g2 - improvement in newborn care through increased compliance with the neonatal resuscitation...
DESCRIPTION
This presentation was delivered in session G2 of Quality Forum 2014 by: Adele Harrison, Neonatologist, Victoria General Hospital Medical Director, Quality & Patient Safety, Island HealthTRANSCRIPT
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Improvement in newborn care through increased compliance with
the Neonatal Resuscitation Program: sustaining improvement
Dr Adele Harrison; Island Health Jessica Belle, Shaun van Pel, Ashley
Jewett; Island Medical Program
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Disclosure
• I have no affiliation with any commercial or industry interest in relation to this presentation.
• Adele Harrison is a Neonatal Resuscitation Program (NRP) instructor and regional instructor-trainer.
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Neonatal Resuscitation Program
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Key Measure
• Percentage of resuscitations in which there is accurate documentation of correctly performed resuscitation as characterized by correct use of oxygen and correct use of ventilation pressures according to NRP.
• Target: 100%.
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Methods
• A multidisciplinary working group of healthcare providers who were involved in teaching and clinical delivery of NRP was established.
• Hospital charts of up to 5 newborns admitted to the Neonatal Intensive Care Unit were audited every 2 weeks from April 2012 to May 2013 and from November 2013 to February 2014.
• Plan-Do-Study-Act cycles were utilized to evaluate change ideas
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Planning for Success: DICE Methodology
• Duration of project • Integrity of project team • Commitment of top management • Commitment of employees affected • Effort over and above usual work
– DICE Score =12 “Win Zone” (7 to 14)
Hal Sirkin, Perry Keenan and Alan Jackson. The Hard Side of Change Management, October 2005, Harvard Business Review . 6
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Early findings
Healthcare professionals like doing, not charting!
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Completion of Resuscitation Record
Correct equipment available
Team composition
Knowledge/skills of NRP
Improve compliance with NRP to 100% by
March 2013
Specific Aim
Key Drivers
Teach resuscitation record completion to NRP instructors
Develop multidisciplinary NRP courses
Develop VIHA “program” of NRP courses
Develop recommendations for course content for different HCPs
Implement checklist for resuscitation equipment
Design Changes/Interventions
Optimize team structure at deliveries
Strategy for Change
Team functionality
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Quality Forum 2013
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0102030405060708090
100
Perc
enta
ge o
f rec
ords
com
plet
ed
Newborn extended resuscitation records completed
10
0
10
20
30
40
50
60
70
80
90
100
Perc
enta
ge o
f rec
ords
initi
ated
Newborn extended resuscitation records initiated
median
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0102030405060708090
100
Perc
enta
ge o
f rec
ords
com
plet
ed
Correct use of pulse oximeter and oxygen documented
0102030405060708090
100
Perc
enta
ge o
f rec
ords
com
plet
ed
Correct use of pressures documented
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median
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4
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16Benefits
Credibility of evidence
Adaptability
Monitoring Progress
Involvement and training
Behaviours
Senior leaders
Clinical leaders
Fit with goals and culture
Infrastructure
Sustainability
Sustainability Radar Chart
Source: NHS Institute for Innovation and Improvement. Sustainability Model and Guide. 2010. Adapted by BC Patient Safety Quality Council
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Key Factors in Sustainability Strengths Challenges
Benefits Efficiency
Credibility of benefits Evidence-based Communication
Adaptability of process System change
Ability to monitor progress Ongoing
Staff involvement/training From the beginning
Behaviours towards change Some buy-in QI not part of the culture
Senior leadership support Engaged Not visible
Clinical leadership support Engaged and involved
Strategic aims and culture Clear goals Culture
Infrastructure Adapted environment
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Summary
• Visualize success • Articulating clear goals and sharing the data
helped drive positive change • Get everyone on board
• Including multidisciplinary clinical staff in the process positively impacted sustainable change.
• Make it child’s play • Environmental modifications and system changes
were powerful drivers of behaviour and promote sustainability.
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