Care of patient who has

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CQI Patient Safety
Care of patient who has Upper GI Bleeding
By Narparphatt Akrakulrit RN. /02/2012
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?????????????
?????????????
Initial Assessment Taking patient
history
Anti-coagulant ????????????
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????????????? ?? 2010 ???? Occurrence 2 ???
1. ??????????????????????? ?? shock
???????????????????????????????????????????
Shock
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?????????????
2. ?????????????????????? Pt. on ASA
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????????????????????????????????
??????????????????????????????????? UGIB

• Initial Assessment
• Good team work
• Initial Resuscitation
• Critical care, monitoring, and identification
  source of bleeding
• Definite diagnosis and management

??????????????????????????????????????????????????
??
Reference ?????????????????????????????????????
??????
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???????????????????????
Finding Problem FMEA
Analysis
Intervention
Improvement
Monitoring
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UGIB Patient Care Process
UGIB
4. Asking food/ drug Allergy and Current
medication
3. Taking History and PE Lab, medication,
Differential DX
1. Initial Assessment

• 2.Hemodynamic
• Assessment

8. Care of Patient during EGD V/S,
Medication And IV.fluid
7. Taking EGD within 30 mins When Pt. arrived
Endoscopy Center
5. Give patient instruction for EGD
Informed consent
6. Preparing patient , staff and
Equipment
9.Care of patient post EGD Observe
Complications , Treatment
11. Patient Discharge
10.Patient Education
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FMEA Analysis
2
3
 
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FMEA Analysis
1
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Definition
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????????? RPN ???????? FMEA
Total RPN 280
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?????????????CQI ????????????????
???????????? ?????????????????
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????????

• ??????????????????????????????????????????????????
  ???????????????????????????????????????????? Care
  map of UGIH
• ???????????????????????????????????????????,??????
  ?????????????????????
• ??????????????????????????????????????????????????
  ??????????????????????????????
• ?????????????????????????????????? (Recurrent
  bleeding )????????????????????????????????????????
  ???????????

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(No Transcript)
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Plan
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Do
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Check
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Act
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???????????????

• Start Project May-Oct 2011
• 1. Implement care map of UGIB with RN and GI Man
• 2. Data collection Turn around time for GI
  endoscopy within 30 mins in UGIB
• 3. Analysis
• 4. Evaluation
• 5. Continuous Improvement

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Care map of UGIB
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Care map of UGIB
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Care map of UGIB
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Nursing process of UGIB
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Nursing process of UGIB
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Nursing process of UGIB
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Nursing process of UGIB
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Indicators
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??????????? Care Map Of UGIB
Target gt 90
100
100
100
100
100
100
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??????????????????????????????? UGIB
??????????????????????????????????????????????????
??????
0
0
0
0
0
0
Target 0
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???????????? UGIB ?????????????????? ??????????
Endoscopy Center ????? 30????
Target 100
100
100
100
100
100
100
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???????????? UGIB ?????????????????????????
???????????????????? 72
???????
Re-Bleeding 2 cases
Re-Bleeding 1 case
Re-Bleeding 2 cases
Re-Bleeding 1 case
Target 0
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???????????? UGIB ????????????????.???????????????
? ???????????????? ???????????????????????????????
??? ????????????????????????????
0
0
0
0
0
0
Target 0
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????????????? ??????????? Re-Bleeding ????????
???? ???... ?????????????????? CQI
???????????????????? Care map ???????????????????
?????? GI ????????? Endoscopy Center????
????????????????
???????
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Outcome
?????????? care map ??????????????? ??????????
GI ????????? Endoscopy Center
Problem
Re-Bleeding
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PDCA ?????? CQI

• Plan ?????????????????????????????????????
  ???????????????????
• Do ?????????????????????????????????????
  ??????????????????????????????????????
• ?????????????? Gastroscopy
  ?????????????????????????????????????????????????
• ????? ???????????? conference
  case ??????????????
• Check ????????????????????????????????????????
  ???????????????????????????
• ????????????????????????
  ????????????????????????????????
• Act ?????????????????????????????????????
  ???????????????????????????????????????????????

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No. Process Timeline Planner Time frame
1 ??????????????????????????? UGIB (Care Map) ??? Nursing care of UGIB ?????????????? NSO Meeting ???????????????????? BMC - Dec11 May 12
2 ????? CPG UGIB ?????????????? ?????? MEC ?????????????????? E-doc - Nov11 May12
3 ????????????????????????? ??? GI Man ???????????????????????? med clearance form ?? case ??????? criteria - Nov11 May12
4 ???????? conference case ?????????????????? ???? RN level 4 ???? Nurse Coordinator ????????? ??????????????????????????????????????????????? ????????????????????????????????????????????????????? ???? ????? ??????? ?????? ER/ OPD /IPD / CCD - Nov11 May12
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????????????????????????????
No. Process Timeline Planner Time frame
5 ??????????????? Patient Self Assessment ??? Nurse Co-ordinator - Nov11 May12
6 Nurse Co-ordinator ????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? - Nov11 May12
7 ??????????????? Medication reconciliation form ???????? Anti coagulation drug alert box ??? Notify ????? ??????????????????????????????????? - Nov11 May12
8 ????????????????????? Current medicine ?????? trakcare ?? Nurse portal - Jan11 May11
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??? Conference case ??????????????????
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????? flow chart ???????????????????

• ???????????????????????????????????? Medication
  reconciliation form ???????? Anti coagulation
  drug alert box
• ??????????????????????????????????????????????????
  ??????? 7 ??? ????????????????????????????????????
  ?????

?????????????????????
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??????????????? Patient Self Assessment
??????????????
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??????????????? Patient Self Assessment
??????????????
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??????????????? Patient Self Assessment
??????????????
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??????????????? Patient self assessment
??????????????
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??????????????? Patient self assessment
??????????????
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??????????????? Patient self assessment
??????????????
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UGIB Patient Care Process
UGIB
4. Asking food/ drug Allergy and Current
medication
3. Taking History and PE Lab, medication,
Differential DX
1. Initial Assessment

• 2.Hemodynamic
• Assessment

8. Care of Patient during EGD V/S, Medication
And IV.fluid
7. Taking EGD within 30 mins When Pt.
arrived Endo
5. Give patient instruction for EGD Inform
consent
6. Preparing patient ,staff and
Equipment
11. Patient Discharge
9.Care of patient post EGD Observe
complications ,Treatment
10.Patient Education
14.After D/C telephone visit by GI Coordinator
before F/U at OPD
12. Patient self assessment
13. Start Nov 11 Case conference in Re-bleeding
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FMEA score decrease
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????????? RPN ?????? CQI
Total RPN 280
Total RPN 140
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Thank You