1. Designing Systems of Care for Reliability The content for the module is from the following: “Improving the Reliability of Health Care.” IHI Innovation Series. Institute of Healthcare Improvement. 2004. http://www.ihi.org/IHI/Topics/Reliability/ReliabilityGeneral/ For a template example of designing a reliable care system for AMI: http://www.ihi.org/IHI/Topics/Reliability/ReliabilityGeneral/EmergingContent/ TemplateforApplyingtheReliabilityFrameworktoHeartFailure.htm http://www.ihi.org/IHI/Topics/Reliability/ReliabilityGeneral/EmergingContent/ TemplateforApplyingtheReliabilityFrameworktoHeartFailure.htm

2. Designing Systems of Care for Reliability 1.Prevent: a.Standardize whenever possible (equipment, order sheets, etc.) b.Follow uniform process or guidelines (Ventilator Acquired Pneumonia prevention bundle) c.Measure if the guidelines are being followed and provide feedback on compliance d.Memory aids (checklists) e.Awareness-raising and training (pt safety posters and training) 2.Identify and mitigate 3.Redesign

3. Designing Systems of Care for Reliability 1.Prevent 2.Identify and mitigate (Error-proofing) a.Reminders: calling pts before appt to reduce no-show; alarms that IV solution almost finished b.Differentiation: reduce confusion when parts or number or meds are similar (i.e. color coding solutions; putting poison labels on cleaning solutions) c.Constraints: restrict or limit the use of equipment of doing certain actions. Need to be MD or NP to access CPOE; computer system will not allow two contraindicated meds to be ordered d.Clear visual or sensory cues: a outward swinging door with a push plate but no handle. e.Making the desired action the default: all patients who have a diagnosis of pneumonia have standardized orders for antibiotic automatically come up on the CPOE. 3.Redesign

4. Designing Systems of Care for Reliability 1.Prevent: 2.Identify and mitigate (Error-proofing) 3.Redesign (Identifying the failure modes of the standardized process) a.Focus on process b.Focus on structure in which the process operates (link between location, information transfer, roles of caregivers, etc) c.FMEA (failure mode effects analysis) is a systematic way to evaluate a process in order to identify where and how it will fail and to assess the relative impact of different failures.

5. Designing Systems of Care for Reliability FMEA (failure mode effects analysis) is a systematic way to evaluate a process in order to identify where and how it will fail and to assess the relative impact of different failures. For more information on this FMEAs, see the following: –http://www.jointcommission.org/PatientSafety/fmeca_bibl. htmhttp://www.jointcommission.org/PatientSafety/fmeca_bibl. htm –http://www.patientsafety.gov/safetytopics.html#HFMEAhttp://www.patientsafety.gov/safetytopics.html#HFMEA