McLaren Lapeer hospital is a 222 bed hospital located in Lapeer, MI. Our hospital joined the collaborative in 2010. Our HMS team includes Dr. Salem, DO, VPMA, Chairman/Co-Physician Champion, Dr. Ledezma, Interventional Radiologist, Co-Champion, Colette Stearns, QM/CM Director, and Alicia Cummings, RN clinical data abstractor.Others involved in HMS- related work include: Dr. Blaker, Alternate ER Representative, Janet Nixon, CNO, Pam Wills-Mertz, RN, Director, Trauma/Critical Care, Betsy Felton, RN, Director, Patient Care Services, Linda Deitering, PharmD, Pharmacy, Jennifer Patrick, RN, T2, Nurse Manager, Jennifer Chavez, RN Educator, Jacqui Jedrzejczak, Cath Lab Supervisor , Scott Roseberry, Lab Manger, Florence Elston, RN, Infection Prevention/EH Manager, Traci Raymond, NP Infectious Disease, Dr. Abter, Infectious Disease, Dr. Down, ER Physician Representative, and Stephanie Wilson, RN Educator.PICC-Our vascular access team uses MAGIC as a decision making tool to determine line appropriateness prior to each PICC line insertion. In April 2016 we put a Midline policy in place which is based on the MAGIC tool and assists in evaluating appropriate indications for Midline vs PICC line insertion. This policy was created by the Cath lab manager, nurse educator, and the HMS physician champion. The vascular access team reviews each patient case for line appropriateness and eGFR prior to PICC insertion. A nephrology consult is required to approve PICC placement when the eGFR is <45. Since May 2016 we primarily use 4 fr single lumen PICC lines on a routine basis instead of the 5 fr double lumen as a way to decrease the complications of DVT/infection. We also replaced the 6 fr/triple lumen catheter with the 5 fr/double lumen for the critically ill patient/icu.
VTE-All ER Physicians use a full Caprini risk assessment tool to perform a VTE risk assessement and have an electronic physician order set to identify patient population risk for VTE low or high risk which contains recommendations for appropriate prophylaxis on admission. Nursing adopted the second check with VTE Risk assessment performed on admission to verify the physician admitting VTE score. Nursing is given autonomy to hold pharmacological and/or mechanical prophylaxis until contact is made with physician if any change in VTE Risk score is identified. As of June 2017 the RN abstractor receives a daily VTE report of new inpatient admits for a real time review for appropriate VTE prophylaxis and risk assessment on admission.
2015 VTE Highlight-Our HMS team Dr. Salem, Colette Stearns, and Elizabeth Gildner presented our VTE success in a McLaren Corporate Video shown to each Mclaren subsidiary. The project focused on reducing pharmacological prophylaxis in the low risk population. Before we had the highest percentage in the HMS collaborative and after we decreased the percentage to below the HMS collaborative mean. This data was also displayed in a VTE Poster in 2016 at one of the HMS Collaborative Wide Meetings.