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Quality & Safety

This past year in patient quality and safety affirmed that our patients and residents’ well-being is always worth taking to the next level.

2016-17 saw renewed vigour in our staff and Infection Protection and Control (IPAC) teams, with leadership shown from our point-of-care staff upwards, our lowest rate of C. Difficile (CDI) achieved since the inception of CDI surveillance, and a third consecutive year of recognition on a national level.   

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Antimicrobial resistance is an urgent public health threat. Optimal antimicrobial prescribing is our shared responsibility.

The Antimicrobial Stewardship Program’s (ASP) recent innovation, the ASP App (available for free download on iPhone and Android), provides prescribers with the tools to optimize prescribing and easy access to resources, including local clinical guidelines, antimicrobials on the hospital formulary (a list of medications that are readily available in the hospital), and antibiograms (patterns of antibiotic susceptibility in bacteria). The app also includes a call feature that connects users directly to PHC’s ASP Physician or Pharmacist.

Since launching the app, there have been more than 2000 downloads, and an estimated 900 active users. New messaging features are in development.

Making monitoring easier

Proper follow-up and surveillance following a C-section is a must, but new moms have enough to keep them busy without having to fill in a long-form survey on how their surgical wound is healing. Thankfully, a new web-based program has revolutionized this communication between hospital staff, and new moms.  

Following a caesarean section, the Quantified Care (QCare) program automatically emails and texts patients – whichever the new mom prefers – 30 days post-discharge with one question: “Have you had any problems with your surgical procedure?”  

A simple “no” response means that the surgical site is healing well and isn’t at risk for infection, whereas a “yes” flags the need for a follow-up phone to assess the symptoms and schedule an appointment if necessary. Patients and health care providers reported numerous advantages with using QCare including accessible and flexible follow-up (post-discharge response rate increased from 20% using traditional surveillance to 87% with QCare) and convenience and ease-of-use (the majority of responses were received in less than one day).

This innovative program was awarded a Quality Award from the BC Patient Safety and Quality Council (BCPSQC) in the “Getting Better” category in 2017.

CST

In the fall of 2016 a major milestone of the Clinical and Systems Transformation (CST) project was achieved.

The establishment of the new expanded Vancouver Pharmacy Production Centre, which was previously located at St. Paul’s Hospital, will be essential to accomplishing one of CST’s key goals of implementing closed loop medication management. PHC clinical leadership is participating in all levels of project governance, with subject matter experts and physician champions from VCH, PHSA and PHC providing input into the design of the new Cerner clinical information system. The first group of sites to be activated will be the Lions Gate Hospital campus and Sea to Sky sites.

Challenge, Accepted!

New for 2017, Providence launched its inaugural Quality Improvement (QI) Challenge: a complementary six-month professional development program, open to all PHC staff and care providers. 

Seven teams were accepted into the inaugural cohort, with the goal of learning to use  the PHC QI Framework to make lasting improvements in their work area. Participants are trained up in a quality improvement curriculum, being introduced to the standardized QI tools and methodologies used at PHC and, with the support of a QI mentor, ultimately using their learning to  bring to life an improvement project that’s  a priority for  their work area, with a goal of creating significant change by the time the Challenge wraps in September 2017.

Accreditation

Providence continues to use the Accreditation Canada framework as a key element to advance the Quality and Safety work.

Accreditation is an internationally recognized process that health care organizations use to demonstrate, evaluate and improve the quality and safety of the everyday care and services they provide to patients and residents. This process allows us to showcase our innovative work, identify areas of strength and those needing improvement, and celebrate the excellence of our care providers, physicians and volunteers. Accreditation is also a requirement for teaching and research.

Although health care organizations are surveyed only once every four years, it’s integral that the processes and themes highlighted during Accreditation are maintained as ongoing essential quality and safety priorities at Providence Health Care.  

Eight peer surveyors from across Canada will be onsite at all of PHC’s acute and residential, ambulatory clinics, administrative sites and select community dialysis clinics in November 20-24, 2017 to evaluate our everyday activities and services against national standards of excellence.

As we look ahead to our upcoming Accreditation Canada onsite visit we will continue to strive for excellence and demonstrate our compliance with the Accreditation Canada standard and celebrate the opportunity to be recognized as an accredited organization.

End of Life

Extensive foundational work has been done to move forward with our aim to improve end of life care for patients and residents throughout PHC.

Starting this summer, we will be holding workshops for staff to help develop confidence in using the “Serious Illness Conversation Guide” in order to support practitioners who need assistance in developing skill in having this conversation with their patients. Our intention is that serious illness conversations will become the norm at PHC, and working in partnership with the Palliative Care team we will ensure that patient/resident’s informed end-of-life wishes will be known and respected.

It’s all about the socks!

Falls prevention is a key priority for Providence. In conjunction with our recent  adoption of new Falls Injury Prevention guidelines, the Red Socks pilot project kicked off on 5A and 5B last fall in the hopes of helping reduce patient falls.

Many patients on 5AB, cardiac medical and surgical units at St. Paul’s Hospital, are considered high-risk for falls due to the side effects of sedation, multiple medications and heart failure. By using red socks to identify patients as at-risk for falls when they are not in their bed, hospital staff, the patient’s family and other hospital visitors will pay particular attention and offer assistance if a patient with red socks is struggling with mobility.

Before the pilot, the project team conducted a pre-assessment survey to assess staff comfort levels with identifying patients at risk for falls – 53% of staff felt they could identify a patient who is at high-risk for falling. After red socks were implemented the number increased to 92%.

St Paul’s Hospital Foundation donated the funding for the ‘Red Socks’, through the Enhanced Patient Care fund to make this pilot project possible.

It’s not just yogurt!

PHC has a culture too!  Patient safety culture surveys allow organisations to assess the strengths and weaknesses of their safety culture.  In 2016, we distributed our 4th Patient Safety Culture Survey, to all clinical and credentialed staff.  32% of recipients responded to the survey – and while we always hope for more, this is a big enough sample upon which to base our analysis.

Overall, we saw significant positive increases in staff’s perception of our patient safety culture at PHC.  Looking at the entire survey, positive response scores increased by 190 points.  This means that overall, respondents perceive patient safety in a significantly more positive manner since 2012.  

Our greatest gains are in staff’s perception of our organisational leadership’s support for safety and our commitment to embracing a learning culture. Where we still see our biggest opportunity is in living the ideology of a “just culture” – where people are not punished for making a mistake, but instead their decisions are viewed within the context of the system that is provided for them to work in.

 

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