Partnership for Safety Keeping Patients Safe Terrence Shenfield BS, RRT-RPFT-NPS Education Coordinator A & T Lectures LLC What is the Partnership for Patients Initiatives Key Elements of the Partnership 10 core areas of focus Care transitions Hospital Engagement Networks Community-Based Care Transitions Program What we have done so far Cather associated urinary tract infections Injuries form falls and immobility Pressure ulcers Surgical site infections Venous thromboebolism ( VTE) Preventable readmissions Objectives Health and Human Services plan to save lives and prevent medical errors and complications Affordable Care Act Invested millions of dollars and wants to ensure appropriate care and money spent wisely Goals in savings: Save $35 billion in health care costs Save $10 billion for Medicare savings Partnership for patients to improve care- so what is it? Affordable Care Act invested 1 billion dollars CMS Innovation Center invested $500 million in additional funding to test different models and practices Improving patient care Patient engagement Collaboration between hospital systems Reduce hospital-acquired conditions and improve care transitions nationwide Partnership for patients to improve care- so what is it? Partnership for patient safety video The Partnership for Patients Initiative Public-private partnership (health systems) working to improve the quality of health care for all Americans Who is involved? Physicians Nurses Hospitals Employers Patients and their advocates Federal and State governments have joined together to promote better care What is the partnership and who are the key players? 3,700 participating hospitals are focused on making hospital care safer, more reliable, and less costly through the achievement of two goals: Making Care Safer Preventable hospital-acquired conditions Goal- decrease by 40% compared to 2010 Improving Care Transitions Preventable complications during a transition from one care setting to another Decreased so that all hospital readmissions would be reduced by 20% compared to What is the Partnership about? 26 State, regional, national and hospital system organizations joined forces to implement best practices 1) Identify solutions already working for leading healthcare systems to reduce hospital-acquired conditions 2) Community-Based Care Transitions Program 82 sites Nursing homes, pharmacies, and area agencies for the aging 3) Patient and Family Engagement Key 3 elements of the Partnership Ten core patient safety areas of focus that include nine hospital- acquired conditions Adverse Drug Events Catheter-Associated Urinary Tract Infections Central Line Associated Blood Stream Infections Injuries from Falls and Immobility Obstetrical Adverse Events Pressure Ulcers Surgical Site Infections Venous Thromboembolism Ventilator-Associated Pneumonia Readmissions Patient Safety Areas of Focus Ten years after publication of the Institute of Medicines report To Err Is Human study We still have about 25 events per 100 admissions preventable injuries and harm occurred to patients A recent study by the Office of the Inspector General (OIG) 13% of hospitalized Medicare beneficiaries experience adverse events Resulting in: Prolonged hospital stay Permanent harm Life-sustaining intervention or death Increased Medicare cost Almost half of those events are considered preventable. Making Care Safer- Improving the safety of our patients Care transitions refer to the movement of patients from one health care provider or setting to another Serious and complex illnesses are prone to errors with transition from one location to another 20% of patients discharged from the hospital to home experience an adverse event within three weeks of discharge Care Transitions The most common adverse events are medication related 20% of discharged patient report inappropriate transitions in medication reconciliation Contributing to lower patient satisfaction and rising health care costs Readmissions have been tied into this too! Improving Care Transitions Hospital Engagement Networks (HENs) work at identifying solutions already working in leading healthcare systems The goal is to disseminate working processes to other hospitals and providers In other words share what they know Develop learning collaborative for hospitals so that there is training available and to promote best practices Hospital Engagement Networks Provide a wide array of initiatives & activities to improve patient safety and reduce medical errors $218 million was awarded Identify high performing hospitals and their leaders to coach and serve as national faculty to other hospitals committed to achieving the Partnership goals Establish QA programs to track and monitor progress Conduct intensive training programs to hospitals that need help Provide technical assistance to help hospitals achieve quality measurement goals Most importantly. Funding to support leadership in going to other health care systems to share knowledge Hospital Engagement Networks Created by the Affordable Care Act Tests models for improving transitions from the hospital to other care settings such as Nursing homes LTACHS Assisted living facilities Home Community-Based Care Transitions Program The goals of the Community-Based Care Transitions Program Reducing readmissions for high-risk Medicare beneficiaries Improve transitions from the inpatient hospital setting to other care settings Improve quality of care Community-Based Care Transitions Program Document measurable savings to the Medicare program $500 million in total funding is available for 2011 through 2015 to community-based organizations Partnering with hospitals and other providers to provide care transition services to effectively manage Medicare patients Community-Based Care Transitions Program ( contd) We have targeted Cather associated urinary tract infections Injuries form falls and immobility Pressure ulcers Surgical site infections Venous thromboebolism ( VTE) Preventable readmissions What has our hospital done so far? Improvement needed Account for 30% of all hospital acquired infections 80% are a result from indwelling catheters Increases length of stay by 0.5 to 1 day Cost vary from $ $ to treat these infections Cather associated urinary tract infections What we have done Campaign to reduce these infections CDC best practice guidelines Adjusted policy and procedure to reflect these guidelines Unit based competencies for aseptic insertion and maintenance Unit huddles and black board listing date of insertion/removal dates Revised CPOM Foley catheter orders to include reason for using the device Discontinued catheter 2 days post op Monitor bundle compliance Created score cards for each unit Recognition program for units being the best Cather associated urinary tract infections Improvement needed Each year 700,000-1,000,000 falls each year in hospital 30%-50% result in injury Serious fall-related injury is more than $13,000, and the patient's length of stay increases by an average of 6.27 days Increased health care utilization Fractures, dislocations, lacerations, and internal bleeding 1/3 of all falls can be prevented Fall prevention strategies require optimizing hospitals physical design and environment Our goal is decrease falls by 40% from baseline Injuries form falls and immobility What we have done Created schedule that had same RN and CNA caring for the same patients- resulted in fewer falls and greater patient satisfaction Developed and improved policies in the hospital that were evidence based. Consulted with third party Post fall huddles to increase awareness of contributing factors that lead to fall Early mobilization program in floor and soon to be in ICUs ( younger patients perceive themselves stronger) Piloted music headphones to distract patients Fall risk assessments shared with managers Lifting equipment should be utilized Results- we reduced our number of falls Injuries form falls and immobility Pressure ulcers Improvement needed The percentage of pressure ulcers is 0.4%-38% in acute care settings The cost range from $ to $70, Annual hospital cost $400, to $700, More likely to die during the hospital stay Longer hospital lengths of stay Be readmitted within 30 days after discharge. What we have done Goal is to decrease the incidence of hospital acquired pressure ulcers thru evidence based intervention Used out side consultant to determine if policy and procedures are evidence based With a Braden score of less than or equal to 16 prophylactic use of a foam dressing (Mepilex) Patient Safety Grand Rounds performed pertaining to pressure ulcer prevention Early mobilization initiatives Wound care team developed new pressure ulcer guidelines Develop new education programs for CNA Reduction in pressure ulcer rates for the last two quarters Pressure ulcers Improvement needed Surgical site infections major source of morbidity 300,000 SSI each year Additional 7-10 post operative days Cost $ to $29, Surgical site infections What we have done Root cause analysis Preoperative and post operative interventions Tracked surgical scrub time and trending Education to physicians about Chlorprep surgical prep time Surgical scrub time policy updated Surgical site infections Improvement needed DVT and Pulmonary Embolism 50% of VTE are hospital acquired PE results in 100,000 deaths each year Goal is to decrease VTE by 40% from baseline Venous thromboebolism ( VTE) What we have done Introduced evidenced based risk assessment tool to categorize risk and offer appropriately ordering interventions Clinical integration team monitored compliance with tool Updated CPOM VTE order sets Shared PI data with nursing PI department Venous thromboembolism ( VTE) Part 1 What we have done Looking over data showed