Systematic Improvement VTE 1 Courtesy Reminders: Please place your phones on MUTE unless you are speaking (or use *6 on your keypad) Please do not take calls and place the phone on HOLD during the presentation. Travis Dollak Improvement Advisor WHA

Poll Question #1 Which of the following Action Items did you complete for June? a.Submit Baseline Data b.Hold a Team Meeting c.View Science of Safety Video d.Review Quality Center Resources 2

Today’s Call Past 30 days Staff Safety Assessment Intervention Analysis Model for Improvement (including PDSA and Small Tests of Change) Next 30 days – Assessing your Change Ideas – AIM Statements 3

Last Month’s Survey Results 4

ACTION ITEMS Submit Baseline Data Hold an initiative team meeting View Science of Safety Video Review Quality Center 5 What went well? What could be improved? Past 30 Days

Science of Safety Recipe Educate on the Science of Safety Identify Defects (Staff safety assessment)* Learn from Defects Implement Teamwork & Communication Tools 6

What is a Defect? Simple Answer: Anything you do not want to have happen again. VTE risk assessment is not routine or standard Noncompliance with prophylaxis exists Protocols differ among orthopedics, surgery, and medicine. Unnecessary immobility occurs because of excessive sedation, central lines, catheters, etc. VTE and bleeding risks change, but there is no routine or standard reassessment. Widely different impressions are held from when it is safe to start anticoagulation per-procedure and post-trauma. 7

Identifying Defects Review error reports, liability claims, sentinel events Ask staff how the next patient will be harmed 8

The Staff Safety Assessment How will the next patient be harmed? One way to make harm visible– get staff thinking about safety and how to improve it Have team review responses and suggestions 9

Action Item #1 – Staff Safety Assessment Just two (2) very important questions for any clinical unit: Please describe why you think the next patient in your unit/clinical area may experience a Venous Thromboembolic Event. Please describe what you think can be done to prevent or minimize this harm. Thank you for helping improve safety in our workplace! 10 Available in the Webinar Folder on the Quality Center

Poll Question # 2 Please describe why you think the next patient in your unit/clinical area may experience a Venous Thromboembolic Event. (Free Text Response) 11

Options for Collecting Assessments What Team Leaders can do: 1.Hand out a Staff Safety Assessment form to all staff, clinical and non-clinical, in the unit. 2.Assure participants of their confidentiality. 3.Establish a collection box or envelope OR alternatively use an on-line survey tool. 4.Set an end date for compiling all the responses. 12

Every improvement is a change, but every change is not always an improvement 13

Intervention Analysis Analyze feasibility of the ideas from the Staff Safety Assessment Analyze feasibility of secondary drivers (from literature) 14

Poll Question # 2 Responses Please describe why you think the next patient in your unit/clinical area may experience a Venous Thromboembolic Event. 15

Prioritizing Your Ideas Review responses from Staff Safety Assessment Categorize them based on primary driver Primary DriverStaff Safety Assessment Effective Risk StratificationI Standardized Care ProcessesIIIIIII Decision Support (or Smart Use of Technology) IIII Prevention of FailureIII Identification and Mitigation of Failure II Other 16

Prioritizing Your Interventions Low Impact High Impact Difficult to Implement Easy to Implement 17

Action Item #2 – Assess and select an intervention using assessment tools Considerations: How would this intervention work on the unit? Who would be willing to try the intervention? Could you try this within the next three days? 18

Questions on How to Assess Interventions? 19

20 Testing ideas before implementing changes Change ideas Measurement Aims Systematic Improvement

AIM Statement – What are we trying to accomplish? By when? What? Who? How much? Sample Aim Statements Wisconsin Hospitals will reduce the incidence of hospital-acquired VTE by 50% by December 31, By July 1, 2012, 95% of hospitalized patients in our unit will receive VTE prophylaxis as defined by protocols and according to a patient’s assessed status of VTE risk or prophylaxis contraindications based on the VTE prophylaxis assessment tool. Contraindications will be clearly documented in the medical record for 95% of the cases in which VTE prophylaxis is not ordered. 21

Evaluate these AIM Statements The med/surg unit will reduce the incidence of VTE by 30% 5 North will improve the VTE risk assessment tool before January 2013 The pilot unit will achieve zero VTE incidences over a 5 month period by September

Action Item #3 – Develop Your AIM Statement 23

24 Testing ideas before implementing changes Change ideas Measurement Aims Systematic Improvement

Measurement Annotated Run Chart – plot small samples frequently over time. 25 Time (e.g., Month) Observed Data Value (e.g.,med errors) Observed Data Value (e.g.,med errors) TOPIC SPECIFIC “In God we trust. All others bring data.” W. E. Deming

VTE Process Measures Action Item #4: Submit Data Percent of patients screened on admission using VTE risk assessment toolOR Prevalence of appropriate VTE prophylaxis * Minimum of 20 patients/month for either measure 26

From Practice to Application: What to do next? Engaging front-line staff in innovation and quality improvement 26

28 Testing ideas before implementing changes Change ideas Measurement Aims Systematic Improvement

Change Ideas To be considered a real test… Test was planned, including a plan for collecting data Plan was carried out and data was collected Time was set aside to analyze data and study the results Action was based on what was learned 29

Repeated Use of the PDSA Cycle 30 Changes That Result in Improvement Implementation of Change Hunches Theories Change Ideas AP SD A P S D AP SD D S P A DATA Very Small Scale Test Follow-up Tests Wide-Scale Tests of Change IHI – Adapted from “The Improvement Guide” by Lloyd Provost

PDSA Cycle for Learning and Improving 31 Act What changes are to be made? Next cycle? Plan Objective, questions and predictions (why) Plan to carry out the cycle (who, what, where, when ) Study Complete the analysis of the data Compare data to predictions Summarize what was learned Do Carry out the plan Document problems and unexpected observations Begin analysis of the data

Action Item #5 – Test an Intervention Rule of 1 Apply the Rule of 1: try the intervention with one patient, one nurse, one hour, one room. Expand the participants systematically three nurses, six patients, one shift. The goal is to have at least 20% of those doing the work to have a chance to try it before it because a standard. Topic Example 32

Action Item #6 – Make a Prediction and Measure Benefits: Know what you are doing is making an impact Early indicator that you may be getting off track Opportunity to identify obstacles Answers the question: “Can we rapidly adopt this practice?” 33

Keep Track of Your Findings TESTPREDICTIONRESULTS Try simplified risk assessment tool on one patient Speed up process, clearer instructions for prophylaxis Add contraindications to order sheet Increase likelihood contraindications are identified 34

The Next 30 Days ACTION ITEMS Staff Safety Assessment Assess your interventions Develop an Aim Statement Test ONE intervention Make a prediction Submit Outcome and Process Measure 35 Tools available on WHA Quality Center: Assessment Toolkit Aim Statement Template Data Portal

Thank You! Questions? 36