McLaren Flint is a 377 licensed bed hospital in Flint Michigan. Our hospital joined the HMS collaborative in 2011. Our HMS Taskforce includes Dr. Prajesh Patel as our physician champion, Linda Weirauch, RN serves as our quality administrative lead and Jackie Washburn is the clinical data abstractor. Dr. Jason White, VPMA is also involved with the HMS-related projects. We have implemented a number of initiatives to HMS to improve the quality of our hospitalized medical patients and reduce the risk of a hospital acquired venous thromboembolism. McLaren Flint began abstraction of PICC lines in April 2015 with goals to assure appropriate use of PICC lines and best practices to avoid complications related to PICC insertion.
Summary of initiatives or improvements for VTE:
- VTE Taskforce meets bi-monthly to review HMS reports, VTE core measure results and HAC VTE events.
- Risk assessment compliance by nursing is summarized by nursing unit the results are shared with our nursing quality council.
- Individual physician VTE prophylaxis (chemical and mechanical) compliance reports are generated on regular basis. The reports display graphically each physician’s compliance rate along with the rates of their peers for comparison. Letters are forwarded to all providers in the study.
- Beginning 2015, McLaren Flint has been focusing on process to avoid pharmacological prophylaxis in our low risk patient population. In the initiative phase we have:
- Updated our EMR (Paragon) to create low, moderate and high risk categories based on Caprini5 scoring that is calculated at time of admission by nursing.
- An “alert” CPOE order is electronically generated to the physician at each assessment or reassessment of risk score by nursing displaying if patient is low, moderate or high risk for DVT.
- Nursing has been educated to communicate with the physician if patient is high risk, the patient has no contraindication to pharmacological prophylaxis and patient is not receiving any type of anticoagulant.
- Hospital acquired conditions of VTE are reviewed and determined to be either “not-preventable” or “possibly preventable” which warrants further review at the peer review level. The results are also incorporated into the physician’s OPPE file for the reappointment process.
- PICC abstraction results will be reviewed at VTE Taskforce when the 1st reports are generated at the July 2015 HMS Quarterly meeting. The results of the report will determine what QI initiatives are appropriate for consideration in the future.