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KP Riverside Medical Center
                                  2008-12




Riverside Maternity Service HCAHPS
Scores Past Present and the Future
   To provide the best possible patient
    centered care maximizing the overall
    health of our members




What is our goal?
Overall rating of hospital stay
             90

             80

             70
Axis Title




             60
                                                                       Series1
             50

             40

             30
                  1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
willingness to recommend
             100

              90

              80
Axis Title




              70

              60

              50

              40

              30
                   1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Nurse Communication: treat you with respect
             90
             85
             80
             75
Axis Title




             70
             65
             60
             55
             50
                  1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Nurse communication: how often they listened to you
             90
             85
             80
             75
             70
Axis Title




             65
                                                                        Series1
             60
             55
             50
             45
             40
                  1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Nurse Communication: nurse explain things in a way you
                                  could understand
             90
             85
             80
             75
             70
Axis Title




             65
             60
             55
             50
             45
             40
                   1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Doctor Communication: treat you with respect
             100

              95

              90
Axis Title




              85

              80

              75

              70
                    1 3 5 7 9 111315171921232527293133353739414345474951
Doctor communication: listen to you carefully
             95

             90

             85
Axis Title




             80

             75

             70

             65

             60
                  1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Doctor Communication: explain things in a way you
                               could understand
             95

             90

             85
Axis Title




             80

             75

             70

             65

             60
                  1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
responsiveness: how fast you got help as fast as you
                                       wanted
             90

             80

             70
Axis Title




             60

             50

             40

             30
                  1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
responsiveness: how fast you got help to go to
                                      bathroom
             100

              90

              80
Axis Title




              70

              60

              50

              40

              30
                   1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Pain Management: how well your pain was managed
             90
             85
             80
             75
Axis Title




             70
             65
             60
             55
             50
             45
                  1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Pain Management: how often they did everything to
                                control your pain
             95
             90
             85
             80
             75
Axis Title




             70
             65
             60
             55
             50
             45
                  1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Communication about medication: explain what the
                               new medication is for
             100
              95
              90
              85
Axis Title




              80
              75
              70
              65
              60
                   1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Communication about medication: explain possible side
                              effect of new medication
             80

             70

             60
Axis Title




             50

             40

             30

             20
                   1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Discharge: did the staff talk with you about whether you would have the
                                 help you needed when you left the hospital

             85

             80

             75
Axis Title




             70

             65

             60

             55

             50
                  1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Discharge: did you get discharge information in writing
             100
              98
              96
              94
Axis Title




              92
              90
              88
              86
              84
              82
                    1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
cleanliness: how often were your room and
                              bathroom kept clean
             90
             85
             80
             75
             70
Axis Title




             65
             60
             55
             50
             45
             40
                  1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Quietness: how often was the area around your
                               room quiet at night
             80

             70

             60
Axis Title




             50

             40

             30

             20
                  1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
 Concentrate on Medication communation
 Our goal is to increase our HCAHPS score
  pertaining to communication about
  medication from 66% to 75% by 12/12
  and to 85% by 6/13
 This will place us in top 100 percentile in
  6 months.




What now?
 1-Education (knowledge base)
 2-Communication
 3-Workflow




The Primary Drivers for Change
   Every provider (MDs, Nurses, Lactation
    Consultants) that become in contact with
    patient is aware of this goal

   Provider education about every
    medication that is dispensed to the
    patient.

   Patient education becomes a priority


Education
 Disseminate the goals to staff through
  every mean
 MD’s (OBGYN, Anesthesia and Pediatrics),
  Midlevel providers (OBGYN, Anesthesia
  and Pediatrics) will be notified via Email
  announcements, and department meeting
  announcements of this goal.
 Nursing Staff will be notified through UBT
  meetings, News Letter, and Daily Huddle



Education – PI goal
   Nursing staff and Lactation consultants – education about
    the purpose of the any medication administered to the
    patient and possible side effects to the fetus, or the new
    born
   Devote 1 minute of the daily Huddles to a new drug that is
    common to the MAR of the patients who are in the unit.
   Staff will be provided with concise written information
    about the medication on rounds.
   Will request a member of each discipline to produce such
    flash cards.
   Will educate the Providers about the medication on their
    department meeting.
   On average there are about 15 medication on a low risk
    Obstetrical patient intra-partum and post-partum




Education – Provider Knowledge base
 Provide the patient with information about
  the medication, possible side effects, and
  safety during lactation
 Provide the patient with printed
  information upon request
 Document on care board the number of
  medications that were discussed with the
  patient on daily basis
 Leadership rounders will track such
  documentation on care board


Education - patient
   Process measure
    ◦ Daily huddle documentation
    ◦ Daily and hourly round documentation on Care
      board
    ◦ Brief survey of patients prior to implementing
      the change regarding medication education
      from 5/23/2012 – 6/08/2012 (roughtly 100
      patients) and compile the information weekly
    ◦ Update the staff about improvement In the
      measure



How do measure change?
   Outcome Measure
       HCAHPS score usually delayed by 90
           days.
       update the staff regularly of the
           improvement of the measure.




How do we measure change?
Questions?

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Medication 53333-phpapp02

  • 1. KP Riverside Medical Center 2008-12 Riverside Maternity Service HCAHPS Scores Past Present and the Future
  • 2. To provide the best possible patient centered care maximizing the overall health of our members What is our goal?
  • 3. Overall rating of hospital stay 90 80 70 Axis Title 60 Series1 50 40 30 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
  • 4. willingness to recommend 100 90 80 Axis Title 70 60 50 40 30 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
  • 5. Nurse Communication: treat you with respect 90 85 80 75 Axis Title 70 65 60 55 50 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
  • 6. Nurse communication: how often they listened to you 90 85 80 75 70 Axis Title 65 Series1 60 55 50 45 40 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
  • 7. Nurse Communication: nurse explain things in a way you could understand 90 85 80 75 70 Axis Title 65 60 55 50 45 40 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
  • 8. Doctor Communication: treat you with respect 100 95 90 Axis Title 85 80 75 70 1 3 5 7 9 111315171921232527293133353739414345474951
  • 9. Doctor communication: listen to you carefully 95 90 85 Axis Title 80 75 70 65 60 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
  • 10. Doctor Communication: explain things in a way you could understand 95 90 85 Axis Title 80 75 70 65 60 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
  • 11. responsiveness: how fast you got help as fast as you wanted 90 80 70 Axis Title 60 50 40 30 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
  • 12. responsiveness: how fast you got help to go to bathroom 100 90 80 Axis Title 70 60 50 40 30 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
  • 13. Pain Management: how well your pain was managed 90 85 80 75 Axis Title 70 65 60 55 50 45 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
  • 14. Pain Management: how often they did everything to control your pain 95 90 85 80 75 Axis Title 70 65 60 55 50 45 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
  • 15. Communication about medication: explain what the new medication is for 100 95 90 85 Axis Title 80 75 70 65 60 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
  • 16. Communication about medication: explain possible side effect of new medication 80 70 60 Axis Title 50 40 30 20 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
  • 17. Discharge: did the staff talk with you about whether you would have the help you needed when you left the hospital 85 80 75 Axis Title 70 65 60 55 50 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
  • 18. Discharge: did you get discharge information in writing 100 98 96 94 Axis Title 92 90 88 86 84 82 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
  • 19. cleanliness: how often were your room and bathroom kept clean 90 85 80 75 70 Axis Title 65 60 55 50 45 40 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
  • 20. Quietness: how often was the area around your room quiet at night 80 70 60 Axis Title 50 40 30 20 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
  • 21.  Concentrate on Medication communation  Our goal is to increase our HCAHPS score pertaining to communication about medication from 66% to 75% by 12/12 and to 85% by 6/13  This will place us in top 100 percentile in 6 months. What now?
  • 22.  1-Education (knowledge base)  2-Communication  3-Workflow The Primary Drivers for Change
  • 23. Every provider (MDs, Nurses, Lactation Consultants) that become in contact with patient is aware of this goal  Provider education about every medication that is dispensed to the patient.  Patient education becomes a priority Education
  • 24.  Disseminate the goals to staff through every mean  MD’s (OBGYN, Anesthesia and Pediatrics), Midlevel providers (OBGYN, Anesthesia and Pediatrics) will be notified via Email announcements, and department meeting announcements of this goal.  Nursing Staff will be notified through UBT meetings, News Letter, and Daily Huddle Education – PI goal
  • 25. Nursing staff and Lactation consultants – education about the purpose of the any medication administered to the patient and possible side effects to the fetus, or the new born  Devote 1 minute of the daily Huddles to a new drug that is common to the MAR of the patients who are in the unit.  Staff will be provided with concise written information about the medication on rounds.  Will request a member of each discipline to produce such flash cards.  Will educate the Providers about the medication on their department meeting.  On average there are about 15 medication on a low risk Obstetrical patient intra-partum and post-partum Education – Provider Knowledge base
  • 26.  Provide the patient with information about the medication, possible side effects, and safety during lactation  Provide the patient with printed information upon request  Document on care board the number of medications that were discussed with the patient on daily basis  Leadership rounders will track such documentation on care board Education - patient
  • 27. Process measure ◦ Daily huddle documentation ◦ Daily and hourly round documentation on Care board ◦ Brief survey of patients prior to implementing the change regarding medication education from 5/23/2012 – 6/08/2012 (roughtly 100 patients) and compile the information weekly ◦ Update the staff about improvement In the measure How do measure change?
  • 28. Outcome Measure HCAHPS score usually delayed by 90 days. update the staff regularly of the improvement of the measure. How do we measure change?