BMBX Presentation - Copy.pptx [Read-Only]...2nd Qtr 2014 3rd Qtr 2014 4th Qtr 2014 1st Qtr 2015 2nd...
Transcript of BMBX Presentation - Copy.pptx [Read-Only]...2nd Qtr 2014 3rd Qtr 2014 4th Qtr 2014 1st Qtr 2015 2nd...
12/17/2015
1
mayoweb/creatingthefuture
©2012 MFMER | 3226733-1
Driving Outcomes: Registered Nurses Performing Bone Marrow Biopsies Utilizing a Battery Operated Rotary Device
Jay Maningo-Salinas, PhD, RN, NE-BC, FACHEMayo Clinic Arizona
©2012 MFMER | 3226733-2
Objectives
• Identify understand drivers for change
• Identify steps taken to implement new procedure
• Describe metrics used to ensure quality
12/17/2015
2
©2012 MFMER | 3226733-3
Disclosure Statement
• Author and speaker have no financial or commercial interest in this content.
• Author and speaker have no financial or commercial interest in products discussed in the presentation.
©2012 MFMER | 3226733-4
Background
The Arizona State Board of Nursing – Scope of Practice Committee Advisory opinion:
“Based on national and local evidence, it is recognized that an RN who has satisfactorily completed an instructional program or supervised clinical practice in bone marrow aspiration and biopsy, can safely perform bone marrow biopsy and aspiration.”
12/17/2015
3
©2012 MFMER | 3226733-5
Overview of the Problem
• Performed in multiple areas in the organization and by various staff (nurses, physician, NP/PA, fellows, residents)
• Challenges• Conflicts in scheduling • Differences in paperwork among sites• Inconsistency in how the procedure is performed• Training and education of proceduralist• Quality of samples
©2012 MFMER | 3226733-6
Drivers for Change
• Team based model • Quality outcomes• Consistency of samples• Safety of nurses and patients• Nurses performing role at top of scope, education
and training• Free up provider calendar for new patients
12/17/2015
4
©2012 MFMER | 3226733-7
Timeline of the Journey
©2012 MFMER | 3226733-8
February – June 2008
• Consolidation discussion initiated
• Two physicians (hematologist and pathologist) agreed to champion the project
• Interprofessional planning meetings every 2 weeks
• Physician champions communicated the process changes with key referring physicians and hospital administration leaders via email, division meeting, presentations and newsletters.
• RN team implemented June 2008 with manual procedure
12/17/2015
5
©2012 MFMER | 3226733-9
June – November 2008
• Team challenges encountered with manual method
• Explore alternative with the use of the driver
• Check with Arizona Board of Nursing
• Physician champions on board and committed to quality and safety
©2012 MFMER | 3226733-10
November 2008
• A subset of 10 Ambulatory Infusion Center nurses who had previously completed an instructional program and supervised practice were scheduled to attend a 1-day workshop
• Each nurse had to perform 10 supervised BMBX using the driver procedures over a span of 6 months until the trainer and the nurse were both comfortable of the operator’s ability
• Documentation of satisfactory completion and competency is maintained in the nurses file
• Two laboratory staff personnel were also invited to attend the workshop
12/17/2015
6
©2012 MFMER | 3226733-11
The Innovative Way of Delivering Care
©2012 MFMER | 3226733-12
• All bone marrow biopsy procedures are performed by a subset of group of AIC RN staff who have undergone education and training.
• 2-3 nurses per day are scheduled to perform bone marrow biopsies (ambulatory & inpatient)
• One nurse performs the procedure and another RN provides analgesia and monitoring of the patient
• A lab technician is present to prepare the slides and transports samples to the lab.
12/17/2015
7
©2012 MFMER | 3226733-13
• Outpatient BMBXs are scheduled in the morning and inpatient are performed in the afternoon
• Anticipated start-up volume was between 5-6 biopsies per day. Current volume from 5-10 per day
• An audit tool was developed to aid in evaluating outcomes.
• Patients will are called at home 24-hours after procedure by the bone marrow procedure nurse for follow-up assessment.
©2012 MFMER | 3226733-14
12/17/2015
8
©2012 MFMER | 3226733-15
Metrics & Outcomes
©2012 MFMER | 3226733-16
BMBX Procedures 2008 - 2015
453
989
1172
1369
1451 1446
13371310
0
200
400
600
800
1000
1200
1400
1600
CY 2008 CY 2009 CY 2010 CY 2011 CY 2012 CY 2013 CY 2014 YTD 2015
12/17/2015
9
©2012 MFMER | 3226733-17
273
237 243
277
319
289
334
362
396
337
306325
345 352
308322
288301 300 300
323
288278
0
50
100
150
200
250
300
350
400
450
1stQtr2010
2ndQtr2010
3rdQtr2010
4thQtr2010
1stQtr2011
2ndQtr2011
3rdQtr2011
4thQtr2011
1stQtr2012
2ndQtr2012
3rdQtr2012
4thQtr2012
1stQtr2013
2ndQtr2013
3rdQtr2013
4thQtr2013
1stQtr2014
2ndQtr2014
3rdQtr2014
4thQtr2014
1stQtr2015
2ndQtr2015
3rdQtr2015
Sedation Status
Sedated Non Sedated Total
©2012 MFMER | 3226733-18
0 1 0 0 2 1 0 0 0 0 0 1 1 2 1 0 0 0 4 7 3 0 3
62
3035
2837
44 42 3844
30 28 26
914
19 188
1621 17 20
616
162154 156
178170
183
201 200
215
200
184190
214 212
176
206197 198 196
211
228
201
186
81 81
65
89
127
71
104
142
164
131
114124
147157
147
123 119124
112106 109
121
108
0
50
100
150
200
250
1stQtr2010
2ndQtr2010
3rdQtr2010
4thQtr2010
1stQtr2011
2ndQtr2011
3rdQtr2011
4thQtr2011
1stQtr2012
2ndQtr2012
3rdQtr2012
4thQtr2012
1stQtr2013
2ndQtr2013
3rdQtr2013
4thQtr2013
1stQtr2014
2ndQtr2014
3rdQtr2014
4thQtr2014
1stQtr2015
2ndQtr2015
3rdQtr2015
How would you rate the instructions you recieved regarding the BMBX?
Poor Satisfactory Excellent Not Available
12/17/2015
10
©2012 MFMER | 3226733-19
291
256241
280
318
283
319
359
395
331
307321 320
369
323 330310
321312 314 321
304286
14 10 15 15 16 1629
11 1827
17 14 12 15 20 16 14 13 1827
3823 25
0 0 0 0 2 0 6 10 10 3 2 1
39
1 0 1 0 4 3 0 1 4 20
50
100
150
200
250
300
350
400
450
1stQtr2010
2ndQtr2010
3rdQtr2010
4thQtr2010
1stQtr2011
2ndQtr2011
3rdQtr2011
4thQtr2011
1stQtr2012
2ndQtr2012
3rdQtr2012
4thQtr2012
1stQtr2013
2ndQtr2013
3rdQtr2013
4thQtr2013
1stQtr2014
2ndQtr2014
3rdQtr2014
4thQtr2014
1stQtr2015
2ndQtr2015
3rdQtr2015
Pre Procedure Pain Score
Pain Score 0‐4 Pain Score 5‐10 Not Available
©2012 MFMER | 3226733-20
297
258240
274
318296
327350
386
335319
338 331
376
338 339317 324 322 331
343320
306
8 5 8 4 5 3 1 1 5 4 2 2 3 6 2 7 6 4 6 7 10 6 50 3 8 17 130
26 29 3222
5 1
37
3 3 1 1 9 5 3 7 5 20
50
100
150
200
250
300
350
400
450
1stQtr2010
2ndQtr2010
3rdQtr2010
4thQtr2010
1stQtr2011
2ndQtr2011
3rdQtr2011
4thQtr2011
1stQtr2012
2ndQtr2012
3rdQtr2012
4thQtr2012
1stQtr2013
2ndQtr2013
3rdQtr2013
4thQtr2013
1stQtr2014
2ndQtr2014
3rdQtr2014
4thQtr2014
1stQtr2015
2ndQtr2015
3rdQtr2015
Pain score prior to discharge
Pain Score 0‐4 Pain Score 5‐10 Not Available
12/17/2015
11
©2012 MFMER | 3226733-21
197
175 173
190 190
209
229237
252
223207 212
231221
193
227
202 203 203 205217
201194
27
10 15 1928
19 174
11 13 13 8 215 9 8 9 14 18
28 3022
13
81 8168
86
118
71
108
139
160
125
106121
138149
141
112 113121
112 108 113 108 106
0
50
100
150
200
250
300
1stQtr2010
2ndQtr2010
3rdQtr2010
4thQtr2010
1stQtr2011
2ndQtr2011
3rdQtr2011
4thQtr2011
1stQtr2012
2ndQtr2012
3rdQtr2012
4thQtr2012
1stQtr2013
2ndQtr2013
3rdQtr2013
4thQtr2013
1stQtr2014
2ndQtr2014
3rdQtr2014
4thQtr2014
1stQtr2015
2ndQtr2015
3rdQtr2015
Pain Score at 24 hour follow up
Pain Score 0‐4 Pain Score 5‐10 Not Available
©2012 MFMER | 3226733-22
0 1 0 1 5 0 0 3 0 3 0 0 0 0 2 2 0 0 2 0 0 0 0
305
265249
275
319298
331351
390
343322
340
370381
338 343320
337 331 338360
328311
0 0 719 12
123 26 33
154 1 1 4 3 2 4 1 0 3 0 3 2
0
50
100
150
200
250
300
350
400
450
1stQtr2010
2ndQtr2010
3rdQtr2010
4thQtr2010
1stQtr2011
2ndQtr2011
3rdQtr2011
4thQtr2011
1stQtr2012
2ndQtr2012
3rdQtr2012
4thQtr2012
1stQtr2013
2ndQtr2013
3rdQtr2013
4thQtr2013
1stQtr2014
2ndQtr2014
3rdQtr2014
4thQtr2014
1stQtr2015
2ndQtr2015
3rdQtr2015
Bleeding requiring dressing change prior to discharge
Yes No Not Available
12/17/2015
12
©2012 MFMER | 3226733-23
1 1 1 3 3 0 4 1 2 4 3 2 4 5 4 3 2 1 0 4 1 1 4
223
184 190207 214
229
349
248265
237221 222 230 231
196
235216 223 220
234
257
230211
81 8165
85
119
70
101
131
156
120102
117137
149 143
109 106 114 113100
1
100 98
0
50
100
150
200
250
300
350
400
1stQtr2010
2ndQtr2010
3rdQtr2010
4thQtr2010
1stQtr2011
2ndQtr2011
3rdQtr2011
4thQtr2011
1stQtr2012
2ndQtr2012
3rdQtr2012
4thQtr2012
1stQtr2013
2ndQtr2013
3rdQtr2013
4thQtr2013
1stQtr2014
2ndQtr2014
3rdQtr2014
4thQtr2014
1stQtr2015
2ndQtr2015
3rdQtr2015
Patients who developed issues requiring emergency care of physician follow up 24 hours post BMBX
Yes No Not Available
©2012 MFMER | 3226733-24
https://youtu.be/-snQBm_cuv8