1-30 CSE final 2

1TEXAS HEALTH PRESBYTERIAN DALLAS04/18/23 1TEXAS HEALTH PRESBYTERIAN DALLAS

SCIP Venous Thromboembolism Prophylaxis

Jennifer Caldwell, RNKathy Moon, BSN, RN

February 8, 2012

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AIM STATEMENT

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The project aims to increase Inpatient SCIP VTE prophylaxis compliance to top decile by December 31,

2012.


Team Members – Jen Caldwell, RN- CS&E Participant– Kathy Moon, BSN, RN- CS&E Participant – Dr. Hagood- Physician leader– Jen Rainer-Facility Facilitator – Eleanor Phelps- CS&E Facilitator – Team Members:

Dr. Appel- physician Keith Turner-IT physician liaison Jen Mosley-nursing Andrew Faust- pharmacy

Susan Cooper-nursing Phyllis McCortsin- APN nursing Michelle Phillips- nursing Annette Cox- nurse education

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Measure of Success

• Achieve and sustain top decile SCIP VTE prophylaxis compliance by December 31, 2012

• Top Decile 100% VTE-1 and 99.84% VTE-2• Currently VTE-1, VTE-2 compliance trending upward • Preliminary Q4, VTE-1 and VTE-2 99.5%

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PDSA

SA

DP

Improve SCIP VTE

Prophylaxis

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• Continue education and data collection • Monitor compliance of SCIP checklist usage with reports• Continue open communication with staff to further identify opportunities to hardwire the VTE prophylaxis process

• Review new care connect standard order setsafter 2013 changes

• Continue with concurrent review• Continue to monitor use of SCIP checklist• Monitoring VTE core measure scores• Feed back from physicians/nursing regarding process

• PI Team co-chaired by Jen Caldwell and Kathy Moon• Develop charter for project team• Nursing representation from nursing units, Care Connect team and Quality • Brainstorming• Ishikawa Diagram • Focus improvements on VTE prophylaxis administration compliance • Literature review to identify EBP opportunities

DO• Used Ishikawa to identify opportunities• Drill down—opportunities on M6E, M6W• Conduct concurrent review of SCIP charts• Implement daily alert sheet for nursing units • Created SCIP checklist TIP sheet• Implement utilization of sticky notes in Care Connect

• Attend nursing and MD department meetings• Implement CARE -Concurrent Accountability Review and Education meetings

• Review of charts for compliance of checklist • Review of order sets• Create pocket guides

PLAN the Change

DO the Change

(small scale)

STUDY the Change

ACT on the Change

(broad spread)

PLAN

ACT STUDY


PLAN

• PI Team co-chaired by Jen Caldwell and Kathy Moon• Develop charter for project team• Nursing representation from nursing units, Care Connect team and

Quality • Brainstorming• Ishikawa Diagram • Focus improvements on VTE prophylaxis administration compliance

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Unable to make VTE Core Measure Metric

Management

Culture of approaching MDs

Clinical leaders not comfortable performing audits

Man

Measurement Machine Material

Method

MDs not wanting to be told what to do

Lack of education

Lack of MD buy in

No policy requiring VTE assessment

Distribution of SCDS

Only able to do sample auditing

SCDs not available

No SCIP list available

Manually enter SCIP core measures Icon daily

Redundancy of BPA alerts

MDs do not know appropriate documentation

Lack of documentation

Knowledge of SCIP

BPA Alerts fatigue

No SCD order set or protocol

OR schedule not linked to order sets

RNs do not use SCIP checklist

Ease of use

Phases of release of orders (PACU)

BPA goes off with SCDs even if Pharm VTE needed

MDs don't know how to use VTE calculator

No problem list, order set, or hard stop

Caprini Ref Tool not used

Pharmacy does not review for appropriateness

Lack Education Support


DO• Used fishbone to identify problems barriers and develop actions• Drill down—opportunities on M6E, M6W• Conduct concurrent review of SCIP charts• Conduct literature review to identify evidence based practice for improvement

opportunities• Implement daily alert sheet for nursing units • Nurses reported inconsistent use of SCIP checklist - created SCIP checklist TIP sheet• Implement utilization of sticky notes in Care Connect• Attend nursing staff meetings• Attend MD department meetings• Implement CARE -Concurrent Accountability Review and Education meetings• Review of charts indicated less than 10% compliance of checklist • Review of order sets• Create pocket guides

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Missed Opportunities by Unit

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Missed Opportunities by Surgery Type

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Missed Opportunities by Surgeon

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SCIP Checklist Tip Sheet

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The SCIP checklist is filled out on all surgical patients. It should be started on admission by the nurse caring for the patient at that time. Ideally, anytime SCIP criteria are carried out, the nurse should go to the checklist and document. It will become easier to do as you are familiar with the criteria. Do not leave the checklist for the discharge nurse to complete. These step-by step instructions will hopefully make completing the checklist a little easier. Each nurse caring for patient should ensure checklist is completed on their shift. In addition, include the checklist during transfer of care.

The checklist box will open, click on the SCIP box (it is on the far right, you might need to scroll over)

To open SCIP checklist click on checklist (IF you do not have the checklist tab, please see superuser or EPIC educator).


Gantt

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STUDY

• Continue with concurrent review• Continue to monitor use of SCIP checklist• Monitoring VTE core measure scores• Feed back from physicians/nursing regarding process

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ACT

• Continue education and data collection • Monitor compliance of SCIP checklist usage with reports• Continue open communication with staff to further identify

opportunities to hardwire the VTE prophylaxis process• Review new care connect standard order sets after 2013 changes

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Checklist Compliance Results

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NEXT STEPS

Ongoing- • MD Education—handouts for MD’s, new physician

orientation • Nursing Education—SCIP purpose, checklist, VBP,

Nurse unit meetings, CARE Meetings, new nurse orientation

• Continue Concurrent Review• Daily Alerts/Sticky Notes• Monitor of Core Measure dashboard

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Project Challenges

• Changes to Care Connect slow- system wide• Physician culture• Resistance to hard stops in EMR• Outreach difficult r/t multiple surgical groups• Owner of SCIP checklist

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Lessons Learned

• Ensure right people at the table• System approach hard to get changes in timely

manner• Physicians more receptive one on one (more time

consuming)


Questions?

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1-30 CSE final 2

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