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Methods for Improvement Where are the Ideas? David I Gozzard Quality Improvement Fellow Health Foundation
An International Movement of Movements?
The Entire UK Is Engaged
England ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Scotland ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Denmark ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.operationlife.dk
Canada ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.saferhealthcarenow.ca
http://kyodokodo.jp/ “ PARTNERS for Patient Safety ” National Campaign for Patient Safety in Japan Japan
Wales ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.1000livescampaign.wales.nhs.uk
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],100,000 Lives Campaign
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],5 Million Lives Campaign
Reducing Surgical Complications ,[object Object],[object Object]
Four Key Interventions ,[object Object],[object Object],[object Object],[object Object]
Reduce Surgical Site Infections  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Beta Blockade ,[object Object]
[object Object],[object Object],What Does the Evidence Tell Us?
Venous Thromboembolism Prophylaxis (VTE) ,[object Object],[object Object]
Tips for Getting Started ,[object Object],[object Object],[object Object],[object Object]
Ventilator-Associated Pneumonia ,[object Object],[object Object],[object Object],[object Object],[object Object]
Four Key Changes ,[object Object],[object Object],[object Object],[object Object]
Reducing Harm from High-Alert  Medications ,[object Object],[object Object]
What Are High-Alert Medications? ,[object Object],[object Object],[object Object],[object Object],[object Object]
What Does the Evidence Tell Us? Several studies have identified adverse drug events as the single most frequent source of health care mishaps, continually placing patients at risk of injury. -Rozich JD, Haraden CR, Resar RK.  Adverse drug event trigger tool: A practical methodology for measuring medication-related harm.  Qual Saf Health Care . 2003;12:194-200. -Bates DW, Boyle DL, Vander Vliet VM, et al. Relationship between medication errors and adverse drug events.  J Gen Intern Med . 1995;10:199-205. -Bates DW, Cullen DJ, Laird NM, et al. Incidence of adverse drug events and potential adverse drug events: implications for prevention.  JAMA . 1995;274:29-34. -Lesar TS, Briceland L, Stein DS. Factors related to errors in medication prescribing.  JAMA . 1997;277:312-317.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],What Does the Evidence Tell Us?
[object Object],[object Object],[object Object],[object Object],[object Object],What Does the Evidence Tell Us?
Prevent MRSA Infection ,[object Object],[object Object],[object Object]
MRSA Bloodstream Infections 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% A Vision For The Future? MRSA in Denmark Rosdahl VT et al.  Infect Control Hosp Epidemiol  1991;12:83-88. 1960  1965  1970  1975  1980  1985  1990  1995
Or This? MRSA in the UK
What Does the Evidence Tell Us?  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevent Infection  and  Colonization ,[object Object],[object Object],[object Object],[object Object],[object Object]
Five Key Interventions ,[object Object],[object Object],[object Object],[object Object],[object Object]
Tips: Hand Hygiene ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tips: Decontamination of Environment and Equipment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tips: Active Surveillance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Reduce Re-admissions from Congestive Heart Failure (CHF) ,[object Object],[object Object]
What Is “Congestive Heart Failure?” ,[object Object],[object Object],[object Object],[object Object]
What Does the Evidence Tell Us? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ACC/AHA Guideline, Circulation 2005;112:154-235
What Does the Evidence Tell Us? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Seven Key Interventions ,[object Object],[object Object],[object Object]
Seven Key Interventions ,[object Object],[object Object],[object Object],[object Object],Hospital performance on all interventions is sub-par (54% on the discharge component, 2005 CMS data)
Other Interventions to Consider ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevent Pressure Ulcers ,[object Object],[object Object],[object Object]
What Does the Evidence Tell Us? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Reddy et al., JAMA 2006;296:974-84
Six Key Interventions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Conduct a Pressure Ulcer Admission Risk Assessment; Reassess Daily ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Inspect Skin Daily ,[object Object],[object Object],[object Object]
Manage Moisture ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Optimize Nutrition/Hydration ,[object Object],[object Object],[object Object],[object Object]
Minimize Pressure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Engage Leadership and Governance ,[object Object],[object Object],[object Object]
What Does the Evidence Tell Us? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Vaughn T, Koepke M, Kroch et. al.  J of Patient Safety 2:2-9
Six Things That Boards Can Do ,[object Object],[object Object],[object Object],[object Object]
Six Things That Boards Can Do ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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The art of the possible ideas

  • 1. Methods for Improvement Where are the Ideas? David I Gozzard Quality Improvement Fellow Health Foundation
  • 3. The Entire UK Is Engaged
  • 4.
  • 5.
  • 6.
  • 7.
  • 8. http://kyodokodo.jp/ “ PARTNERS for Patient Safety ” National Campaign for Patient Safety in Japan Japan
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23. What Does the Evidence Tell Us? Several studies have identified adverse drug events as the single most frequent source of health care mishaps, continually placing patients at risk of injury. -Rozich JD, Haraden CR, Resar RK. Adverse drug event trigger tool: A practical methodology for measuring medication-related harm. Qual Saf Health Care . 2003;12:194-200. -Bates DW, Boyle DL, Vander Vliet VM, et al. Relationship between medication errors and adverse drug events. J Gen Intern Med . 1995;10:199-205. -Bates DW, Cullen DJ, Laird NM, et al. Incidence of adverse drug events and potential adverse drug events: implications for prevention. JAMA . 1995;274:29-34. -Lesar TS, Briceland L, Stein DS. Factors related to errors in medication prescribing. JAMA . 1997;277:312-317.
  • 24.
  • 25.
  • 26.
  • 27. MRSA Bloodstream Infections 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% A Vision For The Future? MRSA in Denmark Rosdahl VT et al. Infect Control Hosp Epidemiol 1991;12:83-88. 1960 1965 1970 1975 1980 1985 1990 1995
  • 28. Or This? MRSA in the UK
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 38.
  • 39.
  • 40.
  • 41.
  • 42.
  • 43.
  • 44.
  • 45.
  • 46.
  • 47.
  • 48.
  • 49.
  • 50.
  • 51.
  • 52.
  • 53.

Editor's Notes

  1. Not to mention nursing home and home health campaigns You’re a part of an international network, too… Canada, Wales, England, Scotland, Japan, Australia, Brazil, Scandinavia (Denmark, Sweden)
  2. 8. marts 2011
  3. Targets for each intervention: AMI: All patients receive perfect AMI care (all 9 strategies implemented 100% of the time) Med Rec: Reduce unintentional discrepancies by 75% in one year. SSI: 95% or more of all surgical patients will receive timely prophylactic antibiotics CLI: Reduce Central Line Infections by 50% in one year RRT: Decrease the Rate of Codes by 50% (per 1000 discharges) VAP: 95% of all patients on mechanical ventilation in the ICU receive all 4 elements of the VAP bundle Reduce VAP by 50% over one year Phase II: April 2008: Expanded LTC and Home Care MRSA: Reduce the Healthcare Associated MRSA by 50% Fall: Reduce the number of falls in LTC by 40% Med rec in LTC: Reduce unintentional discrepancies by 75% in one year VTE: 100% of patients receive appropriate thromboprophylaxis Two Pilots: Delivery of High Risk Medication in paediatric settings Med Rec in Home Care Targets TBD through evaluation of pilot projects.
  4. The ventilator bundle is a package of interventions that reduce the risk of the harm associated with being on a ventilator. The risk of ventilator-associated pneumonia is reduced by elevation of the head of the bed, a daily sedation vacation, and daily formal assessment of readiness for weaning. In addition, all patients should receive prophylaxis against deep venous thrombosis unless this is specifically contraindicated, and should receive prophylaxis against peptic ulcer disease.
  5. Mention country and hospital variability
  6. Mention C. diff as effect of antibiotics