Quality indicators for clinical pharmacy services Head of Quality and Improvement, Nordsjælland Hospital Dorthe Vilstrup Tomsen Assuring quality in clinical pharmacy services Following international, national and local guidelines Formal and informal training of pharmacists Audit and follow up Quality Control 1
Shift in paradigm QA QA QC QI QC QI Roadmap for Quality Improvement 2
Zoom out Clinical Pharmacy services as part of the larger Health Care system Trends in the development of Health Care The Danish National Quality Program 8 goals for the entier health care system 21 National Quality Indicators Applying to both primary and secondary sector 3
Ledelse af kvalitets- og forbedringsarbejde Dorthe Vilstrup Tomsen Leadership Goals Management Goal National goals 1 Rapported in national datasources Regional goals Rapported through local management Hospital goals Department goals Ward goals 4
Econimic support of QI Leadership Transparent and visible data Co-creation with patients New approach to improvement cultur Continuously improvement of quality Quality goals with room for local priority Fra: Nationalt kvalitetsprogram for sundhedsområdet 2015-2018, SUM april 2015 Sustainability in Healt Care.with Triple Aim 5
Joy at work Take care of those, who care for others What matters to you? Models for Quality Improvement The new trends in Quality work calls for new methods. Strong emphesis on data and Statistical Proces Control Incremental improvement work and small scale test of change 6
Model for Improvement 3 essential questions What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement? A Model for Learning and Change When you combine the 3 questions with the PDSA cycle, you get the Model for Improvement. 7
How does Clinical Pharmacy Services fit in? Ledelse af kvalitets- og forbedringsarbejde Dorthe Vilstrup Tomsen 8
Hospital Acquired Infections Ledelse af kvalitets- og forbedringsarbejde Dorthe Vilstrup Tomsen Nordsjællands Hospital Kvalitets- og Udviklingsafdelingen Decomposition of quality indikators Hand Hygiene Cleaning Nursing Antibiotic Stewardship 9
Nordsjællands Hospital Kvalitets- og Udviklingsafdelingen Decomposition of quality indikators Hand Hygiene Cleaning Nursing Antibiotic Stewardship Nordsjællands Hospital Kvalitets- og Udviklingsafdelingen What are we trying to accomplish? Some is Not a Number, Soon is Not a Time! Local goal for Antibiotic Stewardship: Cefalosporines: 25 DDD/1000 bed days Quinolones: 25 DDD/1000 bed days Regional goal: 70% of the total AB use should be on penicillin Dorthe V Tomsen, Nordsjællands Hospital 10
How will we know that a change is an improvement? Nordsjællands Hospital Kvalitets- og Udviklingsafdelingen How will we know that a change is an improvement? Dorthe V Tomsen, Nordsjællands Hospital 11
Mortality before and after intervention 25% 20% 15% 10% 5% før efter 0% 1 3 5 7 9 11 13 15 17 19 21 23 Måned Mortality before and after intervention 25% p = 0,05 20% 15% 10% 5% før efter 0% 1 3 5 7 9 11 13 15 17 19 21 23 Måned 12
How will we know that a change is an improvement?.. Also in everyday life? Indicatores that matters to clinicians Feasible data collection Ledelse af kvalitets- og forbedringsarbejde Kilde: Dorthe Anhøj Vilstrup J, Dansk Tomsen selskab for patientsikkerhed Navn (Sidehoved/fod) 13
24.0 28.0 03.0 08.0 11.0 16.0 29.0 05.0 08.0 13.0 20.0 23.0 02.0 06.0 12.0 17.0 20.0 25.0 30.0 03.0 08.0 11.0 16.0 21.0 24.0 29.0 01.0 06.0 11.0 14.0 19.0 22.0 27.0 01.0 04.0 09.0 12.0 17.0 22.0 25.0 30.0 03.1 08.1 13.1 16.1 21.1 24.1 29.1 03.1 06.1 11.1 14.1 19.1 24.1 27.1 02.1 05.1 10.1 15.1 18.1 16-10-2017 Nordsjællands Hospital Kvalitets- og Udviklingsafdelingen How will we know that a change is an improvement?.. Also in everyday life? #of pt without stop-date 16 UCL 14 C Chart LCL Dorthe V Tomsen, Nordsjællands Hospital 12 10 8 6 4 2 0 What changes can we make that will result in an improvement? 14
Implementation traditional Approach Plan Plan Peer Review Plan PROGRAM Approval At the desk The real world Implementation Reinertsen, Bisognano & Pugh (2008) Implementation through small scale testing Plan Approval At the desk The real World Test and modify Test and modify Test and modify Implementation Reinertsen, Bisognano & Pugh (2008) 15
What changes can we make that will result in an improvement? Knowlegde Feed-back on behaviour Implementation Feelings Social structures The Sequence for Improvement Test under a variety of conditions Make part of routine operations Implementing a change Sustaining improvements and Spreading changes to other locations Theory and Prediction Developing a change Testing a change Act Study Plan Do 16
Nordsjællands Hospital Kvalitets- og Udviklingsafdelingen Dorthe V Tomsen, Nordsjællands Hospital How do we display Project Progress? Ledelse af kvalitets- og forbedringsarbejde Dorthe Vilstrup Tomsen 17
Nordsjællands Hospital Kvalitets- og Udviklingsafdelingen Dorthe V Tomsen, Nordsjællands Hospital Ledelse af kvalitets- og forbedringsarbejde Dorthe Vilstrup Tomsen 18
So! What happened? Antibiotic (DDD) 19
% penicillin indkøbt ud af det samlede antibiotikaindkøb jan mrt me jul-13 se no jan mrt me jul-14 se no jan mrt me jul-15 se no jan mrt me jul-16 se no jan mrt me jul-17 16-10-2017 % Penicillin at NOH 100 90 80 70 60 50 40 30 % penicillinindkøb i forhold til det samlede indkøb (uden sengedage) Mål % penicillin i forhold til samlet antibiotikaindkøb 20 10 0 Clinical Pharmacy is now part of a team effort to serve the patient 20
Steal shamelessly! Write, Call or come visit! and JUST DO IT 21
Questions? 22