by lynne meyer, phd, mph august 2014. what is cler? cler site visits are required by the acgme every...
TRANSCRIPT
I’m CLER,You’re CLER,
We’re All CLERBy Lynne Meyer, PhD, MPH
August 2014
What is CLER?CLER Site Visits are required by the ACGME
every 18 months (similar style to JCAHO)
Focuses on the learning environment, not just the residency program
Focuses on Patient Safety, Quality, Health Care Disparities, and more
Effective July 2013 for all ACGME-accredited programs
The Big Picture: Resident, Faculty, Program and Institution ReviewsReview of Program Personnel
Review of Program Institutional Review
Every 6 months: Semi-Annual Review of Residents
Once a year: Review of Program by Program Evaluation Committee (PEC)
Every 18 Months: Clinical Learning Environment Review (CLER)
Once a year: Review of Faculty
Once a Year: Review of Program by ACGME Review Committee
PRN: Progress Reports, Focused or Full Site Visits as determined by Review Committee based on data review
Every 10 Years: Self-Study Visit
CLER Site Visit Components: Meetings and Walk AroundsMeet with:
Senior Leadership Quality and Safety LeadershipResidents/FellowsCore FacultyProgram Directors
Walk Arounds to check on 6 focus areas for CLER
Who’s involved?EVERYONE
Program DirectorsFacultyResident/FellowsHospital AdministrationNurses/Technicians/Pharmacists, etc.
CLER Site Visit InformationSHORT NOTICE: 10 days to 3 week noticeVisits will last 2-5 days (probably 2-3 days)Our 1st CLER visit will only be used for
feedback and baseline data
CLER’s 6 Focus AreasPatient SafetyQuality Improvement (including Health
Disparities)Transitions in CareDuty Hours, Fatigue Management &
MitigationSupervisionProfessionalism
CLER Focus AreasIntegration of residents into institution’s Patient Safety programs, and demonstration of impact including opportunities
for residents to report errors, unsafe conditions, and near misses, and to participate in inter-professional teams to promote and enhance safe care
CLER Focus AreasIntegration of residents into institution’s Quality Improvement programs and efforts to reduce Disparities in Health Care Delivery, and demonstration of impact including how sponsoring institutions engage
residents in the use of data to improve systems of care, reduce health care disparities and improve patient outcomes
Patient Handoffs: A Typical Day on the Wardshttp://
www.youtube.com/watch?v=JzCdoQEYHkY
What processes do you use to standardize and improve your handoffs
CLER Focus Area: Hand-offs
Oversight of Transitions in Care including how
sponsoring institutions demonstrate effective standardization and oversight of transitions of care
We will be implementing a standardized process
CLER Focus AreasOversight of Duty Hours Policy, Fatigue Management and Mitigation including how sponsoring institutions: (i) demonstrate effective and meaningful
oversight of duty hours across all residency programs institution-wide;
(ii) design systems and provide settings that facilitate fatigue management and mitigation; and
(iii) provide effective education of faculty members and residents in sleep, fatigue recognition, and fatigue mitigation.
CLER Focus AreasEstablishment, implementation, and oversight of Supervision policies including how sponsoring institutions maintain and
oversee policies of supervision concordant with ACGME requirements in an environment at both the institutional and program level that assures the absence of retribution
Excerpt from Resident Survey
CLER Focus AreasEducation and monitoring of Professionalism with regard to how sponsoring institutions educate for professionalism, monitor behavior on the part of residents and faculty and respond to issues concerning: (i) accurate reporting of program information; (ii) integrity in fulfilling educational and professional
responsibilities; and (iii) veracity in scholarly pursuits
Excerpt from ADS Annual Update
How would you answer these?What areas have the hospital identified as opportunities for
improvement?What types of patient safety activities are you involved in?What is an RCA?Do you know how your individual QI and patient safety projects
relate to the hospital’s overall plan? Have you reported Medical Errors, Unsafe Conditions, or Near
Misses?What is the process for reporting Medical Errors, Unsafe
Conditions, or Near Misses?How effective is the dialogue during hand-offs? How effective are educational efforts around sleep and recognizing
and preventing fatigue? Is the level of supervision you experience adequate for your level of
training?
SV Components: Walk AroundsPossible Areas of Focus:
Primary focus on hand-off for change of dutyCheck for variability in process and oversight
of resident hand-offsLook for examples of both under and over
supervisionSee if knowledge of need for direct supervision
appears to be limited to GME facultyLook for consistent vs. variable evidence of
effective management strategies for duty hours and fatigue management
SV Components: Walk AroundsWalk arounds of patient floors, OR and clinics: need
experienced chief or senior residents (PGY3 or higher)Random interviews of staff (e.g. nurses, techs,
pharmacist): Talk with nursesTalk with other residents and physicians on unitsPossible patient contactMay ask people encountered about their perspective of
residents related to the six focus topicsThe CLER team will want to observe a handoff without
supervisionMay return in the evening
Accessing the PSR….
https://my.portal.shands.ufl.edu/portal/page/portal/SHCEMPAUTH
After you log in, an express report is available
Examples of Medical ErrorsFailure to employ indicated testsError in the dose or method of using a drugFailure to provide prophylactic treatmentFailure of communicationEquipment failure
Why Report Near MissesNot wait for harm to occurTrigger improvements in weak spots in the
care processAlert others for possible vulnerabilities and
training gapsContribute to planning, recovery testing,
harm mitigation strategies following events that do result in harm
PDQ List
https://intranet.ahc.ufl.edu/ForwardTogether/qualitycenter/Lists/PDQ%20List/AllItems.aspx
CLER and our Focus on Patient Safety and QualityWe need to role model and teach these concepts to our fellows, residents and medical students so they become a way of life.
Documentation of CLERWe must document what we teach, what we learn and outcomes for:Patient SafetyQuality Improvement -- if on QI/PS project – document in New
InnovationsTransitions in Care – used a standardized process such as SBAR
or I-PASSDuty Hours, Fatigue Management & MitigationSupervisionProfessionalism
Do you use the PSR when indicated? Do you review the goals and objectives with your learners? Do you provide your learners with feedback? (formative) Do you return your evaluations on time with meaningful
data/comments? (summative)
ResourcesGME Housestaff: Housestaff Patient Safety and Quality Improvement Committee – Lee Titsworth, MD, Chair
http://gme.med.ufl.edu/policy-procedures/patient-safety/https://ufhealth.org/quality-and-patient-safety/welcome
UF Health: Sebastian Ferrero Office of Clinical Quality and Patient Safetyhttps://intranet.ahc.ufl.edu/ForwardTogether/qualitycenter/SitePages/Home.aspx
ResourcesACGME’s CLER Program http://acgme.org/acgmeweb/
Sites with Curriculum and Cases to work through
AHRQ Patient Safety Network http://psnet.ahrq.gov/
AHRQ webM&M http://www.webmm.ahrq.gov/
VA National Center for Patient Safety http://www.patientsafety.va.gov/professionals/training/curriculum.asp
