Improving Tobacco Use Screening and Cessation for Hospitalized Patients through Evidenced Based Practice Multiple Cycles of Refinement (PDSA) Utilizing.

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Presentation transcript:

Improving Tobacco Use Screening and Cessation for Hospitalized Patients through Evidenced Based Practice Multiple Cycles of Refinement (PDSA) Utilizing VA-TAMCCS Cheryl Huff, Psy.D. Ralph H. Johnson VA Medical Center Charleston, SC

APPROACHING & FRAMING PROCESS IMPROVEMENT PDSA TAMCCS SIX SIGMA LEAN VALUE ANALYSIS TEAMS QUALITY CIRCLES TQM JURAN’S TRILOGY All quality intervention methodologies are interrelated…….

APPROACH / METHODOLOGY standardization & continuity….. INCREASE EFFICIENCY LEAN SIX SIGMA IMPROVE QUALITY

FRAMEWORK VA-TAMCCS HFMEA PDSA PDSA

TEAM Leonard Alsfeld, MD - Chief Resident for Quality and Safety Beth Carbonneau, LISW-CP, Social Work Service Deb Cutts, Systems Redesign (Facilitator) Cheryl Huff, PsyD, Health Behavior Coordinator Kathy Jenkins, Performance Improvement Coordinator Patrick McGillicuddy, RN, Clinical Applications Coordinator Amy Millett, MSN, RN, CNL, Clinical Documentation Specialist Jamie Sicard, MSN, RN, CCRN-CMC-CSC, & PCCN, Clinical Documentation Specialist Team Support: Sara Henderson, Program Analyst Quality Management Jonathan Kessler, LISW-CP Theresa Medley, LISW-CP, Chief Social Work Service Cheryl Karn, RN Brandy Manigo, RN Kathleen Fowler, RN, MSN

Reason for action Plan + Vision and Analysis: High quality, Veteran-centered care Best in measured outcomes Leverage models of health care delivery – Motivational Interviewing Optimize individual & population health outcomes Engage and inspire Veterans to highest possible level of health and well-being Problem Statement: There is a lack of awareness of process and performance expectations, and of available innovative techniques and resources related to tobacco cession. There is a sense of competing priorities. As a result, we are not providing the best available tobacco cession interventions for our patients while they are in acute care. Process Start: Patient is admitted to acute care Process Stop: Patient is discharged from acute care* In Scope: All patients over the age of 18 with =>3 day length of stay and discharged alive Out of Scope: Patients less than 18 years of age, patients with <3 day length of stay, patients deceased while in acute care

Plan + Current State Value of screening……

Current State 11 Process Steps 19 “Moments of Truth” Plan + Current State 11 Process Steps 19 “Moments of Truth” Current Process State Attributes: Resources ? Learned Helplessness “Check the box” Culture

Plan + Target State AIM Design a replicable multidisciplinary approach to improve both clinician and patient engagement in tobacco cessation activities resulting in achievement of “Top Performer” Status for evidenced based care by improve performance of ORYX and Accountability Tobacco Measures from FY16 average baseline for each metric to 95% for all four metrics by 4th Qtr. FY17. Target State attributes Empowered multidisciplinary team Patient centered approach

MOTIVATIONAL INTERVIEWING FOR HEALTH BEHAVIOR CHANGE Plan + Target State MOTIVATIONAL INTERVIEWING FOR HEALTH BEHAVIOR CHANGE ADDRESSING AMBIVALENCE OARS RULE IMPORTANCE / CONFIDENCE

Target State 18 Process Steps 4 “Moments of Truth” Plan+ Target State . 18 Process Steps 4 “Moments of Truth” Target versus Ideal…….

Plan + Gap Analysis Inpatient tobacco cessation interventions assumed useless Duration of habit/previous failed attempts = cessation interventions not a priority for patients/staff Tobacco use screening repeatedly completed and documented but no effective intervention taken Lack of ownership/check the box syndrome, template fatigue = Veteran does not receive effective/timely intervention ISHIKAWA

Solutions / Countermeasures Do+ Solutions / Countermeasures

Do+ Rapid Experiments This list should be made up of new or revised steps in the process you implement and study to determine effectiveness versus a list of team deliverables which can be tracked off line. Several small cycles of refinement…… measured frequently

Implementation / Completion Plans Do+ Implementation / Completion Plans Everyone involved in the process..... at the table improving the process

Confirmed State Measure / Change Cross Functional Process Flow 6 Unique Process Owners

ACT / SPREAD Potential Insights

Cheryl Huff, PsyD Health Behavior Coordinator Thank you! Cheryl Huff, PsyD Health Behavior Coordinator Contact: 843-577-5011 x5601 Questions?