In the Q CDH Quality Director Charts a Course

It’s called ‘medication reconciliation.’That’s a process for ensuring that patients are getting only the medications intended for them, and that those medications do not react negatively with anything the patient is already taking. Northampton’s Cooley Dickinson Hospital is addressing the matter through a number of programs, including medication cards, carried by patients, which alert caregivers to the full list of medications an individual is taking.

This is one of many patient safety initiatives in which Cooley-Dickinson is no longer trying to merely match industry best practices, but in many instances, establishing best practices.

And leading such efforts is Donna Truesdell, MS, RNC, CDH’s director of Quality Improvement, who says she takes enormous pride and satisfaction in her work.
She told The Healthcare News that medication reconciliation is just one of several quality initiatives ongoing at Cooley Dickinson, all designed to improve patient safety, reduce medical errors, and enhance the overall quality of care being administered. Other efforts include everything from a program to reduce the incidence of falls among patients to an effort to speed up the time it takes to make a room ready for a patient to a new system that dramatically reduces the time it takes to secure clean IV pumps and other equipment.

Quality has been the informal, one-word job description for Truesdell for much of her 25-year career in health care. Originally a staff nurse in a hospital in Punxsutawney, Pa. (home of the groundhog), she relocated to Massachusetts in the mid ’80s, and eventually landed at Franklin Medical Center in Greenfield. There, she assumed titles that included director of Quality, Diagnostic, and Clinicial Support Services, and director of Performance Improvement and Clinical Support Services.

In those capacities, as in her current one at CDH, the focus was on process improvement, she explained, and giving staff members — from those who make the beds and clean patient rooms to physicians and nurses — opportunities to do what they do better, and in the process, improve safety and save lives.

This is work much different than hands-on delivery of care, she said, but, in many ways just as rewarding.

“Early in my career, I was frustrated with systems that didn’t help people; I was frustrated when I saw barriers,” she explained. “When I moved into management, I sought to remove barriers and make it easier for people to do their work and care for patients.

“A good day for me,” she continued, “is when I know my work has resulted in a front-line staff person doing their job better.”

Care Package

Truesdell vividly remembers the two years she spent as a school nurse, first at the Academy at Charlemont, and then at Mohawk Trail Regional Schools in Shelbourne Falls.

“When people think of the school nurse they picture Band-aids and skinned knees,” she said. “That’s not what it’s like in many places, including Charlemont.”
Indeed, the school nurse was often the primary care giver for low-income families with no access to health care — real or imagined, she said. “Mothers with no health insurance would bring in pre-school aged children for me to look at and give assessments. Often, I would send kids home with supplies like bandages, because there weren’t any at home.”

There was an educational component to the school nurse duties — working with teachers to help young students learn the basics of health care, she said, adding that she sometimes referred to this period as the “vacation” in her career because of the less hectic, enjoyable nature of the work.
But in many ways, it created an effective bridge to the next stage of her career, which has focused primarily on the two words quality and safety. And they go hand in hand, she said.

From the Mohawk Trail schools, Truesdell moved on to FMC, part of the Baystate Health system, where she served first as manager of the hospital’s Education Department, a post she held from 1988 to 1992. From there, she moved up the ladder to manager of Education and Medical Information Services, where she managed hospital-wide education, patient registration, medical records, and ultilization management departments.
In 1996, she became senior manager at FMC, and a year later was promoted to director of Performance Improvement and Clinical Support Services. And in 2000, she became director of Quality, Diagnostic and Clinical Support Services.

In that role, she coordinated the hospital’s quality-management program and chaired its Performance Improvement Committee, among many other duties. And it was in that capacity that she developed a passion for quality and the processes for achieving it, especially the coaching and mentoring of front-line managers to solve problems.

She said she came to CDH in part for quality-of-life reasons — she had a 2-year-old at the time and desired a position with more reasonable hours — but also because of the facility’s commitment to quality and continuous improvement.

“I had never heard of a community hospital where the CEO, the medical staff, and the leadership team had such an obvious vision for quality care and putting resources toward that,” she explained. “It was that vision that attracted me — and the desire here to become one of the best hospitals in the nation for its size.”
Today, Truesdell, who oversees a staff of nine, is spearheading CDH’s efforts as part of the Institute for Healthcare Improvement’s 100,000 Lives campaign, which is working to enlist 1,600 hospitals across the country to adopt changes in care that have been proven to prevent deaths due to medication errors. She also heads up the hospital’s participation in the Mass. Hospital Association’s Patient First program and other initiatives aimed at improving the quality of care delivered.
This assignment is carried on in many ways, she explained, and in every department of the hospital, from maintenance to the operating room.

Getting Pumped

Ext. 6867.
That’s the number nurses at CDH punch when they want a clean IV pump. That’s what the numbers spell — pump — said Truesdell, adding that the extension was chosen, like all other elements of this particular quality initiative, to save people time and trouble.

And the IV pump is just one of 21 different pieces of equipment brought together in one area of the hospital for faster distribution by something called the Centralized Equipment Management Team. Working with survey data — time studies, employee surveys, and focus groups, the team identified one key concern; an inability to access common patient-care equipment when needed.

“Nurses were spending too much time searching for equipment,” said Truesdell, noting that initiatives like the new extension for pumps have helped reduce that time from several hours — and several phone calls — to an average of seven minutes and one call.

CDH has logged a number of other quality improvements over the past year, including:

• A drop in the percentage of unreconciled medications from 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in May 2005 to 5.22{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in November of that year in the units where the medication-reconciliation program had been rolled out. (It has now been implemented in all inpatient and outpatient settings);

• Decreased bed-turnaround time from an average of more than 90 minutes to less than 45 minutes from the time the Environmental Service office is paged to the completion of the discharge patient room cleaning;

• Decreased facility-acquired pressure ulcers (similar to bed sores) by 8{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}, to a rate of zero, between December ’04 and December ’05. The achievement was attributed to hiring a dedicated wound and skin care nurse and implementation of a multidisciplinary pressure ulcer prevention program, and

• The hospital even received commendation from the Northampton Fire Department for the reduction of hallway clutter over the past year.

Assessing these and other quality success stories, Truesdell said solutions usually come through common sense analysis and breaking a process into its specific steps, a methodology that manufacturers have employed for many years now.

In the case of the bed turn-around-time-reduction efforts, she said the solution was fairly simple — outfitting Environmental Service staffers with pagers that would enable them to be notified the moment a room was ready to be cleaned and prepped for the next patient.

“Before, people simply put notes on the door alerting staff that a room was ready to be cleaned,” she said. “Sometimes, it would be a while before anyone saw the note.”

To effectuate changes and improvements such as the IV pump program, medication reconciliation, patient room-preparation, and a fall-reduction effort called “Striving for Zero,” Truesdell said CDH uses team of individuals on the front-lines, as she called them. These are the people directly effected by a problem or issue, and they are the ones best able to help brainstorm an answer.

“In hospitals, we have to continually remember to get the front-line people involved,” she said. “In the past, a group of managers would sit down in a room and think they were going to solve the problem. My experience has been that they will either solve the wrong problem or come up with a solution that doesn’t address the real issue.”

Breaking Down Barriers

Empowering staff members and providing them with the tools they need to develop answers to quality issues is one of the many rewards Truesdell says she derives from her current assignment.

Another is the successful — and ongoing — removal of the kinds of barriers that frustrated her when she was a staff nurse in Pennsylvania.
Her dedication to quality and CDH’s ability to establish benchmarks rather than aspire to reach them, has enabled her to have a number of good days — with the promise of more to come.

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