Florida Hospital Association Hospital Engagement Network (HEN) Office Hours Wednesday, July 10, 2013 12 – 1 p.m. EDT Audio for today’s presentation is broadcast via phone access only: Please Dial-in - 866.740.1260 (Access Code - 8416230) We will begin momentarily . . . thank you for standing by as we allow participants to connect

Agenda for Today’s Call Recent HEN events Readmission meeting – Kim Streit Patient/Family Engagement – Phyllis Byles Harm Across the board templates and meetings – Sally Forsberg Overview of Quality Components in the Proposed Medicare Payment Rule – Kim Streit How are we doing as a HEN? – Sally Forsberg Sustaining zero – Phyllis Byles Nicole Hawkins, Orlando Health Pharmacists workgroup/call – Phyllis Byles 2

Recent HEN Events Readmissions Workshop June 6- Building Your Care Transitions Team Involvement of Pharmacist SNF, HHA Palliative Care Discharge medications June 27 Office Hours Follow up conversation with community providers July 25 Office Hours Walgreens Bedside Program August 22 Office Hours

Recent HEN Events Patient & Family Engagement Summit Patients as Partners Training Guide The Hospital Engagement Network GUIDE to Working Effectively with Patient and Family Advocates to Achieve Safer Care Healthcare and Patient Partnership Institute H2 Piorg

Reducing Harm Across the Board Regional Meetings Date Region Location JULY 12 Central Florida Marriott Lake Mary JULY 16 West Coast Hyatt Regency Sarasota JULY 17 South Broward Health North – Deerfield Beach (Ft. Lauderdale) Registration:  8:00 a.m. - 8:30 a.m. EDT Program:  8:30 a.m. - 12:30 p.m. EDT FREE for FHA HEN Hospitals It is not too late to RSVP online – visit the FHA HEN Education & Events Calendar http://www.fha.org/hen

Florida Harm Across the Board Templates Broward Health Coral Springs Orlando Health Arnold Palmer Hospital for Children Broward Health Imperial Point Dr. P. Phillips Hospital Broward Health Medical Center Orlando Regional Medical Center South Seminole Hospital Broward Health North Winnie Palmer Hospital for Women Delray Medical Center Health Central Hospital Lake Butler Hospital Lee Memorial Health System Cape Coral Hospital Gulf Coast Medical Center HealthPark Medical Center Lee Memorial Hospital

Florida Harm Across the Board Templates Congratulations to the Florida hospitals whose Harm Across the Board Templates were selected for presentation at the Quality & Safety Road Map in San Diego this month: Lake Butler Hospital Orlando Health Arnold Palmer Hospital Dr. P. Phillips Hospital Orlando Health South Seminole Hospital Orlando Regional Medical Center Winnie Palmer Hospital

Overview of Quality Components in the Proposed Medicare Payment Rule Readmissions Penalty Program 2% penalty Exclusion on “planned readmissions” Expands to COPD, total Hip/knee in FY2015 Hospital Acquired Conditions FY 2015 – 1% reduction if in top quartile Eight measures AHRQ PSIs (either six individual or composite) HAIs (CLABSIs, CAUTIs) + more in FY 2016 Value Based Purchasing (VBP) FY 2014 – 1.25% of payments to fund FY 2016 – add CAUTI, SSI FY 2017 – MRSA and C diff

How are we doing as a HEN? Met the interim CMS goal for 30/6/60 Topics that met the goal for 30/6/60: Catheter- Associated Urinary Tract Infections Central Line Associated Blood Stream Infections Obstetrical Harm Pressure Ulcers Surgical Site Infections Ventilator- Associated Pneumonia Congratulations to 58 FHA HEN hospitals that met the 30% improvement in 6 topics!!!

Catheter-Associated Urinary Tract Infections Rate - All Tracked Units - (CDC NHSN) How Are We Doing? Improvement # Hospitals >40% 29 0 for 12/24 months 10 0 for 6-11/23 months 6 2/11/13 – CDS data file now has this compiled! Effective July 9, 2013

CLABSI Rate - All Units (by Device Days) (CDC NHSN) How Are We Doing? Improvement # Hospitals >40% 31 0 for 12/24 months 13 0 for 6-11/23 months 2 Effective July 9, 2013

Surgical Site Infection Rate (in-hospital) (CDC NHSN) How Are We Doing? Improvement # Hospitals >40% 31 0 for 6-11/23 months 14 2/11/13 – CDS data file now has this compiled! Note: Insufficient baseline data have been reported for inclusion in this graph. Effective July 9, 2013

Ventilator-Associated Pneumonia Rate - All Units (CDC NHSN) How Are We Doing? Improvement # Hospitals >40% 38 0 for 12/24 months 19 0 for 6-11/23 months 1 2/11/13 – CDS data file now has this compiled! Effective July 9, 2013

Decubitus Ulcer - Adults (AHRQ PSI-3) vs Decubitus Ulcer - Adults (AHRQ PSI-3) vs. Pressure Ulcer (MCR FFS) (CMS HAC)* How Are We Doing? Improvement # Hospitals >40% 39 0 for 12/24 months 18 0 for 6-11/23 months 6 Note: CMS HAC is AHCA Administrative Data Effective July 9, 2013

Falls With or Without Injury (NSC-4) vs Falls With or Without Injury (NSC-4) vs. Injuries from Falls and Trauma All Patients (CMS HAC)* How Are We Doing? Improvement # Hospitals >40% 36 0 for 12/24 months 6 0 for 6-11/23 months 2 Note: CMS HAC is AHCA Administrative Data and includes all payers Effective July 9, 2013

Elective Deliveries at >= 37 Weeks and < 39 Weeks (JC PC-1) How Are We Doing? 39 hospitals have a Hard Stop Policy Improvement # Hospitals >40% 19 0 for 6-11/23 months 2 Effective July 9, 2013

Post-op PE or DVT (All Adults) (AHRQ PSI-12) vs Post-op PE or DVT (All Adults) (AHRQ PSI-12) vs. Potentially Preventable PE or DVT (30)* How Are We Doing? Improvement # Hospitals >40% 23 0 for 12/24 months 8 0 for 6-11/23 months 1 Note: CMS HAC is AHCA Administrative Data Effective July 9, 2013

Readmission within 30 days (All Cause) How Are We Doing? Improvement # Hospitals >20% 29 Effective July 9, 2013

Project Title: VAP Reduction & Prevention Date: June 2013 Hospital Name: ORMC Multisystem ICU State: Florida Self Assessment Score = 4 (1=Planning; 2=Some Activity; 3=Some Improvement; 4=Significant Improvement; 5=Outstanding Results; See AHA/HRET Assessment Scale document for more detail) Lessons Learned Aim Statement Run Charts Aim? Decrease the rate of Ventilator Acquired Pneumonia (VAP) by 50% within 6 months and achieve a rate of 0% by October 2013. Improve safety culture .Improvement in documentation of: HOB elevated at time of audit. Documentation of teeth brushed every 24 hrs. Sedation Vacation/Weaning. Consistent documentation of: HOB elevation every shift. Stress Ulcer Prophylaxis Decrease in documentation of: Oral care documented Q4 hours Total compliance of VAP bundle. Why is this project important?: VAP is the leading cause of death among hospital-acquired infections, with mortality as high as 40%. VAP ventilator days, length of ICU stay, excess use of antibiotics and length of hospital stay after discharge from the ICU. Recommendations and Next Steps Changes Being Tested, Implemented or Spread Continue to reinforce with staff, all components of the VAP Bundle, including appropriate documentation of such. (T) Compliance with elevation HOB 30-45 degrees (T) Oral Care & Brushing of Teeth (T) Implementation of GI Prophylaxis (T) Sedation Vacation and weaning trials Patient and family education for VAP prevention (I) Education provided to all staff regarding ways to prevent VAP, process indicators. Team Members Executive Champion: Anne Peach Nursing Champion: Alisa Slimick, & Mary Rodgers Physician Champion(s): Drs. Jimenez, Dr. Sadowsky, Dr. Venus and Dr. Spack Project Manager: Nicole Hawkins Rate of Infection 2012 0.3/1000 vent days

Sustaining Zero Dr. Philips Hospital (DPH) ICU-427 days South Seminole ICU-407 days Arnold Palmer Peds ICU-424 days Winnie Palmer ICU-1157 days Multisystem ICU at Lucerne-412 days ORMC Cardiovascular ICU-226 days Multisystem ICU at ORMC-175 days Trauma ICU at ORMC-53 days Neuroscience ICU at ORMC-30 days previous VAP days were 579!

Pharmacists Workgroup / Call Provide an opportunity for pharmacists around the State to share best practices in quality work. The goal would be to enhance and accelerate work in decreasing ADEs, falls, readmissions through multi-disciplinary collaboration. A pharmacist would be facilitating the group process with FHA support.

Upcoming Events HRET OB Harm Boot Camp – Session 2 (Live Stream) July 10, 11:30 a.m. – 4:30 p.m. EDT Where’s Your CAUTI Rate? (Webinar) July 10, 1-2 p.m. EDT Reducing Harm Across the Board (Regional Meetings) July 12 (Lake Mary), July 16 (Sarasota) and July 17 (Deerfield Beach) The Patient and Family Engagement Webinar July 15, 3-4 p.m. EDT Transitioning Asthma Care from the ED to Prevent Repeat Visits (Webinar) July 18, 1-2 p.m. EDT FHA Collaborative on Improving HCAHPS (In-person meeting) August 19 (Orlando) Mark Your Calendar for next month’s FHA HEN Office Hours – Wed., August 14, at 12-1 pm EDT Watch for the weekly “Upcoming HEN Events” e-blast ! 18

QUESTIONS 19