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Obtaining Success Our Journey to 100%

Obtaining Success Our Journey to 100%. MITCHELL COUNTY HOSPITAL CORE MEASURES Presented by: Vicki Cox, RN MSN. Identifying Areas of Weakness. HF - discharge instructions PN - documentation of blood culture time prior to antibiotic initiation. Engaging the people that matter.

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Obtaining Success Our Journey to 100%

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  1. Obtaining SuccessOur Journey to 100% MITCHELL COUNTY HOSPITAL CORE MEASURES Presented by: Vicki Cox, RN MSN

  2. Identifying Areas of Weakness • HF - discharge instructions • PN - documentation of blood culture time prior to antibiotic initiation

  3. Engaging the people that matter Discussed importance of Core Measures with our physicians and nurses Stressed significance of buy-in to assist in accomplishing success Welcomed suggestions for improvement

  4. Did the WRITTEN dc instructions (or other documentation of educational materials) given to the patient/caregiver address… Activity level Diet/fluid intake Follow-up with MD after dc All dc medications What to do if HF symptoms worsen after dc Weight monitoring after dc

  5. Putting Our Heads Together • Nursing • Administration • Quality • Case Management • Medical Staff

  6. A Form is Born…

  7. So…which patients get the form? All patients with an admitting diagnosis of HF or any patient that has HF listed as a co-morbidity

  8. Safety Net ALL patients sign & receive copies of: Home Meds Reconciliation Discharge Report + Discharge Assessment

  9. Discharge Assessment Contains: • Discharge Diet • Discharge Activity • Follow-up Appointment(s) • ‘I should call my doctor if’ box ….combined with Med Reconciliation DC Report, meets all 6 elements of the discharge instruction standard.

  10. Ongoing focus… • Concurrent reviews when possible • One-on-one education as non-compliance is noted • Compliance posted in nursing departments quarterly • Core measure education yearly at annual skills/equipment workshop • Report to physicians quarterly on “report card” • Educate and collaborate with all new physicians regarding core measure process

  11. Contributing to our Success: • Engage ALL staff • Utilize a collaborative/team approach • Implement ideas/suggestions such as rewards …most importantly… Change the culture (and maintain the excellence)

  12. Because it’s the RIGHT thing to do for thePatient EVERY time …

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