Grace Cottage Hospital’s 2008 Hospital Report Card
2007 QUALITY IMPROVEMENT INITIATIVES

Patient Safety:
Medication Process Improvement

Project Description:
A Continuous Quality Improvement (CQI) team was established in 2007 to review the process of providing medications to a patient at Grace Cottage Hospital, beginning with the initial patient assessment, and continuing through to monitoring the outcome of administered medications.

Problem:
The medical staff and nursing staff expressed frustration with using the current computer software in a busy work environment.

Goal:
The goal of the team’s work was to identify problem spots within the current medication process, improve the flow of information between all involved in the process, provide for a smooth flow between shifts, and recommend to the hospital’s Quality Council an improved medication process that could be implemented for further analysis.

Intervention Process:

• Flow charts were developed to identify problem spots
• A computerized Pyxis medication dispensing system was introduced
• A specialized technology position was added to the hospital’s staff

Evaluation:
The improved medication process was approved by the Quality Council and put into practice October 1, 2007. No hard data is yet available.

Patient Safety:
Medication Reconciliation

Project Description:
In June 2005 Grace Cottage Hospital participated in the Institute for Healthcare Improvement’s nationwide campaign “100,000 Lives”. This campaign encouraged a comprehensive medication reconciliation practice to increase patient safety and eliminate medication errors at specific intervals of patient care.

Grace Cottage Hospital’s approach to the solution was two-fold: 1) wallet medication cards issued to each patient, and, 2) an electronic medication list or reconciliation that stays within our hospital computer system.

Implementation and utilization of electronic medication reconciliation focused on specific intervals of patient care:

• When a patient enters the hospital
• When a patient is transferred to our hospital from another facility
• When a patient is discharged from our hospital
• When a patient transfers from one level of care to another level of care within our hospital

Problem:
Patients at times forget their medication cards leaving gaps in their medication history. Without written or computerized medication records, patients frequently do not remember the name of a medication, reporting to medical staff only that they are taking “a green pill”.

Project Goals:

• Develop an accurate system for the transfer of medication information at all transfer points of patient care
• Reconcile all medications - including all over-the-counter and herbal preparations - being taken prior to the patient’s hospital admission, with current medications ordered
• Reconcile medications ordered during one level of care with the medications ordered at the next level of care within the hospital
• Introduce an electronic adaptation that can be easily updated and shared among providers and patients alike

Intervention Process:
To complement the wallet medication cards, an electronic Medication Reconciliation application was added in 2006 to the Initial Interview portion of Grace Cottage Hospital’s admission and discharge. The Initial Interview is also repeated when the patient transfers to another facility, or to another level of care within Grace Cottage Hospital.

The data in the Medication Reconciliation is a cumulative effort from the patient, nurse, and provider. Should the patient forget their wallet card, the hospital can now accurately participate in reconstructing the patient’s medication list by referring to the electronic Medication Reconciliation in our records.

Evaluation:

1. Audits of patient charts have confirmed that Grace Cottage Hospital is now at 98% compliance with Medication Reconciliation
2. Staff evaluation of the patient safety benefits provided by the electronic medication reconciliation, has led to investment in a new software application to maximize the usability and impact of the process. The future use of medication reconciliation in the format of an E-form is being discussed
3. The use of the electronic medication reconciliation as a E-form will streamline the input process and create a more fluid document that electronically travels with the patient from care level to care level with minimal manual input from the staff

Quality Improvement:
Picture Archiving Communication System (PACS)

Project Description:
The digital Picture Archiving Communication System (PACS), installed at Grace Cottage in October 2007, is a means of managing radiographic medical images by replacing hard-copy images with digital renderings. It gives the radiologist the capability to view images off-site and provide a rapid interpretation.

Problem:
Prompt interpretations are imperative for the quality of care to our patients. Using a volunteer courier to transport hard-copy images to a radiologist in Brattleboro is time consuming and can cause delay in an interpretation. With an antiquated system, referring physicians can not get an immediate interpretation and therefore the patient needs to be transported to another hospital for diagnostic imaging and care.

Project Goals:

• Improve quality of patient care
• Improve turn-around time of interpretations from a daily service to twenty-four (24) hours a day, seven (7) days a week
• Provide a single point of access for images and their associated data
• Integrate dictation of reports into a single system
• Provide a robust method of merging images from another hospital to our database
• Reduce cost by archiving images digitally versus purchasing film, using a processor, and storing hard copies

Intervention Process:

• Install CPSI ImageLink PACS and related hardware; provide initial training, follow-up, and ongoing support to imaging and medical staff
• Utilize system for 12 months for evaluation regarding improved patient care and staff performance

Evaluation:
No PACS data is available for the last three months of 2007, which was a PACS training period. 2008 quantitative data of the digital Picture Archiving Communication System (PACS) will be evaluated using the number of radiology interpretations provided to patients at Grace Cottage Hospital during the overnight hours of 5:00pm through 8:00am.

For more information on these projects as they relate to Grace Cottage Hospital practices
and patients, please contact

Effie Chamberlin,
Director of Compliance, Quality Improvement and Risk Management
(802) 365-7357 voice (802) 365-9500 fax
ec@otishealthcarecenter.org e-mail
PO Box 216, Townshend VT 05353

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