Moving the Needle: IHI and Anticoagulation Safety and ...

16th National Conference on Anticoagulation TherapyOctober 28-30, 2021

Moving the Needle: IHI and Anticoagulation Safety and

StewardshipPresenter:

Frank Federico, RPhInstitute for Healthcare Improvement


Institute for Healthcare Improvement (IHI)

Our vision: Everyone has the best care and health possible.

Our mission: Improve health and health care worldwide.

Our Values

• Courage

• Love

• Equity

• Trust


How IHI Works

• Teach our improvement methods- IA program, PSE, Open School

• Convene like minded organizations to share and learn – “All teach, all learn”- Leadership Alliance, European Health Alliance, expert panels, National Forum, Campaigns

• Organize and support collaboratives focusing on difficult problems in health and health care – medication safety, patient safety, flow

• Provide coaching and support to organizations – consults, contracts, grants


Theory of Change

• Every system is perfectly designed to get the results that it getsBatalden/Berwick

• All improvement requires change, but not all change is an improvement


6

In order to achieve this…

We need to ensure that…

Which requires…


Improve Medication Safety by Decreasing Harm and Errors

AddressMedication Reconciliation

Engage all layers of the organization

Patient/Family/CaregiverEngagement

Use Systems Approach

Primary Drivers

High Risk Areas identified

Reporting Culture Cultivated

Safety Lessons Learned & Shared

Build Will

Get Results

Effective Communication and Collaboration

within/ between organizations

Secondary DriversOutcomes

Segment the population

Collect Ideas

Standardized Protocols and Algorithms

Measurement /Assessment of Processes

Health Literacy

Mechanism to Listen and Learn from

Patients/Families

Patient and Family Engagement & Education

Reduce Polypharmacy

Use improvement science

Aim:

By When:

16th National Conference on Anticoagulation TherapyOctober 28-30, 2021Langley, et al, The Improvement Guide, 2009

Our RoadmapA Model for Learning and Change

When you combine

the 3 questions with the…

…the Model for Improvement.

PDSA cycle, you get…


Three Types of Measures

Outcome Measures: Voice of the customer or patient. What is the result of interest?

Process Measures: Voice of the workings of the system. Are the parts/steps in the system performing as planned?

Balancing Measures: Looking at a system from different directions/dimensions. What happened to the system as we improved the outcome and process measures? (e.g. unanticipated consequences, factors influencing outcome)


Clarify “Where” To Spread

What is your level of our ambition?

• Every unit or ward in a hospital?

• Every service line (clinical & operations)?

• Every hospital in a system or region?

• All primary care clinics?

• All inpatient and outpatient mental health?

• All levels of care across a population?


Some Thoughts on Spread

• Adopters may need to “reinvent” the interventions

• Influencers or opinion leaders in the social system serve as the best messengers

• Identify key strategy to get early adopters from decision to action

• Identify issues that are barriers to adoption and remove

• The spread process needs to be managed

Langley J. Nolan K. et al. Improvement Guide. Jossey Bass, 2009.


Vital Behaviors of Institutionalizing a Process

1. Develop the Infrastructure for sustainability

2. Make a prediction about whether the change will be sustained

3. Ensure you have capability & reliability of the change

4. Continuous ongoing control measurement both for the change and for the sustain process

5. Redesign sustainability support processes if something falls out of control

16


Transparency

Leadership

Psychological

Safety

Negotiation

Teamwork &

Communication

Accountability

ReliabilityImprovement

&

Measurement

Continuous

Learning

Engagement of

Patients & Family

Engagement of Staff

What matters to you

Framework for Safe, Reliable and Effective Health Care

© 2017 Institute for Healthcare Improvement and Safe & Reliable Healthcare

Source: Frankel A, Haraden C, Federico F, Lenoci-Edwards J. A Framework for Safe, Reliable, and Effective Care. White Paper. Cambridge, MA: Institute for Healthcare Improvement and Safe & Reliable Healthcare; 2017. (Available at ihi.org)

Learning System

Culture


Six Interventions to Prevent Harm

• Prevent Pressure Ulcers

• Reduce Methicillin-Resistant Staphylococcus aureus (MRSA) infection

• Prevent Harm from High-Alert Medications starting with a focus on anticoagulants, sedatives, narcotics, and insulin

• Reduce Surgical Complications

• Deliver Reliable, Evidence-Based Care for Congestive Heart Failure to reduce readmission

• Get Boards on Board


General Principles for Reducing Harm from High-Alert Medications

Hospitals and other care settings should adhere to the following principles of a safe system:

• Design processes to prevent errors and harm

• Design methods to identify errors and harm when they occur

• Design methods to mitigate the harm that may result from the error


Suggested Changes Proposed During the Campaign

• Format anticoagulation flow sheet and orders to follow the patient through transitions from hospital to skilled care to home

• Use an anticoagulant dosing service or "clinic" in inpatient and outpatient settings

• To reduce compounding and labeling errors, ensure that the organization uses ONLY oral unit-dose products and pre-mixed infusions, when these products are available

• Ensure that staff undertaking anticoagulant duties are trained and competent

• Conduct an ISMP Antithrombotic Therapy Self-Assessment


Spread of a Stewardship Program

• Explain WHY- who will benefit?

• Engage the willing

• Have a theory of change

• Use an improvement method to test your theory

• Track measures for process and outcomes

• Develop a spread plan

• Monitor process and outcome measures over time


Transparency

Leadership

Psychological

Safety

Negotiation

Teamwork &

Communication

Accountability

ReliabilityImprovement

&

Measurement

Continuous

Learning

Engagement of

Patients & Family

Engagement of Staff

What matters to you

Framework for Safe, Reliable and Effective Health Care

© 2017 Institute for Healthcare Improvement and Safe & Reliable Healthcare

Source: Frankel A, Haraden C, Federico F, Lenoci-Edwards J. A Framework for Safe, Reliable, and Effective Care. White Paper. Cambridge, MA: Institute for Healthcare Improvement and Safe & Reliable Healthcare; 2017. (Available at ihi.org)

Secure Administrative Leadership Commitment

Establish Professional Accountability and Expertise

Engage Multidisciplinary Support

Perform Data Collection, Tracking, and Analysis

Implement Systematic Care

Facilitate Transitions of Care

Advance Education, Comprehension, and Competency


Thank [email protected]

Moving the Needle: IHI and Anticoagulation Safety and ...

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