1. Use of Tracers as a Leadership Tool

2. Creating the Opportunity for Excellence in Patient Care

3. Objectives
Upon completion of this presentation, the participant should be able to:
Articulate an overview of the process used when tracing the care of a patient
Identify how to use tracers as a method of improving quality and patient safety within the organization
Articulate how to use tracers as a leadership tool in this organization

4. The hypothesis is: If we look at health care as a series of systems and subsystems, and identify the “defects” within the system(s), errors causing patients harm will be reduced

5. Method of identifying “broken” systems is through the use of tracers

6. Systems
The new way of
thinking

7. Accreditation and Systems
Consensus definition of system:
A group of interacting, interrelated, or interdependent components that form a complex, unified whole

8. Accreditation and Systems (cont.)
The accreditation process is a system
Overall quality and safety of patient care and the patient environment are measured by:
Standards and measurable elements
International Patient Safety Goals
International indicators

9. What is a Tracer?

10. An individual patient tracer follows the experiences of a patient throughout the health care system. An individual-based system tracer examines high-risk processes (medication management, infection control, data) across the organization

11. Using Tracer Methodology in the Survey Process

12. Tracers in the Survey Process
Gradual introduction into the survey process in 2006; official part of survey and accreditation decision process in 2007
Comments are positive – focus on the process of caring for the patient and their environment
Changes in survey process are not significant

13. Changes include: New Patient system focus
Patient is the center of activity – visits focus on the contacts the patient has or will have
Standards compliance based on review of systems and process – unified, relationship to the whole
Old
Department function focus
The departments is the focus – scheduled visits to each department
Standards compliance based on department functions without examining the relationship to the whole

14. Changes continued: New Patient system focus
Interviews focus on systems and processes (medication management, infection control, data/ quality, and competency)
Bottom line is how you care for your patients and their environment each day
Old
Department function focus
Interviews focus on questions and answers

15. You can learn more in 8 hours of tracing than in 20 hours of
Bottom-line Focus
How the care is delivered to the patients, and how their environment is maintained each day
You can learn more in 8 hours of tracing than in 20 hours of
chart review!

16. Performing Successful Tracers

17. Tracer Varieties Individual patient tracer
Performed by those who have a broad organizational perspective

18. Tracer Varieties (cont.)
Individual-based system tracer
Theme-based tracer
Hospitalwide issues, such as medication management, infection control, or data
Typically performed by chapter teams or key organizational personnel
Unit-based tracer
Tracing or monitoring issues at the unit – pain assessment, advance directives, medication administration, etc.

19. Getting Started Don’t expect it to go perfectly at first
Be willing to modify your process
Frame all communication around patient safety and quality improvement

20. Selecting a Patient to Trace
Use patient census – as an organization you will be asked to provide census with patient admission date, location, diagnosis
For focused tracers such as a patient with an infection, you may be asked to compile a list – this usually will not be the first tracer
Consider using the top diagnosis or top procedures performed

21. Approach Initial review of the record to determine: Process
Care experience of the patient being traced (nursing care, diagnostic testing, treatments, etc.)
The staff caring for the patient
The medications ordered
Process
Interview staff delivering care, treatment and services
Evaluate the environment
Interview the patient and family, if appropriate

22. Area of Focus/Presenting Symptoms
Start the process
Patient Information
Area of Focus/Presenting Symptoms
Moist lungs, Decreased activity tolerance,
Fatigue, Shortness of breath
History
Congestive heart failure, Coronary artery disease,
Cardiac catheterization, Stent placement
Admission
To Emergency department, Intensive care unit

23. Departments Visited: Discussion Points
1. Current Location of the Patient
Assessment and care
Medication process
Verbal orders
Screening for nutrition, rehabilitation, fall, and skin
Pain assessment and control
Patient education
Discharge planning
Staff competency

24. Departments Visited: Discussion Points
2. Emergency Room / Preadmission Triage Process
Assessment and reassessment
Communication with laboratory and radiology
Medication process, especially high-risk IVs
Hand-off process

25. Departments Visited: Discussion Points
3. Radiology: Patient Had X-ray
Assessment and reassessment
Communication with laboratory and radiology
Medication process, especially high-risk IVs
Hand-off process

26. Departments Visited: Discussion Points
4. Laboratory
CBC
Data collection and trending
Chemistry profile
Critical test results

27. Departments Visited: Discussion Points
5. Intensive Care Unit (ICU)
Communication from emergency department
Emergency department admission delays
Assessment and reassessment
Medication process
Verbal orders
Critical equipment alarms
Informed consent and education on procedure

28. Departments Visited: Discussion Points
6. Pharmacy
Identification of high-risk drugs and safety measures
Reconciliation process
Data regarding the use of these drugs
Education regarding medications
Involvement in discharge planning

29. Departments Visited: Discussion Points
7. Physical Therapy (Patient Rehabilitation)
Referral process
Assessment and reassessment
Goal setting (long-term, short-term, and patient goals)
Patient and family education
Pain assessment and documentation
Discharge planning

30. Map of Individual Tracer
7. Physical Therapy (Patient
Rehabilitation)
Referral process
Assessment and reassessment
Goal setting (long-term, short-term,
and patient goals)
Patient and family education
Pain assessment and documentation
Discharge planning
1. Current Location of the Patient
Assessment and care
Medication process
Verbal orders
Screening for nutrition, rehabilitation, fall, and skin
Pain assessment and control
Patient education
Discharge planning
Staff competency
Patient Information
Area of Focus/Presenting Symptoms
Moist lungs, Decreased activity tolerance,
Fatigue, Shortness of breath
History
Congestive heart failure, Coronary artery disease,
Cardiac catheterization, Stent placement
Admission
To Emergency department, Intensive care unit
6. Pharmacy
Identification of high-risk drugs
and safety measures
Reconciliation process
Data regarding the use of
these drugs
Education regarding medications
Involvement in discharge planning
2. Emergency Room/Preadmission
Triage Process
Assessment and reassessment
Communication with laboratory
and radiology
Medication process, especially
high-risk IVs
Hand-off process
5. Intensive Care Unit (ICU)
Communication from emergency
department
Emergency department admission delays
Assessment and reassessment
Medication process
Verbal orders
Critical equipment alarms
Informed consent and education
on procedure
3. Radiology: Patient Had
X-ray
Assessment and reassessment
Communication with
laboratory and radiology
Medication process, especially
high-risk IVs
Hand-off process
4. Laboratory
CBC
Data collection and trending
Chemistry profile
Critical test results

31. Tips for Tracing Trace the patient, not the department
Ask open-ended questions
Listen…the answer you’re expecting may not be the answer you get!
Be ready to show documents and policies or to demonstrate a process
Validate discrepancies from policy, good practice, or system failures
Include more people than just the nurse (dieticians, physicians, therapists, clerks, etc.)
Stay staff-focused, not leadership-focused

32. Tips for Tracing Survey for environmental compliance
Go into patient rooms, medication rooms, supply rooms
Scan for unsafe situations in the environment
Include a facilities or safety person on teams
Note equipment models and serial numbers
Do a competence assessment
Check human resources, competency, medical staff, and allied health files

33. Benefits Patients – Safety, Quality, Systems flow, Interest
Staff – Team building, Systems thinkers, Understanding of each others jobs
Organization – Happy patients, Systems improvement, Team focus among staff

34. Therefore, as leaders, let’s focus on systems and processes as we continually strive for quality and safe care for our patients.