Page 24 - HOI Outcomes 2019
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Proactive performance improvement is vital for HOI to deliver on its promise to “Get You Back to You.” Specific, measurable, attainable, realistic and timely (SMART) opportunities for improvement were identified in 2018. To achieve these initiatives, HOI used a Plan-Do-Check-Act (PDCA) approach. Results continue to be studied in 2019 to implement and/or refine sustainable actions.
  Opportunities for Improvement
MRSA Screening Discharge – Ensure the process meets regulatory requirements for Senate Bill 1058 and HOI’s MRSA screening policy. SB 1058 states that MRSA screening must be completed within
24 hours of a hospital admission scheduled for inpatient surgery. Discharge MRSA screening must also be completed on this population, excluding known MRSA-colonized or -infected patients.
Glycemic Control for Spinal Fusion – Decrease surgical site infection risk on both diabetic and non-diabetic patients in accordance with CDC SSI Prevention guidelines.
Fall Prevention – HOI Nursing team members realized that the strategies for fall prevention were too generalized to meet HOI’s specific needs.
Hand-Off Communication – Is the transfer of patient information from one health care provider to another adequate and consistent?
All discharge MRSA screening specimens collected and processed in the lab are now monitored and validated. On a weekly basis, an audit is conducted comparing all patient discharges from the prior week to an MRSA discharge screening cultures report from Microbiology for the same time period to find any missing discharge screening cultures. Missing screens are forwarded to the floor manager/educator for follow-up.
Creating a protocol to implement perioperative glycemic management. Based on HOI SSI data, protocol will be applied to all inpatient fusion patients.
A Falls Prevention Team was created to specifically identify areas keeping HOI patients safe. The goal is to enact gradual improvements through PI initiatives to achieve zero falls.
Created a standardized hand-off tool specific to perioperative services for a consistent, verbalized hand-off each time a hand-off of care occurs. This involves registered nurses as well as surgical technicians.
 Infected Joint Protocol – Decrease care variability for infected joint patients.
 PACU Discharge Process – Discrepancies were identified in discharge instructions. Redesign warranted to improve patient satisfaction and engagement during the perioperative experience with a target goal of 95 percent satisfaction or better.
Actions Taken
Protocols standardizing intraoperative specimen collection and testing for suspected/known infected joints were developed in accordance with American Academy of Orthopaedic Surgeons guidelines.
Redesigned the current discharge instruction process and contents to include: identified discrepancies in the areas of post-op nausea and vomiting, bleeding, infection, pain management and constipation.
 Bedside Table – A random compliance audit by Nutrition Services revealed setting up bedside tables prior to meal service was inconsistent, creating an opportunity to enhance the patient experience.
Audits were conducted and reported to nursing leadership, leading to these process improvements: Ongoing staff education by a registered dietitian, Nursing manager and a meal delivery process video shown to Nursing staff; Food and Nutrition Service calling the floor and clerical coordinators consistently sending out a page to the floor staff; a competition with most compliant staff receiving a prize.

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