QUALITY IMPROVEMENT
& DATA COLLECTION
How can you make data collection the “easy part”?
Naomi Erickson, BSN, MHS
Quality I...
WHY DO WE NEED DATA?
Because…
 it helps us understand if a change is leading to an
improvement
 it moves from subjective...
DOES DATA HAVE TO BE DIFFICULT?

DATA
COLLECTION
MODEL FOR IMPROVEMENT
AIM STATEMENT
 Helps us understand what we are trying to improve

 Ensure your aim statement is SMART:

Specific

Measur...
AIM STATEMENT EXAMPLES
 To improve compliance with MedRec by 70% in Royal Inland

Hospital, by April 15, 2014.

 To decr...
MODEL FOR IMPROVEMENT
TYPES OF MEASUREMENT
 There are three types of measurements that you should

keep in mind when making an improvement
 Ou...
OUTCOME MEASURE

These are the overarching end result(s) of the
improvement(s) that we are trying to achieve
OUTCOME MEASURE EXAMPLES
 reduction in the number of unnecessary antipsychotics
 reduction in the number of venous throm...
PROCESS MEASURES
•

Logically connected to the
outcome measure

•

Often the steps or process of
achieving the outcome

•
...
PROCESS MEASURE EXAMPLES
 completing the Best Possible Medication History
 use of the Venous Thromboembolism Pre Printed...
BALANCING MEASURES
• Evaluate whether changes
made in one area are at the
expense of another area
• Helps us detect uninte...
BALANCING MEASURE EXAMPLES
 staff satisfaction with a new process
 readmission rates
 may decrease length of stay howev...
FROM THE BEGINNING
 Think about what to measure right from the start of your

improvement project
 what is your baseline...
MEASUREMENT
 Collect enough to know how the change has lead to an

improvement

 “just enough” data, small sequential sa...
MEASUREMENT
 Create clear audit instructions and tools
 Ensures everyone is collecting data in the same way (Needham et ...
DATA COLLECTION TOOLS
 Paper

 Excel spreadsheets
 Apps
12 (Mar
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12...
MEASUREMENT EXAMPLE (2)

Just enough to
know a change
is an improvement

Simple yes/no
answers
HOW OFTEN?
 You and your team can decide what is appropriate
 flexible depending on your project and who is able to coll...
HEART AND THE MIND

Impact to the patient/client/resident and family
SHARE THE DATA
 Share the data with stakeholders
 Display it where stakeholders can view their progress

 Take opportun...
DISPLAYING DATA
Quality Improvement and Patient Safety
Engage ~ Inspire ~ Empower ~ Celebrate

RIH Med Rec Monthly Report ...
QUESTIONS
REFERENCES
 Needham et al. (2009). Improving data quality control in quality

improvement projects. Retrieved from
http:/...
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Quality Improvement and Data Collection

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Presented at Optimizing Medications workshop in Vancouver by Naomi Erickson

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Quality Improvement and Data Collection

  1. 1. QUALITY IMPROVEMENT & DATA COLLECTION How can you make data collection the “easy part”? Naomi Erickson, BSN, MHS Quality Improvement Consultant & MedRec Lead Interior Health
  2. 2. WHY DO WE NEED DATA? Because…  it helps us understand if a change is leading to an improvement  it moves from subjective opinions to objective information about a process  hospitals face pressure to report on the quality of care provided  it engages stakeholders (Provost and Murray, 2011;Needham et al. 2009)
  3. 3. DOES DATA HAVE TO BE DIFFICULT? DATA COLLECTION
  4. 4. MODEL FOR IMPROVEMENT
  5. 5. AIM STATEMENT  Helps us understand what we are trying to improve  Ensure your aim statement is SMART: Specific Measurable • what is the specific improvemen t you are to accomplish? • how will we know we reached our goal? Achievable • Is this a possible goal? Relevant • Does this goal matter? Timebound • By when would you like to accomplish your goal?
  6. 6. AIM STATEMENT EXAMPLES  To improve compliance with MedRec by 70% in Royal Inland Hospital, by April 15, 2014.  To decrease PSLS reported medication adverse events by 30% in Kelowna General Hospital by June 30th, 2014.  To reduce the number of prescribed antipsychotics in residents by 30% in Overlander Extended Care Hospital by January 15th, 2015.
  7. 7. MODEL FOR IMPROVEMENT
  8. 8. TYPES OF MEASUREMENT  There are three types of measurements that you should keep in mind when making an improvement  Outcome  Process  Balancing
  9. 9. OUTCOME MEASURE These are the overarching end result(s) of the improvement(s) that we are trying to achieve
  10. 10. OUTCOME MEASURE EXAMPLES  reduction in the number of unnecessary antipsychotics  reduction in the number of venous thromboembolisms (pulmonary emboli and deep vein thrombosis)  reduction in the number of medication errors  reduction of adverse drug events
  11. 11. PROCESS MEASURES • Logically connected to the outcome measure • Often the steps or process of achieving the outcome • Tends to show improvement before the outcome measure does
  12. 12. PROCESS MEASURE EXAMPLES  completing the Best Possible Medication History  use of the Venous Thromboembolism Pre Printed Order  number of staff educated about polypharmacy issues  number of residents who are properly screened for risk of a fall
  13. 13. BALANCING MEASURES • Evaluate whether changes made in one area are at the expense of another area • Helps us detect unintentional consequences
  14. 14. BALANCING MEASURE EXAMPLES  staff satisfaction with a new process  readmission rates  may decrease length of stay however, the patients are being readmitted two days later  volume of workload
  15. 15. FROM THE BEGINNING  Think about what to measure right from the start of your improvement project  what is your baseline?  is there opportunity to collect data from the Pre Printed Order Set you develop?  When planning to collect data think about:  who, what, and how  does not have to come only from the chart  staff and patient surveys/interviews/focus groups
  16. 16. MEASUREMENT  Collect enough to know how the change has lead to an improvement  “just enough” data, small sequential samples (Provost and Murray, 2011; Needham et al. 2009)  this is not research sample size  keep it simple  Ministry of Health reporting requirements?  Ensure each question leads to an action  Ask the question: what will we do with this information?  If you are not doing anything with it….don’t collect it
  17. 17. MEASUREMENT  Create clear audit instructions and tools  Ensures everyone is collecting data in the same way (Needham et al. 2009)  Be aware of who is collecting the data (clinical and/or non clinical)  Involve stakeholders as able  Unit or site audit champions  Provides peer to peer learning  Engages individuals in the project
  18. 18. DATA COLLECTION TOOLS  Paper  Excel spreadsheets  Apps
  19. 19. 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 12 (Mar 22222222222222222222- med surg med surg med surg med surg med surg med surg med surg med surg med surg med surg med surg med surg med surg med surg med surg med surg med surg med surg med surg med surg yes yes yes yes no yes yes no yes yes yes yes yes yes yes yes yes yes yes yes yes yes no yes yes yes no yes yes yes no yes yes yes yes no yes yes no no yes yes yes yes yes no yes yes yes yes yes no yes yes no no yes yes yes yes yes no no no yes yes no no yes yes yes yes yes no no TRUE TRUE FALSE TRUE TRUE TRUE TRUE TRUE FALSE TRUE TRUE FALSE FALSE TRUE TRUE TRUE TRUE TRUE FALSE FALSE 14 yes yes no yes yes yes yes yes no yes yes no no yes yes yes yes yes no no yes yes no yes yes yes yes yes no yes yes no no yes yes yes yes yes no no Orders Complete* Physician Signatures Physician Orders Verification Complete * HMR Medication Section Complete Medication verification Unit BPMH Form On Chart Fiscal Period BPMH Completed BPMH Required MEASUREMENT EXAMPLE (1) TRUE TRUE FALSE TRUE TRUE TRUE TRUE TRUE FALSE TRUE TRUE FALSE FALSE TRUE TRUE TRUE TRUE TRUE FALSE FALSE 14
  20. 20. MEASUREMENT EXAMPLE (2) Just enough to know a change is an improvement Simple yes/no answers
  21. 21. HOW OFTEN?  You and your team can decide what is appropriate  flexible depending on your project and who is able to collect the data  Ministry of Health may dictate reporting timelines  Think about:  more frequently at the start  once goal is reached how often do you need to collect for sustainability?
  22. 22. HEART AND THE MIND Impact to the patient/client/resident and family
  23. 23. SHARE THE DATA  Share the data with stakeholders  Display it where stakeholders can view their progress  Take opportunities to celebrate success  Simple is okay Great Work Everyone
  24. 24. DISPLAYING DATA Quality Improvement and Patient Safety Engage ~ Inspire ~ Empower ~ Celebrate RIH Med Rec Monthly Report - Nov, 2013 Detailed audit results from November, 2013: (n = 26) Med Rec Completion - Nov, 2013 100% 80% 60% 40% 92% 81% 54% 20% 92% 50% 0% BPMH on chart Verification Complete HMR Complete Physician Orders Complete Signature Complete How we're doing over time: Oct-13 Nov-13 Sep-13 Jul-13 Aug-13 Jun-13 Apr-13 May-13 Mar-13 Jan-13 Feb-13 Dec-12 % w/ HMR Complete 100% 80% 60% 40% 20% 0% Nov-12 Nov-13 Oct-13 Sep-13 Aug-13 Jul-13 Jun-13 May-13 Apr-13 Feb-13 Mar-13 Jan-13 Nov-12 Dec-12 % w/ Verification complete 100% 80% 60% 40% 20% 0% % w/ Signature Complete % w/ Physician Orders complete 100% 80% 60% 40% 20% 0% Nov-13 Sep-13 Oct-13 Aug-13 Jul-13 Jun-13 May-13 Apr-13 Mar-13 Feb-13 Jan-13 Dec-12 Nov-12 Nov-13 Oct-13 Sep-13 Aug-13 Jul-13 Jun-13 May-13 Apr-13 Mar-13 Feb-13 Jan-13 Dec-12 Nov-12 100% 80% 60% 40% 20% 0%
  25. 25. QUESTIONS
  26. 26. REFERENCES  Needham et al. (2009). Improving data quality control in quality improvement projects. Retrieved from http://intqhc.oxfordjournals.org/content/21/2/145.full.pdf+html  Provost, L. and Murray, S. (2011). The health care data guide: Learning from data for improvement. San Francisco: Jossey-Bass.

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