Author(s): Deborah Johann, RN
Quality Facilitator - Baptist Health Little Rock
After more than 30 year in heath care in a variety of clinical setting and administrative position, I have a rich understanding of health care. I have a BSN in Nursing and MSN in Administration and have served in critical care, med surg, rehabilitation and interventional positions in the acute care setting. I have worked in both academic and community hospitals. The highest rank achieved was Director of Informatics, where I assisted in the implementation of two EMR, Meditech and McKesson. after a After a relocation I moved away from administrative duties and currently serve the single Clinical Quality Facilitator at a large community hospital. In my role I work on regulatory compliance and action plans as needed, along with policy development and complaint investigations. I have had the opportunity to earn Lean Six Sigma Black Belt certification from the Juran company who provided excellent training. In my role I have successfully led large quality improvement projects that significantly impacted not only my hospital but all 11 that are in the system. Examples include CLABSI reduction, and another on reduction of c.Diff and antibiotic utilization. In 2023 I was very proud to have earned CPHQ certification. I would like to put my knowledge and experiences to good use by sharing our successful journeys on quality improvement initiatives.

Jennifer Hall, MBA, CLSSBB, CPHQ
QA Supervisor - Baptist Health

Jared Heiles, PharmD, BCIDP, BCPS

Competency Domain: Performance & Process Improvement

Description: In 2019, our multi-facility System identified reduction of Broad Spectrum Antibiotics utilization rates, reduction of hospital acquired Clostridioides difficile and increasing rate of conversion from intravenous to oral antibiotics as a priority. A multidisciplinary team used Lean Six Sigma methodology to identify opportunities for improvement. Two pilots were initiated, first where an alert was implemented in the electronic health record to prompt providers to consider antibiotic de-escalation. The second pilot modified pneumonia order sets to contain a pre-populated duration of therapy. Without additional costs, antibiotic utilization decreased by 24.4% and conversion to oral antimicrobials increased 9%.C.diff rates decreased by 76.9%.Problem:Elevated antibiotic use, elevated rates of IV antibiotic use and higher than expected c.Diff rates were the problems we were trying to solve.Measurement:As part of our discovery process we use fishbone diagrams, control charts, and Failure Mode Effects Analysis.Analysis:We used Lean Six Sigma and rates to quantify our analysis and findings.Implementation:1.An alert was piloted and implemented in the EHR to prompt providers to consider antibiotic de-escalation. 2. Pneumonia order sets were modified as a pilot with a pre-populated duration of therapy. 3. An alternative two step process to test for C.diff was implemented. Keeping administration and providers informed was essential.Results/DiscussionWithout additional costs, antibiotic utilization decreased by 24.4% and conversion to oral antimicrobials increased 9%. The change in testing decreased C.diff rates by 76.9% and remains low. Utilization of Lean tool gave structure to our efforts, lending insight to contributing factors. Going to Gemba in the lab was critical.

Evaluation: Complete Poster Evaluation