Enhancing Patient Identification for Point of Care Glucose Testing in the Clinic Setting

1. Enhancing Patient Identification for Point of Care Glucose Testing in the Clinic Setting

2. Performance Improvement Leadership Development Program • Executive Sponsor: David Mountjoy, Associate Director Practice Mgmt • Advisors: • Laura Burnett, Manager of Outpatient Services • Sue Scott, RN, MSN Patient Safety Coordinator • Team: • Cindy Roller, MLT Point of Care Testing • Shelly Jackman, RN Nurse Supervisor • Support: • Jeanne Harmon, RN Nurse Supervisor February 19, 2010

3. AIM STATEMENT Develop an electronic process for entering patient information into Point of Care (POC) glucose meter (Roche Accu-Chek Inform) to increase operator accuracy and satisfaction by 50% on or before Jan 31, 2010.

4. October 6 Time Study with Diabetes Clinic, GM C413, and Urgent Care Clinic August 28 PI-LDP Project Team Convened February 19 Project presentation November 15 (Barcode Added) Developed plan to initiate barcode on outpatient home medication/allergy form Schedule Weekly Meetings January 21 Send out post- implementation survey December 21 Roll-Out to all clinics Lost Team Member #2 2009 2010 November 6 Send out pre-implementation survey Lost Team Member #1 January 14 Refined Aim Statement/ Added Project to PI-3 October 27 Refined Aim Statement February 8 Evaluate data/prepare presentation September 9 Aim Statement Developed December 15 Pilot with Urgent Care and Diabetes Clinic

5. Goal for University Physicians Clinics • Improve patient safety in accordance with National Patient Safety Goals • Increase operator accuracy and satisfaction

6. Service = Improve turn around time • People = Increase patient safety and increase staff satisfaction • Financial = Streamline workload • Quality = Deliver accurate and timely patient results

7. Point of Care Glucose Testing Process 1. Order received to perform test 2. Gather equipment 3. Operator prepares for test 4. Verify patient information (Two patient identifiers) glucometerglucose strip vialslancetsalcohol wipescotton balls Complete 24 hour control, if requiredwash handsput on gloves 5. Conduct pre-test identification process A. Scan staff ID badge C. Scan glucose strip vial 9. Obtain glucose values 8. Post sample care 7. Place glucose strip in meter 6. Prepare sample site B. Manually enter patient information Wait for display of value – 40 seconds.Evaluate valueEnter Physician provided ICD-9 and any other applicable comments Ensure no bleeding from site. Apply bandaid, if necessary Clean area with alcohol wipes. Allow alcohol to air dry (15 seconds) Obtain capillary specimen, Fill test window of glucose strip 10. Obtain glucose values 11. Return equipment 12. Operator post test ‘clean-up’ Dock Inform meter to down load result to PathNet/PowerChart Return strip vial to carrying caseDispose of lancet in sharp box Remove glovesWash hands

8. Patient Identification Error Inaccurate Manual Entry Wrong visit number Visit number not used Numbers transposed Random numbers entered Incorrect visit selected from computer Inaccurate initial patient identification MRN entered DOB entered

9. Manual Entry ID Error by Clinic UP Clinics performing POC Glucose: 19 Total 2009 POC Clinic Glucose tests: 1,988 Number of clinics with manual entry ID errors: 7 Total manual entry errors 2009: 21

10. Pre-Implementation Staff Survey Results Results: • 56/138 (41% return) • 57.2% very satisfied/satisfied with ease of entering patient identification into Inform glucose meter • 42.8% neither satisfied/dissatisfied/very dissatisfied • 55.4% perceived time to perform test was 2-3 minutes • At the time of the survey, 23.2% reported scanning (work-around already in place) Comments: • “It would be less time consuming to scan a barcode rather than entering a visit number, I also think this would cut down errors in entering patient info.” • “Would be nice and quicker to get to the testing if we had a barcode with patient information.”

11. We know what the problem is, now how do we fix it? • Meet with clinic staff to determine current procedures and possible alternatives • Barcode scanning would be great – but what should we scan? Different clinics had different options • Several clinics had already established “work-arounds” • Work with IT to create a barcode for the medication/allergy form that all clinics were able to print for each patient – this will enable us to standardize the procedure

12. We know what the problem is, now how do we fix it? • Change to policy and procedure • Education and training must be adapted to meet the new standards • Managers and trainers were notified of the change and encouraged to update all staff • Emergency “Unregistered Patient” barcode available to scan

13. Post-Implementation Staff Survey Results Results: • 57/138 Responses (41%) • 78.2% very satisfied/satisfied with ease of entering patient identification into the meter (up from 52.7%) • 21.7% neither satisfied/dissatisfied/very dissatisfied (down from 42.8%) • 60.9% reported time <1 minute (up from 28.6%) Comments: • “Awesome Change!” • “I hated doing the manual entry of patient information – transcribing errors were a problem. Love the new way with the bar coding. THANK YOU!!!!!!!” • “Love the bar code on the med sheet, it does save a few seconds and that is important - seems very accurate and it worked well” • “So much more convenient!”

14. Outcomes • Increased patient safety / Decreased error rate • No patient ID errors post implementation when using barcode scanning • Two manual entry errors post implementation • Operator manually entered another patient’s visit number • Operator manually entered patient’s medical record number • Decreased “Work-Arounds” • Scanning patient labels/stickers • Standardized process • New CED module • New training/orientation • Policy updates • Increased staff satisfaction • Shortened overall time to perform test • Staff confidence in accuracy • Limit # of PSN reports • Limit lab staff interventions

15. Lessons Learned/Future Plans • Smiley Clinic does not print the Medication/Allergy form – how do we accommodate them? • Turn off manual access – allow barcode scanning only • Ongoing monitoring for compliance and operator satisfaction • PI-LDP project could have been more efficient with additional team members

16. Barriers • Multiple processes in place • Staff Education • Staff Compliance • Sustaining PI-LDP Team

17. Questions?