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3965fec6596cd291f131837fce67e412
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A Common Approach to Problem-Solving
The Problem
Examples of Practitioner Improvement Projects
Every day BIDMC staff members encounter problems in their work areas. While it is easy
to jump to solutions, solving these problems with a common approach provides
opportunities for idea sharing and cross-functional collaboration. There is a need to drive
continuous improvement competency in the organization to enhance the value and results
of improvement activities by BIDMC staff.
Aim/Goal
“I knew we needed to improve,
so I outlined current issues and
figured out a new method using
the principles I learned in the
Level 1 Course”
– Redesigning Copay Processing
4
-Kristin Donnelly, APG Practice
Coordinator
Diffuse problem solving thinking throughout the organization so that everyone, every day,
can solve problems at their appropriate level.
The Interventions
Develop a lean certification practitioner program that teaches a common and scientific
problem solving approach. Certify 400 people in year 1.
Teach
DO!
Classroom Session (2 hrs)
There are 3 options for a homework
assignment to be completed to receive
Level 1 Practitioner certification. The goal
is to engage participants in continuous
improvement work in their own workplace
by doing one of the following:
1 Identify each of the 8 wastes within
their work area
-John Goulart, Director - Compliance
3 3 – “5S” the Team Shared Drive
Homework (2 hrs)
Business Transformation has
developed a comprehensive, multi-level
Lean certification practitioner program
that teaches a common and scientific
problem solving approach with the
following course objectives:
Know a common approach to
solve problems: A3 Problem
Solving
Explain the value of going to see
Identify the 8 wastes of Lean
Understand the importance of
making problems visible
“Because my team went through
this training together, we agreed
on an approach. We all own this
project – we discuss it, and
that’s why it works.”
.
2
Identify and eliminate 3 of the 8
wastes in their work area
3
“5S” their work area
4
“Our improvements have been successful in reducing registration times per patient, but we aren’t
finished. Providing the best care possible is about adjusting and continuously making
improvements.”
Solve a problem using A3 thinking
Includes over 80
participants from BID
Needham, BID Milton,
and BIDCO
Westwood!
-Nate Beyer, Administrative Lead - ED
3
– “5S” ER Registration Desk
Sign Up Today!
Offered Monthly
https://research.bidmc.harvard.edu/Training/ClassRegistration.aspx
For More Information Contact
Alice Lee, alee1@bidmc.harvard.edu
�
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Bonnie Baker (<a href="mailto:bbaker2@bidmc.harvard.edu">bbaker2@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Business Transformation
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Alice Lee
Bonnie Baker
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Title
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A Common Approach to Problem-Solving
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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The file format, physical medium, or dimensions of the resource
pdf
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9b301ddfb065547fa1393e709dcba107
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A Motion-less Blood Bank
The Problem
Excess human movement is one of the 8 wastes of LEAN.
The Results/Progress to Date
The layout of the East Campus Blood Bank impeded workflow adding excessive
human steps and double-backs for medical technologists in the preparation and issue
of blood products.
Aim/Goal
Our goal is to streamline the layout of the blood bank, by removing obstacles and
decreasing the number of steps required to prepare and issue blood components.
The Team
Blood Bank Team - Medical Technologists, Leads and Manager
Business Transformation- Alice Lee, Vice President, Business Transformation
Facilities management- Doug Barletta, Senior Project Manager, Facilities
Total length 156ft
Total length 61ft
The Interventions
39% decrease in walking length
The opportunity to implement a LEAN project in the blood bank arose due to a broken
sink. The affected plumbing was under a counter that was a known obstacle in our
daily workflow.
Blood bank requested a GEMBA walk from the Business Transformation
team. They agreed with the inefficiencies of our workflow. An increase in the
scope of the project was then approved and budgeted.
A team effort was undertaken on all shifts to map out potential solutions by
using sticky notes for equipment placement and suggesting different
workflow patterns. Ultimately a mutually agreeable proposal was conceived.
Blue prints were drawn and work proceeded in stages, minimizing disruption
to patient care.
Lessons Learned
Including staff from all roles and shifts is critical when reconfiguring a
shared space.
Planning the staging of construction project in a busy 24/7 location is
critical.
The timeframe for involvement from IS, telecommunication and other
non-project staff needs to be carefully mapped out.
Once construction started some adaptations to the plan were made,
but the final result was very close to our original plan and on budget.
Staff report increased satisfaction with the layout.
For more information, contact:
Pamela Doty, Blood Bank Medical Technologist
pdoty@bidmc.harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Pamela Doty (<a href="mailto:pdot@bidmc.harvard.edu">pdot@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Blood Bank
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Blood Bank Team
Alice Lee
Doug Barletta
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Title
A name given to the resource
A Motion-less Blood Bank
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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The file format, physical medium, or dimensions of the resource
pdf
Efficiency
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cd59f57bdfdfebe3f215bc4549b0e620
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Beth Israel Deaconess Hospital-Milton
Achieve Leading Practice Designation in Operating Room Turnover Times
The Problem
The Results/Progress to Date
In May 2013, an onsite audit was performed by an external vendor specific to
peri-operative services at Beth Israel Deaconess Hospital-Milton. The objective
of this internal audit was to review the hospital’s Operating Room (OR)
scheduling process and staffing, as well as to evaluate opportunities to enhance
OR efficiency and utilization. The measurement period for this audit was from
April 2012 through March 2013.
LOWER IS
BETTER
Audit
completed
Interventions
implemented
From this audit, one of the opportunities for improvement identified related to
the timeliness of OR turnover between operative cases. The established industry
standard for this process is <25 minutes, however the actual time for BID-Milton
was 43 minutes.
G
O
L
Aim/Goal
Reduce OR Room turnover time between surgical cases to achieve leading
practice goals, i.e., 20-25 minutes for inpatient surgeries.
The Team
OR Staff
Environmental Services
Department of Anesthesia
Department of Surgery
Lessons Learned
The Interventions (Select Actions Taken)
Reviewed AORN recommended practices on room cleaning to expedite
room turnover and terminal cleaning of ORs – no opportunities identified
Considered eliminating the OR RN in the patient transport process from
the PACU – could not be implemented
Allowed for patient early entry into the operating room (prior to completion
of room setup) to maximize effects of parallel processing (LEAN – optimize
‘External Setup’)
Led by a new Interim Director of Surgical Services in November of 2013,
performance expectations set with staff as a means to modify historical
behavior/practices
Staff held accountable for performance – times tracked and shared with
staff – overall, by OR room and by responsible individual staff member
OR Manager performed daily rounds
Worked collaboratively with Anesthesia at start-of-day “flow” meeting
Engagement and education of CSR staff on their role in OR flow
Decreased OR room turnover times allowed for daily “add-on” cases to be scheduled
during normal OR hours – i.e., decreased incidence of OR day being extended beyond
normal close time (decreased use of overtime)
Accountability and data transparency drove changes required to improve OR
utilization and efficiency
Next Steps/What Should Happen Next
Celebrate leading practice achievement in room turnover time with staff
Continue with interventions and monitor ongoing success relative to goals
Build on this success through other in-progress PI initiatives to address additional
opportunities identified as part of audit, e.g., first case start times, block booking,
OR room utilization etc.
For More Information Please Contact: Alex Campbell, MSN, RN, NE-BC, CPHQ, Director HCQ & PS
alex_campbell@miltonhospital.org
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Alex Campbell (<a href="mailto:alex_campbell@miltonhospital.org">alex_campbell@miltonhospital.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Operating Room Staff
Medical Staff
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Milton
Project Team
Operating Room Staff
Environmental Services
Department of Anesthesia
Department of Surgery
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Title
A name given to the resource
Achieve Leading Practice Designation in Operating Room Turnover Times
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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The file format, physical medium, or dimensions of the resource
pdf
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Timeliness
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6621e9089de2e16cd656d356efe1c4b6
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ACMS Stable Patient Extended INR Protocol as a model for reviewing, assessing, and
implementing new clinical guidelines into patient care practices.
men
Jennifer E. Mackey, PharmD; Lynde K. Lutzlow, Scot B. Sternberg, MS; Diane M. Brockmeyer, MD;
A teaching hospital of
Harvard Medical School
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Problem:
The 2012 update to the American College of Chest Physicians (ACCP) Guidelines included
a recommendation that patients with “consistently stable INR results” on warfarin may extend
the INR monitoring interval from the every 4 week standard to “up to 12 weeks.”1
Anticoagulation Management Service (ACMS) patient care practices must continually evolve
to incorporate updated evidence-based guidelines. A formalized process is necessary to
review, evaluate, and implement new procedures to reflect current recommendations.
Objectives:
Establish a model process for review of new clinical recommendations and patient care
protocols as they pertain to BIDMC Anticoagulation Management Service (ACMS) patients.
Create a protocol that incorporates updated INR testing frequency recommendations and
standardizes anticoagulation clinic practices.
Reduce patient INR testing burden while maintaining safe warfarin therapy.
Context and Intervention:
The BIDMC ACMS is composed of nurses, pharmacist, and a medical director who manage
warfarin care for about 800 patients with primary care doctors in a large academic care
practice.
ACMS established the below process for new evidence review to be utilized:
Identify new
published
practice
guideline
Review
primary
evidence
and expert
opinions
Draft new
patient care
protocol
Multidisciplinary
external review,
input, and
approval
Staff Training,
Pilot the protocol,
Assess staff
compliance
Assess outcomes
and revise
protocol
The updated ACCP Guideline INR frequency recommendation and supporting clinical
studies were critically evaluated by the ACMS team.
Review of primary data led to team assessment that the data for extending test interval
to 12 week INR checks are not robust. The team decided on a conservative approach
of maximum duration between INR tests of 6 weeks.
A Stable Patient Extended INR Testing Protocol was created.
Inclusion, exclusion/discharge criteria were defined:
General inclusion criteria: patients enrolled in ACMS with therapeutic INR results
and no maintenance warfarin dose changes for the previous three months.
General exclusion/discharge criteria: 80 years or older; home INR monitor use;
recurrent thrombotic event or major bleeding history; recent INR values less than
1.5 or greater than 5.0; episodes of being overdue for an INR; requests for more
frequent testing.
Eligible patients were offered the option of extending their INR testing frequency to
every 6 weeks. The standard process followed by the ACMS includes:
Reminding the patient to contact ACMS if there are changes to medications, diet,
scheduled procedures, and/or clinical status. This occurs at the time of protocol
enrollment and with each subsequent INR assessment.
Informing the patient that more frequent INR tests will be required if subsequent
results are outside of goal range; clinically significant to medications, diet, or clinical
status occur; warfarin is held as part of a peri-procedural plan; or episodes of being
2 weeks or more overdue for an INR test arise.
Standardized documentation in the electronic medical record was defined.
The protocol was reviewed and a plan to pilot over a 6 to 12 month period was enacted:
Healthcare Associates QI Committee and ACMS Leadership approved the protocol.
ACMS staff were trained regarding the new protocol and completed a competency
test before proceeding independently with patient assessment and enrollment.
The protocol was initiated into ACMS daily practice in February 2013.
Measurements of Improvement:
Clinic adherence to the protocol.
Decreased INR test burden and increased convenience for patients.
Maintenance of INR results within range and overall safe warfarin care.
Findings to date:
Patients were enrolled in the extended INR testing protocol and electronic medical records
were reviewed to assess outcomes at 6 and 11 months following piloting of the protocol.
Overall staff adherence to the extended INR testing protocol process was 95%.
Analysis was performed on patients with at least 12 weeks of data over the last 11 months:
58 patients enrolled
41 males (71%), 17 females (29%)
Average age 67 years (range 41-79)
45 anticoagulated for cardiac condition (78%; 37 patients (82%) with atrial fibrillation/flutter), 13 for DVT/PE (22%)
Duration of anticoagulation: <1 year: 2 (3%) ; 1-5 years: 31 (53%) ; 6-10 years: 16 (28%); >10 years: 9 (16%)
46 patients with > 12 weeks data
Average length of time on protocol 40 weeks (range 14-48)
402 INR results were recorded:
Reasons for early
Days
INR tests
between
INR results
[Average
(range)]
INR results
INR results Reasons recorded for Dose adjustments
within goal range outside goal out of range INRs
(% of occurrences)
range by
>0.2
29 (1-88)
315 (78%)
MD appointment
Hospital admission
Pre/post procedure
Antibiotics
Last INR outside goal
38 patients (83%)
had >65% INRs
within goal range
88 (22%)
Unknown (48%)
Illness (18%)
Dietary change (16%)
Periprocedure (8%)
Dosing error (7%)
Interacting med (3%)
66 one time changes
32 weekly changes
Clinical events that were noted during the pilot period included:
2 patients stopped warfarin (failure to thrive and apixaban conversion, respectively).
1 patient moved out of state and transitioned to a local anticoagulation service.
13 hospitalization episodes involving 9 patients: influenza-like illness (#2), mechanical fall
(#2), failure to thrive (#2), TIA/stroke (INR within goal) (#1), epistaxis (INR 3.39) (#1), atrial
fibrillation (#1), atrial tachycardia s/p PVI (#1), leg injury (#1), non-warfarin allergic reaction
(#1), ileus (#1).
o 2 patients were discharged to rehabilitation facilities following hospitalization.
9 patients had procedures performed: colonoscopy (#3); endoscopy (#1); epidural steroid
injection (#1); eye surgery (#1); prostate biopsy and seed placement (#1); PVI (#1); rectal
banding (#1)
4 patients were 2 weeks or more overdue for an INR tests. One patient had four overdue
episodes of 2-4 weeks. Six subsequent INR tests (86%) were within goal range.
No patients met protocol discharge criteria.
Key Lessons Learned:
A standardized multidisciplinary process for addressing new clinical guidelines is an
effective method for evolving patient care in safe manner.
Extending INR interval to 6 weeks in stable patients appears to provide safe care in pilot.
Next steps include continuing to monitor and track patient success in the pilot program;
refining protocol inclusion criteria based on additional data; and standardizing protocol
resumption following temporary discontinuation (e.g. out of range INR, overdue episodes).
Acknowledgements:
BIDMC Coumadin Clinic team members include: Patricia Glennon, RN; Lisa Jachowicz, LPN; Marie
Mahony, RN; Colleen Monbleau, RN
For More Information, Contact Jennifer E. Mackey, PharmD: jemackey@bidmc.harvard.edu
¹ February 2012; 141(2_suppl) Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians
Evidence-Based Clinical Practice Guidelines
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Jennifer Mackey (<a href="mailto:jemackey@bidmc.harvard.edu">jemackey@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Patricia Glennon
Lisa Jachowicz
Marie Mahony
Colleen Monbleau
Dublin Core
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Title
A name given to the resource
ACMS Stable Patient Extended INR Protocol as a Model for Reviewing, Assessing, and Implementing New Clinical Guidelines into Patient Care Practices.
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Efficiency
-
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2bd089c9ad8473d914a11c3237b88960
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Text
Adding Value- The New Glover Cafe
The Problem
The Glover Café at BIDN has been a tradition in the Needham communityserving the hospital’s many employees, patients, and even local residents. Until 2013,
the Café stood in its small corner of the old hospital wing with a handful of tables and
limited food production capabilities. Though the old Café was a favorite of many, wait
times were long, food production was limited, and there was little room for growth. As
a result, the potential for increased sales and transactions was minimal. With the
hospital continuing to expand, there was a need for a larger facility in order to provide
the best service possible to our many loyal customers.
In July 2013, the new Glover Café opened. More than triple the size of the
previous space, it now offers a variety of cold and hot food and beverage options. The
Café includes a hot entrée line, a salad bar, a deli station, a soup station, smoothies,
coffee, cold foods and beverages, and more.
The Results/Progress to Date
53.8% increase
frpm FY2012
Aim/Goal
Our goal was to increase the value in the new Glover Café, as measured through
both qualitative measures (customer comments, feedback forms) and quantitative
measures (revenue, average sales, transaction average, rate of capture).
Katie Laycock- Sodexo, General Manager
Michele Morgan RD LDN Sodexo Clinical Nutrition Manager
Erin Boudreau- Sodexo, Executive Chef
Monica Vasquez, Francesca Serpa, Don Regan- BIDN Staff
Lois Marks, Helaine Yanofsky- BIDN Volunteers
The Interventions
“The space is
really inviting
and uplifting”
‐ customer
In January 2013, the old Glover Café closed.
An interim Café was established from January-June 2013
The new Glover Café opened its doors in July 2013.
Quantitative measures of value were gathered, including revenue, average
weekly sales, average rate of capture, and transaction average
Qualitative measures of value were gathered, including customer comments
and feedback forms
Customer-oriented initiatives in the Glover Café:
o
o
o
o
o
Lessons Learned
The Team
Meatless Mondays and Wellness Wednesdays
BIDMC Chef Series
New Product Tastings
Pedometer Challenge and Employee Wellness
Seasonal Farmer’s Market
The new Glover Café has resulted in increased annual revenue, average
weekly sales, and rate of capture. The trends for these quantitative
measures of value have not plateaued and continue to increase.
o Annual revenue in 2012 was $143,412.00 and annual revenue in
2013 was $203,018.00.
o Average Weekly Sales skyrocketed from $13,000/week in 2012 to
$20,000/week in 2013- these continue to increase in 2014.
o Average Rate of Capture for 2012 was 21% and for 2013 it
increased by 14% to 35%.
Though many are nostalgic for the old café, customer comments about the
new Glover Café have been overwhelmingly positive. We continue to see
more and more customers in the new space.
Customer-oriented initiatives, such as the Farmer’s Market and Product
Tastings, have helped bring awareness to the new Glover Café and its many
offerings. These initiatives have also helped to add value to the space.
Next Steps
Continue to track quantitative and qualitative measures of value
Continue to promote the new Glover Café and increase rate of capture
Continue with customer-oriented initiatives and other community activities
For more information, contact:
Jeanine LeDoux, MS RD LDN
Sodexo Food and Nutrition at BIDN
jledoux@bidneedham.org
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Jeanine LeDoux (<a href="mailto:jledoux@bidneedham.org">jledoux@bidneedham.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Food Services
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Needham
Project Team
Katie Laycock
Michele Morgan
Erin Boudreau
Monica Vasquez
Francesca Serpa
Don Regan
Lois Marks
Helaine Yanofsky
Dublin Core
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Title
A name given to the resource
Adding Value - the New Glover Cafe
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/2ebaeedf43d8d81d5f469a9e96f1107b.pdf?Expires=1712793600&Signature=t3aPJHRxADbjhkkSidkCAjtz3hEzfu2HhB33uR%7EiPcxJ5mtVEBe0GZ%7E7ay3YOtFjLuXVW24KFbp2OhFe%7E6P3NdPYTmxG0yKdCNnCV2D26GR88uDzK3Y6yaS1DvR3RznsEmaFEvpHCpQIPEUaDNKTDowEp-GrOoVGjSY3To8wTZBK5D3YJMIEQDVm%7ElxONVf5VtXH3IZoUjsHr363kCaj5m2Vzq6Sgm6u0C%7EQT-tyxqVrY6Vkj%7ES3SUxHU64NO%7EZyQbwu6p4qPazeGHe2oaf3KofR0EHobwwsocu8OagNv60XF8Pb8vGlzSrymh8dPoj2i7JkK6SD4kt6ALHYpzBLuw__&Key-Pair-Id=K6UGZS9ZTDSZM
5967d3a93da7129834614d6252f717e1
PDF Text
Text
Add‐On Team
A Faculty Hour Team
IV. Solution
I. Background
Unscheduled cases that unexpectedly require surgery and must be added on to the OR schedule represent both a high priority and a
dilemma to the OR care team. How should cases of varying levels of urgency and emergency be classified and handled while continuing
to provide optimal care to all surgical patients? How can the needs of urgent, complex surgical patients be met, particularly when
resources are constrained on nights and weekends? How can a communication system be instituted to serve all team members in a
timely and reliable way? This team will benchmark other institutions that have re‐designed perioperative flow and test best ways to
improve access, safety, and efficiency as well as clinician satisfaction regarding add‐on cases at BIDMC.
GOALS:
1. Develop and implement a priority‐based system to define the order of cases. Concerns include:
• When booked?
• Urgency?
2. Make resources evident and ensure that they are communicated early
3. Optimize matching of resources and expectations
4. Improve the communication system between the anesthesia floor manager, front desk, surgeon and resident
Project Team
Mary Austin
Seema Chowdhury, MD
Jane Cody
Jonathan Critchlow, MD
Alok Gupta, MD (Co‐Leader)
Stephanie Jones, MD
Pete Panzica, MD
Beth Person (Co‐Leader)
Verna Rettagliati
Edward Rodriguez, MD
Dottie Sarno
Ross Simon (Facilitator)
Jason Wakakuwa, MD (Co‐leader)
Sponsor: Richard Whyte, MD
II. Current Condition
III. Analysis
For More Information Contact
Alok Gupta, MD agupta4@bidmc.harvard.edu
Beth Person, bperson@bidmc.harvard.edu
Jason Wakakuwa, MD jwakakuw@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Jason Wakakuwa (<a href="mailto:jwakakuw@bidmc.harvard.edu">jwakakuw@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
Anesthesia
Surgery
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Mary Austin
Alok Gupta
Verna Rettagliati
Jason Wakakuwa
Seema Chowdhury
Stephanie Jones
Edward Rodriguez
Jane Cody Pete Panzica
Dottie Sarno
Jonathan Critchlow
Beth Person
Ross Simon
Richard Whyte
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Title
A name given to the resource
Add-On Team
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/eb6b6d095b0ae9e9f3c745b16a2cd97e.pdf?Expires=1712793600&Signature=vOqEAiL0WZG4qNTaBBLEyIikkOHuQW4PCwMMzYtPWScHvkKkIxuR0XnsmOB4NnMhR9JQB%7EHp6No-rxHzjNxyV2ZoLXW-7%7EhlgUvcFEkeoLOU3XbE8RYBAYeLJ4HteoKuIVzE6YVPiBt2Aw0pftFInMJ46HeH13IgaOsriw41lt6qUgTy0es51GqLg1vKVDahaa9gIDEQ2I5exo4Ojq%7EahnxUMMoaSO3Aa%7EH9TsvBazm-bSEKseCDRLXs9TWQ0idGhPWmhv27XacwtDrbrez0-3lYEGNvTzDwN4986xwtAjHMC1gQGob3lmXp8PzULuK4u5O8AOWL8aUI0T6ZEvcMuw__&Key-Pair-Id=K6UGZS9ZTDSZM
a1167cd06175d98dbb5f4c9cbba4ae95
PDF Text
Text
Re-designing the Division of General Surgery’s General Appointment Line
The Problem
The Results/Progress to Date
The General Surgery Line (GSL), a resource intended to streamline the appointment
scheduling process for referring provider and non-directed referral patients, was not
meeting the intended need. Schedulers could not schedule appointment without
physician office approval, causing delays and frustration. Many of the patients
scheduled often missed appointments or arrived at the wrong time. Surgeons
questioned the appropriateness of the referrals and referring provider offices were
often frustrated with the length of time it took to obtain an appointment.
The creation of the GSL and Doc-to-Doc appointment types allowed us to track and
report results. In FY13 a total of 417 new patients entered the Division via GSL
(kept appointments). Of those patient, 45 outpatient procedures were performed
(11%), and 151 OR cases completed (41%).
Aim/Goal
To improve access and communication within the Division of General Surgery,
thereby, improving customer service.
The Team
Mark P. Callery, MD- Division Chief, General Surgery; Yaramalies Davila,
Administrative Manager, Divisions of Acute Care Surgery and General Surgery;
Ailicet Montilla, Program Administrator, Division of General Surgery; Jazmin Vega,
Administrative Assistant, Division of General Surgery; all Surgeons and administrative
staff within the Division of General Surgery.
The Interventions
Creation of The GSL Guidelines and Protocol, which outlined
expectations and provided guidance on dealing with different situations
and clinical resources.
Cross training administrative staff and establishing a coverage plan for
unexpected and expected staffing shortages.
Creation of appointment intake sheet for internal communication.
CCC template review and standardization.
Reserving slots for open booking.
Surgeon support and engagement.
Creation of GSL specific reports to track DNK, patient distribution,
booking diagnosis, and surgical and procedural intervention, allowing us
to track resource volume and effectiveness.
Lessons Learned
General Surgery clinics are held on the East and West campus along with
Chelsea, Lexington, Milton and Needham; given our scope, physician support and
engagement was very important to our success.
Training and physician engagement are on going. Administrative and Faculty
meetings, along with combined bi-annual meetings are forums by which we
communicate and re-enforce our commitment to access and service excellence.
Next Steps/What Should Happen Next:
Work towards open-access booking across more sites.
For More Information Contact
Yaramalies Davila, Administrative Manager
Divisions of Acute Care and General Surgery
ydavila@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Yaramalies Davila (<a href="mailto:ydavila@bidmc.harvard.edu">ydavila@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Surgery
General Surgery
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Mark P. Callery
Yaramalies Davila
Ailicet Montilla
Jazmin Vega
Dublin Core
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Title
A name given to the resource
Re-designing the Division of General Surgery’s General Appointment Line
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/e403b445d8f9689a876bb75d524e391d.pdf?Expires=1712793600&Signature=DSiRhkXdmi2BJqex2ACTd82oqjGmW4pF3eH5z7vnD8XRmcVgsFuGLACf2GX5SQddC8d85m9LHMCfpbPGjaZVilR1FHL9-RVoshHBJ3dRlVQml%7EjZsGu4TSSbbklSka-zg85b0eCUnSCxl0YuwZP12CvQgBP%7Es9SLHFTXz0ygkHZ-8yY0Rxi5vDxktO8sj1OMFzfLbSDIQC4HU4QSdgjFFeKqTW9jp-Rs6sxFD7OLhUpgW5h5G4e7Xkfe-icFmDLpS7g2JLarQdVDrmudAj-kw%7EvJKI-WCLnRWOsJGaMz59VGqWk1QeCIKWBeYhWIlsKNOBHJxRtRFNugn-d9FJEARQ__&Key-Pair-Id=K6UGZS9ZTDSZM
ffd7c8a8b1cb6c32358140b53cfef35c
PDF Text
Text
Advantages of Programming and Implementing an
Internally Developed NICU/Newborn Nursery cPOE
AIM
Beth Israel Deaconess Medical Center
Boston, Massachusetts
RESULTS: cPOE DEVELOPMENT
To develop a Computerized Provider Order Entry
(cPOE) program that mimics the order sets and
forms that were currently being used in the NICU
and Newborn Nurseries.
Original Paper PN Order Form
NICU Daily Orders Entry Screen
cPOE PN Order Form
SETTING
48 bed Level III NICU, Academic Medical Center
Approximately 5,000 deliveries per year
METHODS
IMPLEMENTATION
The team began meeting in June, 2008.
The neonatal formulary weight based dosages
were programmed into cPOE using the existing
renal dosing for adults.
Clinicians worked directly with our medical center
programmers to develop a user friendly cPOE
with good work flow.
The internally developed cPOE programming allowed customization
to include:
a scrolling view of all active orders
the ability for clinicians to make changes and enter new orders
while scrolling through active orders
a total fluid goal bar created by all parenteral and enteral orders
display of birth weight and weight from last 3 days
The cPOE went live in our NICU and Newborn
nurseries on November 29, 2011.
ASSESSMENT
To assess one measure of impact of the cPOE
implementation, we reviewed orders for
parenteral nutrition entry for 3-month periods
prior to and after cPOE launch. Parenteral
nutrition is the most complicated platform within
cPOE. Orders were reviewed for number
requiring revision after pharmacy review.
RESULTS: cPOE ASSESSMENT
Order Revisions Pre- and Post- cPOE
To assess staff satisfaction, a survey was sent to
NICU clinicians in September 2013.
TEAM
Chair: Susan Young CNS
LESSONS LEARNED
Survey of NICU Staff cPOE Users
• Following implementation of cPOE, more pharmacy interventions
were seen with PN orders than with paper order entry.
Babies on PN vs. PN orders with interventions
80.00%
• Developing a PN order for cPOE that could do calculations and
osmolarity checking proved to be a challenge. The paper form was
more time consuming, but communicated changes more clearly
than the cPOE PN order.
70.00%
60.00%
50.00%
Clinical Systems: Laura Ritter-Cox, Mary Biagiotti
40.00%
Dietitian: Claire Shoaie
% Babies on PN
30.00%
% PN orders with
interventions
10.00%
ry
br
ua
Fe
ar
y
nu
ec
e
D
Zinc
2
2
Selenium
Error Subtype
4
Fluids
2
5
• Keep paper orders updated with cPOE format in case there is a
computer downtime.
Potassium
2
L-cysteine
11
Total fluid goal
23
1
PTE
2
2
• Continue to update cPOE to maintain patient safety and reflect
clinical practice changes.
Protein adjustment
PN rate
8
0
• Add a feature to the cPOE PN order entry so that additives that are
held are highlighted rather than deleted.
Fat Emulsion
5
Enteral intake
10
15
n
CORRESPONDING AUTHOR:
Greg Dumas, RPh
gdumas@bidmc.harvard.edu
NEXT STEPS
1
Programmers: Kevin Afonso, Jeanne Hurley, Nan
Zullo
Respiratory Therapist: Nina Koyama
• It is important to retest all aspects of cPOE when it is launched to
insure that the functionality in Test is transferred to Live.
Overall Error Subtypes
Pathology: Gina McCormack
Pharmacy Interns: Jessica Baron, Lauren Escobar
Ja
m
m
ov
e
N
RNs: Radka Arnold, Janine Caruso, Jane
Smallcomb, Deirdre Wooley
Pharmacy Information Systems: Steve Maynard
be
r
er
ob
r
m
be
Se
pt
e
be
r
0.00%
NPs/PA: Aimee Madden, Mary Ann Ouellette,
Mary Quinn, Laura Tannenbaum
Pharmacists: May Adra, Holly Creveling, Greg
Dumas, Christine Huynh, Rena Lithotomos
• Additives held for clinical issues were crossed out on the paper
form making the change visible. With cPOE, the additive is deleted
from the printed form which resulted in ordering and
compounding errors.
20.00%
O
ct
MDs: Munish Gupta, Stephanie Hale, Camilia
Martin, DeWayne Pursley, Vincent Smith
• Internally developed cPOE programs allow clinicians to work
closely with programmers to reflect established clinical processes.
20
25
Dextrose
Calcium, Phoshate
Number of responding clinicians
110 clinicians responded to the survey and 81% felt satisfied with cPOE.
• Continue to evaluate cPOE to insure that it accommodates order
entry for infrequent clinical occurrences.
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Greg Dumas (<a href="mailto:gdumas@bidmc.harvard.edu">gdumas@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Clinical Systems
Nutrition Services
Neonatology
Newborn Nursery
Nursing
Pathology
Pharmacy
Information Systems
Respiratory Therapy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Susan Young
Laura Ritter-Cox
Mary Biagiotti
Claire Shoaie
Munish Gupta
Stephanie Hale
CamiliaMartin
DeWayne Pursley
Vincent Smith
Aimee Madden
Mary Ann Ouellette
Mary Quinn
Laura Tannenbaum
Radka Arnold
Janine Caruso
Jane Smallcomb
Deirdre Wooley
Gina McCormack
May Adra
Holly Creveling
Greg Dumas
Christine Huynh
Rena Lithotomos
Steve Maynard
Jessica Baron
Lauren Escobar
Kevin Afonso
Jeanne Hurley
Nan Zullo
Nina Koyama
Dublin Core
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Title
A name given to the resource
Advantages of Programming and Implementing an Internally Developed NICU / Newborn Nursery cPOE
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/5fc1533e4b00ef8cccc05e2e2290e59b.pdf?Expires=1712793600&Signature=cJvaYqxOir5JjeRFBIw7ddcoBagbzW-XHz2iBw7FQOoAYFIt21lJVlLtzm-lC3vePma6qAfRni9Abr2sa8CdxuEM9w23EcDGqmFrUfV91-hsdWniVBQnz36KA9kQmpInOY0OVy8Ut2nGXD5Ey8BOBKH4VbR0Hm512kTZpP9ltZW-ckitneel-eKBSRyO9khhJO7w54lpt5UPpN52Wc07d-idL%7E3mK4SpROmbQUvlsrNnIvvEt3%7E58cmXLkxtMv1uIBHVMlIQKM5O9-7tTWfU381SpGGig0s0mlBWbJY08oB3rD340ZmRCdaAyZPlEgtoSyUUdx5loOvP1i97Jbg%7EAA__&Key-Pair-Id=K6UGZS9ZTDSZM
cb6e0700faad7db7955c2c9b71c9620a
PDF Text
Text
BID-Plymouth Low Back Pain Clinical Pathway
The Problem
Due to a lack of adherence to low back pain best practice guideline, there is significant geographic
variation in quality and utilization of surgical, interventional procedures, imaging, opioids and
psychosocial intervention related to low back pain.
This variation leads to:
•
Significant rise in costs of evaluating and treating LBP - IOM dimension of quality: inefficient
care
•
Significant rise in costs associated with LBP impairment/disability - IOM dimension of quality:
ineffective care
•
Compliance concerns associated with the constraints of new payment models on hospital
admissions which are deemed inappropriate for admission - IOM dimension of quality:
appropriate care
In most communities, there is no established or quantatively defined standard for evaluation and
management of the psychosocial components of a low back pain patients presentation.
Aim/Goal
•
•
•
•
•
•
•
Define, develop and implement a comprehensive, patient centered and evidence based Low
Back Pain Clinical Pathway that is the standard of care for the BID – Plymouth community.
Encourage physician behavior to utilize this pathway
To effectively manage the psychosocial concern in our communities LBP patient population.
Achieve 95% compliance for BIDP-ED back pain patients completing STarTBack questionnaire
o
STarT Back tool is validated to assess a LBP patients psychosocial risk factors.
To increase the number for patients seen in spine center with >3 score on STarTBack
To reduce by 50% the number of return visits to BIDP ED for LBP.
To reduce hospital admissions for Medical back pain (MS DRG 552)
The Results/Progress to Date
Aug 27, 12-Oct 5, 13 N-793 – Seen in ED/Referrals Sent to BID-Plymouth Spine Center
>1000 Visits assessed in ED – StartBack Score >3-100% offered appointment within 48 hr
ED Questionnaire Completion Nov 7 -Dec 31 12 Compliance: 65% (96/148)
Jan 2 – Nov 12,13 Compliance: 93% (963/1033)
42% (340/793) seen in BID-Plymouth Spine Center
60% (204/340) Returned Pt Satisfaction Survey – 91%Rated Care (Excellent)
Note: Primary Negative Comment-will not refill opioid prescriptions
6% (21/340) of pts seen in BID-Plymouth Spine Center returned to ED for additional visits
26% (118/453) not seen on referral at BID-Plymouth Spine Center
Returned to ED for additional visits-Avg 2.6 visits/pt (118 pts with 313 visits)
BID-Pymouth Admissions
MS DRG 552 Medical Back Pain w/o MCC
2009-132 2010-125 2011-90 2012-59 2013-31
MS DRG 551 Medical Back Pain with MCC
2009-10 2010-12 2011-5 2012-5 2013-12
Spine Center (SC) Referrals: N-150
50% treated >1x SC 35% Physical Therapy 25% CT/MRI 22% Pain Management 18%Neurosurgery
The Team
Ian Paskowski, DC Medical Director, BIDP Spine Center
Christine Healey, RN, Office Manager BIDP Spine Center
Mark DeMatteo, MD, Chief, BIDP Emergency Services
Jessica Nichols, RN, Nursing Director, BIDP Emergency Department
Judy VanTilburg, RN,BSN,MHM,CPHQ, BIDP Senior Director of Quality and Safety
James A. Berghelli, RPh, MS, BIDP/JCACO Director of Clinical Integration
BID-Plymouth Clinical Pathway Team
The Interventions
•
Implemented hospital wide LBP Continuum of Care Clinical Pathway in 2011 with
training/education of all key stakeholders throughout the community.
•
Gathered data:
1. Within ED for administration of STarTBack questionnaire to those patients with
LBP
2. Patients seen at BIDP ED for LBP and percentage of return visits to ED for those
groups who did follow through with referral to Spine Center and those patients
who did not follow through with their referral to Spine Center
3. Data for patient satisfaction and appointment offered within 48 hours of ED visit.
4. # of admissions for past 3 years with diagnosis of MS DRG 551 and 552
•
Track changes in measures defined above.
Lessons Learned
•
When appropriate resources are established, physicians will employ patient centered,
evidence based care for low back pain patients.
•
Involving key stakeholders at the initiation of the project ensures ‘buy in’ and greater ease
during implementation and increasing physician behavior changes
•
Utilization of a Primary Spine Practitioner model facilitates quality care for patients and
enhances “Patient-Centered Care” for LBP patients within the BID – Plymouth system
Next Steps/What Should Happen Next
•
Continue to monitor the above data sets to ensure sustainability of the model and make
modifications if trending changes to ensure patient centeredness and quality.
•
Expand the BIDP LBP Continuum of Care Clinical Pathway to other facilities within the Atrius /
BID health care system
For more information, contact:
James A. Berghelli, R.Ph.,MS
Director of Clinical Integration/JBerghelli@BIDPlymouth.org)
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Ian Paskowski (<a href="mailto:ipaskowski@jordanhospital.org">ipaskowski@jordanhospital.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Spine Care
Emergency Department
Quality and Safety
Clinical Integration
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Plymouth
Project Team
Ian Paskowski
Christine Healey
Mark DeMatteo
Jessica Nichols
Judy VanTilburg
James A. Berghelli
BID-Plymouth Clinical Pathway Team
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
BID - Plymouth Low Back Pain Clinical Pathway
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/1842a6b3e29f2421db8469d4155ac341.pdf?Expires=1712793600&Signature=klr0XZTazcEGOk5N-9gXG7XnL1pMJd0NJt0xqQsB1UQ25Kj3j9Q9HrFkSoGuo6FE1CXuH15FjcdKsqJPIlRYwwEtGRgQEMKy0ugf-rtakAgGytNXOcxvQNI1yMoHgpSiF84i0UT68UUApa2hIO%7E56GT4LfPd43RiHM5SJ8BuYuSY0ynlxM9uDXuAxlkcv335-WMUMb04SQXlS5J%7E0M7xECr340yP5eaWd-u5aXinfODtpYYcaqaav5xk9wGsj1uop5%7EMsuhztQmbb4u0p8aa7mLDB%7EUOPWnu3TD9pWad7Cx8WhT1TW0dvGTvUaecEVxCTia3JPe%7EQv2zyUM46kV-1w__&Key-Pair-Id=K6UGZS9ZTDSZM
35b0a6360220f6881d24352b05791bad
PDF Text
Text
BIDMC: BECOMING A NETWORK
by Integrating the Supply Chain at Affiliate Hospitals
The Problem
BIDMC is a fast growing network of hospitals. To achieve the benefits of an affiliation,
the supply chain at the Boston campus must work closely with the affiliates to align
products, purchases and processes. Some of the problems encountered were:
Different material management information systems not permitting access to
item file information which made standardization opportunities difficult.
Various processes for approving new products and initiating saving initiatives.
Different supply distributors for medical surgical supplies.
Lack of standard supply chain communication processes between facilities.
The Goal
The goal was to streamline communication and processes throughout the supply
chain network to include contracting/purchasing, materials management, the Group
Purchasing Organization (GPO) and Clinical Quality Value Analysis (CQVA).
The Interventions
The “Team” traveled to Needham and Milton hospitals monthly having
meetings to include key leadership within supply chain and administration.
Purchasing and contracting personnel were incorporated in weekly roundtable
contracting meetings in Boston.
Needham converted to a “Just In Time” distribution model with our Med Surg
Distributor with close oversight and assistance from Bill Pyne
Milton also converted to the same Med Surg Distributor to provide continuity at
all three campuses.
Novation reviewed potential contracts, conversion opportunities, monitored
pricing, and tracked results.
CQVA is an embedded process at each facilities product committees, to guide
initiatives and monitor savings.
The Results and Progress to Date
The Team
Bob Cherry, SVP Support Services
Steve Cashton, Director of Contracting and Purchasing
Shane Egan, Director of Finance for Support Services
Chip McIntosh, Director of CQVA
Nancy Miller, Sales Executive On-site for VHA/Novation GPO
Bill Pyne, Director of Materials Mgmt.
In FY’13, $643,402 in supply costs were attained for Needham and Milton
hospitals. BIDMC is on track to save $1.6 million in FY’14 for all three of our
affiliates.
Needham and Milton experienced a successful implementation of a “Just In
Time” (JIT) program for delivery of medical surgical supplies reducing
warehouse space.
Purchasing silos were reduced as each facility now has access to the same
contracts and pricing.
Collaborative relationships were built to foster trust and further engage in
streamlining processes which further integrated all three facilities.
The Lessons Learned
Executive support at each facility is paramount.
Community hospitals have unique needs, they are quicker to redesign
processes, but they may not have the resources to make those changes
happen without support from the Boston campus.
Next Steps
Review a process to integrate the affiliates master item file and purchasing
history with the Boston campus
Implement a process to track initiative conversions at affiliate sites.
Review the supply chain and purchasing structure with affiliates to be
consistent with Boston campus leadership
Continue same process with new affiliates
Request further standardization and price reduction from vendors as our
physicians from BIDMC practice at our affiliates
Focus on moving outsourced purchased services at affiliates to an in-sourced
BIDMC model.
For more information, contact:
Chip McIntosh, NP, PhD
Director Clinical Quality Value Analysis (CQVA)
amcintos@bidmc.harvard.edu
�
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Chip McIntosh (<a href="mailto:amcintos@bidmc.harvard.edu">amcintos@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Support Services
BIDMC Location
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BIDMC
Project Team
Bob Cherry
Steve Cashton
Shane Egan
Chip McIntosh
Nancy Miller
Bill Pyne
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Title
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BIDMC : BECOMING A NETWORK by Integrating the Supply Chain at Affiliate Hospitals
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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pdf
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1beb173fc679d8fd354fe1037482dfb1
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Text
BIDMC Outpatient Parenteral Antibiotic Therapy (OPAT)
Program: Process Improvement Study
The Problem
The Results/Progress to Date
The BIDMC OPAT program is dedicated to providing longitudinal care for patients
requiring prolonged intravenous antimicrobial therapy in the outpatient setting. A
continued increase in patient volume has strained the resources of our service and
prompted our study of process improvement.
Our program received 302 requests for patient enrollment from 7/1/13 to
12/31/13.
Our current major problems recognized are: 1.) enrollment is requested by
email communication 2.) patient tracking is performed using an excel spread
sheet, leading to significant time spent on updating and managing this list.
We sought to study our time spent on the tasks involved in our program to
identify ways to enhance the efficiency and timeliness of our patient care.
Baseline time study data is presented in Graph 1. Data demonstrates 6-10
hours/week spent on the review of lab results and result entry into OMR.
Approximately 8-10 hours/week are spent on calling to request lab work. 5-10
hours/week are spent on managing our current excel spreadsheet.
Aim/Goal
To perform a time study on the OPAT clinic staff assessing the time spent on
the standard tasks of enrollment, monitoring and medication adjustment.
To develop and implement IT support for patient enrollment, lab monitoring
and clinic visit tracking, eliminating the need for an excel spreadsheet.
To study a change in available time dedicated to direct patient care, lab review
and management of abnormal lab results.
The Team
Division of Infectious Diseases: Mary LaSalvia, M.D., Rachel Baden, M.D., Laurie
McGuire, R.N., Christina Fowler, MA, Sharol Vaughan, R.N., Mimi Gunning, Admin,
Robyn Bluestein, Clinic Manager, Dept. of Medicine: Julius Yang, M.D., Angela Tess,
M.D., Dept. of Health Care Quality: Sarah Moravick, M.B.A., Ken Sands, M.D.
The Interventions
The Medical Director shadowed each member of the team to outline the
current processes.
Worksheets were created by the group, outlining each task of the program
with start and stop times to document duration of time spent on each task.
Three weeks (11/11-11/15, 11/18-11/22, 1/6–1/10) of data were collected by
the OPAT clinic staff.
Request placed for IT programming to create an OPAT Program order field in
OMR to allow for the creation of a census and enhanced patient tracking.
Lessons Learned
Our staff spends a significant amount of time each week calling for labs and entering
the results for physician review. We expect to significantly decrease the time required
managing our excel spreadsheet with IT support. However, we will need to pursue
further intervention regarding outreach to referring physicians, home infusion
companies and rehab facilities to impact the time spent calling for lab results.
Next Steps/What Should Happen Next
Repeat our time study post intervention after implementation of IT support
for census management
Meet with representatives of our frequently used home infusion
companies and rehab facilities to standardize the day of lab draw and
result communication to our program
Consider enhanced ID input on medication/lab orders at the time of
discharge
For more information, contact:
Mary LaSalvia, M.D.,
Clinical Instructor, Division of Infectious Diseases
mlasalvi@bidmc.harvard.edu
�
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Mary LaSalvia (<a href="mailto:mlasalvi@bidmc.harvard.edu">mlasalvi@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
Division of Infectious Diseases
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Mary LaSalvia
Rachel Baden
Laurie McGuire
Christina Fowler
Sharol Vaughan
Mimi Gunning
Robyn Bluestein
Julius Yang
Angela Tess
Sarah Moravick
Ken Sands
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BIDMC Outpatient Parenteral Antibiotic Therapy (OPAT) Program: Process Improvement Study
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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5038f322b79882ab81f5627a40b0ae9e
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Text
CaterTrax –Tracking Opportunities in Floor Stock
Problem
The Results/Progress to Date
Outpatient clinics were allowed to pick up food for their unit from the kitchen and were
not being cross-charged for the products. This uncontrolled process was causing
food costs for the department to increase (tracked on the monthly DBCR report).
There were other resulting issues including inefficient ordering/storage systems as
well as non-food employees (likely not trained in food handling procedures) in the
kitchen. It was ineffective, inefficient and compromised the safety of our kitchens.
Aim/Goal
CaterTrax was a software program already in place for customer ordering for catering
events. This best practice needed to be utilized for outpatient floor stock ordering as
well. Our goal was to have over 75% of ordering through the online tool within five
months. In doing so, the aim was to implement a more efficient ordering system,
increase accountability of ordering and decrease food waste while allowing food
service staff to manage food preparation and deliveries.
The Team
Gail Spileos, Catering, Sodexo Food Services
Lucy Addo-Frimpong, GCRC Diet Technician
Chris Weiss, Account Controller Sodexo Food Service
Bob Drinan, Storeroom Attendant, Food Services
Joanne Radziejowska RD, GCRC Manager
CaterTrax Technical Support
Nora Blake, Food Services Director
Overall, spending continues to decrease in all outpatient clinics despite high census and
increase in patient floors/clinics. Thus, floors are more aware and accountable of what
they are ordering/consuming, thus having a more efficient system.
Lessons Learned
The Interventions
Create standard template in CaterTrax (electronic online ordering system) for
floor stock purchasing
Meet with each clinic to determine their demand, frequency of ordering,
special requests and any budgetary allowances for charging
Trained outpatient clinic employees how to use CaterTrax for ordering floor
stock as well as inform them of our standard offerings.
Train storeroom employees to pull CaterTrax orders, collect products and
manage delivery or pick-up systems which means less time away from the
patients and more time to focus on patient care.
Costs are cross-charged and tracked, giving outpatient clinics more visibility
on what they are spending, hopefully allowing them to control their
consumption more efficiently.
Some clinics were able to allow for spending in these areas and pay for
product directly to food service
An impressive unexpected outcome was the time saved by both the food service and
outpatient clinic staff. Labor time to pick up the orders by non-food employees took
upwards of 1 hour. Due to leaned processes the food service staff can create the orders
for pick up or delivery saving hours weekly/annually.
Next Steps/What Should Happen Next
The next goal is to “spread” this improvement and utilize CaterTrax and the floorstock
module for inpatients as well.
Food service employees can continue to handle inpatient floorstock, but enter
the deliveries and pick-ups in real time with the use of an ipad.
This will improve the accuracy of floorstock cross-charging and allow endusers electronic tracking of their consumption.
An improved process flow will decrease labor by eliminating the waste of
timely manual data entry.
For More Information Contact
Gail Spileos, Catering Manager
Sodexo Foods Services
gspileos@bidmc.harvard.edu
�
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Gail Spileos (<a href="mailto:gspileos@bidmc.harvard.edu">gspileos@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Food Service
Outpatient Clinics
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Gail Spileos
Joanne Radziejowska
Lucy Addo-Frimpong
CaterTrax Technical Support
Chris Weiss
Nora Blake
Bob Drinan
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Title
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Catertrax - Tracking Opportunities in Floor Stock
Date
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2014
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pdf
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8c92a49f9ab5063e00c158f3ac884054
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Text
Stat Cesarean Deliveries!
Improving Efficiency & Communication
The Problem
Cesarean delivery is sometimes performed emergently because of concern for
the wellbeing of the fetus. This is a very high-risk event.
Emergency cesarean delivery requires activity by multiple teams of caregivers.
These activities require coordination, communication and teamwork.
Historical practice was to train each team of caregivers independently.
This resulted in great variability of individual practice and inconsistent results.
The Results/Progress to Date
Staff activities have been reassigned with several changes:
o
o
o
Reduction in number of people needed to complete tasks
Reduction in time required to complete tasks
Reduction in number of missed items
Aim/Goal
To create a standardized practice for caregivers that would result in consistent and
efficient teamwork.
The Team
Tracey Pollard RNC, BSN –Labor & Delivery
Susan Crafts MS RN- Labor & Delivery
Toni Golen MD- Labor & Delivery
Phillip Hess MD - Anesthesia
Amanda Russell RN- Labor & Delivery
Leslie Guglielmo RN- Labor & Delivery
Tom Laws- Media Services
The Interventions
A series of in situ simulation sessions were scheduled creating an
environment similar to an emergency cesarean.
Each session included dedicated observers who recorded events and took
notes, and sessions were also filmed by media services.
Observations of practice from observers and filming were made and corrective
changes were brainstormed.
Actions focused on the movement and activities of personnel, specifically
eliminating unnecessary actions and coordinating activities.
Staff education occurred prior to the next session as to the expectations for
each team member.
After multiple observations, changes were made to attempt to improve
coordination of the team tasks.
Interventions were focused on
o
o
Room preparation and instrument counting
Patient preparation by nursing
Lessons Learned
Education of multiple disciplines is difficult with many different opinions and
agendas
Designing staff roles allows for standardization of care and improves the
ability to effect further changes
Some things are unpredictable: e.g. Staff who are right vs. left handed affect
foley insertion assignment
The Plan-Do-Check Act process can be used to improve teamwork function in
healthcare.
Next Steps/What Should Happen Next
Continue monthly drills for both training and further improvement
Goal of including every staff member at least once
Examine STAT Cesarean sections to determine the effect
For more information, contact:
Tracey Pollard RNC, BSN L&D
tpollard@bidmc.harvard.edu
�
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Tracey Pollard (<a href="mailto:tpollard@bidmc.harvard.edu">tpollard@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Labor and Delivery
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Tracey Pollard<br />Susan Crafts <br />Toni Golen<br />Phillip Hess<br />Amanda Russell<br />Leslie Guglielmo<br />Tom Laws
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Title
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Stat Cesarean Deliveries! Improving Efficiency & Communication
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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pdf
Efficiency
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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/24ece5aabb06ef4befbdc7bfd8f5ec4d.pdf?Expires=1712793600&Signature=Ll7ESsy5WMRbS0hQKA2HefNhZkPfWo2Pztl86lNS78Rr9VZPBZhZemO6DoxEFg3Bl-kXqqNVJ%7Ek1%7EY-CyzqtrLRJssatO8-aYrsBGBPixNyW-G8shFariD0gjtpvAe50rs9GDJHkAqY0C6nfReJpJg4dErt2OuQH9BIBCOvZKDt1Wov7oJrC7AO8qvu25s8AUYaRe19alLCe17A5Z2BFs4mHwtGTboibJx5Vm7SgEqwrh3tVrmkTtziv0I0Dt6gaQutHbCMv6lom94SRWRlfiq5yiUIQTYdpqhq4M78YKqSWgqOldxDZCpz8WS54fXuRxL81-bgZLsgyGHkfzoUL3Q__&Key-Pair-Id=K6UGZS9ZTDSZM
b7671fd50c2d16c332dfc31fdd909bf5
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Coordinated Care in Massive Obstetric Hemorrhage
The Problem
The Results
A 32 year-old female presented to Labor & Delivery at 31 weeks gestational age with
known placenta percreta for Cesarean/hysterectomy. Her obstetrical team recognized
the potential for massive hemorrhage and began planning
months in advance.
After approximately 12 hours (8 hours in the operating room, 4 hours in interventional
radiology) the patient was transferred to the Finard ICU intubated in stable condition
on a low dose vasopressor infusion. A balanced transfusion ratio of 6:6:6:1 (pRBCs,
FFP, platelets and cryoprecipitate) had been designated in advance and was
reflected in every cooler received from the blood bank. Only three calls to the blood
bank for general updates were required the entire case. Estimated blood loss was
greater than 60 liters.
Placenta percreta is associated with a high morbidity and
mortality, and many aspects of the Institute of Medicine
Dimensions of Quality Care were required – Effectiveness,
Efficiency, Timeliness, Safety, and perhaps most importantly,
Patient Centeredness. Preparation for this case was
markedly different from a normal delivery.
Goals
Our goals were 1) deliver a viable, healthy infant and 2) maintain end-organ perfusion
to minimize morbidity to the mother in the face of massive hemorrhage.
The Team
Multidisciplinary, collaborative preoperative planning group
Anesthesiology team
Blood Bank team
Gynecology/Oncology team
Interventional Radiology team
Neonatology team
Obstetrics and L&D nursing team
Urology team
Additional colleagues called to the
operating room to assist
Acute Care Surgery team
East OR staff/team
Perfusion (cell saver) team
Vascular Surgery team
The Interventions
The anesthesia team was divided into roles - one person was assigned to each of the
three intravenous catheters, one person charted and sent labs every 30 minutes, one
checked and distributed blood products and one communicated with the OB team,
administered miscellaneous medications (calcium, antibiotics, muscle relaxant,
narcotics, anti-fibrinolytics). Coordinating everything was one senior anesthesiologist
who was designated team leader. A dedicated OB nurse made continuous trips to the
blood bank with coolers.
Transfusion totals included 73 units of pRBC's, 72 units of FFP, 66 units of platelets,
12 units of cryoprecipitate, ten liters of crystalloid and a liter of cell saver.
Obstetrics and anesthesia maintain preparedness for cases of this magnitude with
simulation as well as a maintaining an obstetric hemorrhage protocol.
Labs upon arrival in the ICU showed a pH of 7.53, a normal ionized Ca++ (nadir was
0.26), lactate was 3 mmol/L (peak = 8.3), Hct was 25% (nadir was 21%). Coagulation
profile demonstrated an INR of 1.3 (peak = 1.5), fibrinogen of 203 and platelets of
79,000 (nadir 62 K).
Mother was extubated on POD #5 and transferred to the floor on POD #8. Her
newborn son was transferred to the NICU for care related to his prematurity.
Lessons Learned
Preparation for these patients demands coordination among multiple disciplines well
in advance of delivery. Interventional radiology was involved pre-operatively but
general surgery and perfusion (for cell saver)
were not; given the important role they ended
up playing it would have been optimal to
include them in surgical planning.
Assigning specific roles to each anesthesia
provider in the operating room was essential
to maintaining order in the controlled chaos of
having multiple surgical teams in the
operating room and the near-constant
checking, documenting and administration of
over 150 blood products.
The unconventional 6:6:6:1 ratio of pRBCs,
FFP, platelets and cryoprecipitate
transfusions resulted in minimal coagulopathy
both intra-operatively and post-operatively.
Next Steps/What Should Happen Next
A post-operative debriefing with nearly all involved parties led to several suggestions
for future similar cases including a more standardized pre-procedural checklist,
involvement of several departments earlier, and a more in-depth discussion of
whether these cases should be done on Labor & Delivery or downstairs in the main
operating room.
For more information, contact:
John McNeil, M.D., jsmcneil@bidmc.harvard.edu
Yunping Li, M.D., yli1@bidmc.harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
John McNeil (<a href="mailto:jsmcneil@bidmc.harvard.edu">jsmcneil@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Multiple
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Anesthesiology team <br />Acute Care Surgery team<br />Blood Bank team <br />East OR staff/team <br />Gynecology/Oncology team <br />Perfusion (cell saver) team <br />Interventional Radiology team<br />Vascular Surgery team <br />Neonatology team <br />Obstetrics <br />L&D nursing team <br />Urology team
Dublin Core
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Title
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Coordinated Care in Massive Obstetric Hemorrhage
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Patient and Family-Centeredness
Safety
-
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e4bb328b2e7e4a8c212374320d7332ad
PDF Text
Text
Creating a Medication Knowledge Assessment Test
The Problem
The Steps Taken for Practice Change
The Medication Assessment Test used to assess basic medication
knowledge of new-hire RNs was outdated and did not reflect current practice.
Additionally, the way the test was applied lacked consistency between units.
A nursing group met monthly for 6 months to review test and decide if
Aims/Goals
Develop a medication assessment test using evidence and best
practice models. The test should include:
o Questions that reflect organizational priorities
o Questions that have been suggested by staff, Unit Based
Educators, Clinical Nurse Specialists, and Nurse Managers
based on lived experiences
Develop a medication assessment test that has been tested by endusers and vetted through representatives of the various clinical
specialties and job roles in Nursing
Develop a standardized approach to delivering the test
Develop a standardized approach to remediation
any questions remained current
A review of the literature revealed there was no consistent standard for
assessing medication knowledge of new-hire RNs
The UBE group was asked to provide question recommendations based
on their lived experiences
A 25-question Medication Knowledge Assessment Test was developed,
tested using Survey Monkey, and revised based on feedback
The Team
John Whitlock, RN, MS; Clinical Nurse Specialist, Cardiac Surgery &
Invasive Cardiology
Bridgid Joseph, RN, MS; Clinical Nurse Specilist, Emergency Cardiac
Care
Jennifer Barsamian, RN, MS; Clinical Nurse Specialist, 12 Reismann
& 5 Stoneman
Marnie Chaves, RN; Unit Based Educator, Farr 6
Kathy Baker, RN, MS; Clinical Nurse Specialist, 11 Reismann &
Feldberg 7
Kim Campbell, RN, MS; Unit Based Educator, Farr 7
Tracey Pollard, RN; Unit Based Educator, Labor and Delivery
Linda Denekemp, RN, MS; Nurse Manager, Farr 5 & VICU
Christine Kristeller, RN, MS; Clinical Nurse Specialist, Farr 11 & CC7
Progress to Date
The revised Medication Knowledge Assessment Test was implemented
Summer 2013 and entered into myPATH Fall 2013
Next Steps/What Should Happen Next
Monitor pass/fail rate using myPATH Learning Management System to
determine if further changes need to be made
Monitor compliance of test application for new-hire RN using myPATH
Learning Management System
For More Information Contact
John Whitlock RN, MS
jwhitlo@bidmc.harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
John Whitlock (<a href="mailto:jwhitlo@bidmc.harvard.edu">jwhitlo@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
John Whitlock
Bridgid Joseph
Jennifer Barsamian
Marnie Chaves
Kathy Baker
Kim Campbell
Tracey Pollard
Linda Denekemp
Christine Kristeller
Dublin Core
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Title
A name given to the resource
Creating a Medication Knowledge Assessment Test
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/63147cda31d7b540e85ed622ad64c507.pdf?Expires=1712793600&Signature=dpd1YMAq6CBOYSSB1BG479S7MwS5rHpY8ES4bN6gqKivO0FTXPZwxyOgUMAmWzWZ4qbukEUYryEppzDCyHPDWdU1ZOND-0avodZI4BED2QvJWrG332qciIxxMfLUwPBb55BT2YR2lbZclHPrh3K7AZhONzbq7-vTcc2CikPKEEQwxqPMqTUj4bguxyyfDq5TQxZNvi-Rd7gchz7ZBg6nmEOzJ9zmCYhIynMtZTvt2nZUfMdsqVya6eUZVYEczIyj3oHm0pRY2WznrNpFt8YNaWMMSquB%7E7kpUPd-Q6tEYc%7EFzTmNxD5yGw%7EAder8kTiITwUo2rybdfKVBd3325mDMQ__&Key-Pair-Id=K6UGZS9ZTDSZM
484bb1f04ee7934749d4d129b398d79f
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Text
Data Driven Education for Front Line Staff
The Problem
The Results/Progress to Date
We wanted to have meaningful use of data in frontline care. We continually use
Quality and Safety audit data to identify compliance with process as well as gaps in
nursing staff knowledge and want to effectively use these results to target our
education toward identified problem areas.
Metrics that were removed began with 30‐45% compliance rate and with
education improved to >99% and this was sustained over multiple quarters
.
120
Meaningful use has been defined as” using electronic health records to improve
quality, safety, efficiency. “(Health IT. gov.)
100
Aim/Goal
80
To provide real-time education and feedback derived from the monthly audits to
correct substandard practice, thus supporting efforts to prevent harm and improve
patient outcomes.
60
40
To monitor meaningful metrics and return compliance summaries that align to internal
priorities, external reporting requirements and pay-for – performance initiatives.
20
The Team
0
Kim Sulmonte,
Jaime Levash,
Barb Donovan,
Linda Denekamp,
Susan DeSanto Madeya,
Susan Kitchens
White Boards
Clean shared
equ
1st Qtr
2nd Qtr
3rd Qtr
4th Qtr
45.9
99
99
99
30.6
99
99
99
The Interventions
The team’ wanted to focus our audits on current new roll outs:
We solicited input from staff and colleagues about the need to change the
Lessons Learned
metric to assess new rollouts
Added “yes with correction” to allow for real time staff training to reinforce
correct practice
On-going performance measurement and monitoring to assess effectiveness
of education.
We simplified the audit tool by removing those metrics we determined were above
benchmark for the prior year and added the new IHI fall bundle and IV observations.
Next Steps/What Should Happen Next
The Team will continue to:
Monitor monthly audits for need to focus on metric for education
Base our nursing practice decisions on real time audit information
identify improvement opportunities through data
It directs us to focus our resources where the need is the greatest.
Example: Changed metrics to assess new IHI fall bundle and new IV tubing
and Curos caps compliance.
For more information, contact:
Kim Sulmonte Associate Chief Nurse BIDMC Quality and Safety
ksulmont@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Kimberly Sulmonte (<a href="mailto:ksulmont@bidmc.harvard.edu">ksulmont@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Patient Care Services
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Kim Sulmonte
Jaime Levash
Barb Donovan
Linda Denekamp
Susan DeSanto Madeya
Susan Kitchens
Dublin Core
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Title
A name given to the resource
Data Driven Education for Front Line Staff
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/3a6928f604249f4faa84e780c68aac98.pdf?Expires=1712793600&Signature=HNIn%7EeEHOTtVbXuf7P55PlWEwq2EXKjRpUAhs84NDvve04P8%7EFTvdm%7Evmzd3uy5ENdnH5iuZBY7DTSClgoN90A93e2JflOFV4h3fsZFfvfJSNqWGa6CvB5pE84Yk9ix0ZJRx26GwS5Y8EsdEqCHxTTd6f1Y9ZA9I3Yrf4KD7%7Ess%7EV-fialKlPuERjxjPqumgmArVENLT1P2t3GZbCB9JVXnZV2sx4lvW1Wt2Kw2Ne-WKnd5GrOV33x2kyboRVAzl30kmZwmVQz0hW38ptz2-NBjyBy46iVpEpD4ATOe1ST4qHI4IRUwqIL4mrqmCtMlKxyQJCYDDILhVfA8sUtQSng__&Key-Pair-Id=K6UGZS9ZTDSZM
625eec750027a80e790bed1d40fc443c
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Text
Design Orientation to Engage New Faculty and Accelerate High Performance
Discovery Site: External Site Key Learnings
Defined 1‐2 Week Training Program including partnering with a designated trainer
Recognition for high performance
Staff is motivated and encouraged to develop job skills
Consultation with Workforce Development: Joanne Pokaski, Director
In‐person training & designated resource
An online resource guide or binder for quick reference
Aim/Goal
The Results/Progress to Date
Develop a comprehensive multidisciplinary perioperative orientation program for new
faculty and staff in Anesthesia, Surgery, and Perioperative Services.
Perform a needs assessment
Solicit current clinician perspectives and explore potential resources such as peer
mentoring, simulation, and a web‐based resources
Explore orientation practices at other institutions
Assess program quality by instituting 360 feedback
Most Useful Orientation Items: Incorporate in Onboarding Checklist
The Problem
Clinician engagement and retention are crucial to carrying out the mission of providing world
class, high quality, and coordinated care. Structured orientation programs for new faculty
are lacking in many departments, notably Anesthesia and Surgery. Inadequate orientation
during onboarding and lack of interdisciplinary training can result in high job dissatisfaction,
iindividual and system stress impacting patient care, retention challenges impacting MD and
RN shortages, and costly recruitment.
The Team
Anesthesia
Ruma R. Bose, MD
Brian P. Ferla, MD
Surgery
Selena E. Heman‐Ackah, MD, MBA (ENT)
Sahar Kohanim, MD (Ophthalmology)
John Tumolo, MBA, MPH
Nursing & Periops
Maureen Houstle, RN
Sheila Hunter, RN
Angela Kelly, RN
Charlotte Guglielmi, RN
The Interventions
Needs Assessment Survey Results: 104 Faculty & Periops staff respondents
Anesthesia & Surgery have revised departmental orientation processes to include
onboarding checklists with useful orientation items, resources for new Faculty, and
transparency in process
Surgery has implemented a 360 Review of Faculty
Lessons Learned
Key Takeaways Regarding Needs Assessment:
Orientation is NOT standardized across Departments and Divisions
Checklist for orientation should include key items
o A list of resources, names, numbers, maps, administrative contacts
o Clear definition of orientation, expectations, process & timeframe
o Orientation to IS systems
o Mentor/Preceptor(s)/designated resource for orientation
o Easy accessibility to Departmental Policies and Procedures, Guidelines
Multidisciplinary learning and strategy enabled identification of existing resources
and practices and how tools might be deployed to a wider audience
Perioperative Services maintains a well‐organized and thorough orientation
process reinforced by designated RN Educators
Scale: Creating an interdepartmental onboarding process electronic resources
requires significant resources and time to design and implement
Next Steps/What Should Happen Next
Use Departmental resources to create an Interdepartmental Orientation Process &
Checklist
Deploy Departmental and Interdepartmental Mentorship Program
Create of Online Resource Guide integrated into the Portal
Explore team building exercises across departments to improve communication
that includes both experienced staff and those employees new within the last year
For more information, contact:
Ruma Bose, MD, Anesthesia
rbose@bidmc.harvard.edu
Selena Heman-Ackah, MD, Surgery
sackah@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Ruma Bose (<a href="mailto:rbose@bidmc.harvard.edu">rbose@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Ruma R. Bose<br />Selena E. Heman-Ackah<br />Maureen Houstle<br />Brian P. Ferla<br />Sahar Kohanim<br />Sheila Hunter<br />John Tumolo<br />Angela Kelly<br />Charlotte Guglielmi
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Title
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Design Orientation to Engage New Faculty and Accelerate High Performance
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/2ad0f0043f62b9ef821079d487170fb0.pdf?Expires=1712793600&Signature=j5JFCsxnxDo7j%7EFkHabzIvX0PdVcHaANsUjB7H5U21wsi02zYFJcqwQF9jRnKCqcU7I8LH37UUtJW4TyI59XSDua2VqDvewgw3VR7p4NQSDJkrrX94q%7E%7EDPD6DpQGmvv-F3nDJUgerBgsbEpOmqtaehYA9xCgpSFMopHok0bL5-nJdRPQ-5lFdVYJBEqXd-3NvSGqUi89p9e73BLCSfqkCFn9xw6I1EI0Op2%7EsvOseT0R0KSCOypFdRPdM4vS729hDVNgePRS%7EPBRV6g-sQSR7KeFx-jsJJLJNBITAV8WLZ66cWPwW8z1ulYILEawyhKSC-%7En%7EozaAWi9JPifHlfPg__&Key-Pair-Id=K6UGZS9ZTDSZM
32a4720cf3d496abf633b16f0f9d2fa3
PDF Text
Text
Developing a Dynamic Postoperative Neurosurgical Triage System
The Problem
The Results/Progress to Date
An
increase
in
neurosurgical
and
high-‐risk
spine
volume
has
strained
the
resources
of
our
neurological
intensive
care
unit.
This
has
resulted
in
unplanned
admissions
to
other
critical
care
locations,
including
the
postoperative
anesthesia
care
unit
(designated
as
“neurosurgical
boarders”).
Data
supports
improved
outcome
when
such
patients
receive
the
specialized
care
provided
in
a
neurological
ICU.
Ø Collected
AIMS
Data
1/1/13-‐12/31/13
Ø Track
postop
destination
of
neurosurgical
patients
(in
progress)
Ø Correlate
data
since
implementation
(ongoing)
Aim/Goal
NEUROVASCULAR+
Ø Reduce
the
number
of
neurosurgical
boarders
by
designing
a
dynamic
system
to
effectively
triage
patients
between
levels
of
care
(Hospital
floor,
Step
down
Unit,
Neurosurgical
Intensive
Care
Unit)
FUNCTIONAL+
STEREOTACTIC+
SHUNTS/DRAINS+
TUMOR/CRANI+NOS+
EMERGENCY+
The Team
Dustin
Boone,
MD,
Anesthesiia
Brian
Ferla,
MD,
Anesthesia
Ron
Alterman,
MD,
Neurosurgery
Nicole
Catatao,
NP,
Neurosurgery
Suzanne
Joyner,
RN,
ICU
Patricia
Sorge,
RN,
ICU
N=#645#
Lessons Learned
Ø Resource
allocation
can
be
used
effectively
and
safely
to
triage
patients
who
undergo
neurosurgical
and
high-‐risk
spine
procedures.
The Interventions
Ø
Ø
Ø
Ø
Create
criteria
to
assist
with
triage
Daily
multidisciplinary
communication
Daily
pre-‐round
in
Neuro
ICU
to
identify
patients
who
can
be
discharged
Identify
patients
from
OR
who
would
need
admission
to
postoperative
Neuro
ICU
Next Steps/What Should Happen Next
Ø Expand
the
number
of
step-‐down
beds
Ø Continue
to
track
postoperative
critical
care
utilization
For more information, contact:
D. Boone, MD, BIDMC, Department of Anesthesia, Critical Care,
and Pain Medicine, mboone@bidmc.harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Dustin Boone (<a href="mailto:mboone@bidmc.harvard.edu">mboone@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia
Neurosurgery
Nursing
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Dustin Boone<br />Brian Ferla<br />Ron Alterman<br />Nicole Catatao<br />Suzanne Joyner<br />Patricia Sorge
Dublin Core
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Title
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Developing a Dynamic Postoperative Neurosurgical Triage System
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
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71aad7baab55a7539b40bde501015373
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Text
Development of Medication Barcoding & Surveillance Process within Pharmacy
The Problem
The Results/Progress to Date
In preparation for an electronic medication administration record (eMAR) and barcode
medication administration (BCMA), there was the need to develop a system within the
pharmacy to ensure all medications are dispensed with an accurate, legible barcode.
Significant workflow changes would need to be initiated at least six months in
advance of eMAR/BCMA go live, and were focused in these three major areas:
Medication receiving from wholesaler/manufacturer
Medication order processing and handling within the pharmacy
Dispensing medications to inpatient nursing units
Industry Standard ranges from 85%‐90% upon Rollout
Aim/Goal
Every medication dispensed from the pharmacy department will have an accurate,
legible barcode on it. Furthermore, these medications will be processed and
dispensed in a manner that promotes success at the bedside upon BCMA and
documentation within the eMAR.
The Team
John Hrenko, PharmD.
Dave Mangan, PharmD
Steve Maynard, CPhT
Jean Beach, CPhT
Sonia Najdzien, CPhT
Cristina DiSchino, CPhT
Kevin Afonso, IS
Allison MacLeay, IS
Lessons Learned
Frequent monitoring of eMAR/BCMA reports is critical in being able to
troubleshoot problems as they arise and ultimately improve success rates.
Moving to a new electronic medication administration system exposes some
of the vulnerabilities that existed and gone unnoticed within the previous
system. Examples include various elements of Provider Order Entry (POE),
Pharmacy Databases, Clinical Documentation, and workflows.
The Interventions
Creation of a quarantine process upon medication intake from
wholesaler/manufacturer to identify and add new barcodes to the pharmacy
database prior to any stocking and dispensing of the medication.
Development of a repackaging center, of which responsibilities include the
preparation of certain “problem meds” known to other eMAR/BCMA systems.
Examples include: ~40,000+ “half-tablets” annually, and medication drip kits
Changes in the processing, preparation, labeling, and dispensing of
medications to set up for success at the bedside.
Upon go-live, ongoing surveillance of bedside barcode scanning and any
medications administered without barcode verification.
requiring the ability to Plan-Do-Check-Adjust along the way.
Next Steps/What Should Happen Next
The importance of these processes within the pharmacy will become even
more crucial as eMAR/BCMA expands and we encounter more complex
medication order types and other areas.
Certain changes will need to be made within POE and the Pharmacy
system in order to promote future success as eMAR/BCMA expands
Increased surveillance and quality assurance of the processes will be
necessary to ensure the success of eMAR/BCMA.
Programming changes within the pharmacy system to allow for the ability to
print barcode labels upon processing/dispensing of medications.
Developing a homegrown eMAR/BCMA system is an iterative process,
For more information, contact:
John Hrenko, PharmD. Clinical Pharmacy Supervisor
jhrenko@bidmc.harvard.edu
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
John Hrenko (<a href="mailto:jhrenko@bidmc.harvard.edu">jhrenko@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Pharmacy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
John Hrenko<br />Sonia Najdzien<br />Dave Mangan<br />Cristina DiSchino<br />Steve Maynard<br />Kevin Afonso<br />Jean Beach<br />Allison MacLeay
Dublin Core
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Title
A name given to the resource
Development of Medication Barcoding & Surveillance Process within Pharmacy
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/2ad2381a3922aee0310ad6f1acd68b01.pdf?Expires=1712793600&Signature=byDsAH4WXHQnbPwqdBMfx2BRN30tQkOl%7EZZlBHRdGNRcC2Atv6Wx9mYLFGu8ivD95hH1G-l7xeigB-roKPR1YaceuvA8TndbD8RzXiCcx4-G9tRWLoWRZgoVs9F%7El2XGSHprDajhPtE4I%7E0qRb-KsNIPn8dtPyJZo1w4ff9XK-U1YrRyhkTBgqJIzVVHhzxikuzrxSx9Rmnn5OXt%7EW6hnLnPH-kF8p%7EvU6uS8hFzdFjAK76opcU9fJ4JHspuY2ulZFYcHLgo4%7EuaRHU8Ll3WwS273DfvhWtouRjtiKqRhefYd5cxtG0nLqs2mopctsyu%7ECZn8nHGOk23Fcerpd7jMg__&Key-Pair-Id=K6UGZS9ZTDSZM
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Do No Harm: Bridging the Gap between Food Services and Eating Disorder Treatment
The Problem
It is estimated that 8 million Americans have an eating disorder. Given the major
decrease in reimbursement rates, eating disorder patients are often forced to seek
treatment at higher care levels and thus receive an increase of their treatment in
hospitals.
Due to the nature of eating disorders, a collaboration between nutrition and food services
is essential. For these patients as well as many others, food is imperative to their
treatment. Inpatient treatment of eating disorders depends on food service to deliver
trays accurately and in a timely manner. Current food services eating disorder protocol
includes transferring beverages with nutrition labels to unlabeled containers, delivering
trays to the nursing station, and placing mandatory supervisor checks on all trays. Despite
these measures, there were discrepancies on trays. In order to further refine the eating
disorder protocol, additional measures have been introduced. Such accuracy on eating
disorder trays is essential because any discrepancies or missing items compromises
treatment and recovery.
Aim/Goal
Increase the accuracy of all patient line eating disorder trays by following the revised
protocol for breakfast, lunch, and dinner to 100% accurate per RN/RD feedback. The
protocol was designed to decrease the number of incorrect trays and missing items and
thus strengthen the role of food services in eating disorder treatment.
The Team
Julia Sementelli RD LDN Sodexo Food Service Mieka Martin, Sodexo Food Services
Susan Pereira, Sodexo Food Services, CDM CFPP Kelsey Whalen, Sodexo Food Services
Roda Somera Connell, RD, Sodexo Food Services Nora Blake, Sodexo Food Services
Patricia Samour, MMSc, RD, LDN, Nutrition Services Catherine Jackson, Food Services
The Interventions
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Focus groups with Clinical Nutrition and Food Service Management
Best practices reviewed at other hospitals
Eating Disorder Trays placed in a bag and sealed
Created policy on bagging trays introduced to primary eating disorder floors
Both “Tray Checked By Supervisor” bright orange sticker and supervisor signature
on all tickets
Printing out “red flag” patients and placing the list on the trayline and noting when
the ticket is expected to print to further enforce the need for a supervisor check on
each tray
Lessons Learned
The new requirements implemented to ensure eating disorder tray accuracy requires
additional time and effort from the manager on duty. However, given the significant
decrease in reports of discrepancies from the nursing staff of eating disorder
patients, the extra effort is certainly worthwhile.
Next Steps/What Should Happen Next
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Add eating disorder tray protocol to nursing manual
Focus group between clinical and food service
Monitor protocol to qualify efficacy and make necessary changes
For more information, please contact:
Julia Sementelli, RD, LDN, Patient Services Manager
jsemente@bidmc.harvard.edu
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Julia Sementelli (<a href="mailto:jsemente@bidmc.harvard.edu">jsemente@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Food Services
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Julia Sementelli <br />Mieka Martin<br />Susan Pereira<br />Kelsey Whalen<br />Roda Somera Connell<br />Nora Blake<br />Patricia Samour<br />Catherine Jackson
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Do No Harm: Bridging the Gap between Food Services and Eating Disorder Treatment
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency