No Patient Left Behind

Purpose:
The core measures addressed in SCIP are evidence based and are appropriate for all patients. In order to provide the best care to all patients we needed a concurrent process to "catch" correctable defects. Many defects are failure to document and need to be corrected prior to discharge.

Significance:
The most important issue is to provide the appropriate care to 100% of the patients. Wound infections, VTE and UTIs can be major complications for patients with implants - spine and joints. It is also important to be able document care in order to maintain reimbursement from CMS.

Strategy and Implementation:
The team that was comprised of inpatient and perioperative staff met and discussed barriers to our goal of the appropriate care for 100% of our patients 100% of the time. We developed a checklist to be used in every hand off of the patient starting with Preop holding through removal of the foley. Education about the SCIP measures and appropriate documentation was discussed with perioperative staff, anesthesia staff and inpatient nursing staff. The orthopaedic physicians were also included especially around antibiotic selection, appropriate reasons to leave a foley greater than 48 hours and acceptable VTE prevention strategies. Revisions were made to the checklist per suggestions from front line staff. The data is collected real time and reviewed with each handoff. On the inpatient units the need for foleys are discussed daily in huddle. The checklist are collected and reviewed by the clinical specialist. Missing data is retrieved from the electron medical record.

Evaluation:
Greater than 50% improvement in adherence to the SCIP measures. Since we are looking closely at 100% of the patients, all defects are noted. Process issues were identified and corrected. Documentation imporved. Success measured by graphing defects every month and sharing with all of the staff.

Implications for Practice:
Changed the time the anticoagulates scheduled so within 24 hours of end of surgery. Tied the 0 VTE rate with joint surgery patients to the VTE compliance. Increased awareness of the tie between UTIs and foley usage. Increased awareness of appropriate charting of meds not given and changed options.