Zero is Achievable

Hello all, this is my first blog post ever.

Interesting line from today which I figured to be a fitting title. Will be brief here, and let you in on my intent to use part of my time in Telluride to brainstorm ideas (with the help of other residents and faculty) to effect small, cumulative change to get all of us “closer to zero.” To that end my blog will consist of various ideas (open for all) that pertain to possible patient safety and QI project in no specific order:

From session ONE:

1) Post-discharge clinic time slots for inpatient providers to follow up with recent discharges in a timely manner. This is done currently at the DVMC and would decrease 30-day readmission as well as improve transitions of care and also decrease burden on already busy PCPs.

2) Protected time for critical communication (handoffs / consents): minimize pages, RN interruptions and make certain all questions are answered. This could be scripted to assure certain items like clinical status are always communicated.

3) Open notes increase transparency: Real-time to improve team / patient communication

4) qSOFA checklists: This could be analogous or an adjunct to the sepsis early-warning system which empowers RN staff to identify and react to critical changes in patient status. Meeting 2 of 3 qSOFA that are an acute change would prompt RN to notify covering providers emergently and replace the RN “feeling” of the “patient doesn’t look good,” which is often discounted by physicians. This would give objective measure and allow for objective follow of clinical status.

5) Fix the pharmacy alerts in CPRS at the VAMC: Providers get a warning which they need to override on nearly EVERY medication ordered in the CPRS system. This leads to alert fatigue and missed significant drug-drug issues. At least stop the “duplicate medication” alert which you need to override when re-ordering meds that are already on the chart. This is obviously preposterous and is a large part of the problem

6) Only one patient screen allowed to be opened at a time on EPIC: This would stop providers from ordering the wrong medications / studies on patient they did not intend b/c they have 4 different charts open. I and a number of resident I know have done this (even well rested, etc..). It’s just too easy to do. This restriction could decrease provider efficiency but undoubtedly would increase safety and decrease sentinels / near-misses.

See you all on the gondola!