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Virginia
Success
Stories: VIRGINIA
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- The Virginia Health Quality Center (VHQC) is a leading member of Virginia ' s
patient safety coalition, Virginians Improving Patient Care and Safety (VIPCS),
founded in 2000. VIPCS members include the Virginia Hospital and Healthcare Association,
Virginia Association of Health Plans, Virginia Pharmacists Association, and the
Medical Society of Virginia. VIPCS has actively promoted systematic efforts to
continuously improve quality of care and safety through annual statewide educational
programs. Additional information: www.vipcs.org.
- The Virginia
Health Quality Center implemented “Sisters for Mammograms,” a
quality initiative focused on encouraging older African American women to receive
annual mammograms. The initiative seeks to reduce the disparity in mammography
utilization between African American and Caucasian women by raising the rates
for African American women in a targeted region. VHQC collaborated with a variety
of community coalitions and provided a range of educational materials to key
physician practices, collaborators, and beneficiaries. During the period 1997-1998,
there was a 10.8 percentage point disparity between Caucasians and African
American women. This difference was reduced to 7.0 percentage points
during 1999-2000.
- The Virginia
Health Quality Center, the Virginia QIO, is a leading member of
Virginia’s
patient safety coalition, Virginians Improving Patient Care and Safety
(VIPC&S), founded in 2000. VIPC&S has hosted five annual
statewide patient safety conferences with attendance growing to
over 500 at its May 2005 event.
- Friendship
Health and Rehab Center, the largest nursing home facility in the
Commonwealth of Virginia, participated in the QIO-sponsored Virginia
Nursing Home Improvement Collaborative for Pressure Ulcers (VNHIC) from
July 2004 to May 2005. Following participation in the collaborative,
the center was able to significantly decrease rates for all three
pressure ulcer quality measures by at least 20%.
- Working
with the Virginia QIO, Virginia Health Quality Center, Mary Washington
Hospital Home Health Agency in Fredericksburg, Virginia set out to
improve the percentage of patients who get better at taking oral
medications by mouth. The agency achieved statistically significant
improvement—25.3% to 48% as of May 2005–a figure that
is 10% above the state average and 9% above the national average.
- Working with
the Virginia QIO, Virginia Health Quality Association, Mary Washington
Hospital Home Health Agency, a non-profit, hospital based home health
agency in Fredericksburg, Virginia set out to improve the percentage
of patients who get better at taking oral medications by mouth. They
achieved statistically significant improvement -- 25.3% to 48% as of
May 2005 – 10% above the state average and 9% above the national
average.
- Working with
Virginia Health Quality Center, the Virginia QIO, during the first
half of 2004, Montgomery Regional Hospital in Blacksburg achieved 100%
in its medication administration measures, including ensuring patients
received beta blockers at arrival (increased from 83 percent in 2003),
aspirin prescribed at discharge and more than 92% of patients received
ACE inhibitors at discharge for heart failure (increased from 81% in
2002).
- Working with
Virginia Health Quality Center, the state’s QIO, during the first
half of 2004, Montgomery Regional Hospital in Blacksburg achieved 100%
in its medication administration measures, including beta blockers
at arrival (increased from 83% in 2003), aspirin prescribed at discharge
and > 92% in ACE inhibitors at discharge for heart failure (increased
from 81% in 2002). The hospital also achieved 100% in Left Ventricular
Function (LVF) assessments for heart failure and was in the national
top 10 percentile for pneumonia vaccinations.
- Lewis Gale
Medical Center, a large urban hospital in Salem, significantly improves
care for heart patients: Working with the Virginia
Health Quality Center (VHQC), the Virginia QIO, Lewis Gale Medical
Center implemented several effective system changes to improve heart
care for patients. VHQC assisted by providing evidence-based guidelines
and interim data reports that allowed Lewis Gale to assess progress
in improving heart care. As a result, t he hospital increased the early
administration of beta blockers by 37%, beta blockers at discharge
by 33%, and smoking cessation counseling by 59% over approximately
18 months. The hospital experienced a significant decrease in one-day
stays and average-length-of-stays for patients admitted with cardiac
diagnoses, providing the facility with financial rewards as well as
quality improvements.
- CJW Medical
Center, a large urban hospital in Richmond, increases flu screening
by 48% in 2000-2001 and pneumococcal screening by 43% in 18 months:
With help from VHQC, the Virginia QIO, CJW identified screening and
vaccinations as new hospital priorities. Leading up to the 2001 flu
season,CJW reached beyond the original scope of the pneumonia project
and began screening all patients—not just high-risk patients—to
find those who needed flu and pneumonia vaccines. CJW Infection Control
Practitioner Donna Alvis notes that the project has brought additional
benefits: patients admitted with pneumonia also now receive initial
antibiotics more quickly.
- Russell
County Medical Center, a small rural hospital in Lebanon, increases
pneumococcal immunization screening by 56% over 18 months: Russell
County Medical Center recognized the need to improve patient screening
for flu and pneumococcal immunizations. Data provided by Virginia
Health Quality Center (the Virginia QIO) served as an impetus for
the hospital to implement system changes to increase assessments
for immunizations. The hospital added flu and pneumococcal screens
to the nursing admission assessment, implemented physician order
sheets and developed a patient consent form used in both outpatient
and inpatient clinical settings. Using samples provided by VHQC,
the hospital also developed pre-printed clinical protocols to facilitate
screening for flu and pneumococcal immunizations.
- Shore Health
Care At Home, a home health agency in Onley, decreases its acute
care hospitalization rate by 19 percent: Shore Health Care At Home,
while participating in QIO-led outcome-based quality improvement
program in 2001-2002, made patient/family education a key factor
in decreasing its acute care hospitalization rate by 19 percent over
a one-year period, keeping more of its patients from being admitted
to the hospital. These gains followed quality improvement training
provided by the Virginia QIO, Virginia Health Quality Center, and
direct technical assistance in the development of an audit tool that
included key activities pertaining to patient/family education. During
a recent accreditation visit, the agency’s education program
also achieved scores of 100 percent in seven of the Joint Commission
on Accreditation of Healthcare Organizations (JCAHO) standards for
education.
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- Beth Sholom
Home of Virginia, a skilled non-profit nursing home in Richmond,
increases resident immunization rates for flu and pneumonia: Beth
Sholom Home of Virginia instituted an aggressive quality improvement
plan that dramatically increased its flu and pneumonia immunization
rates for residents. The facility’s flu vaccine assessment
rate increased 18 percent and the vaccine administration rate increased
16 percent over 12 months. The facility’s pneumonia vaccine
assessment rate increased 71 percent and the vaccine administration
rate increased 62 percent during the same time period. Working with
the Virginia QIO, Virginia Health Quality Center, Beth Sholom developed
a quality improvement plan that relied on three important factors
to increase immunizations: 1) monitoring immunization need; 2) educating
staff, residents and family members on the importance of immunizations;
and, 3) streamlining the administration of immunizations to residents
in the facility.
- Home Recovery
Home Health, a home health agency in Farmville, decreases the number
of patient surgical wounds by 48 percent: Home Recovery Home Health
worked with the Virginia QIO, VHQC, to implement a plan of action
to decrease the number of patient surgical wounds. The plan included
development of best practices directing wound assessments, documentation
expectations, and patient/caregiver education requirements. For example,
the plan called for nurses to provide patients and their caregivers
with detailed instructions on wound care, recognition of signs and
symptoms of possible complications, and infection control measures.
These efforts produced results. The agency experienced a 48 percent
relative improvement, from 50 percent to 73 percent, in decreasing
the number of their patients’ surgical wounds over a 12-month
period.
- Home Care
Connections, Inc., a home health agency near Richmond, helps improve
measures of patients’ mobility from 52.8% to 57.1% in 2002,
nearly 17% above the national average: Working with the Virginia
Health Quality Center, the Virginia QIO, the agency has improved
patients’ ability to move around their homes. Home Care Connections
formalized proper assessment of patients and educated agency staff,
patients, and their families on proper techniques for moving. “By
increasing mobility, we can take care of patients quickly, get them
to an optimum level of function and discharge them sooner,” said
Marie Foster, performance improvement coordinator for Home Care Connections.
- Virginia
nursing home decreases post-acute pain by more than 36%: The Health
Care Center at Lucy Corr Village in Chesterfield, VA implemented
an aggressive pain management program called “STOP the Pain” that
has decreased its post-acute pain measure by more than 36% since
it began working with the Virginia Health Quality Center, the state’s
QIO. The facility’s chronic care pain measure has also decreased
significantly by almost 23%, from 25.89% in November 2002 to 2.93%
in March of 2004. STOP notes were started which include Severity,
Type, Onset and Place and STOP Signs were posted throughout the facility
with numeric and facial pain scales, the drug regimen was reviewed
and educational activities on pain management were sponsored by the
facility pain team.
- Virginia
home eliminates acquired pressure ulcers in its pilot unit: Woodbine
Rehabilitation and Healthcare Center in Alexandria, VA has been “waging
a war on wounds.” Woodbine kicked off its battle plan in October
2003 with an innovative multidisciplinary wound round process that
involved weekly meetings to discuss wound progress, treatment changes,
nutritional interventions, care plans and resident education. Woodbine
also involved frontline staff in the decision making process, increasing
their willingness to adopt new procedures. For example, a “Turning
and Repositioning Compliance Report” was developed that showcased
those certified nursing assistants who properly turned and repositioned
residents, thus helping to decrease the occurrence and severity of
pressure ulcers. Woodbine reported that the number of acquired stage
II-IV pressure ulcers in its pilot unit had reached zero residents.
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