We have implemented the following quality improvement initiatives related to HMS to improve the quality of care for hospitalized medical patients:
1. MHSM organized a VTE committee that meets monthly to review cases identified in weekly cycle defect reports as potential fallouts – discrepancies in VTE risk scores, low risk patients receiving pharmacologic prophylaxis, and overt bleeds.
2. VTE Discern Advisor went live in December 2013. The VTE Advisor guides clinicians to select an appropriate VTE Prophylaxis regimen. The VTE Advisor is available in all Admission PowerPlans and Orders Sets.
3. Implementation of the Concurrent Reviewer Role, October 2013. MHSM has a total of 4 full-time registered nurses charged with identifying real time events in order to increase patient safety and improve patient outcomes.
4. The VTE Advisor daily report began in December 2013. Daily review provides real time monitoring of incomplete VTE risk assessments, appropriate pharmacologic prophylaxis (pharm ppx), and identification of physician/mid-level providers who may benefit from at-the-elbow education.
5. Development of an early vascular access assessment screening tool in addition to the data we collecting for the HMS PICC appropriateness initiative. The early vascular access assessment process is based on the national Infusion Nursing Standards of Practice which identify that a comprehensive plan of care should be developed for patients who require infusion therapy. The elements of assessment include determining the length of time the patient will require the prescribed infusion therapy (based on disease state and co-morbidities that typically require central access), the pH and Osmolality of the prescribed medication (guide decision making about type of vascular access device for the prescribed infusion therapy), the patient's vascular access history, and the condition of the patient's vasculature (based on number of IV attempts and number of peripheral IV devices this hospital admission).
6. The early vascular access assessment screening tool is available as a computerized report and our next steps will be to put a process in place to facilitate early detection and care planning processes to facilitate patient safety, satisfaction, and quality outcomes.