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QUALITY IMPROVEMENT INITIATIVES  

Birthing Center Improvements

In a continuing effort to improve the quality and safety of the care provided to mothers and newborns, as well as improving the overall care experience, the Birthing Center has implemented the following changes in the past year:

  • Efforts to increase the VBAC (vaginal birth after Cesarean section) rate for patients who have had primary Cesarean sections;
  • Increased staff education and training, as well as new equipment, to ensure optimal care is provided to the newborn;
  • Improved pain management planning and options, to include the availability of epidural pain medication during labor;
  • Refrigerators on the unit for use by breast feeding moms;
    Immunizations offered for both Mom and baby;
  • Expanded discharge instructions for Moms and newborns, to include more symptoms/what to look for after discharge;
  • Efforts to ensure car seat safety, to include improvements to education and car seat checks;
  • Porter care visits scheduled two days post discharge, which includes an assessment of both Mom and baby.

For more information regarding the above changes, or other questions regarding the Birthing Center, please contact Lorraina Smith-Zuba, Director of the Birthing Center, at (802) 388-4225.

Patient Safety Initiative: Medication Reconciliation

Admission medication reconciliation for patients admitted to the Medical Surgical or Special Care Units at Porter Hospital has long been a collaborative effort among Nursing, Pharmacy, and Medical Staff. With the implementation of the electronic medical record, the necessity of obtaining complete and accurate medication lists very early in the admission process is critical to providing safe, effective patient care.

The Chief Nursing Officer, Nurse Manager of the Medical-Surgical and Special Care Units, and the Director of Pharmacy met several times to discuss a way to improve this critical process and were in agreement that the data collection / entry phase of medication reconciliation and the extensive training necessary to properly update and maintain medication lists within the EHR is not a task that a floor nurse can effectively complete while responsible for patient care. In an effort to improve this time consuming process, it was collectively decided that the unit clerks would be trained to complete the data collection phase of medication reconciliation.

The revised Medication Reconciliation process is as follows:

  1. Unit clerk is paged when an admission to Med Surg or SCU is pending
  2. Unit clerk responds to the ED to begin / complete the collection of medication history and enters this information directly into Meditech including last dose times
  3. Unit Clerk follows up with family members, pharmacies, primary care offices, and consults the pharmacists and pharmacy interns as needed
  4. Pharmacists review the medication lists for clinical accuracy and completeness and compare home medication lists to active orders once admission orders are completed

This revised process has the following potential benefits

  • Better customer service to patients who are now only approached by one individual (other than the Physician) to collect a medication list.
  • Cleaner, more concise medication lists due to the detailed training completed by unit clerks on the appropriate management of these lists
  • Decreased time burden on floor Nurses to complete data collection and follow up phone calls
  • Eliminated need for ED Nurses to perform data collection and entry
  • Fewer inappropriate admission orders.
  • Decreased time spent by Pharmacy staff clarifying home mediation lists
  • Decreased “back and forth” interactions with Providers as home med lists and active orders are updated
  • A cleaner, more user friendly medication list flowing back to the primary care offices
  • A smoother admission medication reconciliation process makes for a smoother discharge medication reconciliation process!

The improved process for medication reconciliation on the Medical-Surgical and Special Care Unit has proven to be an improvement in Patient safety and Nursing efficiency. There have been no medication errors related to incorrect or untimely medication reconciliation since the implementation of the new process. The initial team who implemented this process will be reconvening along with input from various end-users to continue to refine this process and begin planning for improvement in medication reconciliation in the Emergency Department.

Additionally, the Pharmacy department, in collaboration with various players from Porter Practice Management (PPM) and Porter Cardiology, conducted a study on medication reconciliation in PPM offices during the week of August 26th. The goal of this study was to uncover inefficiencies and inadequacies in the medication reconciliation process and improve the process in terms of clinical approach and work flow. Findings of this study showed a strong deficit in medication literacy in our patient population. To respond to this need, the Pharmacy Department, with the help of pharmacy interns from the Albany College of Pharmacy and Health Sciences, are preparing materials to launch a community-wide medication literacy campaign. This will be phase one of an approach to stream line medication reconciliation in PPM offices with additional planning for continued improvement being done by a multidisciplinary committee of PPM representatives and the Director of Pharmacy.

Performance Improvement Project: Preventing Catheter Associated Urinary Tract Infections

Although Porter Hospital’s infection rates are consistently low, it is understood that the occurrence of an infection can have a devastating impact on the course of a patient’s care.

In response to a rare increase in the number of urinary tract infections over a one month period, a committee was formed to review Porter’s current patient care protocols related to urinary catheter care. The committee includes Porter’s Infection Control Nurse, Staff Development, Clinical Quality, Nurse Management, as well as members of the direct care Nursing Staff.

As a result of this collaborative review process, new policies and procedures were developed with a focus on not only preventing catheter associated urinary tract infections, but also to increase Nursing and Medical staff awareness of this potential problem. A primary focus of the committee includes efforts to decrease the use of urinary catheters, as well as timely removal of catheters when they are required during the course of a patient’s care.

The committee will continue to monitor the newly implemented processes and infection rates, work closely with Nursing and Medical staff, and implement further change as required to ensure optimal patient outcomes.

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