inahq annual conference may 2011. identify techniques for developing tracer identify how to use...
TRANSCRIPT
![Page 1: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/1.jpg)
InAHQ Annual Conference May 2011
![Page 2: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/2.jpg)
Identify techniques for developing tracer Identify how to use tracers to improve
organizational readiness Demonstrate how to conduct a tracer
![Page 3: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/3.jpg)
◦To provide an accurate assessment of the systems and processes for the delivery of care, treatment, and services
◦Identify gaps or risk points that could affect quality or safety of care
◦Link to TJC elements of performance◦Learn from individuals directly involved in
providing/receiving services about how the process work
![Page 4: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/4.jpg)
• Retrospective-learn more about why a process didn’t work or was successful
• Prospective-evaluate process identified as problematic, determine current practice around new regulatory standards, evaluate high risk populations or processes with poor outcomes
![Page 5: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/5.jpg)
• What would you like to know more about in your organization
• What do you worry about• What keeps you awake at night
![Page 6: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/6.jpg)
Systems Tracers – process focused◦ Infection Control ◦ Medication Management◦ Use of Data
Patient Tracers - patient-focused (PPR and Priority Focus Areas)
Program Specific Tracer – Hospital• Hospital – lab integration is topic – consistent
application of critical value, specimen collection and handling, etc.
• Hospitals with psych – Suicide prevention to include effectiveness of HCO suicide prevention strategy.
• Patient flow tracer
![Page 7: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/7.jpg)
• Relates to specific types of services offered or programs being accredited• Ambulatory• Behavior Health• Lab integration• Home Health
![Page 8: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/8.jpg)
Tracers provide◦Unique opportunity to see the care and
services on a daily basis◦Better understand relevancy of process◦Detect problems that could increase
risk/compromise patient safety◦Cost effective approach to improve safety and
quality
![Page 9: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/9.jpg)
◦Team approach-who should be on team◦Team leader-suggest co-leaders◦Provide Guidance and training for tracer team◦Channel information to leadership
![Page 10: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/10.jpg)
Who should be on the team?◦Performance Improvement◦Nursing leaders◦Pharmacy◦Infection control◦Facilities
![Page 11: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/11.jpg)
◦Determine Goals PI data Sentinel event Sentinel event alerts Confirm practices of key policies Confirm practices of NPSG and UP What unique situations exist in your
organization Clinical Service Groups and Priority Focus
areas
![Page 12: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/12.jpg)
◦Select tracer patient Use active patient list LOS 4-7 days nearing discharge Considerations
Complex situations ICU ED Anesthesia services Surgery
![Page 13: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/13.jpg)
Use Multiple approaches and sources
Interview Read Observe
![Page 14: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/14.jpg)
Interview◦Choose opening, welcoming tone◦Listen attentively◦Restate or clarify responses◦Ask open ended questions
Interview questions◦Use PPR chapter elements of performance as a
guide◦Use national survey questions◦Ask multiple staff the same question◦Have staff answer questions not managers
![Page 15: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/15.jpg)
NPSG
◦Tell me your two patient identifiers
Observe the process of using patient identifiers
Medication administration
Specimens Testing
![Page 16: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/16.jpg)
Pain assessment and reassessment
Is there evidence in the medical record the patient has been reassessed for pain per policy
What is the process for pain assessment and reassessment
How often is pain assessed or reassessed
![Page 17: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/17.jpg)
Data collection◦Develop tools Standardize check list Department relevant standards Measure of success measures
Tools need to help organize findings◦Aggregate data
![Page 18: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/18.jpg)
![Page 19: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/19.jpg)
• Share data with leadership• Develop action plans• Set a timeline and reporting dates
![Page 20: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/20.jpg)
Compliance Issue
Standard Action Date Completed
![Page 21: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/21.jpg)
Tracer Activity Visits For selected patients – visits are focused
around the patient’s care and identified priority focus areas
Utilizing tracer methodology will begin and end in the patient’s current unit
Medical Record review at the end of visit to validate processes and documentation
![Page 22: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/22.jpg)
Classic Tracer Activity: Visit the current unit to get a brief history of the
patient and identify what services were involved in their care
Trace back to units or services who cared for the patient, discussing various processes with unit staff. (may include lab, radiology, ED, Cath Lab, pharmacy, PT, etc.)
![Page 23: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/23.jpg)
Notify the manager or charge nurse of the patient you have chosen to trace
Request patient record◦Be sure to get bedside record if appropriate and
current MAR Ask to have the patient’s nurse assist you with
chart review◦To decrease time staff is away from their patients
you may wish to review part of the record alone.◦Also allows time to formulate questions
![Page 24: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/24.jpg)
Focus on high risk processes◦What is the process◦Trace the process◦Look for risk points
Process changes◦People, equipment◦IT, sequence of procedures, locations
![Page 25: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/25.jpg)
Reports or data will indicate an issue Reviewing the process not an individual patient Where does the process touch Who does the process touch
![Page 26: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/26.jpg)
Infection control◦Learn about planning, implementing,
evaluating infection control program◦What is the process used to reduce infections Proper hand washing Standard precautions Transmission based precautions Sterilization processes
![Page 27: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/27.jpg)
Identify safety concerns within different levels and types of care
Ambulatory-continuity of care Behavior Health-elopement, suicide prevention Home Health-falls, equipment
![Page 28: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/28.jpg)
26 year old male admitted to ICU via ED after MVA. Patient has been to surgery for repair of orthopedic injuries and is on a vent. The patient’s history includes diabetes and he drinks a 6 pack of beer per day. Plan is to move the patient to a surgical floor tomorrow.
![Page 29: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/29.jpg)
What would you look for on the patient’s medical record?
Which staff members would you speak to on the unit?
Which departments might you visit as you continue the tracer?
![Page 30: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/30.jpg)
Start in ICU and track to ED and surgeryH&P – done prior to surgery or a note indicating it
is an emergencyAll surgery related paperwork complete?Consult with dietitian?Consideration of DTs?Restraints used? Documentation?Speak with RT, PT, DietitianIs care plan customized to the patient?
![Page 31: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/31.jpg)
56 year old female post 3 vessel open heart procedure. Patient was admitted via the ED and went to cath lab and subsequently on to OR. Patient is now in a telemetry unit but was in MICU prior to that transfer. Nursing assessment indicates the patient’s faith is very important to her in her recovery. The patient only speaks Spanish.
![Page 32: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/32.jpg)
What would you look for on the patient’s medical record?
Which staff members would you speak to on the unit?
Which departments might you visit as you continue the tracer?
![Page 33: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/33.jpg)
Start in telemetry and visit MICU, ED, cath lab and OR
Interpreter available? Written material such as consent available in Spanish? Staff know how access to interpreter
Chaplain or priest notified if patient requests?Cath lab and OR documentation indicate timeout?
![Page 34: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/34.jpg)
• Don’t trace your own department• Trace processes of care not clinical
appropriateness• Failure to take notes• Failing to summarize findings• Lack of validation• Lack of feedback to staff
![Page 35: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/35.jpg)
Understand Tracer Methods Have a plan Follow through using your PI model Incorporate into annual PPR plan Questions Every level of the organization is involved
![Page 36: InAHQ Annual Conference May 2011. Identify techniques for developing tracer Identify how to use tracers to improve organizational readiness Demonstrate](https://reader031.vdocuments.site/reader031/viewer/2022013004/56649dbd5503460f94aaf2d2/html5/thumbnails/36.jpg)
Questions