Worksheet 2-1: CIS* Inventory



Worksheet 4-1: Intervention Specification Form

Specification Form for Validation

Intervention Name:

1. Clinical objective:

• Improve Patient Outcomes as evidenced by:

o Reduce average length of stay

o Reduce incidence of infection rate

o Reduce additional interventions

o Reduce complications

o Adherence to evidence based medicine

o Reduce or eliminate unwarranted medications

2. Desired action:

• Utilize preformatted order set for use by surgeon

• Alert physician if chooses inappropriate antibiotic for surgery type

• Alert physician/nurse at ADC cart if inappropriate antibiotic dispensed

• Allow for reordering of appropriate antibiotic from choice list

• Report compliance

3. Baseline performance:

Currently takes 1 FTE to report SCIP

|  |  |  |  |  |Current Compliance |Desired Compliance |

|Anesthesia |Administers ABX w/in 1 hour of |  |  |

|  |surgical incision -all cases |80% |100% |

|  | | | | |  |  |

|Surgeons |Prophylactic ABX Selection |80% |100% |

|  |Cardiac |(CABG + Other) |  |80% |100% |

|  |Vascular |  |  |80% |100% |

|  |Ortho |(Hip + Knee) |  |80% |100% |

|  |Colon |  |  |  |80% |

|  |Colon |  |  |

|Physician |Clinical thought leader |Positive patient outcome |Reduce average length of stay by providing |

| | | |preoperative antibiotics by default. |

| | | |Reduce incidence of postoperative infection |

| | | |rate. |

| | | |Reduce incidence of additional surgical |

| | | |interventions related to postoperative |

| | | |infections |

|Patient |Recipient of care |Positive surgical outcome |Eliminate complications |

|Quality Group |Risk management |Positive patient outcomes |Adherence to evidence based practice |

| | | |Ensure physicians comply with best practices |

|Medication Safety Group |Hospital medication safety |Monitor and assure safe |Improve compliance with administration of |

| | |medication practice |antibiotics preoperatively |

| | | |Reduce or eliminate unwaranted medication |

| | | |administration |

| | | |Monitor & report adverse drug events |

| | | |Interface with P&T on best practice guidelines |

| | | |in regard to use of pre-op antibiotics |

|Nursing Management |Proponent & clinical thought |Ensuring compliance with |Assure all ordered meds are given |

| |leader |nursing rules & best practice |Assure all ordered meds are administered in a |

| | |guidelines |timely fashion |

| | | |Staff eduction Regarding pre-op antibiotic |

| | | |policy |

| | | |Patient education regarding pre-op antibiotic |

| | | |policy |

|Revenue Cycle Group | Budget owner |Ensuring efficient & effective |Monitor, by DRG, average length of stay compared|

|(length of stay) | |use of resources. Ensuring |to norm |

| | |reimbursement for provided |Monitor all outliers (case management) |

| | |services. |Report to leadership on financial status |

|Pharmacists |Fulfill and monitor orders, | |Monitor patient safety related to medications |

| |manage stock | |Educate on safe clinical practice related to |

| | | |meds |

| | | |Maintain appropriate inventory and stock on hand|

| | | |(including ADC) |

| | | |Monitor and control costs |

|Nurse |  Clinical coordinator of care  |Coordinate all aspects of |5 Rights (Patient, Drug, Dose, Time, Route) |

| |      |patient care activity |Monitor labs (increasing white blood cell |

| | | |count?) |

| | | |Monitor vitals (fever, pulse rate, blood |

| | | |pressure, pain |

| | | |Look for signs of infection (redness, swelling) |

4. Clinical champion for this project:

• Director of surgery / anesthesia

• Med Exec (physicians that manage hospital)

• Pharmacy and Therapeutics

• Infection Control/Clinical Team

5. Urgency / required delivery time:

• Prior to 1/1/2010

6. Whose jobs do you expect to be affected by this project?

• Current FTE maintaining manual reporting / tracking will need to be retrained for new system.

• Ordering physicians/surgeons will need to be trained on the PFO and alert system (and evidence based guidelines).

• Pharmacists will need to be educated on project.

• Anesthesiologists and nurses who use the ADC cart

What are possible adverse consequences of implementing this project?

• Additional alert fatigue

• Slow down in current workflow

• System will result in decrease instead of increase in compliance

• Increase in costs

• Resistance to change

• Decrease in staff satisfaction

• Workflow issues with the nurse retrieving drug instead of physician (nurse can’t re-order)

Specification Form for Developers

|CDS Intervention Name | |

|Description: |Preformatted orders to increase compliance with SCIP |

|CIS application affected |CPOE |

|Intervention type |Orderset Modification |

|Workflow step |Ordering Medication |

|Specifically triggered by |Surgical Type |

|Presentation type |Orderset |

|What (information presented) |Antibiotic to Surgical Type matrix (see attached matrix for reference) |

|Alerting |Yes |

|Who (user) |Ordering Clinician |

|Action items |Alert for antibiotic outside algorithm, display PFO |

|Feedback channels and plan |Compliance reporting to infection control and risk management. Will bring to ordering |

| |physician as needed. |

|CDS Intervention Name | |

|Description: |Alert at Time of dispense from ADC |

|CIS application affected |EHR (Pharmacy) & CPOE & ADC |

|Intervention type |Alert |

|Workflow step |Dispensing Medication |

|Specifically triggered by |Surgical Type & Antibiotic Algorithm |

|Presentation type |Alert Box with Override Option |

|What (information presented) |Antibiotic to Surgical Type matrix (see attached matrix for reference) |

|Alerting |Yes |

|Who (user) |Clinician using ADC |

|Action items |Alert for antibiotic outside algorithm, suggested antibiotic presented in pick list. |

|Feedback channels and plan |Compliance reporting to infection control and risk management. Will bring to ordering |

| |physician as needed. |

|CDS Intervention Name | |

|Description: |SCIP Compliance Reporting |

|CIS application affected |EHR (Pharmacy) & CPOE & ADC |

|Intervention type |Automated Reporting |

|Workflow step |Data elements needed for measuring compliance gathered, aggregated and reported against |

|Specifically triggered by |Weekly, Monthly and on request |

|Presentation type |Standard report (charts, trends) |

|What (information presented) |Antibiotic to Surgical Type Compliance Metrics |

| |Time of drug administration vs surgical cut time |

|Alerting |No |

|Who (user) |Infection Control and Risk Management. Revenue management (TBD). |

|Action items |Intervention with physicians prescribing outside of guidelines. CMS compliance reporting.|

|Feedback channels and plan |Compliance reporting to infection control and risk management. Will bring to ordering |

| |physician as needed. |

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