Quality Improvement and Data Collection
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Transcript of Quality Improvement and Data Collection
QUALITY IMPROVEMENT
& DATA COLLECTION
How can you make data collection the “easy part”?
Naomi Erickson, BSN, MHS
Quality Improvement Consultant & MedRec Lead
Interior Health
WHY DO WE NEED DATA?
Because…
it helps us understand if a change is leading to an
improvement
it moves from subjective opinions to objective information
about a process
hospitals face pressure to report on the quality of care
provided
it engages stakeholders
(Provost and Murray, 2011;Needham et al. 2009)
DOES DATA HAVE TO BE DIFFICULT?
DATA
COLLECTION
MODEL FOR IMPROVEMENT
AIM STATEMENT
Helps us understand what we are trying to improve
Ensure your aim statement is SMART:
Time-bound
• By when would you like to accomplish your goal?
Relevant
• Does this goal matter?
Achievable
• Is this a possible goal?
Measurable
• how will we know we reached our goal?
Specific
• what is the specific improvement you are to accomplish?
AIM STATEMENT EXAMPLES
To improve compliance with MedRec by 70% in Royal Inland Hospital, by April 15, 2014.
To decrease PSLS reported medication adverse events by 30% in Kelowna General Hospital by June 30th, 2014.
To reduce the number of prescribed antipsychotics in residents by 30% in Overlander Extended Care Hospital by January 15th, 2015.
MODEL FOR IMPROVEMENT
TYPES OF MEASUREMENT
There are three types of measurements that you should
keep in mind when making an improvement
Outcome
Process
Balancing
These are the overarching end result(s) of the
improvement(s) that we are trying to achieve
OUTCOME MEASURE
OUTCOME MEASURE EXAMPLES
reduction in the number of unnecessary antipsychotics
reduction in the number of venous thromboembolisms (pulmonary
emboli and deep vein thrombosis)
reduction in the number of medication errors
reduction of adverse drug events
• Logically connected to the
outcome measure
• Often the steps or process of
achieving the outcome
• Tends to show improvement
before the outcome measure
does
PROCESS MEASURES
PROCESS MEASURE EXAMPLES
completing the Best Possible Medication History
use of the Venous Thromboembolism Pre Printed Order
number of staff educated about polypharmacy issues
number of residents who are properly screened for risk of
a fall
• Evaluate whether changes
made in one area are at the
expense of another area
• Helps us detect unintentional
consequences
BALANCING MEASURES
BALANCING MEASURE EXAMPLES
staff satisfaction with a new process
readmission rates
may decrease length of stay however, the patients are being
readmitted two days later
volume of workload
FROM THE BEGINNING
Think about what to measure right from the start of your
improvement project
what is your baseline?
is there opportunity to collect data from the Pre Printed Order Set
you develop?
When planning to collect data think about:
who, what, and how
does not have to come only from the chart
staff and patient surveys/interviews/focus groups
MEASUREMENT
Collect enough to know how the change has lead to an improvement
“just enough” data, small sequential samples (Provost and Murray, 2011; Needham et al. 2009)
this is not research sample size
keep it simple
Ministry of Health reporting requirements?
Ensure each question leads to an action
Ask the question: what will we do with this information?
If you are not doing anything with it….don’t collect it
MEASUREMENT
Create clear audit instructions and tools
Ensures everyone is collecting data in the same way (Needham et al.
2009)
Be aware of who is collecting the data (clinical and/or non clinical)
Involve stakeholders as able
Unit or site audit champions
Provides peer to peer learning
Engages individuals in the project
DATA COLLECTION TOOLS
Paper
Excel spreadsheets
Apps
MEASUREMENT EXAMPLE (1)
Fiscal Period
BPMH
Completed
Unit
BP
MH
Req
uir
ed
BP
MH
Fo
rm
On
Ch
art
Med
icat
ion
veri
fica
tio
n
HM
R
Med
icat
ion
Sec
tio
n
Co
mp
lete
Ver
ifica
tion
Com
plet
e *
Ph
ysic
ian
Ord
ers
Ph
ysic
ian
Sig
nat
ure
s
Ord
ers
Com
plet
e*
12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes no no no FALSE no no FALSE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg no TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg no yes TRUE yes yes TRUE12 (Mar 2- med surg yes no no no FALSE no no FALSE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes no no no FALSE no no FALSE12 (Mar 2- med surg yes no no no FALSE no no FALSE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes yes yes yes TRUE yes yes TRUE12 (Mar 2- med surg yes no no no FALSE no no FALSE12 (Mar 2- med surg yes yes no no FALSE no no FALSE
14 14
MEASUREMENT EXAMPLE (2)
Simple yes/no
answers Just enough to
know a change
is an improvement
HOW OFTEN?
You and your team can decide what is appropriate
flexible depending on your project and who is able to collect the
data
Ministry of Health may dictate reporting timelines
Think about:
more frequently at the start
once goal is reached how often do you need to collect for
sustainability?
HEART AND THE MIND
Impact to the patient/client/resident and family
SHARE THE DATA
Share the data with stakeholders
Display it where stakeholders can view their progress
Take opportunities to celebrate success
Simple is okay
Great Work Everyone
DISPLAYING DATA Quality Improvement and Patient Safety
Engage ~ Inspire ~ Empower ~ Celebrate
Detailed audit results from November, 2013: (n = 26)
How we're doing over time:
RIH Med Rec Monthly Report - Nov, 2013
81%
54% 50%
92% 92%
0%
20%
40%
60%
80%
100%
BPMH on chart VerificationComplete
HMR Complete Physician OrdersComplete
SignatureComplete
Med Rec Completion - Nov, 2013
0%
20%
40%
60%
80%
100%
Nov
-12
Dec
-12
Jan
-13
Feb-
13
Mar
-13
Apr
-13
May
-13
Jun
-13
Jul-
13
Aug
-13
Sep-
13
Oct
-13
Nov
-13
% w/ Signature Complete
0%
20%
40%
60%
80%
100%
Nov
-12
Dec
-12
Jan
-13
Feb-
13
Mar
-13
Apr
-13
May
-13
Jun
-13
Jul-
13
Aug
-13
Sep-
13
Oct
-13
Nov
-13
% w/ Physician Orders complete
0%
20%
40%
60%
80%
100%
Nov
-12
Dec
-12
Jan
-13
Feb-
13
Mar
-13
Apr
-13
May
-13
Jun
-13
Jul-
13
Aug
-13
Sep-
13
Oct
-13
Nov
-13
% w/ Verification complete
0%
20%
40%
60%
80%
100%
Nov
-12
Dec
-12
Jan
-13
Feb-
13
Mar
-13
Apr
-13
May
-13
Jun
-13
Jul-
13
Aug
-13
Sep-
13
Oct
-13
Nov
-13
% w/ HMR Complete
QUESTIONS
REFERENCES
Needham et al. (2009). Improving data quality control in quality
improvement projects. Retrieved from
http://intqhc.oxfordjournals.org/content/21/2/145.full.pdf+html
Provost, L. and Murray, S. (2011). The health care data guide: Learning from
data for improvement. San Francisco: Jossey-Bass.