September 7, 2017 Experience using The CDC’s Patient Conversation Starter in network 14’S 2017 BSI QIA

Texas Dialysis Facilities: 630 Patient Population: 66,908 Who is the network Our Mission We support equitable patient- and family-centered quality dialysis and kidney transplant health care through patient services, education, quality improvement, and information management. Texas Dialysis Facilities: 630 Patient Population: 66,908

18 ESRD Networks- 2017 Health Insight Independent 1 IPRO 16 11 2 18 15   Health Insight Independent   1 IPRO   16     11 2   18   15   15 WVMI Qsource       17   4       9   9 10 12           17 5     3   18   6   6   6 Alliant Health Solutions   8       13   14   7 FMQAI/HSAG  

BSI QIA Selection Process Baseline Data: Q1/Q2 2016 (January – June) Network 14 Average: 0.53 Focus Facility Average: 1.25 Network 14 facilities eligible to report for all of 2016 (N=553) Facilities ranked by highest BSI rate Selection of 20% of Network 14 facilities with the highest BSI Rates (N=108) Oversampling to account for possible attrition (N=6) Total number of focus facilities (N=114) BSI QIA Facilities: 114 Patient Population: 9,123

Cdc’s conversation starter to prevent infections in dialysis patients

BSI QIA patient engagement MARCH March 12-18 Shared facility’s BSIs and other dialysis events rates with patients using the CDC’s Conversation Starter APRIL April 24-28 Discussed facility’s policy for chlorhexidine or alternative use with patients MAY May 5 Used the CDC’s Conversation Starter to share with patients important hand hygiene practices (links to the CDC’s Clean Hands Count Campaign site)

BSI QIA patient engagement Facility’s Patient Clinic Committee members reviewing the Conversation Starter and the Lead Patient Committee member, Juan Morales, demonstrating teach back with the clinic staff.

BSI QIA patient engagement FPR Role The Conversation Starter flyer introduced to the clinical manager. FPR tested for the Network prior to the Network using it in the BSI QIA’s monthly patient engagement activities. Reviewed with two staff members on an individual basis. New nurse - to measure understanding of blood infections Experienced nurse - realized not enough information given to patients Shared with Patient Clinic Committee Review any education materials prior to sharing with patients in clinic Teach it during monthly lobby education session to patients FPR – Facility Patient Representative

What does the CDC’s Conversation Starter do really well? Visual Appeals to all populations of dialysis patients. Very colorful and eye catching, it makes you want to read it. Attractive layout. Clear and concise message. Easy to read and follow, visually appealing. Colorful - appealing to the eye. Uses short statements. Educate Helps teammates initiate conversations that they might otherwise not really know how to start. Reminds us of all the different possibilities for transmitting infection. It gives the patients a visual and take home while they also get audio from nurses explaining to them. Guide It creates efficiency and direction in infection prevention discussion. The talking points are relevant to the patients lives. Topics on the material are common issues in our clinic. Helps guide staff to appropriate content for infection control conversations with patients. Patient Engagement It is very interesting and helped spark interest with the patients. It gets patients thinking once the questions are asked. It gives the patient an opportunity to be informed about their care by asking questions that will heighten their sense of awareness. Answered: 90 Skipped: 10

What changes would the CDC have to make for you to give it a higher rating? Visual Art work. Larger and simplified. Comments made were that it was lengthy and hard to read. More pictures and visual aids. I would like an area to input specifically how this clinic addresses certain topics, such as an edit feature. Educate The print is too small for some patients and would like it to be offered in different languages. Needs to be pediatric friendly to use with children. The wording at times makes some staff members feel antagonizing against staff. Guide More elaboration on each subject matter. Simplify some of the questions. Decrease the number of topics addressed. Consolidate some of the items such as the information about vaccinations. Too much information for patients all at one time. Patient Engagement Make it more patient centered. Maybe having 1 or 2 less questions on one form would help. Many patients seem disinterested after going over the first 2-3 questions. Maybe suggest some questions to ask patients to provoke engagement. Answered: 82 Skipped: 18

How convenient is the CDC's Conversation Starter to use? Answered: 100 Skipped: 0

How easy is it for staff to understand the information on the CDC's Conversation Starter? Answered: 98 Skipped: 2

How easy is it for patients to understand the information on the CDC's Conversation Starter? Answered: 98 Skipped: 2

How useful would the CDC's Conversation Starter be for other facilities to use? Answered: 98 Skipped: 2

How likely are you to recommend the use of the CDC's Conversation Starter to a colleague or facility staff? Answered: 97 Skipped: 3

When did you review the Conversation Starter with your patients? Answered: 55 Skipped: 0

Where did you review the Conversation Starter with your patients? Answered: 53 Skipped: 2

Which staff member(s) were most likely to review the Conversation Starter with your patients? Answered: 50 Skipped: 5

How long did it take the staff member to review the Conversation Starter with your patients? Answered: 54 Skipped: 1

As a result of reviewing the conversation starter with your patients… Were they more likely to ask follow up questions about other topics or concerns? Answered: 55 Skipped: 0 Were they more likely to be engaged in their care? Answered: 45 Skipped: 10

Will you continue using the cdc’s Conversation Starter with your patients after the network’s bsi project has ended? Answered: 44 Skipped: 11

Takeaways and best practices in utilizing the conversation starter tool When Before and during treatment During lobby days and patient meetings. New patient and bi-annual process Where Chairside gives the most 1:1 attention to answer questions in depth Post in staff and patient areas for common understanding How Cover topic as patient interest is strong Simplify responses Decrease the number of topics addressed in one sitting. Use visual aids Who Infection Prevention Manager Clinical Manager, Facility Administrator Facility Patient Representative

Continue Targeted Staff and Patient Education Looking forward Continue Targeted Staff and Patient Education Distribute CDC education tools and other resources Transparency of facility outcomes-share BSI data Survey patients and staff on resources Promote and train facilities on NHSN

2017 BSI QIA THANK YOU QUESTIONS Lydia Omogah, Quality Improvement Specialist 469-916-3802 lomogah@nw14.esrd.net Kelly Shipley, Quality Improvement Director 469-916-3803 kshipley@nw14.esrd.net QUESTIONS