Presentation is loading. Please wait.

Presentation is loading. Please wait.

Virtua Health Sharon Mindel, Pharm D Terry Rodgers, RN, MSN Jeannie Ritzius, RN.

Similar presentations


Presentation on theme: "Virtua Health Sharon Mindel, Pharm D Terry Rodgers, RN, MSN Jeannie Ritzius, RN."— Presentation transcript:

1 Virtua Health Sharon Mindel, Pharm D Terry Rodgers, RN, MSN Jeannie Ritzius, RN

2 ST P THE CLOT!

3 Four hospital system in Southern New Jersey Two Long Term Care Facilities Two Home Health Agencies Two Free Standing Surgical Centers (JVs) Two Medical Staffs (currently merging) Ambulatory Care - Camden Fitness Center 7,100 employees + 2000 physicians 7,752 deliveries 8% Operating Margin - #1 in the state of NJ STAR Culture Virtua Health Virtua receives the JCAHO Gold Seal for: Stroke Center at Memorial, Total Joint Program, and Spine Program Stroke Center at Memorial, Total Joint Program, and Spine Program

4 200,000 – 600,00 reports of VTE in the United States annually contribute to 60,000 – 200,000 deaths per year More deaths than AIDS, breast cancer and highway fatalities combined VTE is preventable Many patients at risk do not receive prophylaxis DVT + PE = VTE

5 Patient Group VTE Prevalence, % Medical Patients 50-70% General Surgery 15-40% Stroke 20-50% Hip/Knee Arthroplasty, Fracture 40-80% Major Trauma 50-80% Spinal Cord Injury 60-100% Critical Care Patients 10-33% Risk of VTE in Hospitalized Patients

6 Project Title : Standard Practice for Venous Thromboembolism (VTE) Prophylaxis Division (s): Marlton Project Title : Standard Practice for Venous Thromboembolism (VTE) Prophylaxis Division (s): Marlton Sponsor (s): Carol Mullin Process Owner (s): Mary Ann Krug, Sharon Mindel, Terry Rodgers, Dee Page, Sabina Zabrodski, Lynn Block Team Members: Sharon Iannece, Mary Saunders, Jennifer Smith Green Belt: Terry Rodgers Master Black Belt: Donna Forrest Black Belt: Jeannie Ritzius Physician Advisor: Dr. Sutherland Sponsor (s): Carol Mullin Process Owner (s): Mary Ann Krug, Sharon Mindel, Terry Rodgers, Dee Page, Sabina Zabrodski, Lynn Block Team Members: Sharon Iannece, Mary Saunders, Jennifer Smith Green Belt: Terry Rodgers Master Black Belt: Donna Forrest Black Belt: Jeannie Ritzius Physician Advisor: Dr. Sutherland Goal/Opportunity/ Description Statement: To increase clinical quality and patient safety and decrease cost associated with VTE Target 90% of patients identified at risk for VTE will be prophylaxed Goal/Opportunity/ Description Statement: To increase clinical quality and patient safety and decrease cost associated with VTE Target 90% of patients identified at risk for VTE will be prophylaxed

7 What is the Right Y to Measure? How will it be measured? Prophylaxis of patients assessed for risk of VTE. Discrete data was used to be measured through chart review of discharged patients. What is the Right Y to Measure? How will it be measured? Prophylaxis of patients assessed for risk of VTE. Discrete data was used to be measured through chart review of discharged patients. What is a Defect? What are the process specifications? Y1 Defect: Not prophylaxing patients identified at risk for VTE USL = none LSL = noneTarget = 90% based on Sponsor identified CTQ What is a Defect? What are the process specifications? Y1 Defect: Not prophylaxing patients identified at risk for VTE USL = none LSL = noneTarget = 90% based on Sponsor identified CTQ Measurement System Accuracy: An SOP was developed 20 charts were gaged Initial gage revealed 90% agreement Repeat gage after review of SOP revealed 95% correct and agreed upon 20 charts were gaged using hard copy Medical Records This gage also had 95% confidence Measurement System Accuracy: An SOP was developed 20 charts were gaged Initial gage revealed 90% agreement Repeat gage after review of SOP revealed 95% correct and agreed upon 20 charts were gaged using hard copy Medical Records This gage also had 95% confidence Data Sources: Medical Records and Net Access 249 Charts manually and electronically Data Sources: Medical Records and Net Access 249 Charts manually and electronically Measure Phase

8 Initial Z Score for 249 Patients Measure Phase Metrics

9 Pareto Charts for Medical – Surgical Patients

10 VTE Assessment / Prophylaxis Order Form

11 Initial Z score for Surgical Patients 8.8% Defects Initial Z score for Medical Patients 57.1% Defects 11.9% Defects from pilot data for Medical Patients Pre - and Post - Pilot Performance Pre - and Post - Pilot Performance

12 Chi Square Test: # Passed-Failed Chi Square Test Results From Pilot A P-value of <.05 shows a statistically significant difference

13 Project YData Type TestInitial Performance Current Performance Statistical Significance Not prophylaxing patients identified at risk for VTE DiscreteZ- Calc & Chi - Square Z = 0Z = 2.68P- value <.05 Project Performance Project Performance

14 Dr. Chelemer and Dr. Sutherland worked together with the VTE team to develop the final form for VTE prophylaxis, and presented the form to key committees and departments. Gage completed with 95% confidence Shared learning with Physicians from Deborah hospital Piloted electronic chart reviews Pilot program completed with three Physician groups Presentations throughout Virtua: P&T VTE Education with CEUs Forms Committee Development of TRIP sheet Medical Exec for each division Virtua Vine Intranet Education Quality and Risk Committee Guess the Calf Contest Quality News letter NEC – MPNEC Surgical Council Pharmacy Directors Vendor Expo participation Unit Based Council Education All day poster presentations on each campus Individual presentation to physicians / physician groups Unit Secretary education Accomplishments

15 Change Acceleration Process : Leading Change Changing Systems & Structures Current State Transition State Improved State Creating A Shared Need Shaping A Vision Mobilizing Commitment Making Change Last Monitoring Progress

16 Q x A = E Quality X Acceptance = Effectiveness many quality efforts fail due to lack of attention to the cultural and people side of change -- the A Formula for Change

17 Performance after Project implementation to all campuses Performance after Project implementation to all campuses

18 Future VTE Measures VTE prophylaxis addressed in surgical patients with SCIP Joint Commission/NQF Project – currently testing measures NQF VTE Steering Committee will recommend specific measures Anticipate 2008 NQF will endorse measures No specific plans for implementation

19 Lessons Learned System wide focus Focus on broad range of VOC when dealing with multiple medical staffs Over-communicate More CAP with physicians: Q X A = SUCCESS CORE measures can often drive physician compliance Six Sigma is effective for clinical settings Development of EMR will improve compliance

20 Leading Change Creating a Shared Need Shaping a Vision Mobilizing Commitment Changing Systems & Structures Monitoring Progress Making Change Last Cap – O – Gram How likely is this project to be successful ? 60 70 65 45 50 35 90 70 60 45 25 7075 45 55 70 75 80 95 90 50 7580 95 96 95 I 3/17/06 D 1/1/05 M 3/1/05 A 4/1/06 9088 80 75 70 80 88 90 88 95 75 93 92 C 8/16/06 C 4/17/07 100% 50% 0 75% 25%

21 WHAT YOU DONT KNOW COULD KILL YOU… LEARN WHAT YOU CAN DO TO PREVENT VTE TODAY. Contact Information: smindel@virtua.org – trodgers@virtua.org- jritzius@virtua.orgsmindel@virtua.orgtrodgers@virtua.org-jritzius@virtua.org


Download ppt "Virtua Health Sharon Mindel, Pharm D Terry Rodgers, RN, MSN Jeannie Ritzius, RN."

Similar presentations


Ads by Google