Page 50 - ANZCP Gazette MAY 2014

QUALITY INDICATORS TO MONITOR AND IMPROVE PERFUSION PRACTICE OUTCOMES
Vijaykumar N Valiyapurayil, Annette Mazzone, Kuljeet Farrar, Richard Newland, Robert Baker
Flinders Medical Centre, Adelaide, SA
The electronic perfusion record is an important part of the clinical documentation, and as such is a legal record; in addition it’s a source of data for quality assurance and scientific investigation.
At Flinders we have developed a process by which data from the electronic perfusion record is analysed and processed in a Microsoft Access database following a CPB procedure. Data from the blood gas analyzer, anesthetic machine and other peripheral devices can be integrated into the perfusion record. The processing is designed to transfer the collected data to a research database, to facilitate the creation of CPB quality indicators (QI).
QI for blood gas management, arterial outlet temperature, arterial pressure, hematocrit, blood glucose levels are strictly monitored. A Perfusion Quality Report is generated after every case and emailed automatically by the system to the concerned Perfusionist, the Chief Perfusionist & the Operating Surgeon; if any of the parameters are not within the range of predetermined values.
The QI reports are periodically analyzed and plotted for both the individual Perfusionist as well as for the whole perfusion team, for institutional standardization & improvement of perfusion practice. We conduct regular QI meetings among Perfusionists and the issues of practice are discussed. Automated generation of QI has resulted in improved adherence to process of care guidelines, highlighting the potential of electronic data collection for improving quality of perfusion.
At our recent QI meetings variation in practice in relation to the first ACT at commencement of bypass, pCO2 < 35mm of Hg, mean pressure < 40 mm of Hg for more than 5 minutes, arterial outlet temperatures etc. were noted in addition to variation in practice. Practice variations after extended leave were also noted.
Improvement plans including change in practice and protocols were initiated.
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48 MAY 2014 | www.anzcp.org