March 2010 E-zine
From the Medical Director’s Office
The 2010 Annual Meeting is history, and as we prepare to move forward with the exciting plans and projects that lay ahead, it may be worthwhile to stop and reflect on the past year. The admission temperature project has demonstrated that we can work together, from one corner of the state to the other, to reduce variation and improve performance on challenging perinatal projects. In the process we’ve dramatically improved our collaborative QI capacity and created a robust network to share challenges and evidence-based solutions. As a result, we now have the capability to take on Central Line Associated Blood Stream Infections and Human Milk for the Very Low Birth Weight as well as help our OB colleagues with their exciting 39-week project and breastfeeding promotion project. Additionally, we can start to develop new projects to find new opportunities to improve in the first hours of life with the Golden Hour project and further involve key stakeholders, particularly our families, with the How’s Your Baby project. There are many opportunities for each of us to be involved in improving our perinatal healthcare system, but just like the temperature projects, the statewide improvements only happen when each of us is improving what’s in front of us to improve. I hope each of you will read through this e-zine and find your project, your opportunity to improve outcomes for Tennessee’s infants and mothers.
TIPQC Annual Meeting Highlights
The 3rd Annual TIPQC Meeting was held on March 3-4, 2010 at the Cool Springs Marriott in Franklin, Tennessee, with over 265 participants. The first day featured speakers surrounding safety and perinatal issues included Gautham Suresh, MD, as well as M. K. Key who reminded us to “Celebrate to Bring Joy Back into the Workplace.” NICU project teams shared their temperature improvement stories and a highlight of this report can be found on the Admission Temperature Project Page.
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and Wellmont Holston Valley Medical Center share their temperature project.
The two NICU projects for this year, Central Line Associate Blood Stream Infection and Human Milk for Very Low Birth Weight, were discussed by our state leaders and expert panels.
and Sheri Smith (right) were the CLABSI project leaders and presenters at the conference.
New NICU projects were presented and voted on for development and then piloting this next year. The projects that will be developed this year are a family/discharge readiness project called “How’s Your Baby?” as well as a Golden Hour project. A focus group for engaging families in our teams and work also met. The second day’s focus was on obstetrics with Jay Iams, MD & Lucky Jain, MD speaking to the need to eliminate elective deliveries prior to 39 Weeks. For more information on how to join the Davidson County pilot of the 39 Week Project, please email brenda.barker@TIPQC.org or visit the project page. The second project for obstetrics involves OBs, hospitals and pediatricians in Breastfeeding Promotion. Much excitement and enthusiasm around all of the projects energized the meeting. One participant said, “Wonderful environment of professionals for change in this area. Identifying community and others outside of the clinical settings for resources and support is helpful. Comparing Ohio process with Tennessee’s process appeared to energize the desire to succeed and surpass others to have a national impact!” Another participant said, “I was most impressed by how far this initiative has come in such a short time. If you think about getting so many people in so many facilities working in the same direction, it is a wonderful accomplishment.”
The newest stakeholders joining our meeting this year were 8 Tennessee legislators: Senators Douglas Henry, Diane Black, Jack Johnson, Glen Casada, and Representatives Beth Harwell, Brenda Gilmore, Debra Maggart, and Mike Stewart and two gubernatorial candidates, Kim McMillan and Bill Gibbons. This was a great beginning to an ongoing conversation that we need to have with our elected officials to begin changing Tennessee’s outcomes for infants and mothers. One participant said, “A great conference–really enjoyed the legislative aspect–I think a lot of times we just focus on inside the hospital, but we can’t keep doing what we do without the government aspect and we have a responsibility as do our co-workers and staff.”
Chairman Jack Johnson, Representative Mike Stewart, Representative Brenda Gilmore, Chairwoman Debra Maggart,
Dr. Judy Aschner, and Mayor Rogers Anderson
A final participant said in an email to her colleagues who were not able to participate in the conference, “The TIPQC Conference for 2010 is over and there are many ideas swirling in our heads about QI projects that can change the face of infant mortality and morbidity in the state of Tennessee. And right now the piece of it we want to dig into is our project.” The work to improve continues as you learn, join the collaborative effort, and make a difference in the lives of those you serve!
Project Highlights
NICU – CLABSI Reduction
Thirteen teams have joined this project and are working across the state to eliminate CLABSIs! Dr. Gautham Suresh led a workshop for this group at the annual meeting and discussed: organizational culture, application of human factor principles to hand hygiene, videotaping to study central line insertions, and patient family involvement in prevention of hospital-acquired infections. Let’s continue to discuss these four areas on webinar Huddle #2 will be on March 25, 2 - 3:30 PM CST!
OB – Reducing Elective Deliveries before 39 Weeks
The Davidson County pilot reported their initial findings, barriers, and experiences at the annual meeting, along with featured speakers Dr. Jay Iams with the Ohio Perinatal Collaborative and Dr. Lucky Jain. To learn more about joining this project across the state, email brenda.barker@TIPQC.org and see how you can be involved in Reducing Elective Deliveries before 39 Weeks!
Project(s) in Sustainment
their temperature project in sustainment at the Annual Meeting.
NICU – Admission Temperature Project
The 22 NICU hospital teams had the opportunity to bring a poster to the Annual Meeting and share their improvement story. For their 12 month progress report, please go to admission temperature project page. As we enter into the sustainment phase for this project, webinars will be held every six months. Some of the teams have reached a 4 or 5 on the IHI scale for improvement projects, and should be congratulated for all their efforts! These teams will want to make sure your changes have been implemented, and now work to sustain those gains. Sustainment strategy is up to each team. If data collection is easy and automatic, follow all temperatures. For most teams, it is more challenging. It usually helps to have one project champion, and then ask them to go back periodically and check 10-12 consecutive admission temperatures. If everything is OK in one of these audits, come back and check again later. If you see that you are starting to back slide, then you may need to reconvene your team to help you understand why.
About 6 weeks before the follow up huddle this summer, we will send out an email asking everyone to collect data, probably 15-25 consecutive admissions of the type you were previously collecting.
Other teams will need to continue diligently working to regulate temperature during resuscitation and NICU transport until you reach your goals and stabilize your process. The next webinar for the temperature teams will be on July 28, 2010.
Projects Being Piloted
NICU – Human Milk Feeding Project
The four pilot centers met at the Annual Meeting and have completed 95% of their “tool kit.” Final revisions are in process and the teams anticipate active pilot testing in the coming weeks with a Summer 2010 target for statewide kick-off.
Project(s) Being Developed for 2010
OB – Breastfeeding Awareness Campaign
This project is being developed to incorporate the obstetricians, hospitals, and pediatricians. Julie Ware M.D. and Karen Schetzina M.D. have taken the lead to review the evidence on available interventions in each of the 3 domains and the development group ranked strategies for inclusion in this toolkit. A preliminary project data structure was outlined and will be developed in REDCap for pilot testing in the coming weeks.
Project(s) Being Developed for 2011
NICU – “How’s Your Baby?”
During the annual meeting, new projects were presented and “How’s Your Baby?” was one of two projects receiving top votes from the membership. We are still recruiting centers that might be interested in piloting this project. Monroe Carell Jr. Children’s Hospital at Vanderbilt will be leading this pilot group, along with Baptist Memorial Hospital for Women in Memphis, East Tennessee Children’s Hospital, and Johnson City Medical Center.
NICU – Golden Hour
The other new NICU project receiving highest votes by the membership for development is the Golden Hour Project. The Med will be leading this group along with Jackson Madison County General Hospital and Monroe Carell Jr. Children’s Hospital at Vanderbilt.
For information on all projects, see the projects page.
Family & Patient Corner
We want to encourage you to have patients & families on all of your improvement committees! For the NICU CLABSI project, we will be holding a family webinar on Wednesday, May 5 at 2 PM CST to help orient them to quality improvement. Please invite your family members, hospital family mentors, and others who want to learn more about involving families in our projects.
Please note that we have added a calendar feature to our website, where these dates and others can be found.
Watch the web for updates throughout the month!
Sincerely,
Brenda Barker, MEd
Peter Grubb, MD
M. K. Key, PhD
