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Local Improvement Clinic A2

Dr Don Berwick President & CEO, IHI Dr Ross Wilson Chair, Strategic Advisory Board International Forum Ms Nellie Yeo CQO, National Healthcare Group, Singapore. Local Improvement Clinic A2. Project to reduce complications after cardiac catheterisation.

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Local Improvement Clinic A2

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  1. Dr Don Berwick President & CEO, IHI Dr Ross Wilson Chair, Strategic Advisory Board International Forum Ms Nellie Yeo CQO, National Healthcare Group, Singapore Local Improvement Clinic A2

  2. Project to reduce complications after cardiac catheterisation

  3. Improvement at National Healthcare Group SingaporeInternational Forum on Quality & Safety in Healthcare Barcelona 18 April 2007Nellie YeoChief Quality OfficerNational Healthcare GroupSINGAPORE

  4. What is CPIP ? PDSA Toolkit & Methodology - relevant, easy to understand, easy to implement and measure; changes for improvement are introduced systematically. Patient Focus - tailored to the health care setting Since March 2002, CPIP seeks to engage Clinicians, spurring them to become Change Leaders, working alongside team members with fundamental knowledge of the care processes to surface improvements.

  5. What is CPIP ? Science of Improvement - rationale and scientific basis of quality improvement, management of variation, and the relationship between processes of care. 3 Outcomes - impact on clinical, cost and patient satisfaction. Sustain & Spread - many CPI projects, once tested and proven effective through small and rapid improvement cycles (PDSA), moved on to spread beyond their original sites to other wards and hospitals

  6. Numbers Trained As of Oct 06, 13 cycles of CPIP have been conducted over 5 years, training a total of 443 NHG staff – especially the target group of senior clinicians 231 Doctors ( include 46 CMBs, Division or Department Chiefs or Heads) 106 Nurses, 56 Allied Health and 50 Administrative Staff

  7. Types of CPIP Projects 311 projects initiated – top 6 disciplines

  8. Significant Projects 10 projects were identified that emphasized on both Effective treatment and Patient Safety. • The top 3 domains addressed were: • Efficiency • Effectiveness • Safety of Care Quality Function Deployment Diagram of Domains Addressed by Projects

  9. Strategies for Spread 3 CPI projects identified for cluster adoption (AH, NUH, TTSH) : a) Reduce incidence of IV Peripheral Phlebitis b) Reduce admissions following Day Surgery discharge c) Warfarin Management Outcomes were measured as part of hospitals’ KPI: IV Peripheral Phlebitis : Quarterly tracking results shows all 3 institutions have met their own targets for improvement, based on their baseline rates. Reduce admissions following day surgery discharge : AH has done exceptionally well to achieve her target of less than 0.04%, NUH and TTSH are tracking their improvement progress Admission rate of patients with INR >= 5 : All institutions are showing significant improvements in achieving their own targets. FY05 FY06

  10. Other Activities To Date

  11. Inst Name of PSOs NUH Dr Sophia Ang (Lead PSO, NHG) NHGP Dr Hwang Chi Hong IMH Dr Chua Hong Choon TTSH Dr Tan Hui Ling AH Dr Lydia Au NSC Dr Anthony Goon Safety Culture • Ongoing Safety Climate Surveys on 2-yearly basis • Appointed NHG and institutions Patient Safety Officer (PSO) • Ongoing training for PSOs • Institutions appointed Safety Champions in many departments • Ongoing Patient Safety Workshops conducted by PSOs on quarterly basis

  12. Safety Culture • Ongoing Patient Safety Leadership WalkAbouts and Safety Briefings • Open and Fair Reporting Policy – Increased number of reported HORs

  13. Medication Safety CollaborativeAftermath • Sustaining and spread of Medication Reconciliation, Dedicated ICU Pharmacist, Inpatient Warfarin Management Service • Development of the automated ADE surveillance system • Development of the electronic pharmacist intervention database • Study on local ADE costing • Headcount justification

  14. Quality & Patient Safety Initiatives

  15. Thank You

  16. Mission Statement At Level 11 of Tan Tock Seng Hospital, the peripheral iv cannula phlebitis rate will be reduced by 50% in 3 months

  17. Team Members & Roles 1. SNC Margaret Soon 2. NO Wong Siao Pin 3. SN Goh Mei ChernStaff from unit 4. AN Widarni 5. NE Prema BalanTeaching of staff 6. NE Pua Lay Hoon 7. Dr Benjamin TanDr covering L11

  18. Evidence for there being a problem worth solving Point Prevalence Phlebitis rate done on May 31 2002 is 26.3%. • International average = 15% • Institutional average = 11.8% • National average = 8.3% Repeated point prevalence rate in the unit on 28 Nov 2002 is 25%

  19. Pareto Chart

  20. Intervention(s) - plan, protocol etc • Compile, communicate & educate a. antibiotics information chartSpeed of administration & proper dilution b. Drugs not for IV administration c. Flushing of line according to recommendations d. Proper restraint of restless patients 2. Audit compliance to recommendations & phlebitis rate

  21. Point Prevalence Phlebitis Rate

  22. Strategies for Sustaining(holding the gains) • Involve all grades of HCWs within the department • Ownership of the problem/issue • Random point prevalence audit for comparison

  23. Strategies for Spreading • Repeat hospital wide point prevalence study (20 Jan 04) • Target at the next area with problems in peripheral phlebitis

  24. Thank You

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