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Quality: It's all in the details

April 1, 2011
by Dennis G. Grantham, Editor-in-Chief
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Memorial-Hermann PaRC's quality culture sustains four patient-safety projects

Opened in 1999, Memorial Hermann Healthcare Systems (MHHS) Prevention and Recovery Center (PaRC) continues a long history of delivering alcohol and drug treatment services to the Houston area. The PaRC team earned a 2011 James W. West Award for an impressive body of work, including a comprehensive quality improvement program highlighted by four projects.

Project 1: Reducing adolescent elopements

In 2008, PaRC opened a 60-bed adolescent treatment program. And, although the program benefitted from the latest safety, surveillance, and security technology, total elopements averaged 15 percent in 2009 and spiked to 23 percent in early 2010.

The spike got management's attention, says Matt Feehery, CEO at Memorial Hermann PaRC, who, with adolescent program director Stacie Allphin, LCDC, and performance improvement director Theresa Fawvor, LCSW, confronted the issue. Under Allphin's leadership, a new elopement prevention program was launched. Key program elements included:

  • Personnel review, which found that a small number of staff did not have the mix of abilities needed to effectively engage with their young patients.

  • An assessment of the personnel “onboarding process,” to identify and then correct any deficiencies in the training and orientation of new unit staff.

  • Supplemental staff training in adolescent human development, crisis de-escalation, and engagement/rapport building methods suited to adolescents.

  • A new post-admission protocol for evaluating patient history, closely monitoring patient behavior, and staff assessment of patients most “at risk” for elopement.

Memorial-Hermann health systems' prevention and recovery center (parc) treats 150 people daily with all levels of care. parc's main campus, this 145,000 square foot facility in houston, opened in 2008.
Memorial-Hermann Health Systems' Prevention and Recovery Center (PaRC) treats 150 people daily with all levels of care. PaRC's main campus, this 145,000 square foot facility in Houston, opened in 2008.

“At the moment of admission, 90 percent of these adolescents don't want to be here” says Allphin. “Many are in denial. They don't think they have a problem. Or, they're very angry at those who put them in treatment.”

Because 30 to 45 days can seem like forever to these patients, Allphin says it's essential to engage patients immediately to get at those feelings. “We've got to challenge them, appeal to their courage or curiosity, and get them to understand that their life is not working. We've got to convince them that it's not forever and get them to give it a try.”

Building the “culture of vigilance” needed to counter the elopement problem also required strengthening the bond of trust with staff, Fawvor explains. “When we saw this [elopement] trend, we knew that we had to work through the issues with staff, do root cause analysis with them and engage them in performance improvement activities.” The key was to “create an environment in which they felt that they weren't being blamed, yet also had a responsibility to share the thoughts and ideas that would be essential to patient care and getting the right results.”

Elopement program summary

For Feehery, it was about making a strong program better: “Our staff always engaged patients right after admission. But you've got a 24-7 operation here, and you've got to have that buy-in, that engagement from everyone, all shifts. You've also got that patient information-a history and profile. There's a lot there and you can't just say that ‘I'll do this tomorrow.’ You've got to get to it right away, then communicate any risks you see to other staff so they can be appropriately aware.”

PaRC's aggressive efforts to curb adolescent elopements were successful. Following implementation of the program, it achieved its objective of an elopement rate of less than 12 percent for the following nine calendar months.

Project 2: Storing medications appropriately

Because PaRC does not have an on-premises pharmacy, it developed medication storage areas in each of its chemical dependency units according to access and security requirements detailed by the Texas Department of Health. However, when James Kariyaparambil, RN, PaRC's Director of Patient Care, inspected these areas using more specific Joint Commission requirements, he found that the medication storage area in the women's treatment unit fell short in limiting the access of non-licensed staff, necessitating corrective measures.

Instead of taking a single corrective action, however, Kariyaparambil developed a program that would create facility-wide consistency in medication storage and management according to current Joint Commission requirements:

  • Credentialed staff screen all patients to identify medication requirements.

  • Separate patient's external medications from hospital-provided medications and track when and how both are given. Develop measurement and auditing tools.

  • Support through daily audits, shifting to weekly, then monthly audits as process takes hold.