Strategic Clinical Improvement Committee Newsletter

Access Partnership Project (APP)  The Access to Care Survey is presently being administrated with all frontline staff managing referrals. Report to be provided August 2018.  This will provide focus for the final steps for Path to Care implementation before 2019.  The Connect Care – D group is creating a conversation about standardizing the Physician triage process integrating E-CLINICIAN. “The APP and CC-D project teams are moving the DoM to ConnectCare readiness in advance of the projected rollout in the Edmonton Zone”

2 Projects Presented: • Oral PresentationHigh system users • Poster PresentationUtilization of Prophylactic Azithromycin in Patients with Frequent COPD Exacerbations Congratulations

QI Grants- CMO Quality Innovation Projects 2018/19 Series  SCIC Received grant funding for the following projects: 1. Appropriate Lab ordering-Creatinine 2. Access Partnership project 3. CAM tool 4. GI- Inpatient bowel prep 5. UAH- GIM ED Evening Service 6. Living Kidney donor Transplant 7. Improving care of patients with suspected TTP 8. RAH- Reducing Length-of-Stay for Stable Antepartum Patients Congratulations!

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Featured Quality Improvement Project Ensuring Adequate Nutritional Intake While Reducing Oral Nutritional Supplement (ONS) Wastage Problem: ONS accumulation and subsequent wastage continues to be seen on the UAH GIM units.

The waste increases cost to the healthcare system with little impact on patients’ nutrition status. A baseline audit in the five GIM units on March 16th 2018 indicated there were 8 Ensure® bottles found unopened at bedside, which costs $135-195 monthly. Nutritional supplements stored in non-patient room areas on the unit were not accounted for during initial baseline audit. However, a random audit was conducted on two separate dates and a total of 8 bottles were found on the five units Plan: Unit discussions were held to increase awareness of this issue. Along with the following interventions 1. Prescribers will be educated to initially prescribe max 1 bottle of ONS daily and then order dietitian consult. Current practice was often to order initially more than once per day-i.e TID 2. UM/Nurse to flag patient for RD reassessment if accumulation noticed during Comfort Care Rounds.

3. UM/Nurse to notify team during rapid rounds if accumulation noticed.

4. RD to monitor census report for patients on supplements 5. Weekend process: nurse/MD can order max 1 bottle daily, then consult RD for Monday assessment

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2018 SCIC Project list: Appropriate Lab ordering-Creatinine Access Partnership Project CAM tool Usage Living Kidney donor Transplant Improving care of patients with suspected TTP RAH- Reducing Length-of-Stay for Stable Antepartum Patients Ensuring annual pap testing in HIV positive patients GNCH-ED triage and consultation SCH- ED triage and consultationPDSA#2 UAH- Pet Therapy program UAH- GIM ED Evening service UAH- Improving inpatient bowel preparation UAH- Improving GI resident handover Ensuring adequate nutritional intake while reducing oral nutritional supplement wastage Formalization of nutritional screening upon admission MIS- Ensuring appropriate lab ordering UAH- Ensuring correct biopsy ordering-risk mitigation UAH- Haematology MOU- Ensuring appropriate lab ordering GRH- Establishing a hospital site quality structure Acute Kidney Injury-Edmonton Zone

Results: Reduction of ONS ordered initially and stored at bedside. Observational audit indicates Minimal bottles stored and ordered

PDSA#2: ‘Medpass’ concept will be tested to decrease both nursing and RD double checks in PDSA#1

Contact: pam.mathura@albertahealthservices.ca for further questions/comments

Upcoming Events: SCIC Meetings: Quarterly going forward • NO July or August meeting • Sept 20, 2018