Alamogordo Group Experiences Continued Success
Several years ago, an initiative was created for home health and hospice to get together and have one tool for joint care plans in Alamogordo, NM. Once they achieved their goal, they wondered what to do with the group they had formed. So, along with a few home health agencies and assisted living centers added to the group, they invited other health care agencies such as hospitals and case management groups. As they began their work, they thought of even more entities that could join, such as acute rehabilitation facilities, the state health department and income supports. As a result of this inclusion, they grew exponentially and became known as the “Transitions of Care” group.
The group meets monthly, reviewing community health care topics such as local infection outbreaks and other shared problems. At the end of each meeting, they go around the room to discuss and review new issues they are experiencing collectively, focusing their efforts on creating tools and solutions.
One such tool the group created was in tandem with local emergency room physicians. Together, they created a standardized form, used by every local health care agency, in order to send patients to the emergency room. This form includes, at a glance, vital information doctors need to know when treating emergency room patients.
In order to create the form, each group participant submitted their own facility’s form for comparison. They ended up with a 3 ½ page master form they whittled down to one page (by request of participating physicians). Doctors are now familiar with the form and know exactly what to look for when seeing patients.
“It gives doctors exactly what they need in the ER without making phone calls and reading forms from three different agencies in order to find an allergy to medication,” says Marti Heinze RN, BS, Infection Preventionist at Gerald Champion Hospital in Alamogordo, one of the group’s founders. “It drastically reduces time necessary.”
The group has also found the form to be helpful for family members of patients since all medications are listed, along with emergency contact information, Medicare numbers and provider information.
Another success for the group was the development of their infection control reporting form. Patients discharged from the hospital and followed by participating agencies use this form, based on the NHSN criterion of definitions. The form was distributed in electronic format, accompanied by a list of the names and contact information for known IPs in New Mexico, so that the form could be sent to any IP in the state. This form helps providers to track and follow up on infections they might not have caught before.
An example of effective infection prevention work by the group is when Heinze noticed increased C. Diff numbers at the hospital last August. She was able to immediately talk to group participants to find out if they were also seeing increases. The group then cooperated with the local laboratory in order to compare rates, where they found out that the whole community was under a burden for C. Diff. Because of their findings, they focused on C. Diff education and compared experiences. They also distributed educational materials to all participating agencies and trained all staff nurses.
The success of their focused efforts led to the creation of a one-minute instructional brochure for distribution. This instructional form is hung in nurse stations, employee restrooms, and any gathering place for personnel. The brochure has proven so popular that nurses often ask Heinze when the next “potty poster” will be released.
When asked how sharing is fostered within the group, Heinze replies, “There is no blame. They are all in the room together, facing the same problems and working together for solutions. We share these patients. Many of these people are direct competitors, but that’s not the focus. We leave all that at the door. This is all about the patient.”
As part of their antimicrobial stewardship work, the group became aware that the hospital isn’t the only entity affecting prescribing patterns. So they created an Antibiogram for the community comparing the cultures they have for a particular organism with the effectiveness and sensitivity each antibiotic has on it. The Antibiogram then demonstrates a grid of effectiveness.
“When they see that something is perhaps only 80% effective, they [prescribers] realize that there might be a better prescribing solution,” says Heinze. “Without that information, they’re shooting in the dark.”
The Antibiogram goes to every other agency and physician in the community, as well as nursing homes. Since doctors often have to prescribe before culture information is returned, this information helps them make a better prescription and know what is working in the community.
Together with the Antibiogram, they’ve created an “antibiotic choices” sample, which includes instructions on reading a culture. The document simplifies the prescribing choices with graphs of the most common organisms, cost ratings for medications and more.
Another large project of the group was physician contact preferences. They surveyed physicians about the calls they receive in order to streamline the communication process. With this information, they created a large grid showing the preferred contact methods for local doctors, depending on the issue, enabling local providers to know immediately how to best communicate with them.
“It’s made a huge difference in response times,” says Heinze. “The physicians are a lot happier. They aren’t getting a fax for something and then trying to track down a nurse to get the required information.”
When asked how they are evaluating the success of the group, Heinze admits the difficulty in placing numeric value on the networking benefits. “Before, you were just calling around and trying to gather information. Now you can call someone you’ve met before and if they don’t know the answer, they will definitely know who they can talk to. It has opened a lot of doors.”
“We have impacted a lot of different things, but the patient has come up the winner,” Heinze says.
As you work to improve transitions for your patients here are some questions to ask:
- What are the key items necessary for HAI prevention that should be communicated between facilities?
- Which members of your community would you like to see in a group working together in this way?
- How do you think improving transitions might influence readmissions to your facility?