welcome [opqc.net] · 7/26/2012 · 2:00 welcome and roll call sandy fuller 2:05 data for...
TRANSCRIPT
OPQC OB ACTION PERIOD
CALL
July 26, 2012
2:00-3:00 PM ET
Welcome
Please don’t put us on HOLD
• If you need to step away
– Use the MUTE button on your phone or
– You can use *6 to place the call on MUTE and
*6 to come off of MUTE
2:00
Welcome and Roll Call Sandy Fuller
2:05 Data for Improvement Drs. Jay Iams
2:15 “Mind the Gap” Dr. Jay Iams
2:25 Monthly Progress Report and
PDSA’s
Sandy Fuller
2:35 Lessons learned from the 39
week Dissemination and Spread
initiative
Carole Lannon
Beth White and Susan Ford
2:50 Preparing for ANCS
Dissemination
Dr. Heather Kaplan
2:55
Next Steps Sandy Fuller
Agenda
SMART AIM
To increase the
percentage of infants
born in Ohio at 24 0/7
to 33 6/7 weeks’
gestation who receive
pre-delivery ANCS to
> 90%, by June 2013
Global Aim: Assure that all infants born between 24 0/7
and 33 6/7 weeks’ gestation receive appropriate
antenatal corticosteroid treatment to reduce perinatal
morbidity and mortality.
Key Drivers
Documentation System
Identification of Appropriate
Time for ANCS Administration
Optimal and Efficient
Administration of ANCS
Awareness of Benefits and
Risks
Interventions
Identification of Appropriate
ANCS Candidate
• Promote public awareness of benefits of ANCS
• Education of parents & non-perinatal providers
• Link to maternal transfer & tocolysis
• General risks and benefits
• Promote consistent use of common algorithm of
ANCS administration for Betamethasone &
Dexamethasone
• Practitioners
• Prescribing
• Care Giving / Administering
• Hospitals
• Link to maternal transfer & tocolysis
• Pharmacies
• Distributors
• Pharmaceutical Manufacturers
• CHOOSE an ANCS Strategy or Guideline for your
site
• Create an integrated system of recording ANCS
administration among prenatal care sites and
delivery sites encompassing all levels and acuity
of care.
• Standardize birth certificate documentation of
ANCS administration
Aggregate Report
OPQC Obstetric Collaborative to Improve the Use of
Antenatal Corticosteroids
Monthly Progress Report – What have we
Learned?
• Many teams are working on accurately entering administration of
ANCS into the birth certificate system (documentation completeness)
• 2 teams are working with OBTV to help staff enter data into the
system accurately and pull the data out of the system
• 2 teams discovered that the reasons why ANCS was not given was a
systems failure
• Many reported the reasons for not receiving ANCS is because of
“Short interval from Presentation to Delivery; Interval <2 hours”
• Barriers – Having more than one person responsible for data
collection
What are teams working on? • Merging BC data with clinical data
• Next PDSA - ANCS Card
• Increasing communication between data collectors
and monitor information entered into OPQC database
• Improving ANCS documentation of transferred
patients
• Compare nurse collected data with nurse charted
data in OBTV – computer generated data
• Steroid sign in the triage room
• Analyzing all 24-34 week patients for full course of
ANCS
• Complete documentation by nurses so Medical
Records can input the data
Goals for the ANCS Project
> 90% Aggregate ANCS Rx @ 24-34 Wks
Reduce Variation Across the State
Eliminate ANCS System Failures
Maximize the # and % Rx’d in “Sweet Spot”
– 2 to 14 Days Before Preterm Birth 24-34 wks
– Who Is Doing It Best?
• High % Rx’d AND High % In The Sweet Spot
– How Are They Doing It?
– How Can We Spread It to All Sites?
Poll
Help us rename the “Root Cause Analysis”
activity!
•CSI – Corticosteroid Investigation
•MOp – Missed Opportunity
•MSI – Missed Steroid Investigation
•MOA – Missed Opportunity Analysis
39 week Dissemination and
Spread • Spread what we learned from the great work of the
original 20 teams!
• January 2012, in partnership with Ohio Department
of Health Office of Vital Statistics
– 15 hospitals recruited to participate in a pilot learning
collaborative
– Teams consist of Clinical and Data Abstraction staff
– Birth Certificate data used to guide improvement efforts
Bailit, JL. for Ohio Perinatal Quality Collaborative. “Rates of labor induction without
medical indication are overestimated when derived from birth certificate data.”
American Journal of Obstetrics & Gynecology203.3 (Sept 2010): 269.e1-269.e3.
Kamath B, E Donovan, R Christopher, et al. “Using Improvement Science to Increase
Accuracy and Reliability of Gestational Age Documentation.” American Journal of
Perinatology, in press
The Ohio Perinatal Quality
Collaborative
Ohio Department of Health
Office of Vital Statistics
39-Week Scheduled Delivery
Dissemination Project
“The focus of healthcare for
women and infants over the
next century depends on the
quality of the data collected by
those who fill out the birth
certificates”.
Bill Callaghan, MD MPH
Centers for Disease Control and Prevention
December 1, 2011
39-week Project
1. 39-week scheduled delivery clinical project
2. Improving accuracy of birth data entry
** guiding principle:
Importance of regular connection and
communication between clinical and birth data
staff
Top 5 “A-ha Moments” learned
on site visits: 5. Medical terminology can be interpreted in different ways by
different people.
4. Prenatal visits are inconsistently captured after 36 weeks.
3. Breast feeding is being captured as intent, not if it is being
done at discharge.
2. When the value of the birth certificate is known, accuracy of
documentation increases.
Top 5 “A-ha Moments” learned
on site visits:
The number ONE “A-ha Moment” IS….
#1. The source of “obstetrical estimate of
gestation” is often inconsistently and
incorrectly recorded in IPHIS.
Does your site have regular
communication between
clinical and birth data staff?
Hot Off the Press!
Changes in the Indications for Scheduled Births
to Reduce Nonmedically Indicated Deliveries
Occurring Before 39 Weeks of
Gestation
Jennifer L. Bailit, MD, MPH, Jay Iams, MD, Angela Silber, MD, Michael
Krew, MD,
David McKenna, MD, Michael Marcotte, MD, and Edward Donovan,
MD, for the Ohio Perinatal
Quality Collaborative
OBSTETRICS & GYNECOLOGY
VOL. 120, NO. 2, PART 1, AUGUST 2012
ANCS: Thinking about dissemination
from the beginning….
SITE VISITS
St. Elizabeth’s Hospital
Good Samaritan Hospital—Cincinnati
Ohio State University Wexner Medical
Center
Aultman Hospital
University Hospital-Case Western Reserve
St. Elizabeth’s Hospital—Youngstown
Promedica Toledo
Good Samaritan
Hospital
IRB Documentation
• We’ve received documentation from 2
hospitals
• Please send a copy of your IRB # and
expiration date or determination that it was
exempt to:
Next Steps • Continue to collect data and submit July data –
due August 5, 2012
• Complete your Monthly Progress Report (MPR) by
August 5, 2012
• Continue to submit your “ “ for all patients
who have not received ANCS
• Keep testing changes – PDSA’s
• Join the August Action Period Call – August
30th from 2-3
• Mark your calendars! All AP calls from July-Dec
will be on the last Thursday of the month from 2-3
Thank you for joining the call and being
willing to share your great work!