1. AMI Virtual Learning Collaborative Closing Congress Atlantic Node

2. Learning Collaborative Learning Session 1A October 07-09 1B October 21-09 Learning Session 2 January 06-2010 Learning Session 3 February 10-10 Closing Congress!! March 30-2010 Act Plan DoDo DoDo DoDo Study Plan: for change Do: make changes Study: impact of change Act: on changes that work Action Period #1Action Period #2Action Period #3

3. Atlantic Node Self Evaluation Results

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6. LS3

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10. Team Self Evaluation Poll

11. Atlantic Node Session Evaluation

12. Atlantic Node What Worked Best

13. Atlantic Node Recommended Changes more interactive group work as a facilitator, would like to have actually practiced the breakout and use of posters etc. in advance audio is difficult to hear fades in and out Maybe it's because I am a late starter to my AMI team. But a short BIO of all the participants in a WebEx would be helpful. Manger vs. educator vs. core staff. Not sure how you would accomplish that.

14. Atlantic Node Rapid Fire Presentations Assigned to 1 of 3 ‘breakout rooms’ Present: Idea, How it Worked; Results –3-5 minutes for presentation of a Change Idea and Q&A in ‘breakout room’ –Facilitator role: keep time, summarize, and report back to larger group

15. Atlantic Node Brookfield Bonnews Health Center AMI Presentation March 31, 2010

16. Atlantic Node Primary Health Care site includes: 4 small Community Health Centers 1- 45 bed Long Term Care Site 1- 12 bed inpatient acute care site with outpatients and emergency dept.

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18. How we got started? Asked by DHS for our area to become a part of the AMI Virtual learning project Met with Safer Healthcare Now coordinator for Central Health to give us some background information and help us get started. Attended Online sessions (WEBEX) Put together a onsite team

19. Atlantic Node What Our Team Worked on -Collected our data -Completed our process Map -Completed worksheets for testing Changes -Communicated to the team importance of accurate timing to ECG and Thrombolytic goals and asked for suggestions through: - personal contact - computer messages - MAC and staff meetings -Put together our Team Charter

20. Atlantic Node What we tested? -Synchronize clocks, watches, registration computer, EKG machines

21. Atlantic Node Results: -Clock on Cardiac unit was losing time- new digital clock was ordered -25% of staff did not wear a watch -EKG machine time was inaccurate so it was calibrated and is now keeping good time. -In 2009 we gave Thrombolytics to 4 patients, 3 were in the appropriate time frame and one was outside (pt did not present at time of registration with chest pain) -Since the collection of data- all EKG’s to date have been done within 10 minute time frame -No thrombolytics have been administered since the start of the Collaborative.

22. Atlantic Node Thank You!

23. AMI Virtual Learning Collaborative Guysborough Antigonish Strait Health Authority Atlantic Node

24. When we started Our team is made up of representatives from all hospitals in our district:  Guysborough Memorial Hospital  Eastern Memorial Hospital  Strait Richmond Hospital  St. Martha’s Regional Hospital  St. Mary’s Memorial Hospital

25. Atlantic Node Our Journey To date Through our teamwork on this collaborative we have been able to develop relationships with members from other district hospitals, we have been able to share ideas, identify barriers, and develop strategies unique to our varying locations.

26. Atlantic Node Things we Learned We learned that we already do a pretty good job of providing excellent patient care….. But, we have and are developing strategies to ensure that the standard is kept high, that we continue to learn from each other and find ways to do things better!

27. Atlantic Node Things we Learned Staff Education Re: best practice around AMI Care RN’s doing stat ECG’s contribute to better patient outcomes Need for clock synchronization important to track data Flow chart put into use to ensure continuity of cardiovascular care (to help identify atypical presentations) Order sets will help streamline and make cardiovascular care specific to ensure best practice We need to continue to operate this committee to ensure continued awareness and implementation of changes

28. Atlantic Node What we accomplished We have been able to bring about change within our organizations……. We have people excited about ensuring that our patients receive the best care out there……. We will continue to raise the bar and provide patients with the best chances of reaching the most desirable outcomes in relation to their cardiovascular health!!!

29. Atlantic Node Next Steps We are going to meet quarterly to ensure that the groundwork which was laid during the collaborate continues. We will be able to look back at our progress and continue to learn from each others trials and tribulations. We have made relationships that will continue to develop as our work on this continues……..

30. Atlantic Node Q&A

31. Atlantic Node Contact Information Jennifer Delorey R.N., BScN. Guysborough Memorial Hospital 902-533-3702

32. Time Is Muscle Sync The Clock!

33. Objective: 1.Complete ECG within 10 Minutes 2.Complete Lytics within 30 Minutes Goal: Synchronize our clocked instruments

34.  LAB  RADIOLOGY  REGISTRATION  NURSING  MAINTENANCE

35. RADIOLOG Y LAB

37. We Mapped Our Progress On The Information Board Hoping For A Successful Future Our New Goal Is To Get Our First IV In15 Minutes

38. AMI Virtual Learning Collaborative March 31, 2010 Atlantic Node

39. Western Health Two hospitals and four rural health sites participated in collaborative; - Western Memorial Regional Hospital (WMRH) - Sir Thomas Roddick Hospital (STRH) - Calder Health Care Centre (CHCC) - Dr. Charles Legrow Health Centre (DCLHC) - Bonne Bay Health Centre (BBHC) - Rufus Guinchard Health Centre (RGHC)

40. Atlantic Node Western Health

41. Atlantic Node Western Memorial Regional Hospital

42. Atlantic Node When We Started AMI intervention had already been implemented at WMRH, STRH, and DCLHC Regional team established to support a coordinated approach and spread to all sites In fall 2009, initiative implemented at three remaining sites (RGHC, BBHC, CHCC) to coincide with participation in collaborative Regional team assumed responsibility for leading work related to collaborative

43. Atlantic Node Staff at Calder Health Care Centre

44. Atlantic Node Our Journey To Date Established regional charter Identified three improvement objectives: - 90% STEMI or new LBBB patients presenting to ED with chest pain will receive an EKG within 10 minutes of arrival at ED - 90% STEMI or new LBBB will receive thrombolytic within 30 minutes of arrival at ED - 90% of patients presenting to ED with chest pain will receive an EKG within 10 minutes of arrival at ED Completed process maps for individual sites

45. Atlantic Node Baseline Data Period October 1 to December 31, 2009 -100% of STEMI or new LBBB received an EKG within 10 minutes of arrival at ED -83% of STEMI or new LBBB received thrombolytic within 30 minutes of arrival at ED -72% of patients presenting to ED with chest pain received an EKG within 10 minutes of arrival at ED Data from January 1 to March 31, 2010 to be reviewed at next regional meeting

46. Atlantic Node Bonne Bay Health Centre

47. Atlantic Node Opportunities for Improvement Synchronizing clocks, EKG machines, and Meditech System Enhancing awareness and education for physicians and nursing staff related to timely EKGs and administration of Thrombolytics Enhancing orientation for new physicians including locums Public awareness and education

48. Atlantic Node Lessons Learned Importance of broadening focus beyond the typical patients presenting to our emergency departments Challenging issues to address (e.g., synchronizing clocks, EKG machines, and Meditech System) Many factors influence our ability to move forward (e.g., staffing changes) Work from collaborative will continue to be ongoing Raised awareness and education for front line staff

49. Atlantic Node Lessons Learned Challenges of ensuring communication with all appropriate staff (e.g., after hours acute care cover ER department in rural health facilities) Importance of being proactive in initiating standing orders and contacting physician after hours

50. Atlantic Node Educational Opportunities Calder Health Care Centre Education provided during staff meeting regarding: - standing orders - discharge order form - 10 minute time frame for EKG - 30 minute time frame for thrombolytic agents Small staff discussions and huddles Planning additional education session for nursing staff and physicians

51. Atlantic Node Educational Opportunities Sir Thomas Roddick Hospital Dr. Qureshi presented at a Breakfast session for all nursing staff and physicians - This session was well attended with over 20 participants Small staff discussions and huddles Updates provided at staff meetings regarding: - AMI packet - 10 minute timeframe for EKG - Clock synchronization

52. Atlantic Node Sir Thomas Roddick Hospital

53. Atlantic Node Public Awareness and Education

54. Atlantic Node Contacts Ms. Julie Sutton, Western Memorial Regional Hospital, jsutto@healthwest.nf.ca, (709) 637-5000 (ext. 5265) jsutto@healthwest.nf.ca Ms. Karen Alexander, Sir Thomas Roddick Hospital, kalexa@healthwest.nf.ca, (709) 643-5111 (ext. 234) kalexa@healthwest.nf.ca Ms. Kathy Organ, Dr. Charles Legrow Health Centre, kathyorgan@westernhealth.nl.ca, (709) 695-4546 kathyorgan@westernhealth.nl.ca Ms. Laurie Porter, Calder Health Care Centre, laurieporter@westernhealth.nl.ca, (709) 886-2898 (ext. 237) laurieporter@westernhealth.nl.ca Ms. Susan Reid, Bonne Bay Health Centre, susanreid@westernhealth.nl.ca, (709) 458-2211 (ext. 208) susanreid@westernhealth.nl.ca

55. Atlantic Node Contacts Ms. Paulette Lavers, Rufus Guinchard Health Centre, paulettelavers@westernhealth.nl.ca, (709) 861-3139 (ext. 211) paulettelavers@westernhealth.nl.ca Ms. Donna Hicks, Western Memorial Health Clinic, donnahicks@westernhealth.nl.ca, (709) 634-4437 Ms. Barbara Ann Dunphy, Western Memorial Health Clinic, barbaraanndunphy@westernhealth.nl.ca, (709) 634-4311 barbaraanndunphy@westernhealth.nl.ca

56. Atlantic Node View from Man in the Mountain Overlooking the Humber River

57. AMI IMPROVEMENT JOURNEY South Shore Health SSRH FMH QGH Atlantic Node

58. Who Are We… South Shore Health consists of three different Emergency sites –South Shore Regional- Bridgewater –Fisherman’s Memorial-Lunenburg –Queen’s General-Liverpool Total geographical area served-5300 square kilometers, encompassing Lunenburg and Queen’s counties. Total population-58,362

59. Atlantic Node In The Beginning… CVHNS contacted SSH Team engaged by VP Clinical Services and ER manager Initial committee formed in October,2010 Team consists of-SSRH-ER manager, team leader, representatives from Critical care,CVHNS, CIU,Patient Safety, QGH And FMH ERs and Adhoc ER Physician.

60. Atlantic Node Baseline Data ECG within 10 minutes-38% Thrombolytics within 30 minutes-80%

61. Atlantic Node Times They Are A Changing!!! Time synchronization- Triage,ECG machines, monitors and wall clocks synchronized at all sites. Monthly audits to ensure continued accuracy ECG first-Increased Staff awareness re “Time is Muscle”,ECG within 10 minutes,Proirity access to patient by CIU. Physician to initial and time ECG interpretation

62. Atlantic Node Staying Alive First medical contact to ECG time- –EHS-immediate to 92 minutes –ER-immediate to 7 minutes Diagnostic ECG to Thrombolytics –EHS-not available in this district –ER-1-35 minutes On 3 different occasions we were able to administer Thrombolytics within 1 minute of diagnostic ECG !!!

63. Atlantic Node The Future Holds… Ongoing education re: –Time is Muscle –ECG first <10 minutes –Thrombolytics <30 minutes –Continued monitoring and synchronization of clocks –Maintaining competency within district re ECG interpretations and thrombolytic administration –Early interpretation of ECG by ERPs-documented by initials and time –Understanding of term” STAT ECG”.

64. Atlantic Node For more information Contact: –Anne Rogers –Email-arogers@ssdha.nshealth.caEmail-arogers@ssdha.nshealth.ca –Phone number (902-543-4604-ext-2237)

65. Atlantic Node Session Evaluation & Post VLC Qs