PI - Chap 5 7 8 MXW

What is the Performance Improvement and Patient Safety Council?
Performance Improvement and Patient Safety Council - An example of a standing committee in most healthcare organizations that is responsible for coordinating and reporting PI and safety activities. This council receives committee reports of PI activities and in turn, reports significant findings to the leaders of the organization - typically the executive committee and board of directors.
What minutes serve?
Minutes is the documentation of these activities is often recorded in the form of minutes. Recommendations section of the minutes should capture the team's plan for putting its decision into effect, with justification points if necessary
What purpose minutes serve?
Minutes serve as an important part of the PI committee or tea. They keep track of its progress and activities and this is done by recording the minutes. Minutes allow for follow-up section documents whether the actions were accomplished and whether the group is ready to make decisions and recommendations for future activities.
How do minutes work?
The minutes are recorded by the recorder or secretary. This individual should be assigned to an individual trained in the process of recording minutes. Many different formats can be used to record minutes of meetings.
Minute documentation method?
Many different formats can be used to record minutes of meetings. One that is particularly helpful for PI documentation is the CRAF method and stands for: ; Conclusion of group discussion ; Recommendation made by the committee or team ; Actions that the committee, team or individual members decided to take ; Follow-up activity
What is the frequence of reports?
Frequency of reporting is usually based on the committee or team meeting schedule. ; At a minimum, quarterly reports should be submitted to the council
What are reports used for
We need to have reports and they are used to document meeting activities, the committee or team must provide regular reports to the organizations Performance Improvement and Patient safety Council.
What is storytelling?
The act of relaying the performance improvement (PI) process in a structured manner to support learning and organization-wide PI.
Who benefits from PI storytelling?
Very few people do not benefit from learning in a clear, concise manner how a PI effort proceeded; Team accomplishments are documented over an extended period of time in an organized and succinct way; Presentations are focused, and the presenter gains practice in sharing the pride that comes from working on PI projects; Team members crystallize their thinking about the process of improvement; Team members receive the public recognition they are due and learn how they might contribute more in the future; Storytelling provides an outstanding forum for introducing new employees to PI and what it is about; Guests, suppliers and other can learn about PI without placing a significant additional burden on the PI team
Elements of successful storytelling?
"Organization, Structure, Timeliness, Frequencey, Connection, Celebration, Feedback"
General rules that make an effective story board?
Map the board in advance with labels for each section; Prepare clean boards for group presentation and display; Keep detailed information in a team record binder for reference; Plan the presentation to fit the size of the story board and the general size of the panels; Use large fonts so that people can read the boards from a distance; Be creative with the use of color and other visual enhancements.
What is a storyboard?
Storyboard - A graphical display tool used to communicate the details of performance improvement activities
What is continum of care
Continuum of care - The totality of healthcare services provided in all settings, from the least expensive to the most extensive; the emphasis is on treating individual patients at the level of care required by their course of treatment
Why is Continuum of care hard to understand?
Generally understand the background. Very hard to obtain insurance, costly, Patient pulling you one way and insurance pulling you another way
What is Best Practices?
Best-practice standards - A method or technique that has consistently shown results superior to those achieved with other means, and that is used as a benchmark. A technique, method, process, activity, incentive or reward that is believed to be more effective at delivering a particular outcome than any other technique, method, process, etc.
What is Case manager?
Case Manager - Insurance companies and healthcare organizations developed a role for case managers who worked with physicians and hospital employees to ensure that the care ordered was appropriate to the diagnosis and that it was payable covered item under the patient's insurance policy. Thus, the continuum of care model was developed to meet the needs of patients, providers, and payers. Case managers review the condition of patients t o identify each patient's care needs and to integrate patient data with the patient's course of treatment.
What are the steps in case mmanagement?
Step 1: Perform Preadmission Care Planning; Step 2: Perform care Planning at the time of Admission; Step 3: Review the Progress of care; Step 4: Conduct Discharge Planning; Step 5: Conclude Post discharge planning:
What is Case management?
Case management - The principal process by which healthcare organizations optimize the continuum of care for their patients
What is preauthorization
Preauthorization - Manager may contact the patient's payer to confirm that all necessary preadmission authorizations have been obtained, that admission criteria have been met, and that the payer will pay for the patient's service. As part of preauthorization, the payer's representative will have compare the planned services with the payer's criteria of care for the patient's diagnosis.
How does case management work?
Case management works - The principal process by which organizations optimize the continuum of care for their patients
Why is casemanagement needed?
Why Needed - Case manager in many organizations matches the patient's course with a predetermined optimal course (also known as integrated care map, critical pathway, or practice guideline). The pathway is a multidisciplinary outline of anticipated care within an appropriate time frame to aid a patient in moving progressively through a clinical experience that ends in a positive outcome.
How does case management assists patient?
Used by many payers to clearly define when a patient may have a procedure or to stipulate a particular course of treatment that the payer believes will be effective but less costly. Contacts the patient's payer to confirm that all necessary preadmission authorizations have been obtained, that admission criteria has been met, and that the payer will pay for the patient's services. Review all of the information gathered by the clinicians assigned to the case to confirm that the patient meets the admission criteria for an admitting diagnosis. Will confirm that the patient needs services and will arrange for the patient to be transferred to another facility if they cannot get the care needed at the hospital. Review patient's progress through the entire episode of care. Will help the patient plan for discharge. Follow up with patients after discharge to ensure that the transition has gone smoothly and that the patient is receiving all services required.
What is a indicator?
Indicator - Also called a criterion, is a performance measure that enables healthcare organizations to monitor a process to determine whether it is meeting requirements. The criteria may be established and implemented internally, externally, or generically.
What is a Gantt chart ?
A data display tool used to schedule a process and track its progress over time. Gantt charts divide a horizontal scale into days, week, or months and a vertical scale into project activities or tasks. Gantt charts are used in clinical process improvement to depict clinical guidelines or critical pathways in the treatment of common medical conditions.
What are the four core process?
Core process 1- Assessing the Patient's Needs; Core process 2 - Planning Care, Treatment and services; Core process 3: Providing care, treatment and services; and Core Process 4: Coordinating the care, treatment and Services
What is Core process 1- Assessing the Patient's Needs?
Cornerstone of good patient care is the initial assessment, which determines the patient's appropriateness for admission to the facility and the level of care to be rendered.Specific admission criteria based on defined services help caregivers determine which patients will benefit most from services the facility offers during the assessment and reassessment period
What are the needs that need to be looked at in Assessing the Patient's Needs?
Needs to look at there: Physical, psychological, and social assessment; Nutrition and hydration status; III. Functional status, that is, how well and individual performs activities of daily living; ocial, spiritual, and cultural variables that influence the patient's and family members perceptions of their lives;
What is Core process 2 - Planning Care, Treatment and services?
Collaborative written plan of care for patients is begun at the time of admission by the interdisciplinary admitting team, the patient, and perhaps the family and is revised as the patient's condition changes.
Care pathway - Why are they important and how do they work?
Care pathway has become the model for the documented outline of patient's progression of treatment. Goal of care pathway are broad in scope and set the overall direction for care. Multidisciplinary team using data developed through tam assessment processes initiates the care pathway Goals of the care pathway are broad in scope and set the overall direction for care. Care pathways need to reflect the cultural values that affect a client and family in the care setting as well. Patients and families should be involved in this process and should be actively encouraged to take part in the ongoing cycle of planning care.
What is Coordinating the care, treatment and Services
Includes resolving conflicts in scheduled appointments, preventing duplication of services, and ensuring care is administered within a time frame that meets the patient's needs. Information regarding diagnoses and procedures performed must also be transmitted to primary care physicians ore other follow-up providers
What are some of the steps in Optmizing Patient Care?
1. Conduct Patient care Outcome Review ; 2. Conduct Evaluation of the Organization's Use of Seclusion, Restraints, and Protective Devices; 3. Conduct Evaluation of Laboratory Services and the Use of Blood Products; 4. Conduct Evaluations of the Organization's Medication Systems and Processes; 5. Conduct Policy, Procedure and Documentation review; and 6: Evaluate the Organization's Standards of Care and Care Pathways
What do you do when you conduct Patient care Outcome Review ?
Patient care outcomes are reviewed to improve the safety and quality as well as to identify issues related to medical necessity for treatment and appropriateness of care.; Issues trends that are associated with poor outcomes;
What is an example of a Patient care Outcome Review?
Examples - Know one like ORYX imitative (Joint Commission); Heart Failure Core Measure Set; Pregnancy Core Measure Set
Why do you need to conduct Evaluation of the Organization's Use of Seclusion, Restraints, and Protective Devices
Must balance the patients' rights with what we think is safe. Written policies and procedures guide the use of restraint and seclusion for behavioral purposes Restraint and seclusion standards are highly defined by the Joint Commission, CMS and state licensing agencies Most of the monitors are directed toward patient safety, timeliness, care, dignity and least-restrictive use.
What do you do to conduct Evaluation of Laboratory Services and the Use of Blood Products
Parameters and calibrations are checked daily
What does CLIA stand for?
Clinical Laboratory Improvement Amendments
What does CLIA do?
The 1988 reenactment of the 1967 Clinical Laboratory Improvement Act, the federal regulations outlining the quality assurance activities required of laboratories that provide clinical service. It overseeing body of all the labs
What do you do in conducting Evaluations of the Organization's Medication Systems and Processes
Making sure are medication systems are safe and secure.
What do you do in conducting Policy, Procedure and Documentation review?
Make sure that policy, procedures are up-to-date ; Making sure document PI activities. ; Leadership and governing board is aware of our needs and outcomes
What do you do when you Evaluate the Organization's Standards of Care and Care Pathways?
First establish standards of care and care polices. ; Use the models to the best of our abilities. ; Variations from the standards of care; sentinel events; and high-risk, problem-prone activities must be examined
What is a NPSG?
They are areas that Joint Commission has defined as prevalent. Example: Identify patient correctly; Improve staff communication; Use medicines safely; prevent infection; Check patient medicines
What is Pay for Performance (P4P)?
Emerging movement in healthcare reimbursement. Providers under this arrangement are rewarded for meeting pre established targets for delivery of healthcare services that improve quality and efficiency.
What is HEDIS?
Health Plan Employer Data and Information Set
What does HEDIS gather?
HEDIS gathers a significant amount of information about the ambulatory care experiences of millions of health plan members from across the country.
What are some of the things that HEDIS measure?
Measure of quality, such as immunization, cholesterol screening, mammography and prenatal care ; Measures of access, with at least one visit to a provider within three years used as indicator ; Measure of membership, with a particular attention to coverage cancellation as an indicator of dissatisfaction. ; Measures of utilization ; Measures of financial performance, such as cost per member, cost per member plus dependents, and indicators of financial stability
What does MDS stand for?
Minimum Data Set (MDS) for Long-Term Care
What does MDS gather?
Federally mandated On the basis of the data gathered via MDS, the facility is provided a facility quality-indicator profile that shows what proportion of the facility's residents have deficits in each area of assessment during the reporting period and which residents have which deficits.