1. © 2009 Jill A. Marsteller, PhD, MPP May 24, 2011 Assessing Process and Audit Measures

2. © 2009 Learning Objectives You will be able to: – Explain why measuring process is critical to success – Describe process measures planned for collection – Detail the planned collection process

3. © 2009 Donabedian Model Structure ProcessOutcome How we organize care What we do during care delivery The results we achieve E.g., presence of policies or committees E.g., how often are evidence-based interventions performed E.g., how/ how many patients are harmed

4. © 2009 Approaches to measuring process Measures of perception – Accessible – Subject to bias Regular process measures collection – More objective – Burdensome Less frequent auditing – Less burdensome – Less reliable

5. © 2009 Process measures you already collect SCIP/STS – Abx selection – Abx timing – Abx stop w/in 48 hours – Glucose measure – Hair removal

6. © 2009 New Measures/ Audit Topics VAP process measures: – E.g., HOB elevation – E.g., sedation vacation SSI: – Skin prep (type, appropriateness) – Antibiotic redosing ; – Environment CLABSI: – Insertion (OR, ICU) – Maintenance (ICU, Floor) CUSP: – Daily goals; Am Briefing; LFD (ICU, Floor, universal) – Briefing/debriefing ; Huddle; LFD (OR)

7. © 2009 Timeline-OR Baseline period Jul 201 1 AugSepOctNovDec Jan 2012 FebMarAprMayJunJul CLABSI Process Wkl y X (90) SSI AuditsWkly X (90) CUSP Auditsbriefhuddle Aug 2012 Sep OctNov Dec 2012 Jan 2013 FebMarAprMayJunJulAug Sep 2013 CLABSI Process X (90) SSI Audits X (90) CUSP AuditsLFD briefhuddl e LFD

8. © 2009 Timeline-ICU Baseline Jul 2011 AugSepOctNovDec Jan 2012 FebMarAprMayJun Jul 2012 CLABSI ProcessWkly X(90) VAP ProcessWkly X(90) CUSP AuditDGsAMB Aug 2012 Sep OctNov Dec 2012 Jan 201 3 FebMarAprMayJunJulAug Sep 2013 CLABSI ProcessX(90) VAP Process X(90) CUSP AuditLFD DGsAMBLFD

9. © 2009 Timeline-Floor Baseline period Jul 2011 AugSepOctNovDec Jan 2012 FebMarAprMayJun Jul 2012 CLABSI Process— Maint. Wkly X(90) CUSP AuditsDGsAMB Aug 2012 Sep OctNov Dec 2012 Jan 2013 FebMarAprMayJunJulAug Sep 2013 CLABSI ProcessX(90) CUSP AuditsLFD DGsAMBLFD

10. © 2009 Timeline-Universal Bed Baseline period Jul 2011 AugSepOctNovDec Jan 2012 FebMarAprMayJunJul CLABSI ProcessWkly X(90) VAP ProcessWkly X(90) CUSP AuditsDGsAMB Aug 2011 Sep OctNov Dec 2012 Jan 2013 FebMarAprMayJunJulAug Sep 2013 CLABSI ProcessX(90) VAP ProcessX(90) CUSP AuditsLFD DGsAMBLFD

11. © 2009 Audit data: “How To” Reminder email will tell you what to audit for the coming month Collect data once a week and report at end of month Methods: Observations; counts with measure/ count total eligible; answer Qs When you enter web tool, it will tell you what audit data is due this month Web-based data entry forms

12. © 2009 Examples Daily Goal Audit—Once weekly count the number of patients that had a Daily Goals sheet filled for them during interdisciplinary rounds; also count total number of patients. Report: DG patients and total LFD Audit—Count number of defects worked on in last quarter; number resolved; number posted; number evaluated for effects AM Briefing or Huddle/ OR Briefing Audit—observe XX opportunities for briefings; Report: number of briefings conducted and number of opportunities; (Or observe briefings for recommended elements; Report: successes/observations for each element)

13. © 2009 How process measurement helps you Compliance is key to providing evidence-based practice EBP allows you to meet your outcomes goals Process measures provide a “map” to what’s working well and what’s not Regular feedback on performance essential to performance and buy-in (transparency) Use your data to inform, motivate, communicate laterally and upward