• Volunteer to be involved
• Focus on the patient/resident/client
• Build sound process
• Be Continually Ready!

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109H - Are You Ready For Tracers?

• Time for Questions
• shirley.simons_at_va.gov

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109H - Are You Ready For Tracers?

• Instruction Slides for
• CPRS Navigation

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109H - Are You Ready For Tracers?

• LOG IN
• Access Code 01VEHU
• Verify Code VEHU01

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109H - Are You Ready For Tracers?

• Admission Information
• Open CPRS, using the Access Code of 01VEHU and
  Verify Code of VEHU01.
• Double click on One,Patient.
• The chart opens to the cover sheet. Look in the
  bottom right hand corner under,
  Appointments/Visits/Admissions and find the
  date and time of admission for 7a Gen Med
  (4-27-08 _at_ 1100).

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109H - Are You Ready For Tracers?

• Nursing Admission Assessment
• Click on Notes tab.
• Choose Nursing Admission Assessment.
• About 10 lines down you will see, Patients
  Reason for Admission/Procedure.
• On the 5th line below the Vital Signs you will
  see an entry about new allergies.
• Move down five lines to Advance Directive.

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109H - Are You Ready For Tracers?

• Skin Assessment
• Right click within the Nursing Admission
  Assessment note.
• Choose, Find in Selected Note.
• Type in skin and choose Find Next.
• This takes you to the skin assessment.

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109H - Are You Ready For Tracers?

• Nutrition Screening
• Right click within the Nursing Admission
  Assessment note.
• Choose, Find in Selected Note.
• Type in nutrition and click 3 times on Find
  Next.
• This takes you to the nutrition assessment.

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109H - Are You Ready For Tracers?

• Fall Risk Assessment
• The Fall Risk Assessment is located immediately
  below the Nutrition Assessment.
• Review the entries and associated scores.
• Verify the 0 for high risk medications
• Click on the Meds tab.
• Review Outpatient medications.
• Find Metformin and Metoprolol.
• Return to the Nursing Admission Assessment
  under the Notes tab. It should be at the same
  view as before accessing the Meds tab.
• Note the total score of 90.

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109H - Are You Ready For Tracers?

• Medication Reconciliation
• Verify that you are still in the Notes tab.
• Select the Medication Reconciliation note.
• Look toward the bottom of the note for the MED
  RECON entry.

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109H - Are You Ready For Tracers?

• Problem List
• Click on the Problem List tab.
• Note that each diagnosis should be identified as
  active or inactive with appropriate dates.

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109H - Are You Ready For Tracers?

• Learning Assessment
• Verify that you are still under the Notes tab.
• Choose the Nursing Admission Assessment note.
• Right click within the note and select Find in
  Selected Note.
• Type in Education and click two times on Find
  Next.
• Review the education assessment information.

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109H - Are You Ready For Tracers?

• Pre-op Teaching
• Choose the Nursing Surgical Evaluation Unit
  Note
• Review the content

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109H - Are You Ready For Tracers?

• Informed Consent
• Verify that you are still under the Notes tab.
• Choose the note, Informed Consent note.
• Review the content of the note laterality is
  not addressed.
• Open the IMED Consent.
• Choose Tools on the dropdown menu.
• Select VistA Imaging Display.
• Select the IMED consent for Left Inguinal Hernia
  Repair.

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109H - Are You Ready For Tracers?

• Universal Protocol
• Verify that you are still under the Notes tab.
• Choose the note, Procedure Patient Site
  Verification note.
• Compare the content of this note with the
  requirements
• Involves the entire operative team, uses active
  communication and includes at least
• Correct patient identity
• Correct side and site
• Agreement on the procedure to be done
• Correct patient position
• Availability of implants or special equipment, if
  appropriate

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109H - Are You Ready For Tracers?

• Coordination of Care
• Medical Care
• Click on the Notes tab
• Choose the General Surgery Resident Note.
• Review the content of the note

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109H - Are You Ready For Tracers?

• Coordination of Care
• Nursing Care
• Choose the Nursing Reassessment note.
• Find the plan by using the search function.
• Right click within the note.
• Choose Find in Selected Note.
• Type in Plan and choose, Find Next.
• This takes us directly to the plan.
• Using the Find in Selected Note function,
  replace plan with activity
• Click on Find Next
• This takes us to the current activity of the
  patient

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109H - Are You Ready For Tracers?

• Hand-off Communication
• Hand-offs
• Surgical Evaluation Unit to Surgery
• Surgery to the inpatient unit
• Shift to shift during the inpatient stay
• Communication
• Click on the Notes tab.
• Chose the Nursing Surgical Evaluation Unit
  note.
• Review the note.

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109H - Are You Ready For Tracers?

• Critical Test Value
• Click on the Labs tab
• The result that appears is the Potassium (K)
  value of 4.5
• Click on Previous to obtain the result of 2.9.
• Go to the Comments section at the bottom of
  screen

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109H - Are You Ready For Tracers?

• Verification of Ordering Provider
• Click on the Orders tab.
• This order has been completed so on the toolbar,
  drop down the menu for View.
• Choose Custom Order View.
• Choose Completed/Expired on the left hand side
  and Laboratory on the right hand side.
• Double click on the order for Potassium dated
  4/28/08.
• Fourth line down, look for Ordered by and find
  Provider, One.

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109H - Are You Ready For Tracers?

• Verbal Orders
• Click on the Orders tab.
• On the toolbar, drop down the menu for View.
• Choose Custom Order View.
• Choose Completed/Expired on the left hand side
  and Pharmacy on the right hand side.
• Find the order for Potassium in the Inpatient
  Section.
• Note read-back documentation.

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109H - Are You Ready For Tracers?

• Pain Management
• Click on the Notes tab.
• Choose the Nursing Reassessment note.
• Note the pain score of 6 at 1600.

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109H - Are You Ready For Tracers?

• Order for Pain Medication
• Click on the Orders tab.
• On the toolbar, drop down the menu for View.
• Choose Custom Order View.
• Choose Completed/Expired on the left hand side
  and Pharmacy on the right hand side.
• Look in Inpatient Medications to find an order
  for Codeine30/Acetaminophen 300mg.
• Note that the order is written for one or two
  tablets.

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109H - Are You Ready For Tracers?

• Medication Administration
• Click on the Reports tab.
• On the left hand side of the screen, choose Med
  Admin Log.
• Go down to the next box and click on Six Months
  Back.
• Scroll down to find Codeine30/Acetaminophen
  300mg.
• Note the date/time med was given.
• Note PRN Effectiveness entry.
• Click on the Notes tab.
• The Nursing Reassessment note should appear on
  your screen.
• Two lines below the vital signs you will notice
  the entry for LOC.
• Current pain score is 0.
• The time of the note is 1645.

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109H - Are You Ready For Tracers?

• Assessment of Surgical Wound
• Click on the Notes tab.
• Choose the Nursing Reassessment note.
• Right click within the note.
• Choose Find in Selected Note.
• Type in Skin and choose, Find Next.

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109H - Are You Ready For Tracers?

• Discharge Planning
• Click on the Notes tab.
• Choose the Nursing Admission Assessment note.
• Right click within the note and select Find in
  Selected Note.
• Type in psychosocial and click on Find Next.
• Note there are no concerns about returning home.
• Type in home and click on Find Next.
• There are no special concerns in the assessment
  of his home living situation.

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109H - Are You Ready For Tracers?

• Discharge Instructions
• Verify that you are still working under the
  Notes tab.
• Choose the Nursing Discharge Instructions.
• Review the content of the note.