Standardizing Point of Care Testing and Harmonizing ......Standardizing Point of Care Testing and...
Transcript of Standardizing Point of Care Testing and Harmonizing ......Standardizing Point of Care Testing and...
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Standardizing Point of Care Testing and Harmonizing Workflows Between Hospitals and Ambulatory Locations
Presented by: Jeanne Mumford, MT(ASCP) Manager, Point of Care Testing Department of Pathology Johns Hopkins Hospital Baltimore, MD
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Disclosures
• Nonfinancial: Board of Directors- COLA Resources, Inc; President, KEYPOCC Keystone Point of Care Coordinators
• Financial – Honorarium/Author: AAFP POL Insight 2015A
• Financial – Honorarium/Speaker: AACC; KEYPOCC; Whitehat Communications
• Financial – Advisory Committee: BioFire; ASM
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Objectives
At the end of the session, participants will be able to: • Establish open communication and identify key
players in standardization of point of care tests • Discuss tools and strategies for multidisciplinary
collaboration • Identify POCT clinical considerations and managerial
challenges
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Point of Care Coordinators
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Johns Hopkins Medicine
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List of Current POCT Interfaced Devices: ACT-LR,
ACT Plus Creatinine INR Hgb Urinalysis HBA1c Glucose,
whole blood O2
Saturation Blood Gases
pH Strep A Rapid HIV 1/2
Antibody Rapid HCV Urine Drug
Screen PPM Tear
Osmolality Fecal Occult
Blood Specific
Gravity
Urine HCG
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Point of Care Testing JHM operates six academic and community hospitals
Johns Hopkins Community Physicians – 39+ sites, 400+ providers, 1,600 glucose operators, 15 POCT types (primary and specialty care)
Hospital Beds Glucose Operators POCT TYPES
Johns Hospital 1,059 4,313 26
Bayview 545 1,300 19
Howard County 267 1,466 3
Sibley 318 800 9
Suburban 229 1,343 9
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POCT Structure
• Single Medical Director of JHM POCT • JHM Manager • Local Lab Director and POCC at each
Hospital • Except JHCP: Single Medical Director
and POCC
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Quality Structure Across JHM
Defines standards, monitors
performance
Establishes oversight and accountability
JHM Board of Trustees
JHM Patient Safety & Quality Board
Committee
Ambulatory Quality Council
Armstrong Institute for Patient Safety
& Quality
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Procedures
• Single device for each analyte (i.e., glucose) – Biggest challenge!
• Harmonizing templates and HPO Goal – one single procedure with appendix for each facility for differences
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Integrating the System
• Whose procedures do we use • Whose POCT devices? • Whose workflows are the Best Practices? • Where do we start?
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POCT Devices
• Single device and single analyte • Single device with multiple analytes • There is no such thing as one size fits
all for POCT
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Enterprise Interface Infrastructure Present
POC Middleware
EMR LIS
BMC JHH
SM SH
HC
Slide credit: Leandra Soto, MT(ASCP)
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Enterprise IT Successes
As of July 1, Standardized electronic medical record has been completed • Standardized interface platform for Point of
Care testing across 5 Hospitals and all ambulatory sites: POCT Middleware
• Standardized laboratory information system • Standardized testing platforms Chemistry and Hematology lines
Slide credit: Leandra Soto, MT(ASCP)
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Workflows
• Testing personnel and use of EMR/EHR • How does the POCT get entered into
the EMR/EHR? • Single IT platforms = harmonize POCC
duties and responsibilities • EX: Tear Osmolality
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Best Practices
• Steps to standardizing and harmonizing procedures, workflows and processes
• Now what? How to keep in touch and how to run this as one big complicated program?
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Team Meetings
• First Friday • Third Friday • Quarterly (Mandatory) • All JH POCC are invited (including All
Children’s) • Conference Line Open • In Person Optional
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Develop a QC Plan
• Quality Controls • Proficiency Testing • Audits/Rounds • Troubleshooting • Documentation
• Follow Up • Training and
Competency • Annual Review • Risk Analysis
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Communication? Maybe?
Attention: Toilet ONLY
For Disabled
Elderly Pregnant Children
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Communication Cycle
Sender
Message
Channel Receiver
Feedback
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The Message
Sender
Message
Channel Receiver
Feedback
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Good Communication Is Key For Patient Safety
“Poor communication is reported as the root cause in 70% of hospital sentinel events and in 40% of malpractice cases due to medical errors.”
Keynote Session, Safety, Quality and Patient-Centered Care Peter Pronovost, MD, PhD, FCCM Sr. Vice President for Patient Safety and Quality Director of the Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine
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More Communication Options
• Quarterly Flyers Published by Nurse Educations
• Screen Savers on Computers Across Hospital Campus
• Attending Daily Team Huddles and Staff Meetings
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Less Is More
• Nurse Educators can help POCC’s learn how to trim down their message in order to have meaningful exchange of information – Nurses and clinical care teams techniques – Balancing clinical demands with laboratory
regulation demands
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Empathy In Communication
• Understanding someone else’s perspective – How does it impact the nurse or tech if they
have to troubleshoot QC on a meter when a patient is crashing and needs an urgent glucose result?
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Empathy In Communication
• Let the nurse or tech state their point of view – While meeting regulatory requirements,
you may still work with clinical teams to meet their needs
• Take the time to check regularly that the message is still meaningful
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A Nurse’s Perspective: 5 Stages of Emotion • 1st: Denial – It can’t be time for my unit audit, the
coordinator was just here last week. • 2nd: Anger – These Lab People have nothing better to
do than torture me! I’m too busy for this! • 3rd: Bargaining – God, just let me get through this and
I will never forget to run controls again! • 4th: Depression – I’m going to fail, get fired and have
to flip burgers for a living • 5th: Acceptance – Well, they’re going to be on my unit
every week, and I really want to what’s right for my patient.
Adapted from: CLIA Inspection Survival Tips. Barry Craig, MLT(ASCP). 2010C POL Insight.
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What is Your Role?
Patient
Support Team
Clinical Team
Providers
POCC
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Patient Centered Medical Care
• How do you as a laboratory professional enhance the patient experience?
• Supporting the clinical team helps them to better care for patients and their support team
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Unit/Site Audits
• Some units are visited twice per week • Moderate complex testing daily/weekly • Waived testing once per month • Opportunities for improvement easily
identified and addressed with frequent site/unit visits
• Looking for electronic solution
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Have You Considered?
• Monthly meeting with lab vendors such as Quest, Lab Corp and Johns Hopkins Medical Lab
• Monthly meetings with testing personnel, unit managers and trainers
• Meeting with Nurse Administration for high level topics
• Daily huddles on units/floors
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Vendor Support/Training
• Utilizing Vendor Reps for support in training • Vendor reps are brought into sites to perform
on site training with our competency checklist • Vendor reps have a great report with sites
and reach out several times a year for support
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Accomplishments So Far
• Standardized IT platform for Point of Care tests across 5 Hospitals and Ambulatory Medicine Will allow for quality indicators across the enterprise Will allow for centralized reporting and oversight
• Standardized electronic medical record One Patient, One Record
• Standardized laboratory information system Harmonized test panels
• Standardized testing platforms Chemistry and Hematology lines One Patient, One Test Result
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Future Goals
• Electronic Audit/Rounding Tool – Real time grading and feedback on tablets
• Networking Events for all POCC’s • No New POCT Devices Without
Interface Capabilities • Managing Non-laboratory Devices
Through Middleware (i.e., transcutaneous bili)
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References
• Pronovost P. Safety, Quality and Patient-Centered Care. Keynote Sessions Johns Hopkins Armstrong Institute for Patient Safety and Quality. 2013.
• Kravet S, Bailey J, Demski R, Pronovost P. Establishing an Ambulatory Medicine Quality and Safety Oversight Structure: Leveraging the Fractal Model. Academic Medicine. 2016 July; 91(7): 962-6
• Pronovost P. What Can Patient and Family Centered Care Learn from Improvement Science. Johns Hopkins University. 2013 (70%medical errors)
• Mihane, Stephanie. Lab’s Role in Patient-Centered Care. Advance/Laboratory. February 2015. 39-40
• Famitangco, Rex F. Improving Care Through Teamwork, Collaboration, and Engagement. Critical Values. January 2016. Vol 9. 10-12.
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Questions
Jeanne Mumford, MT(ASCP) Pathology Manager, Point of
Care Testing [email protected]
Johns Hopkins Hospital