2008-2009 Best Practices in Managing Hypertension Sponsored by AMGA and Daiichi Sankyo. November 18-20, 2009 San Diego

1. 1 2008-2009 Best Practices in Managing Hypertension Sponsored by AMGA and Daiichi Sankyo. November 18-20, 2009San Diego, CA

2. 2 Project Goal and Objectives Integrate EHR (Allscripts Touchworks) blood pressure readings into the data warehouse Use reporting capabilities to improve blood pressure control in a pilot population with diabetes

3. 3 Project Team Members Physician Site Champion � Phil Yphantides, MD Nursing Leadership Champion � Kathy Knippel, RN Site Operational Leadership Champion � Nina Chenault, RN Clinical Staff � Melanie Macpetrie, LVN QI � Jerry Penso, MD, MBA Estelle Wolf, RN; Karen Alanis, Health Services Analyst Diabetes Department � Margaret Peterson, RN, MSN, MPA; Annamarie Heil, RN, MSN, CDE

4. Project Phases

5. 4 Step Plan for Improvement IMPROVE � Rancho Bernardo Pilot 1. Updated Nursing Competency/ Standardized Rooming 2. Clinical Guidelines � Blood Pressure Management in Patients with Diabetes 3. Patient Educational Handout 4. Monthly Physician Reports Since we last met, we have begun to do things at the Rancho Bernardo pilot site to improve control. We updated the Nursing Competency materials and implemented training for all nursing staff at the Rancho Bemardo pilot site. The Physicians developed and approved clinical practice guidelines for BP control in patient with diabetes We created and are using a patient handout in the offices. We created and are distributing monthly physician reports. Since we last met, we have begun to do things at the Rancho Bernardo pilot site to improve control. We updated the Nursing Competency materials and implemented training for all nursing staff at the Rancho Bemardo pilot site. The Physicians developed and approved clinical practice guidelines for BP control in patient with diabetes We created and are using a patient handout in the offices. We created and are distributing monthly physician reports.

6. 6

7. Percent of Patients with Diabetes with BP 129/79 or less

8. 8 Modifications/Enhancements Fishbone cause/effect diagram Second brochure added to promote patient engagement

12. 12 Challenges Nursing consistency with BP technique Pushback from busy physicians Patient handout design to promote active participation

13. 13 Meeting the Challenges Ongoing follow-up with nurses on technique Developed training tool (process) for physicians to manage meds Eliminated idea to have pens for patient to write their own blood pressure. Redesign of patient handouts to ensure simplicity and readability.

14. 14 Celebrating Accomplishments Dinner last night! Recognition of team in roll-out Train the Trainer event Physician Newsletter

15. Future Steps 2010 Entity Goal for SRS Introduction to program at all-physician meeting Train the Trainer event January 2010 Monthly reports and patient summaries to all internists and family physicians Highlight the successes at each site Inclusion in physician bonus

16. 16 Lessons Learned Hardwire quality goals for disease management into our culture Train nurses and clinical staff appropriately before roll-out to physicians Train physicians to see patients frequently and medically manage aggressively