Virtua Health Hospitals in New Jersey, USA

Virtua Health Hospitals in New Jersey, USA

Achieving and sustaining improvement in cardiac medication administration.

“Increase quality of patient care by use/non use and appropriate documentation of aspirin, beta-blockers and ACE (angiotensin-converting enzyme) inhibitors in congestive heart failure (CHF) or acute myocardial infarction (AMI) patients to achieve or exceed Virtua Health benchmark goals”.

Adrienne Elberfeld, Virtua Health

Customer background:

  • Virtua Health is a four-hospital system located in southern New Jersey
  • One of the first Six Sigma hospitals in the USA. Virtua Health adopted Six Sigma as a rigorous method for improving business and clinical processes
  • 7,100 clinical and administrative personnel
  • 1,800 physicians


Customer objectives:

  • A cardiac programme of excellence aimed at coordinate high quality care, advanced technologies and best practice standards while connecting providers, sites and phases of care was launched. Conventional methods to face cardiac medication challenges failed. Therefore, a Six Sigma team initiative to tackle 2 important issues
  • Improve medication administration and documentation for congestive heart failure (CHF)
  • Improve medication administration and documentation for acute myocardial infarction (AMI)
  • The goal was to meet the standards established by the Joint Commission on Accreditation of Healthcare Organisations


Project focus:

  • Improve administration and documentation of medication for CHF and AMI patients
  • Establish standard operating procedures or “golden standard” for reviewing CHF and AMI patient charts


What we found:

  • More than 70 million Americans had cardiovascular disease and the number was going to rise as the population ages
  • No information on core indicators for medical and nursing staff
  • CHF and AMI patient charts needed to be reviewed
  • 46 out 48 medication defects involving physicians were due to documentation issues
  • Mobile intensive care unit (MICU) run sheets were not available on patient charts
  • Physician compliance issues in completing discharge instructions


Implemented solutions:

  • Developed storyboards with pathways and indicators to be available at key areas throughout the hospitals
  • Developed standard operating procedures by nursing in chart review with stickie reminders for physicians and availability of discharge instructions
  • Worked with ambulatory quality director to have MICU run sheets completed and submitted concurrent with care
  • Physician completion of written discharge instructions specific to medications for cardiac patients
  • Compliance and proper documentation of care for discharge medication indicators
  • Education of nurses to cardiac medication indicators


Customer benefits:

  • Increased compliance for aspirin given within 24 hours
  • Quality of care documented
  • Increased nursing staff knowledge on cardiac medication
  • Exceeded internal and external benchmarks
  • Met standards established by the Joint Commission on Accreditation of Healthcare Organisations