Strategies for quick, lasting change

The St. Marys Hospital Medical Center's IV antibiotic administration improvement team learned the following strategies for rapid cycle change at the Boston-based Institute for Health Improvement's Breakthrough Series on Reducing Adverse Drug Events and Medication Errors. The guidelines helped the Madison, WI, hospital dramatically reduce the length of stay and the hospitalization costs for pneumonia patients.

4 Seek usefulness, not perfection. Instead of tallying all of the medication near misses (anything that would have resulted in an error if not caught), for example, the improvement team isolated the antibiotics near misses. While its first impulse might have been to clean up all the near misses, the team stuck to antibiotics administration until the pilot unit reached 100% compliance in a two-hour order-to-start time for IV antibiotics.

4 Keep measurement simple; think big, but start small. Small, useful data sets that fit work environments, time limitations, and cost constraints are ideal situations in which to test improvements before taking them housewide. Test and refine them in limited settings where the stakes are small. This way, adjustments in things like operational definitions, worksheets, or interdepartmental procedures can be made quickly with minimal loss of time, money, and staff commitment.

4 Measure small representative samples. The team used a random sampling method to determine the rate of timely antibiotic administration. This involved a weekly selection of five medical records for newly admitted patients who had received antibiotics within the last 24 hours.

4 Build measurement into daily work. The medical records selection and review described above took 20 minutes a week for three improvement team members who acted as data collectors. Once it was debugged on the pilot unit, the same data collection and review model was introduced throughout the hospital.