The Transformative Energy of Efficiency Enchancment at Penn Medication

PIIA presentation
Chris Black, MSN, RN, CEN (left) and Elissa Crum, MSN, RN, CEN (proper) presenting the staff’s work on the 2018 Emergency Nurses Affiliation Convention in Pittsburgh, PA.

How do you make well being care higher, extra reasonably priced, and safer for sufferers? In some instances, it begins with figuring out challenges as alternatives for enchancment. Clinicians at Pennsylvania Hospital (PAH) seen an elevated size of keep for sufferers receiving intravenous (IV) antibiotics within the emergency division (ED). This implies extra time spent within the ED and a possible delay for the affected person’s subsequent stage of care.

Using oral antibiotics over IV antibiotics might be extra helpful for sufferers visiting the ED. For one, IV antibiotics can take as much as two hours to infuse, and they’re roughly 10 to twenty instances costlier in comparison with oral antibiotics. It will also be a problem if a affected person must proceed an antibiotic therapy after they’re discharged. It is not all the time the case, however there are various situations the place offering oral antibioitics is one of the best pathway for our sufferers.

PAH determined to take this on as their challenge to review and enhance as a part of Penn Medication’s efficiency enchancment “studying lab” – Efficiency Enchancment in Motion (PIIA) program for chosen teams throughout the group in addition to Foundations of Efficiency Enchancment (FPI), an internet studying program.

“Efficiency or course of enchancment initiatives allow our sufferers to expertise the identical stage of care, expertise, and outcomes in each Penn Medication hospital and clinic, whereas additionally guaranteeing sufferers are continually receiving one of the best care doable,” stated Caryn Douma, MS, RN, IBCLC, CPPS, company director, Affected person Security at Penn Medication.

Manifesting the “Kind” in Efficiency

High quality and course of enchancment (PI) are integral for profitable affected person outcomes and woven into the well being care system’s tradition.  When teams have the chance to work on tasks such because the PAH ED staff, they have an inclination to convey a number of factors of view collectively so many voices might be heard to enhance care collectively. “We method our PI work with cultural humility as a result of selling an inclusive tradition advantages the therapy of our sufferers in addition to our college, workers, and college students. Valuing each other interprets to how we take care of sufferers,” stated Patricia Garcia Sullivan, PhD, chief high quality officer for Penn Medication.

To realize these outcomes, Penn Medication has PI processes in place to assist scientific and non-clinical groups, which permit them to not solely establish alternatives for enchancment however execute options to tackle these gaps. All of that is carried out with the objective of enhancing affected person outcomes, which might embrace enhancing the method between transitions in care from one setting to a different.

FPI and PIIA have been each developed as sources to embed and promote the science of efficiency enchancment at Penn Medication. FPI grounds workers within the fundamentals of efficiency enchancment. Penn Medication workers learn to virtually execute, implement, and maintain efficiency enchancment initiatives. As well as, PIIA is a dwell, teaching expertise that helps group collaboration and teamwork to resolve extra advanced efficiency enchancment initiatives.

“Each FPI and PIIA allow Penn Medication to proceed to offer excellence in affected person and scientific expertise and outcomes. Empowering workers with efficiency enchancment instruments are a key benefit in enabling us to ship versatile and adaptable options that present the most secure care with one of the best outcomes,” stated Cindy Morgan, vp, Studying and Group Improvement.

This brings us again to PAH and their efforts to enhance the method used for offering antibiotics to sufferers.

The Enhancements That Led to Enhanced Efficiency

Angel McCullough, MSN, RN, MBA, CCRN, NEA-BC; Phil Landis, DNP, RN, CEN, NPD-BC; Marc Crane, PharmD, BCPS; Lauren Ellis, MSN, RN, CEN, NE-BC; Ken Wing, MS, CMA, CSSBB (Left to proper). The Pennsylvania Hospital emergency division PIIA staff accepting their 2019 Sustainability Award acknowledged by the High quality and Affected person Security Awards.

The PAH staff centered on three of the most typical illnesses the place IV antibiotics have been being administered within the ED after which discharged the affected person dwelling on oral antibiotics: urinary tract infections, pyelonephritis (kidney an infection) and cellulitis (pores and skin an infection). Of most significance, they wished to grasp why suppliers have been ordering IV antibiotics over oral antibiotics for these sufferers. 

The staff leveraged PI instruments to uncover and perceive the first purpose behind using IV antibiotics within the ED. Utilizing what’s referred to as the Voice of the Buyer, a structured course of to glean buyer expectations and experiences, it helped yield deeper discussions into defining the chance for enchancment. Groups [CMA1] gathered knowledge and carried out analyses to establish that it got here all the way down to suppliers needing a fast and straightforward solution to order the precise antibiotics on the proper time.

“Having pharmacy, nursing, suppliers and our PI advisor all on the similar desk pondering collectively had an impression on our success,” stated Marc Crane, PharmD, BCPS, scientific pharmacy specialist at PAH. “We shared our ideas and views and obtained all the way down to ‘why we do the issues we do’ which helped us drive in direction of an actual resolution.” 

Crane, together with Phil Landis, DNP, RN CEN NPD-BC, a scientific nurse educator, supported their staff in making a prescribing algorithm for oral antibiotics and piloted the workflow. They monitored the change by means of weekly progress reviews, nursing huddles and departmental e-mails. “Anybody can see the progress report proper there, together with in security huddle with nurses. We rounded with suppliers and supplied to assist with tough conversations round using IV antibiotics.” 

On the finish of the pilot with the brand new prescribing algorithm, the staff lowered size of keep within the ED by 4.5 % and provide value by 30 %.

“The sustainability of this work is spectacular. With current spikes within the emergency division, I’m grateful we had this apply in place. Our means to scale back size of keep and drive environment friendly care transitions is vital to affected person high quality of care and security,” Landis stated.

Much more spectacular, the staff has sustained this course of for over three years and garnered a number of awards and accolades, together with Affected person Security & High quality Symposium Award Winner and sharing their successes on the Emergency Nurses Affiliation Annual Convention.

Actually, this expertise led to a rise of physicians and nurses at PAH taking part in PI tasks — clinicians and workers within the ED at PAH are engaged of their third PI challenge.  

Thus far, Penn Medication has hosted 222 tasks over 24 PIIA cohorts impacting greater than 2,300 workers.

Sullivan added, “We do what’s proper, not solely as a result of it’s required by a regulatory physique. It’s why our sufferers belief us.”

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