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The UCSF Center for Healthcare Value (CHV) called for the best ideas to reduce inefficiencies and health care costs as Phase 1 of the Caring Wisely initiative. The top 10 ideas at each site were selected as "Hot Spots" for Phase 2, which will be a call for proposals from within the UCSF and SFGH communities to address the areas of interest identified from the winning ideas in Phase 1.
Situation:
Handwashing is one of the most effective ways to reduce the spread of bacteria and reduce the risk for infection. Patients are encouraged to ask their providers if they have used gel or washed their hands but many are often timid or shy about asking not wanting to question a provider.
Background:
In our current model at UCSF and where I manage practices at the Cancer Center, we have a check-out system where patients are only able to obtain follow-up appointments for their infusion treatment or a future follow-up appoitment with their physician within our practice only. They are also able to get their radiology scans scheduled as well. However, patients are often referred to see practices outside of the Cancer Center but are not able to obtain those appointmetns immediately upon their depature from their appointment.
Patients requiring ophthalmic consultation often require eye drops such as proparacaine for numbing the eye as well as phenylephrine and tropicamide for a dilated eye exam for a total of 3 medications. Due to CMMS regulations, each patient needs a new order and new bottles of each medication for what is most often a single use. These bottles of medication are anywhere from 2mL to 15mL and each bottle retails between $1 to $50 depending on brand and size, which is a hefty cost when often only 2 drops are needed from the entire bottle.
Doctors sometimes order pain meds such as morphine or dilaudid 0.2 mg IV but stock is often more than that and RN often have to waste pain meds while giving only 0.2 mg which is very wasteful. Either we stock the correct dosage on PXIS or the MD order dosage that will not cost such waste.
Retail or community pharmacy has a very tight integration between what is dispensed and what is re-ordered. At the end of each day, reports are generated as to what is short / out and reorder. Occasionally there are exceptions ... A manager or someone in purchasing would do special orders, or review the report and make adjustments, but a highly automated process.
Currently, a 1 ml vial of Aplisol PPD (NDC 42023-104-01), enough for 10 tests, is dispensed each time one dose is ordered. It is a multi dose vial and per manufacturer "Once entered, vial should be discarded after 30 days" (under refrigeration). There is no mechanism in place to use the remaining 9 tests. In simple terms, let's say we bought 100 vials. Currently, this will service 100 patients. Instead, 100 vials have the potential of servicing 1000 patients!!
In the Mt Zion OR we place water and saline in warmers. Our current practice is after 3 days this is considered expired and poured out. It actually has an expiration date of 2 years.
We can still use the fluid. We just can't pre-warm it.
I propose putting this solution in a different location after it has been previously warmed and used in different ways.
For example:
1. Use the fluid for cases not requiring warm solutions.
2. Use a solution warmer for the field to warm your solution.
3. Use the water in your water basin.
Commence an aggressive campaign to locate and repair dripping faucets and toilets. Many bathrooms have small drips from the faucets and/or small drips from the pipes underneath the sinks. In additon, many toilets have small drips from the flushing handle or from the main pipe. These small drips are seldom reported unless they become major drips and cause a flood. The staff bathroom in my area alone has had a small drip for at least the last 6 months. Searching out these drips center wide may lead to
a.) less waste of water in this time of significant drought
Email is the backbone of communications at UCSF Medical Center. Virtually every UCSF clinical and administrative manager-level and above receives hundreds of emails a day, and most typically spend 30 minutes or more of their day "managing" their email by moving them from the Inbox into folders. I have used an email management software called Neo Pro for 10 years, and I can find any email that I sent or received in the last 10 years in 7 seconds or less. Neo Pro gives me powerful search and organization tools that automatically and instantly organize my email for me - no effort required.
I have been an RN on 14 Moffitt for over five years and have participated in many code situations. When a code situation occurs, many of the time blood is collected for STAT labs and ran down to the 5th floor to be processed. If you've even seen a code cart, there is a drawer with all specimen containers and lab bags.
The Problem
(1) Each unit is stocked with two different speciment bags; one for labs to be processed stardard, & the other (red) STAT bag.The bags inside the code cart are your standard specimen bags, NOT the red STAT bags.