1. © The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 Armstrong Institute for Patient Safety and Quality Jill A. Marsteller, PhD, MPP Sept. 27, 2012 Assessing Process and Audit Measures

2. 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 2

3. 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 3

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

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

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

7. Timeline-OR Aug 2012 Sep OctNov Dec 2012 Jan 2013 FebMarAprMayJun Jul 2013 CLABSI Audit – Insertion XXX SSI Audits – Skin Prep, Abx Redosing XXX CUSP Audits Debrief LFD Brief Huddle Debrief LFD 7

8. Timeline-ICU & Universal Aug 2012 Sep OctNov Dec 2012 Jan 2013 FebMarAprMayJun Jul 2013 CLABSI Audit - Insertion X CLABSI Audit – Maintenance XX VAP Process XXXXXXXXXXXX CUSP Audit LFD DGs AMB LFD 8

9. Timeline-Floor Aug 2012 Sep OctNov Dec 2012 Jan 2013 FebMarAprMayJun Jul 2013 CLABSI Process – Maintenance X XXX CUSP Audits LFD DGs AMB LFD 9

10. Audit data: “How To” The timeline 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 10

11. 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 /Huddle/ OR Briefing/ Debriefing Audit— observe XX opportunities for briefings; Report: number of briefings conducted and number of opportunities 11

12. 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 12

13. EXAMPLE: CENTRAL LINE MAINTENANCE AUDIT TOOL 13

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25. Action Items Try out our new site! Set up new members Begin data entry for: –Rates –TCT –Audits Contact us at csts@jhmi.edu for support.csts@jhmi.edu Training for Surveys, VAP Daily Process Forms, Reports, and additional features are upcoming. 25