Dr Adele Harrison; Island Health Jessica Belle, Shaun van Pel, - - PowerPoint PPT Presentation

Improvement in newborn care through increased compliance with the Neonatal Resuscitation Program: sustaining improvement

Dr Adele Harrison; Island Health Jessica Belle, Shaun van Pel, Ashley Jewett; Island Medical Program

Disclosure

• I have no affiliation with any commercial or

industry interest in relation to this presentation.

• Adele Harrison is a Neonatal Resuscitation

Program (NRP) instructor and regional instructor-trainer.

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Neonatal Resuscitation Program

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Key Measure

• Percentage of resuscitations in which there is

accurate documentation of correctly performed resuscitation as characterized by correct use of oxygen and correct use of ventilation pressures according to NRP.

• Target: 100%.

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Methods

• A multidisciplinary working group of healthcare

providers who were involved in teaching and clinical delivery of NRP was established.

• Hospital charts of up to 5 newborns admitted to

the Neonatal Intensive Care Unit were audited every 2 weeks from April 2012 to May 2013 and from November 2013 to February 2014.

• Plan-Do-Study-Act cycles were utilized to

evaluate change ideas

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Planning for Success: DICE Methodology

• Duration of project
• Integrity of project team
• Commitment of top management
• Commitment of employees affected
• Effort over and above usual work

– DICE Score =12 “Win Zone” (7 to 14)

Hal Sirkin, Perry Keenan and Alan Jackson. The Hard Side of Change Management, October 2005, Harvard Business Review .

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Early findings

Healthcare professionals like doing, not charting!

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Completion of Resuscitation Record Correct equipment available Team composition Knowledge/skills of NRP Improve compliance with NRP to 100% by March 2013

Specific Aim Key Drivers

Teach resuscitation record completion to NRP instructors Develop multidisciplinary NRP courses Develop VIHA “program” of NRP courses Develop recommendations for course content for different HCPs Implement checklist for resuscitation equipment

Design Changes/Interventions

Optimize team structure at deliveries

Strategy for Change

Team functionality

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Quality Forum 2013

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10 20 30 40 50 60 70 80 90 100 Percentage of records completed

Newborn extended resuscitation records completed

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10 20 30 40 50 60 70 80 90 100 Percentage of records initiated

Newborn extended resuscitation records initiated

median

10 20 30 40 50 60 70 80 90 100 Percentage of records completed

Correct use of pulse oximeter and oxygen documented

10 20 30 40 50 60 70 80 90 100 Percentage of records completed

Correct use of pressures documented

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4 8 12 16

Benefits Credibility of evidence Adaptability Monitoring Progress Involvement and training Behaviours Senior leaders Clinical leaders Fit with goals and culture Infrastructure

Sustainability

Sustainability Radar Chart

Source: NHS Institute for Innovation and Improvement. Sustainability Model and Guide.

• 2010. Adapted by BC Patient Safety Quality Council

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Key Factors in Sustainability

Strengths Challenges Benefits Efficiency Credibility of benefits Evidence-based Communication Adaptability of process System change Ability to monitor progress Ongoing Staff involvement/training From the beginning Behaviours towards change Some buy-in QI not part of the culture Senior leadership support Engaged Not visible Clinical leadership support Engaged and involved Strategic aims and culture Clear goals Culture Infrastructure Adapted environment

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Summary

• Visualize success
• Articulating clear goals and sharing the data

helped drive positive change

• Get everyone on board
• Including multidisciplinary clinical staff in the

process positively impacted sustainable change.

• Make it child’s play
• Environmental modifications and system changes

were powerful drivers of behaviour and promote sustainability.

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