Transcript Slide 1

Using Quality Improvement
Tools to Improve
Interprofessional Education
Performance Improvement
Leadership Development Program
University of Missouri – Columbia
February 19, 2010
Team Members
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Carla Dyer, MD
School of Medicine
Deepti Vyas, PharmD UMKC School of Pharmacy
Dena Higbee, MS
Shelden Simulation Center
Gretchen Gregory,
MSN School of Nursing
Sue Boren, PhD
Health Management and Informatics
Rusty McCulloh, MD
Brown School of Medicine
Team Sponsor: Linda Headrick, MD
Coaches: Julie Brandt, PhD and Christina Vollrath, MSN
Interprofessional Education in
Quality, Safety and Teamwork
• Focus: Patient safety, QI, and
teamwork/communication
• Four week Curriculum: 7 hours total
• Began in 2003
• Five disciplines: Medicine, Nursing,
Respiratory Therapy, Health
Administration, and Pharmacy
2010 Participants N=274
Student Participants
Medical
Students
Nursing
Students
MHA Students
Pharmacy
Respiratory
Therapy
2008 Curriculum
• Introductory Lecture
– Quality and safety basics
– Local and national context
• Small Group Sessions—six hours
– Interprofessional Roles
– Modified root cause analysis
– Brainstorming solutions; effort vs. yield
• Final Group Presentations
Background: 2008 Curriculum
• Post-course
evaluations, on
average, demonstrated
a decrease in the
perceived value of the
interprofessional
experience and its
benefit to their future
careers
% Students who felt experience
would benefit future career
100
90
80
70
60
50
40
30
20
10
0
MHA
Nursing
Medical
RT
2006
2007
2008
Flow of the Curriculum in 2009
Introductory
Lecture
QI and Safety
Basics
Local and National
Context
National Safety
Goals
(1 hour)
Small Group Sessions
--Professional Roles
--Case Discussion
--Modified Root Cause
Analysis
--Brainstorming Solutions
(3 hours)
IP Simulation
Emphasizing
Teamwork and
Safety
( 1 1/2 hours)
Simulation Scenario
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Semi-urgent setting
5-6 patients/group of 10-12 students
Variable acuity and ages
Communication and teamwork issues
National Patient Safety goals
incorporated
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2010 National Safety Goals
Prevent
surgical
site
infections
Identify
patient
safety
risks
Involve
patients
in their
care
Identify
patients
correctly
Report
critical
results of
tests
National
Patient
Safety
Goals
2010
Prevent
falls
Check
patient
meds
Use
medicine
safely
Prevent
errors with
invasive
procedures
Percentage of Students Responding
2009 Experience: The simulation increased my…”
60
50
40
30
20
10
0
Strongly
Disagree
Disagree
Agree
Strongly Agree
Understanding of the importance of interprofessional
communication
Understanding of the roles of other healthcare professionals
Ability to recognize and respond to patient safety issues
N=171
2009 Simulation Cases—Integrating Teamwork and Safety
Case
Patient 1
Patient 2
Patient 3
Patient 4
Patient 5
Patient Safety Hazards*
%
recognized
by students
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Verbal Order read back
Needle in bed
Wrong ID on arm band
50%
79%
21%
25%
Category X home meds
53%
Drug Allergy
Allergy band incorrect
Unlocked bed
Wrong Dose Medication
94%
17%
6%
50%
Inappropriate home meds
**Based on 18 small groups
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Aim Statement
To increase interprofessional
students’ recognition of selected
patient safety threats by 25% from
baseline by February 2010 through
improved student preparation and
modification of measurement
process.
Why choose safety?
• MU SOM Key Characteristics of our
graduates: “committed to improving care”
• MU SON Core Curriculum Concepts:
Patient Safety
• Similar accreditation requirements for
other programs
• Institution: Closely related to Quality,
Service, People, and Finance
Flow Diagram-IPC 2009
Ishikawa Diagram
Stakeholders
• Students
• Faculty school of medicine,
nursing, pharmacy and health professions
• Shelden Simulation Center Staff
• Office of Clinical Effectiveness
• Senior education leaders and
Administrators at the University Hospital
• Patients– “downstream”
Effort vs. Yield
High Effort
Low Effort
Low Impact
High Impact
-Revise simulation to decrease chaos.
Changing the setting from the mass
calamity to H1N1 coverage? To
decrease student stress
-Adding safety to introductory lecture
-Clarify instructions to students
-Clarify goals/learning objectives
-Clarify roles of students
-Clarify faculty schedules
-Revise Sim Pre/Post Survey with
Identifiers
-Back up system for ensuring
identifiers- faculty double check?
-Create a leadership role in the
scenario/debrief for HMI to integrate QI
concepts in debrief
-Revise observer checklist
-Hire a research assistant to help with
data abstraction
-Introduction/Creation of a Safety
-Increasing number of faculty
observers
Scenario
-Create a faculty debrief guide
-Improve audio/visual equipment
-Involve statistician
Timeline of Events to Simulation
Focus Areas for Change
• Increased emphasis on safety in lecture
and small group
• Measurement tools:
– Increasing Faculty Observer Ratio
– Simplifying Tool and increasing patient role
• Improving Audiovisual capabilities to
capture encounters for future analysis
• Introduction of Environmental
Assessment (based on Safety Seals)
A “Primer” in Safety
Environmental
Assessment
Exercise (1/2)
Team
Deliverable
Debrief
Simulation
Formation
Session
Report
(20
(10
(5
30
minutes)
minutes
minutes)
minutes)
Simulation
(20
minutes)
Deliverable
Report
Debrief
Session
(5 minutes)
30 minutes
Environmental
Assessment
Exercise (All)
20
Measuring Change
• Measured frequency of potential patient
safety hazards recognized by students in
the interprofessional simulation
– Standardized patients
– Faculty observers
– Order sheets
Measuring Change
• Outcome Indicators
– Potential safety hazards identified
– Pre/Post Knowledge, Skills, Attitude survey
– Course Evaluation
• Process Indicators
– Qualitative feedback from students/faculty
during dry runs
– Qualitative feedback from surveys
• Students and Faculty
Preliminary Data Analysis—Based on 24 Groups of Students
Safety Item
% Detected
2009
% Detected
2010
% Detected 2010
with Primer
Inappropriate home
meds
50%
42%
17%
Verbal Order Read
79%
42%
25%
Needle in Bed
Wrong Arm Band
21%
25%
25%
67%
50%
67%
Category X home meds
53%
8%
42%
Drug Allergy identified
94%
92%
92%
Recognize incorrect
arm band
17%
67%
67%
Fall risk identified
6%
42%
50%
Medication wrong dose
50%
66%
55%
Student Feedback
Positives:
--Enjoyed working in teams
--Learned from the other students
perspectives, especially from nurses
Negatives:
Needed more time
Perceived value: (5=high)
– As individual: 3.79 / 5
– As team:
4.13 / 5
Return on Investment
• Increased awareness of potential patient
safety risks in future health care providers
• Thousands of dollars potential cost saving
to institution
– Use of gait belts
– Recognition of medication errors
– Effective handoffs
• Decreasing morbidity and mortality of our
patients
Costs of
Environmental Assessment
• Standardized patients: 8 ----> $312
• Faculty: 13 faculty and 2 grad students
– 2 hours / 4 hours
– 76.5 hrs Manpower
• Equipment (in kind)
• Simulation Center space (in kind)
• Faculty/staff time spent planning and
implementing
Other Costs
• Increased Faculty Observers
– 24 additional faculty—three hours each
• Increased Equipment Cost (microphones)
--$16,000
Challenges
• Cycle of improvement is long
– Yearly Data collection
– Large amounts data/very short time frame
– Pressure to improve several areas at one time
• Logistics of coordination—
– 274 students
– >50 faculty/staff
--28 standardized patients
• Applying QI concepts to education
Lessons Learned
• Applying QI concepts to improving education is
achievable; continuous improvement is critical to
curricular success
• Using technology that supports QI principles
• Access to resources and mentoring increases
success—coaches, sponsors, research faculty
• Balanced team is key to success—highly
invested members; interprofessional
representation
Interprofessional Curriculum
2010
Groups of Students: 24
Faculty/Staff: >50
Students in simulation: 274
Environmental safety room encounters: 404
Safety Issues recognized: over 5000
Future impact on their patients: priceless
Summary
• Continue work regarding effectiveness of
“primer” to increase effectiveness of IP
simulation
• Fine tune measurement tools
• Reinforce patient safety concepts in “real
life” setting
• Emphasize value of interprofessional care
and IP education
Questions???
Carla Dyer, MD
[email protected]
University of Missouri School of Medicine
Deepti Vyas, Pharm D
[email protected]
University of Missouri-Kansas City School of Pharmacy
Dena Higbee, MS
[email protected]
Simulation Center Director,
University of Missouri School of Medicine
Gretchen Gregory
[email protected]
University of Missouri Sinclair School of Nursing
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