The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Brandy Seger2,1, Cynthia White2, Abby Motz2, Tonie Perez2, Beth Cooper2, Ed Conway2; 1PICU, CCHMC, Cincinnati, OH; 2Respiratory Care, CCHMC, Cincinnati, OH

BACKGROUND: With the emergence of the EMR (electronic medical record), both the Joint Commission and Centers for Medicaid and Medicare Services have placed high emphasis on the adherence of barcode scanning to prevent errors in the delivery of medications. The Respiratory Care department was charged with improving compliance for scanning barcodes to improve the safety of medication delivery. From the data collected at CCHMC for RTÂ’s in the PICU, our team formed an SMART (Specific, Measurable, Actionable, Reliable, Time bound) aim statement to increase the compliance of the EPIC barcoding process from 82.7% to 96% for the scanning of medications, and 83.1% to 98% for the scanning of patients by December 1, 2011. The leadership teamed incorporated the yearly performance management evaluation system to promote synergy and to reach a unified team goal for improving bar code scanning compliance during medication delivery. METHOD: In our institution, we are able to generate weekly compliance reports for medication delivery by user through EPIC EMR and pyxis. A task force was united and rapid cycle quality improvement (RCQI) methods were applied to accelerate the results. The team used a process map and a survey to identify the principal failures and to plot a pareto chart. Additional tools that were employed were the FMEA (failure mode effect analysis), key driver, root cause analysis (ask why 5 times method), and the PDSA (plan do study act). All of the interventions applied to this project were level 1 (1-2 failures per 10 or 80-90% and level 2 (< 5 failures per 100 or 95% reliability). RESULTS: The team reached a median rate of 97.2% for scanning medications and 98.7% for scanning patients, both exceeding the goals of 96% and 98% respectively by December 1, 2011. As of May 15, 2012 in preparation of the performance management evaluations that conclude in June, the team has sustained both of the goals. CONCLUSIONS: The use of RCQI methodology proves to be an effective strategy for improving processes. The implementation of small test of change for trial and learn with routine data analysis has not only resulted in increased compliance but was a low cost strategy to reach results. A second sequence of RCQI should be executed to reach a goal of 99.5%, which would require level 3 (< 5 failures per 1000 or 99.5%) interventions resulting in a highly reliable system. Sponsored Research - None