ami virtual learning collaborative closing congress atlantic node
TRANSCRIPT
AMI Virtual Learning Collaborative
Closing Congress
Atlantic Node
Learning Collaborative
Learning Session 1A October 07-091B October 21-09
Learning Session 2
January 06-2010
Learning Session 3
February 10-10
Closing Congress!!
March 30-2010
Act Act
Act
Plan
Plan
Plan
DoDo
Do
Study
StudyStudy
Plan: for changeDo: make changesStudy: impact of changeAct: on changes that work
Action Period #1 Action Period #2 Action Period #3
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Self Evaluation Results
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Team Average Self AssessmentProgress towards AIM
2.32.8
0
1
2
3
4
5
Team Progress
Rat
ing LS2
LS3
Closing Congress
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Team RelationshipAverage Rating
2.4
3
2.11.8
0
1
2
3
4
LS2 LS3 Closing Congress
Rat
ing Intra Team Relationship
Inter team Relationship
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LS3
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Team Self Rating
05
101520253035404550
Non
Star
ter
Activ
ity b
utno
Tes
ting
Mod
est
Impr
ovem
ent
Impr
ovem
ent
Sign
ifica
ntIm
prov
emen
t
Out
stan
ding
Sust
aina
ble
Resu
lts
%
LS2
LS3
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Intra Team Relationship
010
2030
4050
6070
80
Half Hearted CuriousHeart
Beatingheart
Full Hearted
%
LS2
LS3
Closing Congress
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Inter Team Relationship
0
10
20
30
40
50
60
70
80
Weak New Developing Strong
%
LS2
LS3
Closing Congress
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Team Self Evaluation Poll
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Session Evaluation
Learning Session Evaluation
0
10
20
30
40
50
60
70
StronglyDisagree
Disagree Neutral Agree StronglyAgree
%
Interactive
Solutions to Barriers ID
Recommend to Colleague
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What Worked Best
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Recommended Changes• more interactive group work • as a facilitator, would like to have actually practiced the
breakout and use of posters etc. in advance • audio is difficult to hear fades in and out
• Maybe it's because I am a late starter to my AMI team. But a short BIO of all the participants in a WebEx would be helpful. Manger vs. educator vs. core staff. Not sure how you would accomplish that.
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Rapid Fire Presentations• Assigned to 1 of 3 ‘breakout rooms’
• Present: Idea, How it Worked; Results– 3-5 minutes for presentation of a Change Idea
and Q&A in ‘breakout room’– Facilitator role: keep time, summarize, and
report back to larger group
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Brookfield Bonnews Health Center
AMIPresentation
March 31, 2010
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Primary Health Care site includes:
• 4 small Community Health Centers
• 1- 45 bed Long Term Care Site
• 1- 12 bed inpatient acute care site with outpatients and emergency dept.
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How we got started?• Asked by DHS for our area to become a part of
the AMI Virtual learning project
• Met with Safer Healthcare Now coordinator for Central Health to give us some background information and help us get started.
• Attended Online sessions (WEBEX)
• Put together a onsite team
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What Our Team Worked on- Collected our data
- Completed our process Map
- Completed worksheets for testing Changes
- Communicated to the team importance of accurate timing to ECG and Thrombolytic goals and asked for suggestions through:
- personal contact - computer messages - MAC and staff meetings
- Put together our Team Charter
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What we tested?
-Synchronize clocks, watches, registration computer, EKG machines
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Results:- Clock on Cardiac unit was losing time- new digital clock was ordered
- 25% of staff did not wear a watch
- EKG machine time was inaccurate so it was calibrated and is now keeping good time.
- In 2009 we gave Thrombolytics to 4 patients, 3 were in the appropriate time frame and one was outside (pt did not present at time of registration with chest pain)
- Since the collection of data- all EKG’s to date have been done within 10 minute time frame
- No thrombolytics have been administered since the start of the Collaborative.
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Thank You!
AMI Virtual Learning Collaborative
Guysborough Antigonish Strait Health Authority
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When we started
• Our team is made up of representatives from all hospitals in our district:Guysborough Memorial HospitalEastern Memorial HospitalStrait Richmond HospitalSt. Martha’s Regional HospitalSt. Mary’s Memorial Hospital
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Our Journey To date
Through our teamwork on this collaborative we have been able to develop relationships with members from other district hospitals, we have been able to share ideas, identify barriers, and develop strategies unique to our varying locations.
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Things we Learned
We learned that we already do a pretty good job of providing excellent patient care…..
But, we have and are developing strategies to ensure that the standard is kept high, that we continue to learn from each other and find ways to do things better!
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Things we Learned Staff Education Re: best practice around AMI Care RN’s doing stat ECG’s contribute to better patient
outcomes Need for clock synchronization important to track data Flow chart put into use to ensure continuity of
cardiovascular care (to help identify atypical presentations)
Order sets will help streamline and make cardiovascular care specific to ensure best practice
We need to continue to operate this committee to ensure continued awareness and implementation of changes
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What we accomplished
• We have been able to bring about change within our organizations…….
• We have people excited about ensuring that our patients receive the best care out there…….
• We will continue to raise the bar and provide patients with the best chances of reaching the most desirable outcomes in relation to their cardiovascular health!!!
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Next Steps• We are going to meet quarterly to ensure
that the groundwork which was laid during the collaborate continues. We will be able to look back at our progress and continue to learn from each others trials and tribulations.
• We have made relationships that will continue to develop as our work on this continues……..
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Q&A
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Contact Information
Jennifer Delorey R.N., BScN.Guysborough Memorial Hospital
• 902-533-3702
Time Is MuscleSync The Clock!
Objective:
1.Complete ECG within 10 Minutes 2.Complete Lytics within 30 Minutes
Goal:
• Synchronize our clocked instruments
LAB RADIOLOGY
REGISTRATION NURSING
MAINTENANCE
RADIOLOGY
LAB
•We Mapped Our Progress On The Information Board
• Hoping For A Successful Future •Our New Goal Is To Get Our First IV In15 Minutes
AMI Virtual Learning Collaborative
March 31, 2010
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Western Health
• Two hospitals and four rural health sites participated in collaborative;
- Western Memorial Regional Hospital (WMRH)
- Sir Thomas Roddick Hospital (STRH)
- Calder Health Care Centre (CHCC)
- Dr. Charles Legrow Health Centre (DCLHC)
- Bonne Bay Health Centre (BBHC)
- Rufus Guinchard Health Centre (RGHC)
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Western Health
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Western Memorial Regional Hospital
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When We Started
• AMI intervention had already been implemented at WMRH, STRH, and DCLHC
• Regional team established to support a coordinated approach and spread to all sites
• In fall 2009, initiative implemented at three remaining sites (RGHC, BBHC, CHCC) to coincide with participation in collaborative
• Regional team assumed responsibility for leading work related to collaborative
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Staff at Calder Health Care Centre
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Our Journey To Date
• Established regional charter
• Identified three improvement objectives:
- 90% STEMI or new LBBB patients presenting to ED with chest pain will receive an EKG within 10 minutes of arrival at ED
- 90% STEMI or new LBBB will receive thrombolytic within 30 minutes of arrival at ED
- 90% of patients presenting to ED with chest pain will receive an EKG within 10 minutes of arrival at ED
• Completed process maps for individual sites
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Baseline Data
• Period October 1 to December 31, 2009
- 100% of STEMI or new LBBB received an EKG within 10 minutes of arrival at ED
- 83% of STEMI or new LBBB received thrombolytic within 30 minutes of arrival at ED
- 72% of patients presenting to ED with chest pain received an EKG within 10 minutes of arrival at ED
• Data from January 1 to March 31, 2010 to be reviewed at next regional meeting
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Bonne Bay Health Centre
Person with Chest Pain Arrives in ED (either through ER
entrance or registration
depending on time of day)
If pt. arrives through ER entrance either placed in
room or moved to registration depending on assessment/if pt. arrives in registration and indicates
chest pains moved immediately to ER
Treatment commences with
aspirin, oxygen, IV, vital signs, and
ongoing monitoring
EKG given to ER physician for review and interpretation
If ST elevation (as per protocol) physicians order Thrombolytic and/or consult with
Internist before decision made to give
ER staff prepares
Thrombolytic. After 1700 hours
(weekdays) and 2000 hours
(weekends) may need to call in
additional nursing staff
Thrombolytic given to pt.
Notify physician of patient in ER.
Physician in hosp 0800 to 1600 hrs. After 1600 hrs no physician in the hospital and will
need to be called to come assess patient
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Opportunities for Improvement
• Synchronizing clocks, EKG machines, and Meditech System
• Enhancing awareness and education for physicians and nursing staff related to timely EKGs and administration of Thrombolytics
• Enhancing orientation for new physicians including locums
• Public awareness and education
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Lessons Learned
• Importance of broadening focus beyond the typical patients presenting to our emergency departments
• Challenging issues to address (e.g., synchronizing clocks, EKG machines, and Meditech System)
• Many factors influence our ability to move forward (e.g., staffing changes)
• Work from collaborative will continue to be ongoing
• Raised awareness and education for front line staff
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Lessons Learned
• Challenges of ensuring communication with all appropriate staff (e.g., after hours acute care cover ER department in rural health facilities)
• Importance of being proactive in initiating standing orders and contacting physician after hours
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Educational Opportunities
Calder Health Care Centre
• Education provided during staff meeting regarding:
- standing orders
- discharge order form
- 10 minute time frame for EKG
- 30 minute time frame for thrombolytic agents
• Small staff discussions and huddles
• Planning additional education session for nursing staff and physicians
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Educational Opportunities
Sir Thomas Roddick Hospital
• Dr. Qureshi presented at a Breakfast session for all nursing staff and physicians - This session was well attended with over 20 participants
• Small staff discussions and huddles
• Updates provided at staff meetings regarding:- AMI packet- 10 minute timeframe for EKG- Clock synchronization
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Sir Thomas Roddick Hospital
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Public Awareness and Education
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Contacts
• Ms. Julie Sutton, Western Memorial Regional Hospital, [email protected], (709) 637-5000 (ext. 5265)
• Ms. Karen Alexander, Sir Thomas Roddick Hospital, [email protected], (709) 643-5111 (ext. 234)
• Ms. Kathy Organ, Dr. Charles Legrow Health Centre, [email protected], (709) 695-4546
• Ms. Laurie Porter, Calder Health Care Centre, [email protected], (709) 886-2898 (ext. 237)
• Ms. Susan Reid, Bonne Bay Health Centre, [email protected], (709) 458-2211 (ext. 208)
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Contacts
• Ms. Paulette Lavers, Rufus Guinchard Health Centre, [email protected] , (709) 861-3139 (ext. 211)
• Ms. Donna Hicks, Western Memorial Health Clinic, [email protected] , (709) 634-4437
• Ms. Barbara Ann Dunphy, Western Memorial Health Clinic, [email protected], (709) 634-4311
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View from Man in the Mountain Overlooking the Humber River
AMI IMPROVEMENT JOURNEY
South Shore HealthSSRH
FMH
QGH
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Who Are We…• South Shore Health consists of three different
Emergency sites– South Shore Regional- Bridgewater– Fisherman’s Memorial-Lunenburg– Queen’s General-Liverpool
• Total geographical area served-5300 square kilometers, encompassing Lunenburg and Queen’s counties.
• Total population-58,362
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In The Beginning…• CVHNS contacted SSH
• Team engaged by VP Clinical Services and ER manager
• Initial committee formed in October,2010
• Team consists of-SSRH-ER manager, team leader, representatives from Critical care,CVHNS, CIU,Patient Safety, QGH And FMH ERs and Adhoc ER Physician.
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Baseline Data
• ECG within 10 minutes-38%
• Thrombolytics within 30 minutes-80%
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Times They Are A Changing!!!
• Time synchronization- Triage,ECG machines, monitors and wall clocks synchronized at all sites. Monthly audits to ensure continued accuracy
• ECG first-Increased Staff awareness re “Time is Muscle”,ECG within 10 minutes,Proirity access to patient by CIU.
• Physician to initial and time ECG interpretation
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Staying Alive
• First medical contact to ECG time-– EHS-immediate to 92 minutes – ER-immediate to 7 minutes
• Diagnostic ECG to Thrombolytics– EHS-not available in this district– ER-1-35 minutes
• On 3 different occasions we were able to administer Thrombolytics within 1 minute of diagnostic ECG !!!
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The Future Holds…
• Ongoing education re:– Time is Muscle– ECG first <10 minutes– Thrombolytics <30 minutes– Continued monitoring and synchronization of clocks– Maintaining competency within district re ECG
interpretations and thrombolytic administration– Early interpretation of ECG by ERPs-documented by
initials and time– Understanding of term” STAT ECG”.
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For more information Contact:
– Anne Rogers
– Phone number (902-543-4604-ext-2237)
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Session Evaluation & Post VLC Qs