|
Missouri
Success
Stories: MISSOURI
|
-
Primaris,
the QIO for Missouri, the Missouri State Medical Association, and
the Missouri Hospital Association together established the Missouri
Center for Patient Safety (MCPS), a private non-profit patient safety
center that will work to reduce mistakes in all health care settings.
MCPS will become a focal point that coordinates safety activities
among Missouri health care and other organizations. The center is
expected to form advisory panels that will help prioritize issues,
give feedback and generally promote a health care safety movement.
Professional and public education campaigns on patient safety, a
compendium of best practices and a voluntary safety incident “SWAT” team
are also anticipated to develop as the organization grows.
- Primaris,
the QIO for Missouri, worked with various city, county, and public
agencies including faith-based groups, St. Louis Health Department,
and the St. Louis County Health Department to increase awareness of
the benefits of influenza immunization and reduce the disparity of
immunization between African-American and Caucasian beneficiaries.
From 2002 to 2003, flu immunization rates for African-American beneficiaries
increased by more than 3%; far greater than Caucasian beneficiaries.
The number of vaccination clinics in the area increased from just 16
in 2001 to more than 80 in 2004.
- From 2002
to 2005, 81 nursing homes in Missouri worked with Primaris, the state’s
QIO to reduce pressure ulcers and improve treatment of post-acute and
chronic pain in residents. Those 81 nursing homes saw a 57 percent
larger improvement these efforts than the other 461 nursing homes in
the state, which did not receive intensive help from Primaris.
- Primaris,
the Missouri QIO, and the Missouri Diabetes Prevention & Control
Program (MDPCP) are working with 12 hospitals and 42 affiliated physicians
to implement and coordinate a community-based network of care for diabetes
through the Community Care Connection 2005 program. In addition to
free tools to assist in the improvement of diabetes patient care, participants
received a free electronic patient registry system that assists physicians
in recording health data such as HbA1c, lipid profiles, nephropathy
assessment, and proportions of patients self-monitoring their glucose
levels, as well as reminders for foot and eye exams. Within six months,
33 physicians were using the system for 10,417 registered patients,
improving management of the diabetic patient population.
- The Missouri
QIO, Primaris, worked with Comfort Care Home Health Agency, Inc. in
Doniphan, to reduce acute care hospitalization rates from a baseline
measure of 51.48% in January 2004 to 37.64% in January 2005.
- Poplar
Bluff Regional Medical Center Home Healthcare in Missouri worked
with its QIO, Primaris, to improve quality of care in patients’ ability
to bathe, get in and out of bed, and care for surgical wounds. From
2002 to 2005, bathing improved from 49.7% to 58.8%; getting in and
out of bed improved from 40.7% to 51.6%; surgical wound care improved
from 67.4% to 87.2%.
- In 2005,
Primaris, the QIO for Missouri , worked with a hospital in the state
to institute a medication reconciliation program by providing materials
and support to ensure that medications a patient takes at home, those
prescribed at hospital admittance, during the hospital stay, and
at discharge are monitored by nursing staff. The hospital also instituted
an audit procedure to assess the degree of medication reconciliation.
- Missouri
hospitals seek perfect heart care: Through rapid-cycle improvements
conducted between July 2002 and June 2003, Hannibal Regional
Hospital (Hannibal, Missouri) increased the early administration
of aspirin— a crucial step in the care of heart attack patients— to
97%. The key to Hannibal ’s success in aspirin delivery was
early identification of AMI patients in the emergency room where
nurses and technicians were trained to recognize AMI patients with
tools such as chest pain flow sheets. At Jefferson Memorial
Hospital, staff recently achieveda 38% increase in “worsening
symptoms” instructions at discharge and a 21% increase in monitoring
instructions given at discharge. Without this system change, many
heart failure patients would not receive vital information needed
to help understand their condition and maintain a good state of health.
Both hospitals work closely with the state’s QIO, Primaris,
to improve care in a number of clinical areas.
- Truman Medical Center speeds antibiotic administration for pneumonia:
The emergency department at Truman Medical Center (Kansas City, Missouri)
decreased the average amount of time from patient arrival until antibiotic
administration for pneumonia from over 7 hours to just under 3 hours.
Working closely with the state’s QIO, Primaris, Truman boosted
staff education about the standard of care for pneumonia patients
and enhanced emergency department triage assessment skills used to
promote rapid identification and prioritization of pneumonia patients.
In pneumonia patients, blood cultures are vital in order to identify
proper antibiotic for administration. Before working with Primaris,
57% of patients received a blood culture; after participating in
a Primaris learning project, TMC now screens 87% of patients. The
rate of vaccination of Medicare patients at Truman increased from
15% to 45%, with the hospital now striving to vaccinate at least
90% of eligible patients.
- Truman
Medical Center fights diabetes by lowering patient blood sugar levels:
The A1C test is necessary to monitor the health of people with diabetes;
it measures an individual’s average blood sugar level over
a three-month period. The recommended A1C level is 8%. At the beginning
of 2002, barely one-half of Truman Medical Center ’s ( Kansas
City, Missouri ) patients were at this level. By August 2003, 100%
of the patient population was screened and 80 percent of the patients
had lowered their score by 1%. Working with the state’s QIO,
Primaris, Truman established a diabetes patient registry. A clinical
team met on a biweekly basis to discuss diabetes population trends
and concerns. A “Diabetes Day” was held allowing patients
to obtain necessary diabetes tests and screenings including eye screenings,
foot screening, laboratory tests and diabetes education. Each patient
was instructed on basic self-management of their disease and encouraged
to formulate self-management goals, a technique that proved especially
effective.
- Westwood
Hills Nursing Home in Poplar Bluff reduces pressure ulcers by 66%
in just 90 days: Working with Primaris, the Missouri QIO, Westwood
staff first developed a regular skin assessment policy for all residents.
By assigning one person to regularly conduct assessments, Westwood
Hills eliminated inconsistent interpretations and freed up staff.
The facility also established treatment protocols that provided specific
guidance for floor nurses who locate skin impairments. In addition,
weekly wound care meetings were scheduled, and every employee was
kept “in the loop” on the initiative’s progress.
Demonstrations on how to use existing pressure ulcer prevention tools
(like heel protectors and positioning devices) improved the utilization
of these sometimes misunderstood gear.
- 66% Reduction
in pressure ulcers at Missouri nursing home
Westwood Hills Nursing Home
in Poplar Bluff, MO cut the number of pressure ulcers by 66% in just
three months after working with Primaris, the Missouri QIO. In March
of 2003, Westwood Hills detected pressure ulcers in 12 of its 132 residents,
and set a goal to cut that number in half. The staff purchased pressure-relieving
mattresses and cushions, conducted weekly skin reporting, implemented
report-tracking systems, and assigned a dedicated wound care nurse
to oversee the program. By the end of June, Westwood Hills reduced
its pressure ulcer rate by two-thirds to four residents. In addition,
attending to nutrition and hydration needs of all residents to prevent
pressure ulcers, helped staff reduce the number of residents with significant
weight loss.
|
|
