great plains qin-qioestimated u.s. burden of cdi, according to the location of stool collection and...
TRANSCRIPT
Great Plains QIN-QIO C. difficile Reporting and Reduction Initiative for Nursing Homes
Presentation Objectives
• Learn what C.difficile is and the significance in nursing homes
• Review CMS quality strategy and focus on C. difficile
• Review of National Healthcare Safety Network (NHSN) Healthcare-Associated Infections (HAI) resources for Long-Term Care (LTC)
• Discuss the new CDI opportunity for LTC
What is C. difficile
• Clostridium difficile (C. difficile) is a bacterium that causes diarrhea and more serious intestinal conditions such as colitis. – Symptoms include
• Watery diarrhea (at least three bowel movements per day for two or more days)
• Fever
• Loss of appetite
• Nausea
• Abdominal pain or tenderness
Estimated U.S. Burden of CDI, According to the Location of Stool Collection and Inpatient Health Care Exposure, 2011. CO-HCA: Community onset healthcare-associated NHO: Nursing home onset HO: Hospital onset
Estimated Annual U.S. Burden
453,000 CDI cases • 293,000 healthcare-associated
• 107,000 hospital-onset • 104,000 nursing home-
onset • 81,000 community-onset,
healthcare-facility associated
• 160,000 community-associated
• 82% associated with outpatient healthcare exposure
Lessa et al. N Engl J Med 2015; 372(9):825-834.
• Increased risk for persons > 65 years
• Age-related decrease in gastric acid
• Overuse of antibiotic medications
• Risk of cross contamination is substantial • High prevalence of incontinence
• Shared bathroom, dining and rehabilitation facilities
• Reality for hospitals now-future for NH’s
• Expensive to treat
5
C. difficile in LTC
Polling Question
How many CDI cases have been confirmed within your home since January 2016?
A. None B. 1-5 cases C. Greater than 5 cases D. Unknown
The National Landscape
“The Quality Innovation Networks systematically support clinicians in the sharing of best practices in antibiotic
stewardship and prevention of C. difficile.” -CMS Acting Principal Deputy Director Patrick Conway, M.D.
The National Landscape:
• The Skilled Nursing Facility Value-based Purchasing Program – 30 day Readmission Measure
• CDI doubles chances of readmission
• Proposed Rule – Infection Control
• Infection Prevention and Control Program – Antibiotic Stewardship Program
• Infection Prevention and Control Officer (§ 483.80(b))
• CMS Accountable Care Organizations (ACOs) – Readmissions is a Quality Measure
Polling Question
Do you have a designated Infection Preventionist or someone dedicated to this
work? A. Yes, we have an IP on staff who will lead this work in
our home.
B. Yes, we have a dedicated nurse who will lead this work in our home.
C. No, we do not have a dedicated staff member assigned to lead this work in our home.
What is NHSN?
• CDC’s National Healthcare Safety Network (NHSN) is the most widely used healthcare-associated infection (HAI) tracking system. NHSN provides facilities, states, regions, and the nation with data needed to identify problem areas, measure progress of prevention efforts, and ultimately eliminate HAI’s.
What is NHSN?
• NHSN
– Ensures data security, integrity, and confidentiality
– Enables facilities the ability to see their data in real-time and share that information with clinicians, facility leadership, organizational system and partners such as health departments or quality improvement organizations.
What is NHSN?
• NHSN provides medical facilities, states, regions, and the nation with data collection and reporting capabilities needed to: – identify infection prevention problems by facility,
state, or specific quality improvement project
– benchmark progress of infection prevention efforts
– comply with state and federal public reporting mandates
– drive national progress toward elimination of HAIs
Reasons to Participate • Be a leader and become part of creating the first national
LTC CDI baseline • Stay ahead of future federal requirements. On July 16,
2015, CMS published a proposed rule that requires nursing homes to have a system in place for preventing, identifying, reporting, investigating and controlling infections and communicable diseases
• Hospitals are being penalized under the CMS value based purchasing program for high infection rates. Partnering with homes that have low infection rates will become an increasing priority for our local hospitals
• As Accountable Care Organizations (ACOs) proliferate, there will be limitations on their ability to partner with nursing homes that have less than a 3 star rating
Benefits of Participation
• Nursing homes will receive individualized support from the Great Plains QIN-QIO teams
• Nursing homes will have access to specialized resources and tools through this collaboration
• Learn about the principles of LTC Antibiotic Stewardship
• Learn effective communication strategies through TeamSTEPPS® training and resources
Expectations of Participation
• Form an interdisciplinary team in your organization
• Identify a team sponsor and a day-to-day leader
• Consistently submit data during ALL required time periods
• Participate in other collaborative education sessions, conference calls and/or webinars
• Share data, results, best practices and lessons learned
So You Want to Participate . . .
• Complete and return a signed participation agreement to your state QIN contact
• Your state QIN contact will confirm acceptance in project (limited slots available)
• Save the date: 8/9/16 11:00 am -12:00 pm CT for webinar: NHSN First Steps for Nursing Homes (participants will be sent webinar connection details)
• Each home will need to have two persons identified as NHSN administrators
Meet the North Dakota Team
Quality Health Associates of North Dakota [email protected] [email protected]
Michelle Lauckner, RN, BA, RAC-CT Nursing Home
Quality Improvement Specialist
Nathan Brintnell ISSO/Programmer
Jean Roland, RN, BSN HAI Quality
Improvement Specialist
Meet the South Dakota Team
South Dakota Foundation for Medical Care [email protected]
[email protected] [email protected]
Lori Hintz, RN, Quality Improvement
Advisor
Lori Murphy, RN, BSN Quality Improvement
Advisor
Nancy McDonald, RN, BSN, CPHQ
Quality Improvement Advisor
Meet the Nebraska Team
CIMRO of Nebraska [email protected] [email protected]
[email protected] [email protected]
Krystal Hays, RN, MSN, RAC-CT
NE Nursing Home Lead Quality
Improvement Advisor
Peg Gilbert, RN, MS, CIC, FAPIC Regional HAI Lead Quality
Improvement Advisor
Tammy Baumann RN, LSSGB
Quality Improvement
Advisor
Paula Sitzman, RN, BSN Quality
Improvement Advisor
Brenda Groves Regional
Nursing Home Lead, QI Project
Manager
Johnathan Reeves, BA
QI Specialist
Nadyne Hagmeier, RN
QI Project Manager
Brenda Davis, RN, BSN, CIC
QI Project Manager
Tisha Carlson, AA
QI Specialist
Meet the Kansas Team
Kansas Foundation for Medical Care [email protected]
Open Discussion and Sharing
This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy11SOW-GPQIN-KS-C2-130/0616