OASIS Alert

Grace Grider with St. Elizabeth's Home Health in Belleville, IL confirmed the value of the outcome-based quality improvement process during her agency's successful attack on surgical wound care concerns (see related story, article "OBQI Process Can Be the Key to Preventing Adverse Events"). She shares these tips to help jump-start your efforts:

1. Form a committee of enthusiastic volunteers. Grider uses a want ad format at the beginning of each fiscal year asking for volunteers. Current committee members who want to continue also are asked to sign up on an attached sheet, so it's clear that the commitment is for one year at a time. "I asked for four to five people, but ... I had seven volunteers this year," she cheers.

2. Brainstorm first. Considering all possible reasons for the reported results was an important first step, Grider says. "The ones we predicted most likely to be the cause turned out not to be, but several of the other possibilities were important," she adds. And brainstorming increases the involvement of staff members, which is crucial for success.

3. Don't skimp on the investigation phase. Changing something without investigating first may mean you change the wrong thing. For example, St. Elizabeth's has a policy of having a nurse do all start of care OASIS assessments, but in a physical therapy-only case, the PT will do the discharge assessment. One possible explanation for the wound results was a discrepancy between RN and PT answers to the OASIS questions about surgical wounds. But investigation revealed that for about 90 percent of the patients whose surgical wounds didn't improve, the RN did both assessments.

"We also predicted most of the problem cases would be managed care ones, since there may be fewer visits allowed under those plans," Grider notes. But investigation showed more than 60 percent were traditional Medicare patients and the lengths of stay between the two types of patients were very close.

4. Expect tasks to mushroom. The committee found their first task was to create a chart audit tool to investigate the care provided to the patients listed on the adverse event report. But before long they found themselves working to define a healed surgical wound, changing and developing new forms to respond to documentation concerns, and standardizing care plans and instruction sheets.

TIP: Having a data processing staff member on the PI committee was crucial in the process of developing forms, Grider says. "She could tell us what was and wasn't possible and then incorporate changes the committee approved," she explains.

5. Enlist administration support. It's crucial to have active support from supervisors as you hold meetings, develop forms and change processes, Grider emphasizes. "You need the head honchos," she adds.

6. Keep staff informed. Grider posts progress reports for staff to see and includes a report from the PI committee at staff meetings. This keeps staff focused on the effort and celebrates their successes.