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Fistula First Tift Regional Medical Center
Fistula First Tift Regional Medical Center
Fistula First Tift Regional Medical Center
Fistula First Tift Regional Medical Center
Fistula First Tift Regional Medical Center
Fistula First Tift Regional Medical Center
Fistula First Tift Regional Medical Center
Fistula First Tift Regional Medical Center
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Fistula First Tift Regional Medical Center

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  • 1. Fistula First Tift Regional Medical Center 5/13/08 Update
  • 2. AIM Statement <ul><li>Implement plan of care for 100% of identified at risk HTN patients, which includes GFR assessment. Nutritional evaluation, ACEI / ARB therapy prescribed at discharge, follow-up appointment with nephrologists and vascular access plan will be included for patients with HTN and Stage 4 CKD. </li></ul>
  • 3. Pilot Population <ul><li>Patients admitted to the care of hospitalist service (no local physician) </li></ul><ul><li>Patients in the age range of 30 – 50 years </li></ul><ul><ul><li>CVD patients </li></ul></ul><ul><ul><ul><li>Hospitalized (IP or OBS) patients with HTN identified as any diagnosis during their admission. </li></ul></ul></ul><ul><ul><li>CVD patients with Stage 4 CKD </li></ul></ul><ul><ul><ul><li>Hospitalized (IP or OBS) patients with HTN and Stage 4 CKD as any diagnosis during their admission </li></ul></ul></ul><ul><li>Excluded patients </li></ul><ul><ul><li>Comfort care only patients </li></ul></ul><ul><ul><li>Hospice Inpatient / Respite patients </li></ul></ul><ul><ul><li>Patients leaving AMA </li></ul></ul><ul><ul><li>Patients who expired during hospital stay </li></ul></ul>
  • 4. Progress to Date <ul><li>Established regular meeting schedule. </li></ul><ul><li>Developed work-lists to identify records for review monthly. </li></ul><ul><li>Ensured GFR consistently calculated and resulted by lab. </li></ul><ul><li>Developed method for clinical dieticians to identify patients in pilot population for nutritional evaluation. </li></ul><ul><li>Completed assessment of adequacy of documentation of Stage 4 CKD based on GFR results. </li></ul><ul><li>Gained agreement between hospitalist physicians and outpatient clinic for follow-up in outpatient clinic for patients not receiving nephrology consult in inpatient setting. </li></ul><ul><li>Began research on “stick to the hand.” </li></ul>
  • 5. March Senior Leader Report - Results
  • 6. PDSA Cycles <ul><li>P2 - Nephrology Follow-up </li></ul><ul><ul><li>Assessment of adequate documentation of Stage 4 CKD </li></ul></ul><ul><li>P3 – Vascular Access Plan </li></ul><ul><ul><li>To begin research of “stick to the hand” </li></ul></ul><ul><ul><li>Consult outside of team for ideas for system of identification of patients </li></ul></ul><ul><li>P6a – Nutritional Evaluation </li></ul><ul><ul><li>Piloted report from lab to clinical dieticians with GFR in pilot population to assist dieticians in identifying patients for nutritional evaluation </li></ul></ul>
  • 7. Barriers and Solutions <ul><li>Low volume of patients in pilot population </li></ul><ul><ul><li>Determine if there is appropriate documentation of Stage 4 CKD based on reported GFR </li></ul></ul><ul><li>Loss of dietician champion </li></ul><ul><ul><li>Identify new champion(s) in department to ensure process continues </li></ul></ul><ul><li>Time constraints </li></ul><ul><ul><li>Establish regular schedule for meeting </li></ul></ul><ul><ul><li>Assign tasks to be completed outside of meetings </li></ul></ul><ul><li>Limited resources available on “stick to the hand” </li></ul><ul><ul><li>Networking! </li></ul></ul><ul><ul><li>Internet research </li></ul></ul><ul><ul><li>Prepare to develop our own materials </li></ul></ul>
  • 8. For more information please contact: <ul><li>Mindy McStott, RN, BSN, CCM, CPAR </li></ul><ul><li>Director Quality/Case Management </li></ul><ul><li>Tift Regional Medical Center </li></ul><ul><li>229-353-6119 </li></ul>

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