Local Improvement Clinic A2

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Local Improvement Clinic A2

• Dr Don Berwick
• President CEO, IHI
• Dr Ross Wilson
• Chair, Strategic Advisory Board International
  Forum
• Ms Nellie Yeo
• CQO, National Healthcare Group, Singapore

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• Project to reduce complications after cardiac
  catheterisation

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Improvement at National Healthcare Group
SingaporeInternational Forum on Quality
Safety in Healthcare Barcelona 18 April
2007Nellie YeoChief Quality OfficerNational
Healthcare GroupSINGAPORE
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What is CPIP ?
PDSA Toolkit Methodology - relevant, easy to
understand, easy to implement and measure
changes for improvement are introduced
systematically.
Patient Focus - tailored to the health care
setting
Since March 2002, CPIP seeks to engage
Clinicians, spurring them to become Change
Leaders, working alongside team members with
fundamental knowledge of the care processes to
surface improvements.
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What is CPIP ?
Science of Improvement - rationale and
scientific basis of quality improvement,
management of variation, and the relationship
between processes of care.
3 Outcomes - impact on clinical, cost and
patient satisfaction.
Sustain Spread - many CPI projects, once tested
and proven effective through small and rapid
improvement cycles (PDSA), moved on to spread
beyond their original sites to other wards and
hospitals
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Numbers Trained
As of Oct 06, 13 cycles of CPIP have been
conducted over 5 years, training a total of 443
NHG staff especially the target group of senior
clinicians
231 Doctors ( include 46 CMBs, Division or
Department Chiefs or Heads) 106 Nurses, 56 Allied
Health and 50 Administrative Staff
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Types of CPIP Projects
311 projects initiated top 6 disciplines
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Impact beyond NHG

• Caught the attention of MOH
• Dr Ross Wilson was appointed as Advisor to MOH
  for National Adverse Event Study (2003-2004)
• MOH Clinical Audit Division started the 1st
  Clinical Quality Improvement Month in 2005 riding
  on NHG Annual Quality Week event
• A new "Healthcare Quality Improvement Fund" was
  started in FY05
• SingHealth sent participants to join our 4th CPIP
  in Jan 2004
• With 99 of their pioneering staff trained, SHS
  moved on to organize their own CPIP workshops
  independently in April 05 with NHG faculty
  assistance for projects review.

NHG has helped train over 611 healthcare staff
in Singapore, including clinicians and teams from
private hospitals
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Significant Projects
10 projects were identified that emphasized on
both Effective treatment and Patient Safety.

• The top 3 domains addressed were
• Efficiency
• Effectiveness
• Safety of Care

Quality Function Deployment Diagram of
Domains Addressed by Projects
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Strategies for Spread
3 CPI projects identified for cluster adoption
(AH, NUH, TTSH) a) Reduce incidence of IV
Peripheral Phlebitis b) Reduce admissions
following Day Surgery discharge c) Warfarin
Management Outcomes were measured as part of
hospitals KPI IV Peripheral Phlebitis
Quarterly tracking results shows all 3
institutions have met their own targets for
improvement, based on their baseline
rates. Reduce admissions following day surgery
discharge AH has done exceptionally well to
achieve her target of less than 0.04, NUH and
TTSH are tracking their improvement
progress Admission rate of patients with INR gt
5 All institutions are showing significant
improvements in achieving their own targets.
FY05
FY06
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To me CPIP has taught me that there is nothing
that cannot be improved further, if sincere
effort is put into it. It has also taught me the
values of good team effort.     Dr Chinnadurai
Amutha , Registrar Neonatology, NUH
Dr Ross is an excellent teacher! Broad-based
with in-depth knowledge. He presented in a clear,
modulated and thoughtful manner, a privilege to
learn from him.  Dr Wong Hon Tym, Acting Head
and Senior Consultant Department of
Ophthalmology, TTSH
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Other Activities To Date
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Safety Culture

• Ongoing Safety Climate Surveys on 2-yearly basis

• Appointed NHG and institutions Patient Safety
  Officer (PSO)
• Ongoing training for PSOs
• Institutions appointed Safety Champions in many
  departments

• Ongoing Patient Safety Workshops conducted by
  PSOs on quarterly basis

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Safety Culture

• Ongoing Patient Safety Leadership WalkAbouts and
  Safety Briefings

• Open and Fair Reporting Policy Increased number
  of reported HORs

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Medication Safety CollaborativeAftermath

• Sustaining and spread of Medication
  Reconciliation, Dedicated ICU Pharmacist,
  Inpatient Warfarin Management Service
• Development of the automated ADE surveillance
  system
• Development of the electronic pharmacist
  intervention database
• Study on local ADE costing
• Headcount justification

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Quality Patient Safety Initiatives
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Thank You
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Mission Statement

• At Level 11 of Tan Tock Seng Hospital, the
  peripheral iv cannula phlebitis rate will be
  reduced by 50 in 3 months

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Team Members Roles

• 1. SNC Margaret Soon
• 2. NO Wong Siao Pin
• 3. SN Goh Mei Chern Staff from unit
• 4. AN Widarni
• 5. NE Prema Balan Teaching of staff
• 6. NE Pua Lay Hoon
• 7. Dr Benjamin Tan Dr covering L11

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Evidence for there being a problem worth solving

• Point Prevalence Phlebitis rate done on May 31
  2002 is 26.3.
• International average 15
• Institutional average 11.8
• National average 8.3
• Repeated point prevalence rate in the unit on 28
  Nov 2002 is 25

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Pareto Chart
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Intervention(s) - plan, protocol etc

• Compile, communicate educate
• a. antibiotics information chart Speed of
  administration proper dilution
• b. Drugs not for IV administration
• c. Flushing of line according to recommendations
• d. Proper restraint of restless patients
• 2. Audit compliance to recommendations
  phlebitis rate

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Point Prevalence Phlebitis Rate
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Strategies for Sustaining(holding the gains)

• Involve all grades of HCWs within the
  department
• Ownership of the problem/issue
• Random point prevalence audit for comparison

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Strategies for Spreading

• Repeat hospital wide point prevalence study
  (20 Jan 04)
• Target at the next area with problems in
  peripheral phlebitis

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Thank You
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