Transcript Improving Hemodialysis Adequacy

Improving
Immunizations: A CQI
Approach
Safe &
Timely
Immunizations
Coalition
Last week we learned…
Why influenza is specifically harmful
to dialysis patients, and…
Why it is important to immunize
Today we will talk about…
• How to use CQI to improve
vaccination rates
• How to identify common barriers
• How to develop strategies for
overcoming the barriers
What is CQI?
• Improving quality
through:
–Proactive approach
–Optimal orientation
–Process focus
What is CQI?
• Improvement comes from the
application of knowledge.
• Any approach to
improvement must be based
on building and applying
knowledge.
• Significant, long-term,
positive impact occur only
when someone takes the
initiative.
The CQI Cycle
ACT
PLAN
STUDY
DO
The Cycle Never Ends…
It just keeps going, and
going, and going…
A Cycle for Learning and
Improvement
ACT
•What changes are
to be made?
•What will be the
next cycle?
STUDY
•Complete
analysis
•Compare data to
prediction
•Summarize what
was learned
PLAN
•State the
objective
•Make predications
•Develop a plan to
carry out the cycle
DO
•Carry out the
plan
•Document
observations
•Analyze data
The IHI Model for
Improvement
• What are we trying to
accomplish?
• How will we know that a
change is an improvement?
• What changes can we
make that will result in
an improvement?
Act
Plan
Study
Do
Understanding the Problem
• Establishing a problem
statement
• Defining the scope of the
problem
• Refining the problem
Immunizations for Influenza
1. Where are we currently?
- What does the data say?
-What is the trend?
2. Where do we want to be?
- What knowledge do we have?
- What is our goal?
Where Are We Now?
illi
illi
lla
lla
USRDS ADR 2007
ESRD patients
initiating therapy at
least 90 days before
September 1, 2005, &
alive on December 31,
2005; vaccinations
tracked between
September 1 &
December 31.
What Knowledge Do We
Have?
• Increased susceptibility of CKD
patients to pneumococcal and
hepatitis B (CDC)
• Failure to increase rates of
immunization over past 10 years
(USRDS)
Where do we want to be?
• Healthy People 2010 Goals
– Influenza = 90%
– Pneumococcal = 90%
– Hepatitis B = 80%
• Network Medical Review Board
recommendations
• CDC Guidelines
What Are the Barriers?
How Will We Know a
Change Is an Improvement?
• Identify the barriers
• How do we measure that barrier?
• What does improvement look
like?
Identifying the Causes
• Which root causes are are specific to
this dialysis unit?
• What barriers create this cause?
• What strategies can be implemented
to overcome the barriers?
Root Cause Analysis
Medical
Prescription
Technical
Low
immunization
rates
Patient
HP 2010 Goal
Staff-Related
Education
Planning:
Key Components of a CQI Team
• Multidisciplinary
• Common goal
• Day-to-day knowledge
Planning for Improvement
•
•
•
•
•
Thinking outside the box
Establishing accountability
Setting a timeframe
Evaluating results
Documenting change
REMEMBER
All improvement requires
change
but
Not all change is
improvement
Evaluate the results!
Thinking Outside the Box
Rules of Creativity
•
•
•
•
•
•
Challenge the boundaries
Rearrange the order of the steps
Look for ways to smooth the flow
Evaluate the purpose
Visualize the idea
Remove “the current way of doing
things” as an option
Establishing Accountability
From the top down…
-Support
-resources
CREATIVE
CHANGE
From the ground up…
-Problem identification
-Idea development
Implementing Change
• When given a choice between two
systems, one of which they
understand, people will use what
they know.
• If you want to truly make a change,
you must present an expectation and
put in place a structure to effect the
change.
• People need information in order to
change.
Setting A Timeframe
Evaluate the Results
Document the Change
Resources
• Immunization Tools
– www.cdc.gov/vaccines/pubs/downloads/b_dialysis_guid
e.pdf
– www.esrdnetwork6.org/STICCoalition.htm
– www.esrdnet11.org/quality/immunization_coalition.asp
– www.esrdnet15.org/QI.htm#stic
• CQI Tools
– ANNA
– ESRD Networks
– www.ihi.org
Questions?
[email protected]
[email protected]
[email protected]