Yadkin County Health Department

PAP CORNER BLUES TEAM MEMBERS

3 Pap Corner Blues Team Members Debbie Swaim, Lab Tech Pam Wilmoth, RN, BSN, QA Coordinator, Dental Supervisor Martha Powell, RN, Nursing Supervisor Lisa Ivester, RN, Family Planning Coordinator, Abnormal Pap Coordinator Debbie Dennis, FNP Alice Mitchell, Billing Clerk Trish Belton, Administrative Officer Chuck Wood, Environmental Health

Kaizen Event Assigned Coaches Dr. Laura Noonan (center) Norma Rife Iredell County Consultant Carolinas Medical Center Jim Kurrian NC State University 4

PAP CORNER BLUES Had to go to the GYNO - For that yearly Pap smear I wonder just WHY - You’d choose that career The speculum was metal - It seemed pretty large I can’t believe - I will be charged Pap Corner Blues I’m showing my rear

PAP CORNER BLUES He said “now relax” - This won’t take long It’s been more than moment - The DOC’s already wrong Put my clothes on - Got my pride off the floor I held my head high - As I walked out the door Pap Corner Blues I’m showing my rear 6

Final Aim Statement Yadkin County Health Department aims to improve the health of clients receiving PAP smears by successfully notifying the clients of abnormal PAP smear results, thus enabling our clients to make informed decisions on obtaining follow up as recommended by the agency physicians, and mid-level providers. Cervical cancer can best be treated with early detection and treatment. Staff awareness of improvement, goal oriented, plan/implementation, and utilization of policy is ongoing. We will do this by June 2011 by utilizing the Method of Improvement and Lean Methodology.

Project Measures >90% of our clients with abnormal PAP smears will receive timely notifications per ‘Abnormal PAP smear follow-up policy.’

9 YCHD will provide clients education about their abnormal pap smear results. YCHD will call clients in the abnormal pap smear process and evaluate their satisfaction with the education materials and method of notification they desire.

10 50% of the client population with abnormal Pap smears will seek referral process and continued recommendation of following through with next step of process.

11 Decrease the amount of time it takes to receive Pap Smear results back from state lab. 1.Lab tech to send pap smears 2-3 times a week to the NC State Lab. 2. NCSLPH established a full time Pathologist for the Cancer Cytology Unit on March 18, 2011.

Key Improvements New Lab Log created

13 KEY IMPROVEMENTS CONTINUED….. 1.Eliminated steps to documenting pap smear results a. Eliminated the Pap Log form b. Eliminated the Pap Log tickler file 2.Updated the Abnormal Pap Smear Policy 3.Created a Standing Order for Pap Smear Policy 4.Flag – Alert system to Problem List for client in the Abnormal Pap Process 5. ½ slips for clients to put down current address/phone/emergency contact #

Kaizen Event Results Improved the notification time of clients receiving Pap Smear by eliminating waste in the abnormal Pap process. 14

Kaizen Event 15 Creating Standing Orders will eliminate the FNP step of Abnormal Pap Follow up

Kaizen Event 16 Eliminated multiple listings in several tickler files.

Post Kaizen Event Staff Survey 17

Post Kaizen Event Staff Survey 18

Post Kaizen Event Staff Survey Comments Please express your ideas of change in attempts to improve our Pap Smear Process. Good Continue to get staff input Unsure When Staff have been given an opportunity to provide input, change can be good One person in charge instead of multiple hands Lisa needs more time to work on the abnormal pap smears for clients How do you feel about the new half sheets that were created to be utilized with each clinic visit? Good They are still not being checked for emergency numbers We need them and they have proven effective Like them Great asset NOT SURE AS OF YET 19

Post Kaizen Event Staff Survey Comments How do you feel about the new lab log that was created during the Kaizen event? Mixed reviews. Front staff needs to make sure more stickers are on the charts Have not had time to evaluate I think this has been a good change Very neat, well organized More effective Better Like it Looks good and efficient Cumbersome. Papers tear. Would like to see holes on left margin, not on the top margin. In order to improve the Pap smear process, we need feedback from our staff regarding ways to improve the Pap smear process. If you have any comments, suggestions or concerns, please feel free to express your opinion in this survey. More time needed to process letters/client follow up Continue to use out guides when chart is taken from ANYONE’S stack or basket Have all changes been evaluated? Lisa needs designated desk time to work on abnormal pap smear follow up 20

Key Learnings Importance of communicating with staff about changes. Collected a lot of data and completed run charts with information not needed. Very concerned that the QI project we chose would not fill up an entire Kaizen Event. Make sure you have a team with the necessary people to make changes for your project.

Future Plans Several sites within the health department will need 5 S’s done. Several parking lot issues that were found: a. Need to simplify Adult History forms b. Searching for an electronic registry c. Current lab process for other labs d. Child Health Bright Futures implementation