Going the [social] distance: Employees perfect quality improvements while staying safe

October 21, 2020  //  FOUND IN: Announcements,

While the COVID-19 pandemic has changed a lot about the way Michigan Medicine faculty, staff and learners do their work, one thing it couldn’t change was their commitment to improving the quality and safety of care for patients. 

Whether their work started before or during the pandemic, teams from around the organization are being recognized as part of this year’s Quality Month celebrations. Nearly 80 teams submitted posters highlighting projects aimed at everything from improving direct patient care to enhancing systems and processes to reduce possible safety risks.  

Below is a look at two teams whose work is helping Michigan Medicine continue on its journey to becoming a high reliability organization.

Improving diabetes screening 

Undiagnosed diabetes can cause significant health problems, including nerve damage, blindness, amputations, heart disease and strokes. Prediabetes, when blood sugar is elevated but not high enough to be diagnosed as diabetes, can be an early indicator and offers patients an opportunity for intervention before the disease progresses. The Centers for Disease Control and Prevention estimates that 88 million American adults (or one in three) have prediabetes, but 84 percent don’t know they have it.

The Diabetes Quality Improvement (QI) Committee at Michigan Medicine applied known diabetes risk factors to develop a best practice advisory (BPA) to identify patients with diabetes or prediabetes.

“Identifying patients who have diabetes or prediabetes, or are at risk for developing either condition, is an important step in treating the disease and reducing the risk of complications,” said Audrey Fan, M.D., assistant professor of general medicine, and co-lead for the Diabetes QI Committee. 

According to the 2015 U.S. Preventive Services Task Force recommendations, patients should be screened for diabetes if they are between 40 and 70 years of age and are either overweight or obese, based on their body mass index.

“Based on those criteria, we developed a BPA for MiChart that was implemented in primary care clinics as the initial testing phase,” said Fan.  “We utilized existing clinic workflows to reduce the burden on providers and increase the likelihood that the BPA would be used, which appears to have been successful.” 

Following implementation of the BPA, the reportable diabetes population increased by an average of 5.67 percent annually, nearly twice the average prior to the BPA. A review of the BPA data showed that in 2019, 77 percent of eligible patients had A1c or glucose testing done because the BPA fired, and about a thousand patients subsequently had a new diabetes-related diagnosis documented in MiChart. With proper documentation, the patient can be flagged to receive follow-up and repeat testing in the future. 

“In the end, this means more people will get the appropriate medical care to improve their health in the years to come,” said Fan.

It also means fewer diagnostic errors will take place — helping the organization move further along its journey to high reliability.

Managing medication, protecting patients

Another HRO principle is to reduce potential errors from reaching a patient in the first place, including errors in medication dispensing.

“Dispensing of medication in an inpatient pharmacy is typically a manual process. This makes it prone to both process error and human error, which could result in the dispensing of an incorrect product,” said Paul Workman, PharmD, the operational lead for CW10 Pharmacy. “As a department, we wanted to implement Dispense Prep (barcode scanning) to improve the reliability of our dispensed product and reduce the likelihood for harm to reach a patient.”

The team implemented the barcode scanning method into the dispensing process as an added safety check, and measured the percentage of products scanned with the roll-out of each initiative. This process is similar to barcode medication administration scanning (BCMA) at the bedside. However, it instead occurs within pharmacy at the point of dispensing, rather than administration. 

In the past when preparing medications, a pharmacy technician would visually check the label for the correct medication, dose, formulation, and number of doses, and pass it on to a pharmacist for final check. 

With over 7 million doses administered to Michigan Medicine patients each year, even a high performing staff would be at-risk for experiencing human error. Dispense Prep scanning helps to reduce this risk by providing an additional computer-check-technician process to ensure that the expected product is dispensed. The program is also integrated into Epic Dispense Prep. The individual patient’s medication label has a barcode printed on it, which can be scanned against the product being dispensed to confirm the medication, dose, and formulation.  

“This serves as an automated check regarding what is being dispensed,” Workman said. “In the end, it will limit the chances that human error could reach the next level of the medication process and potentially harm a patient.”

The implementation of Dispense Prep was associated with a decrease in dispensing errors reported out of CW10 Pharmacy.  Workman’s team plans to continue collecting data to assess compliance with barcode scanning usage and identify any process barriers that they can improve to ensure continued success with the new program.

“We are also in the process of assessing other areas of patient care to identify other risk reduction strategies to further avoid medication errors,” Workman said. “Patient safety is our top priority. Continuous improvement shows our commitment to caring, innovation, inclusion, integrity, and teamwork.”

Improvement efforts like the two highlighted here are the keys to successfully becoming a high reliability organization.

All Michigan Medicine faculty and staff are required to take high reliability universal skills training. If you have not already completed the training, don’t forget to log in and find it in your MLearning plan. More information on the eLearning series can be found here.