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HOSPITAL IMPROVEMENT INNOVATION NETWORK (HIIN) Amanda Keilholz, Program Manager June 27, 2017

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Page 1: HOSPITAL IMPROVEMENT INNOVATION NETWORK (HIIN)Pressure Ulcers in Individuals Receiving Palliative Care: A National Pressure Ulcer Advisory White ... Milestone 6 Jan. 19, 2018 $475

HOSPITAL IMPROVEMENT INNOVATION NETWORK (HIIN)

Amanda Keilholz, Program Manager

June 27, 2017

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Pressure Ulcer Prevention

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Freeman Health System

Identified an issue with hospital acquired pressure ulcers

How they have used data to drive improvements

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Dmitry S Romanov MBA, CPHQQuality EHR Analyst

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Hospital-Acquired Pressure Ulcer Reduction Project

October 2015 – December 2016Prepared by Valorie Graham, BS, MBA, LSSBB, MT, CPHQ

Director, System Quality improvement

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Purpose

• A spike in hospital-acquired pressure ulcers (HAPUs) occurred in October 2015 in FHS ICU. Pressure Ulcer Prevention (PUP) month, November 2015, was leveraged to focus on prevention and early identification of pressure ulcers. Daily rounding occurred on patients at risk for developing skin ulcers as identified by predictive analytics.

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Pressure Ulcer Facts

https://www.ahrq.gov/professionals/systems/hospital/pressureulcertoolkit/putool1.html

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Interventions• Pressure Ulcer Prevention (PUP) Month in November 2015

included:

– On-spot education

– At-risk patient consults

– PUP Dashboard

• Daily Pressure Ulcer report (with feedback to unit directors)

• Removal of old green mattresses

• Contract for Dolphin fluid beds

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Interventions

• Implementation of new turning system

• Bariatric bed report (to assist in getting Bari beds sooner)

• New bari beds ordered

• NDNQI Pressure Ulcer Surveillance (annually)

• Pressure Ulcer Prevention action team (since July of last year)

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Data Analytics

• Concurrent data monitoring

• Flexibility in report writing

• Immediate notifications for assigned personnel

• Ability to use other relevant clinical data without leaving the software

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Data Analytics (contd.)

• Allows search for interventions, orders

and/or assessments using key words to help

identify patients with wound care needs.

• Provides concurrent monitoring and

notifies Wound Care team members

when new patients meet criteria.

• Wound Care team reports back to SQI team

member who then forwards W/C notes to

appropriate team leaders.

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Data Analytics (contd.)

• For the Pressure Ulcer Prevention Profile, the analytic tool searches for patients with the following conditions:

– Low Braden Score

– Or Skin Alteration

– Or New Ostomy

– Or an Open Wound (related to Pressure)

– Or Wound V.A.C

– Or Diagnosis of Pressure Ulcer

AND

– Absence of Wound Care Assessment, Wound Care Consult Order or Wound Care Charges

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Performance After Intervention

HAPUs in the ICU (blue in graph above) decreased by 44% when comparing overall 2015 performance to overall 2016 performance.

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ICU Financial Savings

72 HAPUs in 2015

x $17,000 Average cost estimate

$1,224,000 Estimated cost for 2015

40 HAPUs in 2016

x $17,000 Average cost estimate

$ 680,000 Estimated cost for 2016

$1,224,000

- $ 680,000

$ 544,000

Estimated ICU cost avoidance in 2016

(32 HAPUs avoided)

http://www.ncbi.nlm.nih.gov/pubmed/19827228

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Pressure Ulcer HIIN Data

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PrU-2 Pressure Ulcer Prevalence, Hospital Acquired Stage 2+

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0.00%

0.10%

0.20%

0.30%

0.40%

0.50%

0.60%

0.70%

0.80%

0.90%

Measure Rate

Average of Rate

MeanBL

MeanTarg

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PrU-1 Pressure Ulcer Rate, Stage 3+

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0.00%

0.05%

0.10%

0.15%

0.20%

0.25%

0.30%

0.35%

0.40%

Measure Rate

Average of Rate

MeanBL

MeanTarg

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Data is in the Numbers

PrU-2: Prevalence year to date improvement of 43 percent over baseline

PrU-3: Rate Stage 3+ year to date improvement of 26 percent

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Pressure Ulcer Prevalence

Costs avoided — $6,208,975

Harms prevented — 365

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Kennedy Terminal Ulcers

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SCALE

Skin Changes At Life’s End — a term used to describe wounds that appear at the end of life

SCALE ulcers develop as part of the dying process

Kennedy Terminal Ulcers are a subset of SCALE

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Kennedy Terminal Ulcers

KTUs develop and deteriorate rapidly

Butterfly-shaped

Predominantly located on the coccyx or sacral region

Will even develop when evidence-based interventions are maintained

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Kennedy Terminal Ulcers

The National Pressure Ulcer Advisory Panel —Pressure Ulcers in Individuals Receiving Palliative Care: A National Pressure Ulcer Advisory White Paper Pressure ulcers in individuals receiving palliative care

Appropriate injury preventative and management interventions that focus on supporting patients’ comfort, dignity and personal choices during the end-of-life period.

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Project Updates

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Stipends are Coming!

Hospital Milestone 4 Achievement

Total — 96 percent/70 HIIN hospitals

Stipend amount — $475

Stipends will be sent out the third week of July

Total disbursement — $33,250

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What is the Stipend Breakdown?Data Due Date

Amount When is $ dispersed

Criteria

Milestone 4 May 8, 2017

$475 July 2017 Hospitals submit 85 percent or greater of their applicable required data (must include core* and readmission measures)

Milestone 5 Sept. 14, 2017

$1450 Nov. 2017 Hospitals submit 85 percent or greater of their applicable requireddata (must include core* and readmission measures) AND must meet Year 1 goals on readmission AND seven other topics.**Hospitals that do not meet Milestone 4 will NOT be eligible for Milestone 5

Milestone 6 Jan. 19, 2018

$475 Mar. 2018 Hospitals submit 85 percent or greater of their applicable required data (must include core* and readmission measures)

Milestone 7 June 11, 2018

- - Hospitals submit 85 percent or greater of their applicable required data (must include core* and readmission measures)

Milestone 8 Aug. 21, 2018

$1525 Sept. 2018 Hospitals submit 85 percent or greater of their applicable requireddata (must include core* and readmission measures) AND must meet Year 2 goals on readmission AND seven other topics.**Hospitals that do not meet Milestone 6 AND 7 will NOT be eligible for Milestone 8

* Core measures are as defined by HRET and subject to change per milestone. As of 3/28/2017 HRET has not defined these core measures. **Maintaining zero meets goal

*There will not be separate educational reimbursements in the HIIN.

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Milestone 5

Milestone 4 has been met

Monthly monitoring data through May

Readmissions data through April

Year 1 goals for Readmissions and seven other topics

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Data Due Dates — HIIN Project Year 1

HIIN Data Due Dates

Task

Deadline For

Hospital to

Submit Data Data Included in Deadline

Baseline 17-Jan Baseline

Monthly Monitoring Data 23-Jan Oct-Dec

Monthly Monitoring Data 20-Feb Oct-Jan

Mid-Year Report 8-Mar Oct-Jan

Monthly Monitoring Data 23-Mar Oct-Feb

Monthly Monitoring Data 20-Apr Oct-March

Milestone 4 8-May Hard deadline for ALL data Oct-Feb

Monthly Monitoring Data 22-May Oct-April

Monthly Monitoring Data 22-Jun Oct-May

Monthly Monitoring Data 21-Jul Oct-June

Monthly Monitoring Data 23-Aug Oct-July

Target Report 6-Sep Oct-July

Monthly Monitoring Data 19-Sep Oct-Aug

Milestone 5 14-Sep Hard deadline for ALL data Oct-May

Monthly Monitoring Data 23-Oct Oct-Sept

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Project Goals

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What is the Stipend Breakdown?Data Due Date

Amount When is $ dispersed

Criteria

Milestone 4 May 8, 2017

$475 July 2017 Hospitals submit 85 percent or greater of their applicable required data (must include core* and readmission measures)

Milestone 5 Sept. 14, 2017

$1450 Nov. 2017 Hospitals submit 85 percent or greater of their applicable requireddata (must include core* and readmission measures) AND must meet Year 1 goals on readmission AND seven other topics.**Hospitals that do not meet Milestone 4 will NOT be eligible for Milestone 5

Milestone 6 Jan. 19, 2018

$475 Mar. 2018 Hospitals submit 85 percent or greater of their applicable required data (must include core* and readmission measures)

Milestone 7 June 11, 2018

- - Hospitals submit 85 percent or greater of their applicable required data (must include core* and readmission measures)

Milestone 8 Aug. 21, 2018

$1525 Sept. 2018 Hospitals submit 85 percent or greater of their applicable requireddata (must include core* and readmission measures) AND must meet Year 2 goals on readmission AND seven other topics.**Hospitals that do not meet Milestone 6 AND 7 will NOT be eligible for Milestone 8

* Core measures are as defined by HRET and subject to change per milestone. As of 3/28/2017 HRET has not defined these core measures. **Maintaining zero meets goal

*There will not be separate educational reimbursements in the HIIN.

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Timeline

Esthetic changes from feedback

Sending monthly with improvement calculator

Sending to CEOs quarterly

HIIN Executive Dashboard

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Claims Measures

Changing inclusion/exclusion parameters for data pull to exclude HIV diagnosis

HIIN monthly data submission is pulled from October 2016 to present date

Resubmitting baselines for claims measures with new exclusion parameters

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HIIN Projects

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Hospital Leadership Quality Assessment Tool

Complimentary offering

Two survey periods

June–Dec. 2017

April–Oct. 2018

Senior leadership and clinical manager surveys

Reports upon completion

Usage reports

Hospital reports

Internal comparison

External comparison

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Qualaris Audit Tool Projects

Hand Hygiene

Culture of Safety Rounding

Sepsis

Readmissions/Care Transitions

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Readmissions Reduction/Care Transitions Immersion Project –Cohort 2

Registration is open, closes 5 p.m. Friday, July 14

Project kick-off — Aug. 15

Limited to 20 Missouri hospital participants

Readiness Assessment

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Sepsis Immersion Project – Cohort 2

Enrollment — Oct. 2017

Project kick-off — Nov. 29

Limited to 20 Missouri hospital participants

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HIIN Physician/Administrator Engagement Opportunities

American Board of Medical Specialties Maintenance of Certification Part IV Final touches are being put on the ABMS MOC Part IV communication

that will go out soon.

FAQ

Adaptive Leadership HRET is excited to announce that the Adaptive Leadership in Medicine

training will be held in Chicago, August 2-3. This is an opportunity for a physician and administrator from the same organization to join together and gain invaluable leadership tools. HIIN hospitals are eligible to receive a scholarship that covers training, hotel and airfare expenses. Those interested in applying will be required at the time of registration to identify the individual from their organization who will be joining them.

Register here!39

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Adaptive Leadership Goals

Enhance capacity to diagnose and solve complex challenges by selecting a real-world issue and applying course strategies, group coaching and mentoring.

Explore the types of leadership required to solve an organization’s most pressing challenges.

Build a network of adaptive leadership champions who have a shared framework, language and toolkit.

Reinforce agility by identifying opportunities to transform an organization’s short- and long-term performance.

Use adaptive leadership principles to identify critical challenges and distinguish between their essential components and those that must be re-envisioned.

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HRET Webinars

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HRET HIIN | MOST WANTED: Guidance to Prevent Surgical Site Infections in the Era of “Unresolved Issues”

June 29, 2017 | 11:00 a.m. - 12:00 p.m. CT Register here | Flyer | Guideline Tool

Are you struggling with providing your surgical team with practical and evidence-based guidance? The recently released CDC HICPAC Guidelines for the prevention of SSI's is the first update since publication of the 1999 SSI prevention guidelines. These new guidelines are based upon randomized controlled trials that were published prior to 2015, and as a result, many practices are listed as 'unresolved' or 'no recommendation.'

Seeking to assist front line staff, The Wisconsin Division of Public Health (WDPH) convened content experts . These experts developed a guideline document to enhance, not replace, the CDC HICPAC SSI Prevention Guidelines.

The WDPH document provides enhanced guidance on the following and more:

Antimicrobial prophylaxis

Glycemic control

Normothermia

Oxygenation

Antiseptic prophylaxis

In addition, it includes recommendations for staphylococcal surveillance and a "surgical bundle."

We are extremely fortunate that one of these experts, Gwen Borlaug, MPH, CIC, will be featured during the HRET HIIN SSI webinar on June 29th from 10am-11am CT. We suggest you review the comprehensive and highly practical guidance tool in advance of the session so that you will be prepared to participate in the open-mic portion of the webinar. Come with your questions and comments. Let's have an "intellectual food fight!"

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HRET HIIN Falls | Hit the Wall on Falls? Time to Recalibrate!

July 11, 2017 2:00 p.m. - 3:00 p.m. CT Register here | Agenda | Flyer

What do you do when you have hit the wall, plateaued or experienced an increase in falls? Join the

July 11th Falls Virtual Event to learn how to dissect your falls program to regroup and re-calibrate.

Amy Hester PhD, RN, BC, Director of Nursing Research and Innovation at UAMS Medical Center, and

Chief Scientific Officer for HD Nursing, will review the common sense key elements that need to be

examined to determine how to intervene to revive a stagnant falls and how care planning can fall

short. She will shine light on common mistakes that make a program unsustainable. Dr. Hester will

challenge participants to go back to the basics to evaluate the effectiveness of current tools and work-

flows, rather than adding more interventions that further dilute the effectiveness of their work.

Participants will share which risk and care planning tools, as well as electronic health record systems,

they are currently using to promote peer sharing.

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HRET HIIN | Rural/CAH Affinity Group Virtual Event

July 17, 2017 1:00 p.m. - 2:00 p.m. CT Register here.

Readmission reduction can be hard to come by if you have already picked your low hanging fruit.

Taking improvement to the next level will require the next tier of sophistication - a data driven

approach looking at your "BIG" and small data. Join the CAH Rural Affinity Group Event on July 17th

at 1:10pm CT for a practical approach to using data to identify high-leverage opportunities to drive

improvement. Learn from HRET HIIN fellows who have pulled and analyzed "BIG" data and "small"

data to find surprising information that led to overall reductions of readmissions in their organization.

In an environment limited by scarce resources, choosing the right path for improvement and

partnerships is key!.

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HRET HIIN Readmissions | Reduce Readmissions Fishbowl Series 3

July 13, 2017 | 11:00 a.m. - 12:00 p.m. CT Register here.

Does your organization have an opportunity to gain new insights and test strategies to

reduce readmissions? Join the HRET HIIN on May 25th for the first reducing readmissions

"Fishbowl" event where you will watch the process improvement journey of five HRET

HIIN hospitals.

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SouthCentral HIINergy GroupTransforming Culture for Safety

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Transforming Culture for Safety

August 2, 2017 | 10:00 a.m. - 11:00 p.m. CT Register here.

Effective communication is essential for a culture of safety. Join us as we hear an

informative overview of best practice from Betsy Lee, MSPH, BSN, RN, a Culture of

Safety content expert from Cynosure Health. Then learn implementation strategies from

two very different organizations in Texas, one a Critical Access Hospital and the other a

large five-hospital system. Specific practices will include: Bedside Report, Safety Huddles

and more!

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HIIN Fellowships

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Upcoming Events

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MHA Strategic Quality Webinars

What’s Up Wednesday

12 noon first Wednesday of each month

Register here

HIIN Huddles

2 p.m. fourth Tuesday of each month

Register here

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HIIN HAI Regional Bootcamps

Hospital-acquired infections

Hand hygiene

Operational-focused

$500 innovation stipend to use toward HAI reduction project

Minimum of three attendees

Two frontline staff

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8:30 a.m.Registration

9 a.m.Welcome and HIIN Project UpdateJessica Stultz

9:15 a.m.TeamSTEPPS Activity

10 a.m.Hand Hygiene Case Study

10:30 a.m.HAI: Proven Tools and Methods to Achieve and Sustain Reductions in Patient Harm – Part IBetsy Lee and Barb Debaun, Cynosure Health

HIIN HAI Regional Bootcamps

11:30 a.m.Lunch

1 p.m.HAI: Proven Tools and Methods to Achieve and Sustain Reductions in Patient Harm – Part 2Betsy Lee and Barb Debaun, Cynosure Health

2 p.m.Antibiotic Stewardship Program Immersion Project Case Study

2:30 p.m.HAI — Action items and synthesis for sustainabilityBetsy Lee and Barb Debaun, Cynosure Health

3 p.m.Wrap-UpAmanda Keilholz, Jessica Stultz and Toi Wilde

3:30 p.m.Adjournment

Missouri HIIN Regional Bootcamps are designed to offer a more interactive and hands-on learning environment. The bootcamps will highlight hospital- or health care-acquired infections and different evidence-based practices and techniques for prevention.

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Springfield

Thursday, Aug. 24

Oasis Hotel Convention Center

Register here

Independence

Friday, Aug. 25

Hilton Garden Inn

Register here

HIIN HAI Regional Bootcamps

Cape Girardeau

Tuesday, July 18

Ray’s Banquet Center

Register here

Chesterfield

Wednesday, July 19

Hampton Inn & Suites

Register here

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Save the Date

Excellence in Clinical Care Series

Sept. 26-29

Lake Ozark, Mo.

2017 Annual Emergency Preparedness & Safety Conference

Oct. 11-13

Lake Ozark, Mo.

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Resources

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Readmission Reductions Whiteboard Video Series

To focus and align with the material in the HRET HIIN Preventable Readmissions change package and top ten checklist.

The goal is to facilitate an improved understanding of best practices to test and implement, in order to support efforts in reducing all cause 30-day readmissions.

Eleven videos in this series for strategies focused on the development and sustainability of readmissions reduction plans and programs.

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Trustee Video

AHA/HRET designed a video guide to illustrate the important role that leaders and trustees can play in the journey to improve patient care. It serves as a tool for all trustees to use as they work towards the goal of eliminating all patient harm within their organizations. To accompany the videos, a workbook has been designed to be used as a tracking tool as viewers prepare for each module, view the videos and then discuss key take-aways.

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Podcasts

Sepsis Snippets for Success — Discusses regulatory

requirements, quality improvement and science information. This podcast can support hospital teams with understanding and use of the sepsis predefinition.

ADE Prevention Hypoglycemia — Provides an

overview of hypoglycemia and adverse drug prevention.

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ListServ

Get access to other hospitals, subject matter experts and other resources to avoid reinventing the wheel.

Listserv sign up open through the duration of the HIIN … Sign up today!

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MHA Trajectories

“Opioid Use Disorder: Assessing and Treating a Chronic Illness”

This issue features a short video of Sam Page, Physician Anesthesiologist from Mercy Hospital St. Louis, discussing the benefits of a Prescription Drug Monitoring Program in a practice setting. This video is a joint effort among many Missouri health care provider associations and will be the first in an ongoing series of physician-to-physician videos about various opioid reduction strategies.

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“Date of Last” Posters

Updated topic-specific “Date of Last” posters now are available to download on the HRET HIIN website including 16 HIIN topics!

This tool is designed to help track the date of the last adverse event at your facility.

As an example, see the “date of last” septic event poster to the left.

Join your colleagues in reaching zero harms!

Hard copies available upon request.

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Change packages have been recently created or updated. Change packages for Culture of Safety, Malnutrition and VTE will be available by the end of next week. Change packages for Diagnostic Error and Antibiotic Stewardship are in development and scheduled to be released in July.

Adverse Drug Events

Airway Safety

Catheter-Associated Urinary Tract Infection

C. difficile Infection

Central Line-Associated Bloodstream Infection

Delirium

Exposure to Radiation

Falls

Multi-Drug Resistant Organisms

Pressure Ulcers

Readmissions

Sepsis

Surgical Site Infection

Ventilator-Associated Event

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Missouri HIIN Team

•Jessica Stultz, RN, BSN, MHA, CPHQ

•Director of Clinical Quality

•573/893-3700, ext. 1391

[email protected]

Jessica Stultz

•Amanda Keilholz

•HIIN Program Manager

•573/893-3700, ext. 1405

[email protected]

Amanda Keilholz

•Toi Wilde, RN, BSN, MBA

•HIIN Program Manager

•573/893-3700, ext. 1406

[email protected]

Toi Wilde

•Mary Shackelford, RN, BSN

•Improvement Advisor

[email protected]

Mary Shackelford

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