Using QA Data to Guide a Successful VAD Program Barbara A. Elias - - PowerPoint PPT Presentation

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Using QA Data to Guide a Successful VAD Program Barbara A. Elias - - PowerPoint PPT Presentation

Dec 05, 2023 141 likes •418 views

Using QA Data to Guide a Successful VAD Program Barbara A. Elias BSN, RN, CCRN VAD Coordinator Texas Children's Hospital Congenital Heart Surgery Page 0 Page 0 xxx00.#####.ppt 5/22/2015 1:36:00 PM Financial Disclosures/Relationships:

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Using QA Data to Guide a Successful VAD Program

Barbara A. Elias BSN, RN, CCRN VAD Coordinator Texas Children's Hospital Congenital Heart Surgery

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Financial Disclosures/Relationships:

  • I have no financial disclosures or relationships to disclose.
  • I will not discuss off label use or investigational use during

my presentation.

  • Permission has been received from patients’ families for the

photographs included.

  • Relationship to disclose: Employee of Texas Children’s

Hospital- RN-VAD Coordinator.

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The Texas Medical Center 1954

Texas Children’s Hospital

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The Texas Medical Center 2013

Texas Children’s Hospital

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  • Administrative/procedural activities implemented in a

quality system so that requirements and goals for a product, service or activity will be fulfilled.

  • Systematic measurement, comparison with a standard,

monitoring of processes with associated feedback that confers error prevention. This can be contrasted with quality control, which is focused on process output.

  • Two principles included in Quality

Assurance/Assessment are: “Fit for purpose" (the product/service should be suitable for the intended purpose); and "Right first time" (mistakes should be eliminated).

Quality Assurance (QA)

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VAD Program Share Holders

Surgeon Team NP/PA’s Cardiologist Team NP/PA’s Anesthesia/ Intensivist Team NP/PA’s VAD/Txp Coordinator Team Perfusionist OR Team Social Work Pharmacist Team PT/OT Nutritionist Team Research Team Quality Management Team

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What we know:

  • INTERMACS tracks patient survival, adverse events and cause of death
  • ver time by patient profile, device and device category/strategy.
  • Understanding of what Intermacs/Pedimacs is.
  • Organized table of contents-> gets you started- orientation to
  • rganization of reports
  • Reports: graphs/charts: creative ways to present data so it is more “eye

friendly”- “easy to understand and follow”.

  • We have the resources and tools = need to USE THEM
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What we need/have:

  • Intermacs/Pedimacs Site Administrator: Oversee data entry, data entry, receive

Quarterly reports, disseminate reports with team members.

  • VAD CMPI: Forum to review Intermacs/Pedimacs data and document QA

reports are reviewed (Surgeon, Cardiologist, Research, VAD Coordinator)

  • VAD/Transplant QAPI/CMPI: Forum to review QA report data that reports up to

QM and administration (need to gain interest of ALL: we need involved SHAREHOLDERS)

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Considerations/Concerns:

  • Staffing to collect & enter data-> RESOURCES (lack of resources = data entry deficit)
  • Interest /Understanding from/of Team to review data->INTEREST (lack of interest = data review deficit)
  • Time frame/Dedication to review data-> TIME (lack of time/dedication = data review deficit)

ISSUES: RESOURCES & TIME & INTEREST

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How can we use QA data?

Review AE’s: Reduce VAD related hospital readmissions- assess for specific causes. Patient Selection/ Optimize mode of treatment: Intermacs Severity score at time of implant?.  Review to Optimize-standardize perioperative antibiotic use, driveline care- reduce infection.  Review and develop Device thrombosis/bleeding protocols of management.  Review to Improve Quality of Life measures, functional status. Relationship of all of the above impacts Program Outcomes

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How do we interpret data?

Oh Oh I wish sh it t woul uld just just ple leas ase go go aw away ay….

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What we look at:

  • Review all data entry points: provides a data snapshot of Key data entered into

Intermacs.

  • Review key points: Total screened and Total enrolled: look for inconsistencies and

why not included- screen all patients. Implants/explants

  • Review and compare Severity scale/preimplant hemodynamics/labs with Adverse

events from your center with Intermacs database.

  • Review NYHA/Intermacs score at time of implant (Ensure accuracy just prior to

implant- not date of MRB = patient status/processes change! Take credit for your patient level of severity!).

  • QOL/Functional capacity/6 minute walks/Gait speed: pre and post LVAD: see how

these points improve= very important as patients are living longer with devices Pediatrics and Adults.

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How we can use QA data:

  • By reviewing all data points and assessing for outliers/inconsistencies:

Transplant/VAD programs can develop QI projects/initiatives as well as Guidelines/Protocols/Policies such as reduced length of stay, blood conservation, patient preparation/preoperative screening/teaching. QUALITY DATA REVIEW

QUALITY IMPROVEMENT PROGRAM

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How we use QA report data:

  • Create Post implant protocol to mirror data entry points for Intermacs = Creates a

standard of care – “Time line testing: labs, echo, 6 minute walk, QOL/KCQS”, Create on Excel spread sheet that plots time frames for testing/data entry-> Helps keep track of data points and prevent gaps in entry.

  • Set benchmarks/goals for program= Using Intermacs data registry as guidelines.
  • QOL questionnaires- pair this with Patient satisfaction score sheet= to help show

patients satisfaction w/ program, device and quality of life prior to implant, post implant and long term.

  • Look at specific AE’s to develop Protocols= if bleeding major concern- why, associated

conditions- create best practice guidelines/protocols to reduce AE’s (Anticoagulation protocols, wound management, renal protection)

  • Review all data- where there are deficiencies or “frequent flyer points of concern”- use

those points to develop program QI projects, VAD program benchmarks, and care progression pathways.

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Example: QOL

Reduced QOL

  • look at specifics-

Activity, Lifestyle, Body Image/inability to work/school? Review with Social work/Psych team on regular basis-Include key players - Develop patient support group/patient volunteers- include Social work/coord/MD Have social work/Coord/Psych follow-up with patient in clinic/phone calls Develop patient satisfaction surveys- reassess on monthly basis- plot interventions on bar graph to show change over time

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Example: Infection

Review and compare centers rates vs Intermacs Registry-Review current practice Review sources of infection/patient selection/geographic area/patient selection/nutritional status pre implant- Team meeting- VAD team/ID Review current practice- create process/protocol to improve

  • utcomes- pt prep/removal old

lines/screening cultures/ID involvement pre- implant. Dressings- sterile dressing applied in OR, VAD coord completes all dressing changes, driveline stabilizer applied from OR. Centralize dressing care kits/teach family to utilize this, screen shots of drivelines when concerned to show progression, stage driveline site infections.

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By reviewing our goals/objectives we develop Quality Performance Measures. By reviewing what/when we develop a Process to follow. By reviewing who and how we develop Procedures to follow. With all above come Templates, guidelines, forms and checklists.

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Staff Meetings- Slides-open discussion, need staff participation- ”buy in”

Postings: Dash boards/Locker rooms informatics boards Hand outs for review: easy to follow graphs/flow charts

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How we share information- CREATIVITY IS KEY Dashboards/communication boards/Programs/Meetings

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How Do We FEEL NOW: LETS AVOID THIS

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Time has come for a change:

  • Isn’t it time to put an end to your frustration, inefficiency?
  • Take back control of your QA reporting and data management

processes with Careful, intuitive, comprehensive reviews builds QI projects, protocols leading QUALITY VAD PROGRAM..

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Shared Challenges moving forward

  • What do we do with the reports/who is responsible?
  • Time to review data/ other research needs
  • Forget to complete/Fall Through the Cracks causing Delays in Data review
  • Limited knowledge : Review, Analyze and Report for QA/QI - Trends Identification
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Key Take Home Points:

  • Review reports: look for missing/late date/outliers= Develop QI projects to address this- if

QOL/KCQS not completed and reason is “no time”- create pre-implant data packets that have all information need pre-implant to ensure all data is captured.

  • Define and raise program goals/benchmarks based on program data reports comparative to

Intermacs database results.

  • Share your outcome data quarterly during Multi-D QI team meetings to bring stakeholdes to the

table: - this will cultivate PI projects leading to improved outcomes.

  • Program data: RESULTS are only as good as DATA ENTRY is= what you see is what you entered.
  • Review of date is KEY to helping Guide program guidelines, setting benchmarks/program goals,

along with evidence based practice- document data review (meeting minutes).

  • Outcomes are an easy way to track program productivity, guide patient management protocol

development and define performance improvement projects.

  • Quarterly reports of quality outcomes, with patient satisfaction surveys can be utilized in Annual

VAD Program Summary Report to Hospital Board.

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Why we do what we do?

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Th Than ank Yo You!