hospital improvement innovation network (hiin)pressure ulcers in individuals receiving palliative...
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HOSPITAL IMPROVEMENT INNOVATION NETWORK (HIIN)
Amanda Keilholz, Program Manager
June 27, 2017
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
Hospital-Acquired Pressure Ulcer Reduction Project
October 2015 – December 2016Prepared by Valorie Graham, BS, MBA, LSSBB, MT, CPHQ
Director, System Quality improvement
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.
Pressure Ulcer Facts
https://www.ahrq.gov/professionals/systems/hospital/pressureulcertoolkit/putool1.html
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
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)
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.
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
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
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
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
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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QI Fellowship Events
HRET HIIN QI Fellowship — Creating a Culture of Safety
1 p.m. Friday, June 30
Register here
Agenda
HRET HIIN QI Fellowship: Foundations for Change Track Virtual Event
11 a.m. Wednesday, July 12
Register here
HRET HIIN QI Fellowship Accelerating Improvement Track Virtual Event
12:30 p.m. Wednesday, July 12
Register here
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PFE Fellowship Events
HRET HIIN PFE Fellowship Coaching Call
11 a.m. Friday, July 14
Register here
HRET HIIN PFE Fellowship — Overcoming Challenges, Barriers and Celebrating Successes
11 a.m. Wednesday, July 19
Register here
Agenda
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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
Jessica Stultz
•Amanda Keilholz
•HIIN Program Manager
•573/893-3700, ext. 1405
Amanda Keilholz
•Toi Wilde, RN, BSN, MBA
•HIIN Program Manager
•573/893-3700, ext. 1406
Toi Wilde
•Mary Shackelford, RN, BSN
•Improvement Advisor
Mary Shackelford
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