All posts by Paula Bitter

Preliminary data – what you are learning?

My project seems to be flowing nicely, according to my champion.  It is hard to believe that there is only 1 ½ months left before my project concludes.

What I am learning is there are issues that can arise, no matter how trivial they may seem.  After my telephone discussion with Dr. Pahls, I was informed I needed additional data for my sample size.  When I expressed this request to the clinical manager, she hesitated and said that she is unsure of how to do that other than look up every patient during the requested time.  After some discussion about how to remedy this situation, she suggested having the IT department pull the data as they would know how to run a report for the specific data needed.  I did try to contact the IT department on Friday, November 8th, but as of today, November 11th, I have not heard from them.  I will keep trying to get in touch with them.

So, long story short is to expect issues to pop up.  When they do, do not panic but to think around the obstacle as there is always a way to remedy things.  At least I hope so.

I have not received any preliminary data as I am waiting to discuss things with the IT department.  I will finish my clinical rotation this week.  I am hoping to get in touch with the IT department on Friday.

Leadership Challenges, Strategies, and Hiccups.

For the most part, my project seems to be going well.  I really do not want to say that because I do not want to jinx myself.  The biggest challenge I have had is lack of time and availability in case the clinic would need something.  I have been trying to finish my clinical rotation as soon as I can because my preceptor in quitting the clinic and going to work at another FQHC in Wichita.  Her last day is November 15th and she worked only one day this week.  I should be finished by next week and can devote more time to my project.

I did visit with the statistician on Monday and we worked out a game plan.  The statistical test I had planned on using was not the right one.  Thank goodness I was able to get in touch with him.

The only hiccup right now, other than lack of time, is needing the clinic manager to pull more data for me.  The statistician explained what data I need from last year and for this year.  I thought having her pull my data would be easier because the issue of HIPAA.  We figured this way would be easier, but I am beginning to think that maybe I should be pulling the data.  I feel like I am bothering her all the time.  I have completed their HIPAA training so maybe I can visit with her and see what we can figure out.  Otherwise, the project is going well.  I am keeping my fingers crossed.

Data collection issues, challenges, and triumphs

My project was implemented on October 1, 2019.  I have not collected any data as of today, October 15, 2019 due to the short amount of time.  There really have not been any major challenges with the exception of the clinic’s EHR program.  The program they are using has ICD-9 diagnosis codes instead of ICD-10 codes.  This should be pose an issue with my project however because my data will be collected using the CPT codes.

Even though I have not started data collection, I have talked with the staff and they said they are giving more pneumonia vaccinations.  That is a win in my corner as that is the goal of my project.  I will begin collection data at the end of the month.  I figure it will be easier on the clinic manager if I asked for data once a month, especially right at this moment and the issues with the ICD codes.

Project Progression and Setbacks

My project of implementing a reminder system into the rural health clinic’s EHR was implemented on October 1st.  My first issue was the fact I was out of town for clinical when it was implemented.  I finally was able to check in with the clinic in person on Friday, October 4th.

I found out the clinic is having issues with the program.  The issue is the program is defaulting to ICD-9 codes instead of ICD-10 codes.  Even though that is an issue for the clinic, I do not think it has any barring to my project.  I attempting to help the clinic manager resolve this issue, but I think it is a program/system issue and she will need to contact the IT department or her sales representative.  The reminder is popping up, however, and the reminder to inquire about pneumonia vaccination status and provide pneumococcal vaccinations is the focus of this project.  When asked about providing pneumococcal vaccinations, the nursing staff reported they have been giving some.  The timing of this project is perfect because it commences during flu vaccination season.

As of right not (knock on wood), I have not had any additional setbacks.  The project is going along perfectly as expected.  I made additional posters to put in the waiting room as they ran out after all the posters were placed in the exam rooms.  Other than that, things are going well.   I am keeping my fingers crossed.

Project Implementation Check Points

My project, increasing pneumococcal vaccinations in adults 65 and over in a rural health clinic, will implement October 1, 2019.  Education for staff was to be completed on September 6, 2019 but due to an illness by the clinic manager, the meeting was cancelled.  Due to that reason, education was provided on September 10, 2019 to each nurses’ station.  There are four different nurses’ stations, so education was provided four times.  Posters and reading material were provided.  The staff said they would hang the posters and place the reading material out the last few days of September.

Data for the previous year had been pulled from the clinic’s data base.  The clinic manager pulled the information for me, eliminating any issues complying with HIPAA and confidentiality.

I will go to the office on Monday, September 30th and make sure things are in place.  The project will conclude on December 31, 2019.   During the project period time, I will check to make sure things are going well, answer any questions, and provide more material if needed.

During the month of January 2020, I will ask the clinic manager to pull the data for the three months.  I will also compile all the information and try to have Dr. Pahls help me with the statistical portion of my paper.  My goal is to have the information completed and disseminate the findings the latter part of March or the beginning of April.

I tried to paste a copy of my timeline into this blog but the computer is smarter than me.  Please click on the “timeline” link to view my timeline.  It is a rough timeline.  As the project unfolds, the timeline will be filled in.

Timeline

Initial Approach and Concerns

Starting this project is beginning to be a challenge.  Initially, I had a conversation with the clinic manager about the idea of my project in fall 2018.  She thought my project of increasing pneumococcal vaccination rates among adults 65 and over was a great idea.  Things seem to be starting off smoothly.

Fast forward to summer 2019.  The clinic manager I was working with and was going to be my champion turned in her resignation.  The new manager was willing to work with me, but seems to lack the enthusiasm the previous manager possessed.  From the conversations I have had with both of them, this transition caused hard feelings.  Neither the out-going manager nor the incoming manager talk to each other.  However, I did secure the commitment from the current manager regarding my project and she is now my champion.  We sat up a meeting time for me to talk to the staff at the clinic this week.  In addition, I have secured a nurse who will also help lead the efforts to make this project successful.

Now for another set-back.  The meeting scheduled for this week has been postponed.  Nobody knows when it or if it will be rescheduled.  The clinic manager is out with an illness and the staff as no idea when she will return.  In addition to my clinic manager being ill, I found out the at the same time the nurse who was going to be my leader in the office is resigning and going to work for a different facility.  Her last day will be next week.

On a positive note however, the nurses said I could come and still talk to them and give them the information I had planned on providing during the meeting.  So basically, I will be giving the same speech four different times at eat nurses station.  I also have another nurse who may agree to be a leader for me within the clinic.

My concerns about starting my project is the staff will not have the motivation to implement the project since two of my primary contacts have or are leaving.  To alleviate this concern somewhat, I will also speak to the IT department and make sure the pop up reminder is ready to be implemented.  But wow, I found all this out yesterday.  I still can make this work though.  It is just a few setbacks.