2011 QUALITY IMPROVEMENT INITIATIVES
Clinical Improvement Project:
Abbott Glucometer Implementation and Ongoing Management
Implementation of an integrated glucometer by Abbott diabetes care for the purpose of enhanced bedside glucose monitoring.
Time Frame:
1. Design, Training, and Testing: November 2011-June 2012
2. Implementation and EMR integration: June 4th and ongoing
Project Description:
In order to improve patient safety and patient care outcomes in the diabetic patient population new glucometers were needed for bedside glucose testing. The current industry standard for this type of testing includes the use of technology designed to identify the patient, the strip lot number, and the employee performing the test. The device is able to scan bar codes on the patient’s wrist band, scan the reagent strips to assure a current product, and scan the employee’s ID to assure accountability in resulting. This information is then uploaded directly to the electronic health record and makes the result available once the device has been docked in a designated docking station. In addition to these patient safety features the system is able to track staff competency, device functionality, and has advanced data reporting capabilities. Software associated with the glucometer will track when an employee needs to be retrained and will not let them use the device until they satisfy this requirement, it will track all quality measures that are performed daily to assure device accuracy, and it will historically log results that are unit and patient specific. Turning this information into retrievable discrete data allows the clinical management staff the ability to run periodic reports and monitor the quality of patient care delivered at the bedside. In addition, the advanced features of this system allows for insight into how we are caring for the diabetic patient population over time while offering the opportunity to improve the care we deliver based on this data.
Problem:
Grace Cottage Hospital is a critical access facility with a three bed emergency room and a 19 bed inpatient unit caring for skilled nursing patients and the acutely ill. According to the United States Department of Health and Human Services “diabetes affects 25.8 million people of all ages” comprising “8.3 percent of the U.S. population”. Due to the prevalence of diabetes in America, organizations need to prioritize maintenance of the most current and safe patient care practices within this population. For this reason, the clinical staff at Grace Cottage determined the need to upgrade our existing bedside glucose testing devices to those that offer state of the art patient safety features found in more modern technology. The existing system did not offer any reporting capabilities nor did it store information centrally. In addition, patient and employee identification at the bedside was not a built in mandatory feature, it did not have bar code scanning capabilities, nor did it integrate directly with our electronic medical record. All of these missing features increased the possibility of misidentifying a patient, entering the data into the wrong chart, potentially administering the wrong dose of insulin, created challenges in assuring staff competency, and prevented the ability to establish clinical trends for the purpose of patient care improvement.
Goals:
- To improve the quality of patient care and outcomes in the diabetic patient population.
- To provide the systems necessary to assure ongoing quality controls, consistent staff retraining, and periodic reporting focusing on end user training, patient glucose levels, and out of range results.
- To integrate our glucometer with the electronic medical record in order to diminish the risk of inaccurate data entry.
- Improve patient safety by reducing the risk of patient misidentification and enhancing clinician identification.
Intervention:
- Product and Vendor selection
- Contract negotiation
- Technology installation and initial training
- Linearity testing and quality measures
- End User training identified as all active nursing staff on the inpatient unit and emergency room.
- Validation of server connectivity and integration with the electronic medical record
- Go live on June 4th with end users utilizing the glucometer for patient care activities after this date.
- Ongoing reporting and training as discussed in the evaluation section.
Evaluation:
Prior to June 4th:
- Assure all technology is installed and functional through collaboration with the information technology department and Abbott.
- Assure all end user training is complete and quality controls have been performed. This will be determined by running the appropriate reports on May 28th.
Post June 4th:
- Run reports bi-weekly for one month to assure user compliance and accuracy focusing on unit wide glucose levels, quality measures, and out of range results.
- Check the electronic health record of every patient with ordered bedside blood glucose levels to assure accuracy of data transmission. This will be performed daily for one week using the glucometer for comparison.
Routine Monitoring:
- Check the quality measures once per month to assure proper use and reporting.
- Check the competency report monthly and retrain staff annually and as needed.
- Run overall unit reports on out of range results and Blood Glucose levels below 60 and above 160 in order to trend the overall clinical care of our diabetics. Follow up individually as needed and utilize the Quality Committee for quarterly reporting.