The Indianapolis Coalition for Patient Safety

It Takes a City

The Indianapolis Coalition For Patient Safety

Opportunities for Research and Partnership

Glenn Bingle, MD, PhDChair, Indianapolis Coalition for Patient Safety

Chief Medical OfficerCommunity Health Network

Kathy Rapala, JD, RN, DNP (c)Executive Director, Indianapolis Coalition for

Patient SafetyVisiting Associate Professor

Purdue School of Nursing

Objectives

• Introduction to the Indianapolis Coalition for Patient Safety

• Overview of Coalition interests and projects

• Opportunities for research and partnership

www.indypatientsafety.orgwww.indypatientsafety.org

Indianapolis Coalition for Patient SafetyEst. 2003

VeteransAdmin

Community

Clarian

St. Vincent

St. Francis

Wishard

Collaboratefor Patient

Safety

Deans of MedicalRN, Pharm Schools

Department of Public Health

Health CareExcel

Health Care Advantage

Marion County Dept of Health

Indiana State Board of Health

Anthem WellPoint

IHIE

RegenstriefInstitutes

Eli Lilly

>>Make Indianapolis safest

For health care

SHAREDVision &

Challenge>> Shared Resources

>> Shared Performance Targets

>> Shared Accountability

>> Shared Funding

>> Shared Learning

Do not compete on safety!

WORKING TOGETHER

>> Outcomes: Accelerated

Improvement

COLLECTIVE ACHIEVEMEN

T

“The Indianapolis Coalition for Patient Safety is a prime example of how collaboration is accelerating change…among very competitive organizations (and) is a national model for community-based process improvement…” --Don Berwick, IHI President and CEO

USA Safety Collaborative View: Where do we fit?USA Safety Collaborative View: Where do we fit?

7

Improved Safety

INDIANA

MINNESSOTA

CALIFORNIA (4)ILLINOISPITTSBURGHWISCONSINTRI CITY (WASHINGTON STATE)

INSTITUTE FOR HEALTH CARE QUALITY IMPROVEMENT

JOINT COMMISSION ON HOSPITAL ACREDITATION

INSTITUTE FOR SAFE MEDICAL PRACTICE

NATIONAL PATIENT SAFETY FOUNDATION

INDIANAPOLIS et al

SAN DIEGO

REGIONAL=8NATIONAL=12

STATEWIDE=31 CITY WIDE=2

Google Search Maryland Coalition Survey

National

Patient Safety

Efforts

Institute for Healthcare

Improvement

Consumer

Groups

Institute for Safe

Medication Practices

Joint

Commission

AHRQ

CMS

National Quality Forum

Partnership for Patient

Safety

LeapfrogGroup

National Patient Safety

Foundation

Ambulatory Quality Alliance

National Committee for

Quality Assurance

National Collaborators on Safety

100K Campaign

Collaboratives

HCUP PSOs

Safety Goals

Data Collection

Hospital Core Safe

Practices

Serious Reportable Events

Nursing Sensitive

Thoracic Surgery

Cancer Care

Safe PracticesSafe practices

Rewards Program

SCIP

8th Scope of Work

ACE

HCAHPS

Sentinel Event Reporting

L Gelinas VHA 07 modified Bingle

2003 2004 2005 2006 2007

Std. UnsafeAbbreviation

Std. SurgicalSafety site; ID; Time out

SafetyRounds &Survey

Accelerate &ImplementAll 100K LivesStrategies

Std.& Improve ReliabilityDelivery to Admin ofAnticoagulants & Insulin

Std singlePlan for EmergencyPreparedness/Avian Flu Response

MRSA collaborativeWith Regenstrief, VA

What activities do city & state collaborations engage in?

• Professional, public, media education• Standardization and implementation of best practice

around safety issues of mutual concern• Coaching; supporting; encouraging best safety practice• Awarding by recognizing excellence• Sharing best practices• Research• Report safety performance • Guideline developing for best practice• Sharing unique resources like simulation labs

• Key milestones include:

– High Alert Drugs • anticoagulants• Insulin

– Surgical Areas

– Root Cause Analysis

– Patient Safety Rounds

– Standardized Abbreviations

– Institute for Healthcare Improvement 100,000 Lives Campaign

Indianapolis Coalition for Patient Safety

Indianapolis Coalition for Patient Safety History

• Officially formed in 2003• 6 Indianapolis healthcare systems—

Clarian, Community, St. Francis, St. Vincent, VA and Wishard--decided to collaborate and not compete on the basis of patient safety.

• Held an first executive session facilitated by the National Patient Safety Foundation in 2003.

Indianapolis Coalition for Patient Safety: Mission & Vision

• Improve the safety of patients receiving healthcare in Indianapolis

• Make Indianapolis (Indiana) the safest city (state) to receive healthcare in the United States.

Initiative Highlights

•Anticoagulation •Lilly/Wishard 6 Sigma Collaboration

•High Risk IV Standardization

 

Methodist may speed up safety updatesBar-code system is in place at Clarian NorthSeptember 20, 2006

Anticoagulation Initiative

 

2 babies at Methodist die of overdose4 others also get wrong dosage of anti-clotting drugSeptember 18, 2006

 

Hospital errors to go public in 2007Indiana identifies 27 mistakes that hospitals will have to reportSeptember 21, 2006

Indianapolis Coalition for Patient Safety

Recognition – Anticoagulant Workgroup

Dan Degnan, PharmD, MS, CPHQ

Jim Fuller, PharmD

Jen Reddan, PharmD

Leann McGinley-Wright, PharmD

Bill Malloy, PharmD

Chris Scott, PharmD

Divya Abraham, PharmD

Mechelle Peck, RN

Tamra Arnold, PharmD

Scott Freeland, PharmD

Jim Eskew, RPh, MBA

Steve Hultgren, RPh, MBA

Susan Brown, RPh, MBA

Anticoagulant Workgroup• Goal: Make the use of anticoagulant

medications in Indianapolis Health-Systems safer

• Partnership identified with the Institute for Safe Medication Practices (ISMP)– Initial model: Collaborative (FMEA, Guided

process)– Final model: Best practice (Self

assessment, commitment to data sharing and comparison)

Core Safe Practice Challenges• Functional drug interaction warnings for CPOE and pharmacy systems• Medication reconciliation for anticoagulants

across the continuum• Majority were “green” across the board

Target Safe Practice Challenges• Pharmacy dispensing for all anticoagulant

doses• Independent double checks• Clinical pharmacy monitoring services for

anticoagulants

Anticoagulant Workgroup – Self Assessment

Universal Metric Identification• Pre-requisite – Minimize chart review, automated

data, meaningful from a safety standpoint, comparable

• ISMP and IHI were starting points• Trial and ErrorHeparin and PTT measures• Protocol (yes or no)• PTT %s in four distinct ranges• Selection rationale

– Protocol effectiveness– Electronic data– Sub therapeutic measurement

Anticoagulant Workgroup – Universal Metric

Anticoagulant Workgroup – Library

Anticoagulant Workgroup – Computer Script

Anticoagulant Workgroup – Computer Script

Research wishes

• Study of the PTTs

• Process/computer studies

• Validation of best practices

• Process measure refinement

Lean Six Sigma

Wishard-Lilly Insulin Safety Project

Coalition for Patient Safety

Executive Leadership Update

Objectives

• Reaffirm the importance and impact of insulin safety in the hospital setting

• Learn how the Lean Six Sigma process and tools were applied to improve the dispensing and administration of insulin at Wishard Health Services

• Share project insights obtained by Wishard and Lilly around patient safety

• Discuss additional opportunities in the hospital setting

Team MembersWishard Health Services Team Lisa Harris, CEO/CMO, Executive SponsorDivya Abraham, Inpatient pharmacyKerri DeNucci, Clinical pharmacyAbby Mortier, Inpatient pharmacy Jim Fuller, Pharmacy DirectorSusan Gallagher, RN Burn UnitCrissy Lough, Quality/Safety Cheryl Young, CNS DMShirley Howell, NP HospitalistTracy Martin, ED DirectorLeeAnn Blue, VP, Nursing Lilly Team

Jim Collins, Exec Director, Devices, SponsorBill Malatestinic, Outcomes Research, SponsorMark Urban, Director B2B, Key StakeholderJana Klopp, PrivacyDoug Whiteman, Outcomes ResearchMatt Thomas, Packaging EngineerJay Yamamoto, Black Belt

• RFP• Pre-determined selection criteria• Targeted opportunity• Mutual Benefit

DMAIC Process and Six Sigma Tool Kit

DefineDefine

MeasureMeasure

AnalyzeAnalyze

ImproveImprove

ControlControl

Charter, Mission statement, SIPOC, Risk analysis, High level process map

Detailed process maps, “Be the vial” hospital tour, Ishikawa fishbone diagram

Baseline data collection

Solutionselection, FMEA

Adherence activities, RACI, Control plan

Unpackage insulinplace in bins

Insulin arrivesat dock

Inventory shipment

Place bins inrefrigerator

Gopher order for insulin comes in

RPh prints orderRPh takes orderand enters in

HMMYES: Label printsif vial charged for

Invento

ry

Tech

RP

hD

esk T

ech

Runner

Tech

Tech pulls labelGoes to refrigeratorto pull appropriate

insulin

Places label and insulin in baggie

Decentral:Set on counter or

on round

Central:Give to RPh tolabel and check

Decentral:Takes baggie to

floor

Decentral:Sets ?? if not

already checked

NO: Vial NOT chargedfor…???

Decentral:Sometimes getschecked here?

Central:Takes baggie to

floor

Central:Sets in “In”basket

*Can sit for minutesto hours here*

Flo

or

Nurs

e

Decentral:Removes from

Inbasket, places inlocked cabinet

Central:Removes from

Inbasket, places in locked cabinet

Insulin sits in refrig until

pulled

Label sits until pulled

Decentral:Tech checks vialsdaily in AM againstcensus for D/C pts

Decentral:Throws away any

open vials

Decentral:Credits any unused

Vials in HMM

Decentral:Removes labels,returns to Dunlap

refrigerator

Sate

llite

RP

h

Decentral:Sets in “In”basketif already checked

Decentral:Stored until

admin topatient

Central:Stored until

admin topatient

Process Maps

Before… After…Unpackage insulin

place in bins

Insulin arrivesat dock

Inventory shipment

Place bins inrefrigerator

Gopher order for insulin comes in

RPh prints orderRPh takes order

and enters in HMM

YES: Label printsif vial charged for

Inve

nto

ry

Te

ch

RP

hD

esk T

ech

Ru

nne

r T

ech

Tech pulls labelGoes to refrigeratorto pull appropriate

insulin

Places label and insulin in baggie

Decentral:Set on counter or

on round

Central:Give to RPh tolabel and check

Decentral:Takes baggie to

floor

Decentral:Sets ?? if not

already checked

NO: Vial NOT chargedfor…???

Decentral:Sometimes getschecked here?

Central:Takes baggie to

floor

Central:Sets in “In”basket

*Can sit for minutesto hours here*

Flo

or

Nu

rse

Decentral:Removes from

Inbasket, places inlocked cabinet

Central:Removes from

Inbasket, places in locked cabinet

Insulin sits in refrig until

pulled

Label sits until pulled

Decentral:Tech checks vials

daily in AM againstcensus for D/C pts

Decentral:Throws away any

open vials

Decentral:Credits any unused

Vials in HMM

Decentral:Removes labels,returns to Dunlap

refrigerator

Sa

tellite

RP

h

Decentral:Sets in “In”basketif already checked

Decentral:Stored until

admin topatient

Central:Stored until

admin topatient

Unpackage insulinplace in bins

Insulin arrivesat dock

Inventory shipment

Place bins inrefrigerator

Gopher order for insulin comes in

RPh prints orderRPh takes order

and enters in HMM

YES: Label printsif vial charged for

Inve

nto

ry

Te

ch

RP

hD

esk T

ech

Ru

nne

r T

ech

Tech pulls labelGoes to refrigeratorto pull appropriate

insulin

Places label and insulin in baggie

Decentral:Set on counter or

on round

Central:Give to RPh tolabel and check

Decentral:Takes baggie to

floor

Decentral:Sets ?? if not

already checked

NO: Vial NOT chargedfor…???

Decentral:Sometimes getschecked here?

Central:Takes baggie to

floor

Central:Sets in “In”basket

*Can sit for minutesto hours here*

Flo

or

Nu

rse

Decentral:Removes from

Inbasket, places inlocked cabinet

Central:Removes from

Inbasket, places in locked cabinet

Insulin sits in refrig until

pulled

Label sits until pulled

Decentral:Tech checks vials

daily in AM againstcensus for D/C pts

Decentral:Throws away any

open vials

Decentral:Credits any unused

Vials in HMM

Decentral:Removes labels,returns to Dunlap

refrigerator

Sa

tellite

RP

h

Decentral:Sets in “In”basketif already checked

Decentral:Stored until

admin topatient

Central:Stored until

admin topatient

Check all meds centrally Quick win, eliminates steps checking @ satellites, delays getting meds to floors

Research wishes

• Process and methodology of Six Sigma for safe insulin administration within facilities; eliminate steps/rework

• Gaps and opportunities analyzing process maps vs. reality• Standard Operating Procedures re: insulin administration• Standard training for physicians, nurses, techs and

pharmacists• Report Card on the progress• Work on other issues identified: meal

times/tests/procedures and relation to our patients on insulin therapy

SPREAD!!!!

Other initiatives

• OR time out/site verification standardization

• Standardization of high risk infusions (collaboration with Purdue PharmaTAP).

• Cardinal grant for IV smart pump comparative data base.

• Severe sepsis initiative

Opportunities for Partnership

• Research opportunities– 6 hospital systems– Suburban Health Organization– Gear toward relevant needs in hospital systems

• Process measurement/validation– Observational research– Process improvement

• Grants, articles, partnerships…many opportunites

How to work with ICPS

• Come to a meeting. We meet the last Tuesday every other month.

• Chat with either of us regarding specific opportunities

• Explore grant opportunties on the subjects we discussed

Thank you!