Over the past several decades, there has been a rapid influx ol new information lor diagnostic and therapeutic interventions. It is increasingly challenging for hospitalists to continue to integrate new knowledge while complying with existing standards of patient care. To create a high reliability system, health care requires a multidisciplinary approach with decision support systems to ensure delivery of consistently high quality of care to every patient, every time.
The goal of the “ABCs of Hospitalized Patients” is to reduce the risk of developing hospital‐acquired conditions (HACs) by using a checklist as a communication tool among health care providers. The tool was designed with the following objectives: (1) reducing the risk of HACs. (2) creating a multidisciplinary team, (3) designing a decision support system that fits into daily worx flow, and (4) building a flexible tool that works with paper orders as well as electronic order entry. Eight measures were chosen: (A) ambulation/fall risk, (B) blood glucose > 200 mg/dL, (C) central venous catheter (CVC) days, (D) deep venous thrombosis (DVT) prophylaxis, (E) erosions of The skin surface/dermal ulcers, (F) Foley catheter days, (G) got restraints, and (H) heart monitor/telemetry.
The ABCs were listed on an orange‐colored sheet with a box under each measure indicating the recommended care. Nightly on the medicine unit, during the regularly scheduled chart review, the night nurse assessed the performance on these 8 measures. If any of the measures were not in compliance with the standards of care, the box indicating the recommended care was checked. The form was signed and placed in the order section of the chart. In the morning when the residents ordered daily labs, they reviewed the ABCs. They had complete autonomy to wile orders for the patient care measure that were not in compliance. Autonomy is critical because deficiencies in care shoutd be considered in the context of the patient's active medical conditions. Institutional review board approval was obtained prior to implementation.
In the 8 months since implementation, DVT prophylaxis rates have increased 14%, Foley catheter use decreased 14%, and telemetry use decreased 9% (all P values < 0.05). Ambulation and erosions of the skin are 2 calculated scores based on inherent patient characteristics, and change was not expected in these measures. Health care providers were interested in these scores for management of the patient. Statistical calculation could not be performed lor CVCs and restraints because of small numbers. Last, blood glucose levels did not illustrate significant improvement This communication tool provided the medical team with a checklist for measures that should be actively evaluated and managed for all inpatients on a daily basis. It is currently being implemented in an electronic form as well as in a different hospital.
N. Afsarmanesh, none: M, Zadunayski, none; K. Breger, none; B. Heftier, none; J. Brasel, none.
To cite this abstract:Afsar‐manesh N, Zadunayski M, Breger K, Heftier B, Brasel J. The ABCs of Hospitalized Patients: A Multidisciplmary Checklist for Improving Quality of Inpatient Care. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 154. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/the-abcs-of-hospitalized-patients-a-multidisciplmary-checklist-for-improving-quality-of-inpatient-care/. Accessed May 26, 2019.