How to claim MOC credit for everyday improvement projects (even in a pandemic)

September 7, 2021 | Author: Guest post

By Dr. Brian Wong, FRCPC, and Dr. Lynfa Stroud, FRCPC

At this point in the COVID-19 pandemic, we’re sure many of you have “near miss” stories. We want to tell you one of ours — how one of us almost walked into a patient room on our dedicated COVID-19 unit at the Sunnybrook Health Sciences Centre in Toronto with the wrong mask on. We’ll also share how we turned that incident into a practice improvement opportunity and reported it in MAINPORT ePortfolio for Maintenance of Certification (MOC) Program credits. This is something you can do, too.

There are many everyday opportunities to turn your problem-solving efforts into MOC credits, which a lot of us overlook. We hope this tip will encourage you to bring a quality improvement lens to your day-to-day tasks, and show how you can claim credit for work you are already doing.

Opportunity from a close call and potential exposure to infection

At our hospital, as the pandemic progressed, we started to use high-flow oxygen on our General Internal Medicine floors to lessen the burden on our Intensive Care Unit. This required a change in behaviour: we now sometimes had to wear N95 masks instead of just surgical masks on our shift.

Sometimes it was difficult to remember this new practice change.

Despite the precautions put in place (such as safety officers posted outside patient rooms) one of us narrowly missed exposure to the COVID-19 virus when we almost walked into a room — without wearing an N95 mask — where a patient with a COVID-19 infection was receiving high-flow oxygen.

An N95 reminder sign was on the door, so how did this happen?

  • The sign was competing with red stop signs and a clutter of other paperwork; this cluttered signage was on every door on the unit irrespective of whether an N95 or surgical mask should be worn.
  • The alert was in small font and obscured by unnecessary information.
  • The visual reminders to wear N95 masks were inconsistent across the ward, as front-line clinicians made various modifications to make the signs more conspicuous.

It became clear to us that here was an opportunity for practice improvement.

New sign became hospital-wide standard where N95 masks need to be worn

We quickly assembled a group of colleagues — physicians, nurses, therapists, a pharmacist, a social worker, a safety officer and a team leader — and came up with a redesigned sign prototype that we thought would be effective.

We trialed it on a door. In general, people were quite positive but felt that it still needed work. So, we took it to colleagues in Communications and Infection Prevention and Control, who also made recommendations. Together, we finalized a new sign that was much better received — a big yellow diamond with only one word: N95.

The new signs have caught on. In our unit, we leave them on all doors at all times, and flip them as soon as a N95 is required. The signs also have clear-space around them, to help them stand out.

We are especially proud that our in-the-moment, team-based continuous quality improvement (CQI) approach led to a lasting impact: our sign is used across our hospital where N95 masks need to be worn, including in our ICU and all unit wards.

Slide 01

Improvement project: The evolution of a hospital sign

All photos provided by Dr. Wong and Dr. Stroud

Photo shows five pages taped to a door. Three of these papers have images of stop signs on them, in various sizes. One of the pages has a yellow diamond on it with a stop sign.

This is what a typical patient door looked like at Sunnybrook. The sign with the yellow diamond was meant to alert providers to the fact that an N95 mask should be worn when entering the room.

Photo shows multiple pages taped to a door. Space has been cleared around one page: the N95 reminder sign.

Attempts were made to remove the extraneous clutter from around existing signs to draw attention to them.

Photo shows a close up of the N95 reminder sign. There is a lot of text in small font, a small stop sign and two image icons depicting that a mask and face shield should we worn.

In addition to the fact that the N95 reminder sign would get lost among all the other signage on patient doors, the actual warning itself was not clear: the N95 print was very small and there is a lot of extraneous information.

Photo shows a close up of the N95 reminder sign with “N95” handwritten twice in permanent marker across the top.

Front-line clinicians started to modify the signs to make the reminder more conspicuous. For example, this photo shows how someone wrote N95 in bold marker on the existing sign.

Photo shows the N95 reminder sign with a second paper posted beneath it with “N95” handwritten in permanent marker, filling the full page.

In an attempt to reinforce the message, someone posted a new sheet of paper with “N95” handwritten in bold. This sheet of paper was actually moved from door to door, as it was felt to be more effective than the official sign.

Photo shows a door cluttered with eight pages. One of the pages has an image of a stop sign on it with the words “AIRVO” and “N95” handwritten next to it in permanent marker.

Another tactic used to draw attention to key messaging was the addition of the words “AIRVO” and “N95” next to the biggest “STOP” sign on the door.

Photo shows Dr. Lynfa Stroud holding a prototype of the new N95 reminder sign. The sign is red and shows a simple black outline of a triangle with the text “N95” encased in it.

The first prototype of a new sign was a simple triangle with the text “N95” encased in it. This sign came from a brainstorm with people working on Sunnybrook’s COVID unit including physicians, nurses, a pharmacist, safety officer and our team leader.

Photo shows a door with six pages on it. One of the pages is the red sign created as the new prototype of the N95 reminder sign.

The new prototype sign was trialed on one of the patient doors. Generally speaking, it received positive reviews but feedback suggested that a different colour of sign would be better.

Photo shows the updated prototype of the N95 reminder sign. It is a bright yellow diamond with a black outline. Encased in the diamond is the text “N95” in big black font.

This is the new standard-of-use sign that was finalized following feedback, and assistance from the hospital’s director of Infection Prevention & Control and the communications team. This sign is now being used throughout Sunnybrook.

Photo shows the new yellow diamond-shaped N95 reminder sign posted on a door, with space cleared around it.

Here is an example of the new sign in use. It is left on all doors, at all times, so that it can be “flipped” quickly when a N95 mask is required. Surrounding clutter on the door has also been removed.

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Our tips for bringing a quality improvement mindset to problem-solving

  • Recognize where opportunities lie: Any time you see a situation where people are creating workarounds, such as makeshift signs in our case, that is an opportunity for improvement.
  • Don’t jump into solutions: A quality improvement mindset takes time to understand why a problem exists, and how a proposed solution might link back to the problem at hand.
  • Don’t make a one-and-done change: Be prepared to test out prototypes and iterate, possibly even fail. There’s a reason it’s called continuous quality improvement (CQI)!
  • Engage and collaborate with stakeholders: Recognize that CQI is a team sport and that incorporating additional perspectives from interprofessional colleagues will lead to a better solution.
  • Give yourself permission to innovate on-the-fly: If there are no obvious negative consequences, don’t overthink it. It may be worth trying a small innovation, in-the-moment, to try and solve a problem (but be open to feedback!)

Ours was not a traditional quality improvement project but is more an example of how to bring that mindset to day-to-day problem solving. We are sure that many of you have had similar experiences, contributing to a variety of innovations (big and small) in the context of the COVID-19 pandemic. We hope our story and the MOC guidance note below inspires you to report your own experiences for Section 3 MOC credits.

Dr. Lynfa Stroud and Dr. Brian Wong (Photo submitted)

Brian Wong, MD, FRCPC, is a staff physician in General Internal Medicine at the Sunnybrook Health Sciences Centre in Toronto, Ont., and director of the University of Toronto Centre for Quality Improvement and Patient Safety.

Lynfa Stroud, MD, FRCPC, is the division head of General Internal Medicine at the Sunnybrook Health Sciences Centre in Toronto, Ont.


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Brian Wong | October 14, 2021
Given that the amount of time spent gathering information (i.e., walking around the unit, taking photos etc.,), discussing with team members what changes could be made (and also what information was unnecessary), prototyping different versions of the sign and liaising with the hospital communications group didn't take that much time, I ended up claiming 1 hour total for this work, which equated to 3 hours within Section 3.
Robert Cooke | October 3, 2021
HOw many credits/hours did you claim?