Apr 9 2014

Improving safety for patients on warfarin therapy

Orthopaedic Surgery/Anticoagulation Service partnership helps meet National Patient Safety Goals for high-risk medication

A partnership between the Department of Orthopaedic Surgery and the Anticoagulation Service improves patient safety for orthopaedic patients who are on high-risk/high-alert Warfarin therapy.

Brian Kurtz, PharmD, and Shelley Howells, LPN, from Anticoagulation Services, discuss a patient referral.

Post-operative Orthopaedic Surgery joint reconstruction patients typically receive anti-clotting medications such as Warfarin (Coumadin) to prevent deep vein thrombosis (DVT)—blood clots in the calf or thigh. This is a life-saving but high-risk/high-alert medication because staff must closely monitor the therapeutic levels in the blood.

In fact, the Joint Commission has made reducing the likelihood of patient harm associated with anti-clotting medications a National Patient Safety Goal.

Back in 2012, U-M faculty, staff — and most importantly patients — were dissatisfied with the level of management this high-risk population received. So, in January 2013, a multidisciplinary team formed to tackle the issue – as one of the inaugural “Lean – Train the Trainer” Projects under the Michigan Quality Initiative.

Using several lean tools, the team identified tasks within their control that they could change to improve the process to identify and monitor patients—and to get them started in the service.

“After several meetings, we aligned clerical work with clerical staff and significantly reduced the involvement of the clinic/phone triage nurses and Joint Service mid-level providers associated with managing these patients,” says Dorothy Nalepa, administrative manager of the Taubman Center Orthopaedic Surgery Clinic. Read the rest of this entry »

Mar 19 2014

Operating room whiteboards help fight infection

Sometimes the best solutions are right before our eyes

Since the 1960s it has been known that certain procedures — such as hysterectomies and colorectal operations — run a high risk for infections, and that if surgeons use prophylactic antibiotics during these surgeries, infection can be avoided.

Now, the Health System hospitals operating rooms are using electronic whiteboards to inform OR medical staff of each patient’s antibiotic needs.

“We had already put up these giant screens in the ORs to show the patient’s name and procedure, and it occurred to us that we could put the screens to even greater use by adding the specific antibiotic individual patients should receive based on the procedure they are having,” says Mark Pearlman, M.D., professor of obstetrics and gynecology, and head of the OB/Gyn portion of the project. Read the rest of this entry »

Mar 5 2014

Safety Huddles: Sports tactic makes U-M hospitals safer, more efficient

University of Michigan hospitals are using a classic team tactic—huddles—to make things safer and more efficient for patients and staff.

These huddles are safety huddles—daily morning meetings that prep staff on necessary information, including patient admissions and discharges, problems with equipment, medication changes, support services, supplies and more. They run Monday through Friday, from 8:45 a.m. to 9 a.m.—a brisk 15 minutes—right after bed briefing.

Chris Dickinson, M.D., professor of pediatrics and the co-architect of patient safety huddles, leads a morning huddle to help staff make the hospital safer and more efficient for patients and staff.

Although the safety huddles have never been mandatory, “everybody wants to come,” says Scott Marquette, intermediate project manager at U-M C.S. Mott Children’s Hospital and Von Voigtlander Women’s Hospital. A typical meeting includes charge nurses, ambulatory care bed managers, laundry managers, support staff, biomed, Office of Clinical Safety and MCIT (Medical Center Information Technology)—in short, everyone with information to give to others and/or a need to know. Marquette sends information gleaned from the huddle to 190 managers and staff across Children’s and Women’s via email. Staff who want to be added to the email list should email Marquette.

“Like all hospitals, we have safety concerns,” says Chris Dickinson, M.D., professor of pediatrics and the architect, with Marquette, of the safety huddles. “To get people thinking about safety, you really have to change your culture. The safety huddles get people thinking about safety all the time. We talk about all sorts of error prevention strategies.” Read the rest of this entry »

Oct 22 2013

Improving work, enhancing care

CVC unit benefits from new Care Management model

This summer, the U-M Health System began improving how care is delivered to our patients through an initiative called Care Management.

Previously, discharge planners and social workers were assigned to specific services throughout the U-M Hospitals and Health Centers. Now Care Management designates a social worker and discharge planner to assist each unit based on where patients are located. Through the model, RN case managers are physically present on their assigned unit, connecting with patients, teams and providing support.

The initiative began in August with rollout on inpatient units in 5A, 5B 7C/D, CVC4 followed by implementation on all C.S. Mott Children’s Hospital inpatient units on Sept. 16.  Following implementation, teams have been rounding and working with individual units to determine what is working well, and identify issues for resolution.

Christopher Title, RN, BSN, clinical nurse supervisor at the Cardiovascular Center on ICU CVC 4, has already begun to see improvements on his unit.

“This initiative has changed our workflow in a lot of positive ways,” says Title.  “It has increased communication and made the process for transferring patients out of our unit more efficient.”

“The Care Management model has allowed us to better identify the patient’s transitional care needs and move them through the system quicker.”

As part of Care Management, Title’s team comes together each weekday to discuss the patient plan for the day, the plan for the patient stay, potential barriers to implementing the plan, along with clarifying assignments of members.  The daily team “huddle” consists of the advance practice team, charge nurse, case manager, social worker, nursing management representative, and bed coordinator.

Title says, “this type of daily collaboration and communication has led to improved transitional care within our facility, the right care in the right location for our patients, along with reducing the transfer times to outside extended care facilities” – important objectives of Care Management.

“When caring for patients, focusing on the family is always a priority,” adds Title. “Our CVC-ICU social worker Liz Rodems now works with case manager Cathy Kolpacki to identify issues like how patients will get home and who will to take care of them during those care transitions.  In addition, our charge nurse works closely with all team members to assure transitional care needs are met.”

In addition to improving patient care, the program is improving staff workflows and satisfaction.

“It has been great to have Liz and Cathy right on our unit,” says Title.  “We used to have to page or call a social worker and wait for help.  Now they are there every weekday to help. Our staff loves that.”

What is Care Management?

The goal of unit based Care Management is to improve communication and coordination of care through integration of discharge planning, utilization review, social work and more even distribution of case manager workload. In addition unit-based case managers and social workers are expected to interface with nursing and other care team members on the unit each day to ensure the plan of care is communicated and carried out in a timely and efficient manner as well as to ensure smooth transitions of care at discharge. They will coordinate with outpatient providers, home care and other services.

Additional information about Care Management, including resources and communication updates, can be found at http://www.med.umich.edu/i/caremanagement/

Sep 20 2013

Gifts of Art names winners of annual UMHS Employee Art Exhibition

U-M Health System employees have a plethora of expertise and skills that help our patients and keep our institution operating efficiently. Now the artistic talents of our faculty and staff are on display through Oct. 7 in the Taubman South Lobby Gallery, level 1 in UH.

From traditional paintings to collages and photography, UMHS projects are featured as part of the 26th Employee Art Exhibition hosted by Gifts of Art. Winners of the exhibition were named at the Artists’ Reception & Awards Ceremony on Sept. 10.

Ten Best in Category awards and a Best in Show award were determined by guest juror Gunalan Nadarajan, dean of the Penny W. Stamps School of Art & Design. A Peoples’ Choice award was given by popular vote from patients, visitors and staff.

The host for the event was Julia Donovan Darlow, regent of the University of Michigan. Winners were selected from 112 pieces submitted by 71 artists and 22 family members of UMHS employees.

“Contributing employees view the Employee Art Exhibition as an opportunity to share a part of themselves, their creative side that they usually can’t share in their jobs,” says Gifts of Art Visual Arts Coordinator Kathi Talley.

Brenda Miller, B.F.A., parent coordinator in the Brandon Newborn Intensive Care Unit, won Best in Category for Collage and Mixed Media.  Millers’ piece is entitled “Salamander”.

“The inspiration for my piece is two-fold,” says Miller. “A nurse in our Newborn Intensive Care wrote a story about a family that was in the unit, with characters from nature. Our conversations resulted in illustrations of these creatures. In addition, the focus of my work has been conservation, sustainability and protecting the most vulnerable.”

Miller’s daughter, Emily Slomovits, won Peoples’ Choice for her work ‘Les Miserábles’.  The mosaic is based on the original book cover art done by Victor Hugo.

Emily Slomovits stands by her work ‘Les Miserábles’ which won Peoples’ Choice in the Employee Art Exhibition.

“For our senior art project at my school, we had to make a mosaic,” says Slomovits, who is a musician and loves musical theater.  “‘Les Miserábles’ is one of my favorite musicals. The picture is so iconic, and I thought it would lend itself well to the medium.”

Chris Hardy, a supervisor in Health Information Management, won Best in Show for his black and white photograph “At a Distance You’re Strong, Until the Wind Comes”.

“In this piece, I found an old abandoned farm house off some rural road,” says Hardy. “Seeing it alone, isolated and centered right in the middle of a large overgrown field, reminded me of strength and loneliness. This simple wooden covered house, with its one window barely hanging on, conveyed the contrast of being so desperately alone in such a vast space, but still having that desire to stand strong through the isolation and despair.” Read the rest of this entry »