Contact the Wyoming QIO for more details Mountain-Pacific Quality Health Foundation See QIO success in other states Success Stories: WYOMING

Mountain-Pacific Quality Health Foundation developed a project to decrease the disparity for in blood collection prior to giving antibiotics to patients with pneumonia in nine critical access hospitals (CAHs) in Wyoming . The baseline rate for the nine CAHs was 75.9% compared to a baseline rate of 89.0% for rural, non-CAH and two urban hospitals. In addition to recruiting 100% of the CAHs for public reporting on this clinical measure, MPQHF developed and implemented interventions such as presentations/webex; on-site visits by MPQHF medical directors targeting local physicians; literature; sample orders and data. MPQHF also assisted the hospitals with data collecting and reporting. At re-measurement, the rural non-CAH and urban hospitals rate dropped to 85.7%; the targeted nine CAHs increased to 88.5%. The CAHs now outperform the rest of the hospitals in the state of Wyoming . With support and assistance from Mountain-Pacific Quality Health Foundation, the Wyoming QIO, clinicians at Castle Rock Medical Center in Green River implemented an electronic health records (EHR) system in 2003. Using the EHR has resulted in providers spending more time during exams with patients—due to reduction in time dictating medical histories and visit notes, as well as chart chasing—which in turn has led to improved clinician/patient relationships and improved health care outcomes. Campbell County Memorial Hospital in Gillete revamps care protocols to significantly reduce surgical site infections: While volunteering in a project initiated by Wyoming ’s QIO to reduce surgical site infections, Campbell County restructured procedures to ensure that its pilot patients received the appropriate prophylactic antibiotics 100 percent of the time, that antibiotics were discontinued within 24 hours 100 percent of the time, and surgical sites were clipped rather than shaved 100 percent of the time. To ensure patients were given the proper treatment, staff listed the appropriate antibiotics, along with the recommended dosages, in the standing orders. To ensure antibiotics were discontinued within 24 hours, they changed the orthopedic standing orders protocol. Campbell County plans to apply successful surgical infection prevention techniques to OB/GYN and general surgery patients. Wyoming home cuts pressure ulcer rate below state, national averages: Working during 2004 with Mountain-Pacific Quality Health Foundation, the state QIO, the staff at the Pioneer Manor Nursing Home in Gillette, WY, cut incidence of high-risk residents with pressure sores to 8% from 21%. The Skin Integrity Tissue Strategy (SITS) Committee, comprised of the director of nursing, nursing managers, dietary managers, a registered dietician, a wound specialist nurse, a physical therapist and pharmacist, meets on a monthly basis to review QI statistics, evaluate anyone identified as high risk, review lab results and the outcomes of the skin & nutritional assessments. Prevention begins before the patient develops a pressure ulcer. If positioning is a problem, physical therapy is instituted. High protein supplements and a multivitamin are also part of the regime. Pictures of wounds are taken upon admission or when identified and additional pictures are taken to document healing at intervals. Staff has standardized dressing supplies and protocols and will begin using an Easy Wound Graph to document wounds on a weekly basis.

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