MetaStar 2005 Some is Not a Number. Soon is Not a Time. Carolyn Coffey, BSN, RN, MS, CPHQ Critical Access Hospital Workshop for Nurses December 6, 2005

MetaStar 2005 Objectives  Save 100,000 lives over the next 18 months Enroll as many as 2,000 hospitals Enroll as many as 2,000 hospitals Hospitals adopt 6 evidence based changes Hospitals adopt 6 evidence based changes  Build a reusable national infrastructure for change

MetaStar 2005 The six changes  Deployment of rapid response teams  Delivery of reliable, evidence-based care for acute myocardial infarction  Prevention of central line infections  Prevention of surgical site infections  Prevention of ventilator-associated pneumonia  Prevention of adverse drug events

MetaStar 2005 Infrastructure for change  Nodes Geographic node—WI Node Geographic node—WI Node Organizational nodes—Ascension Health Organizational nodes—Ascension Health Affinity nodes Affinity nodes  Childrens’ hospitals  Rural hospitals  Non-exclusivity  Take all comers

MetaStar 2005 Campaign statistics  Began December 14, 2005, 9:00 a.m. (ET)  “Ends" June 14, 2006, 9:00 a.m. (ET)  Over 2,900 hospitals currently participating  Over 70 Wisconsin hospitals participating

MetaStar 2005

MetaStar 2005 Node responsibilities  Disseminate improvement tools  Provide support to health care providers throughout Wisconsin  Encourage other hospitals to join the campaign and to participate in improvement efforts associated with the campaign

MetaStar 2005 Node responsibilities (cont)  Act as a communication point between the hospitals in the campaign and the national campaign  Respond to emerging issues during the course of the campaign  Track and support hospitals in measure campaign progress

MetaStar 2005 Wisconsin Node activities  Conducted survey of participating hospitals  MetaStar’s assistance under its CMS contract  MetaStar’s Central Line Infection Initiative  WHA/PSW Medication Reconciliation Project  WONE Rapid Response Team work

MetaStar 2005 Intervention Fully Implemented (6/05) AMI Care 56% Surgical Infection Prevention 32% Medication Reconciliation 26% VAP Prevention 15% CLI Prevention 13% Rapid Response Team 9% * N = 52-54

MetaStar 2005 Of the six changes, establishing rapid response teams has the potential to save the most lives—60,000 of the 100,000 lives—but has the lowest implementation rate—9% of Wisconsin hospitals are fully implemented

MetaStar 2005 Deployment of rapid response teams (RRTs)  Team of clinicians (doctors, nurses, respiratory therapists, etc.) who bring intensive care expertise to the patient bedside (or wherever it is needed).  Goal: To respond to the signs and symptoms of the patient’s worsening condition before the patient’s heart or breathing stops

MetaStar 2005 Wisconsin Node support for rapid response teams  Led by the Wisconsin Organization of Nurse Executives and The Dahlen Company  Established a steering committee  Prepared a sample intervention timeline for hospitals considering starting an RRT  Using RWHC’s quality round tables to discuss implementation issues

MetaStar 2005 Wisconsin Node support for rapid response teams (cont)  Calls to hospitals by The Dahlen Company  Posting list of hospitals that have implemented RRT on WI Node website  Posting contact information for help  Posting tips for those that are stalled

MetaStar 2005 Bundle for delivery of reliable, evidence-based care for AMI  Early administration of aspirin  Aspirin at discharge  Early administration of beta-blocker  Beta-blocker at discharge  ACE-inhibitor or ARB at discharge for patients with systolic dysfunction  Timely initiation of reperfusion  Smoking cessation counseling

MetaStar 2005 What’s a bundle?  Measure of performance of evidenced based practices vs. opportunity  Patient centered  All or nothing

MetaStar 2005 WI Node support for AMI  AMI webinar November 2006  MetaStar work on appropriate care measures (ACM) aligns with 100k Lives AMI bundle  CAH Project Planning Conference Calls December 5, 3-4 PM December 5, 3-4 PM December 12, 12-1 PM December 12, 12-1 PM  Special AMI measures for CAH—Fall 2006  Working to report ACM bundle on Checkpoint

MetaStar 2005 Prevention of central line infections bundle  Hand hygiene  Maximal barrier precautions  Chlorhexidine skin antisepsis  Optimal catheter site selection  Daily review of line necessity, with prompt removal of unnecessary lines

MetaStar 2005 WI Node work on central line infection prevention  MetaStar’s Central Line Infection Initiative  16 hospitals participated  Goals: To reduce the number of central line infections in participating hospitals to zero To reduce the number of central line infections in participating hospitals to zero To understand the economic impact of central line infections To understand the economic impact of central line infections

MetaStar 2005 MetaStar Central Line Infection Initiative (cont)  Format What can you do in 90 days? What can you do in 90 days? One Learning Session: June 27, 2005 One Learning Session: June 27, 2005 Monthly conference calls Monthly conference calls  Process Adopt the central line bundle Adopt the central line bundle

MetaStar 2005 Prevention of surgical site infections (SSI)  Appropriate use of antibiotics  Appropriate hair removal  Maintenance of postoperative glucose control for major cardiac surgery patients  Establishment of postoperative normothermia for colorectal surgery patients

MetaStar 2005 WI Node work for SSI  MetaStar’s new QIO contract aligns with 100k Lives Campaign goals. Project work on the surgical care improvement project (SCIP) aligns with the 100k Lives SSI  SSI—MetaStar planned webinar in January

MetaStar 2005 Prevention of adverse drug events (ADEs) by implementing medication reconciliation Step 1: Verification Step 2: Clarification Step 3: Reconciliation

MetaStar 2005 WI Node work to support medication reconciliation  Led by the Wisconsin Hospital Association and the Pharmacy Society of Wisconsin Developing tools to assist implementation Developing tools to assist implementation Tools posted on WI Node website Tools posted on WI Node website  Developed a medication reconciliation measure for use with in the CheckPoint public reporting initiative

MetaStar 2005 Bundle for prevention of ventilator-associated pneumonia (VAP)  Elevation of the head of the bed to between 30 and 45 degrees  Daily “sedation vacation” and daily assessment of readiness to extubate  Peptic ulcer disease (PUD) prophylaxis  Deep venous thrombosis (DVT) prophylaxis (unless contraindicated)

MetaStar 2005 WI Node work on VAP  MetaStar VAP webinar December 5, 2005, 12:00 – 1:00 p.m.  VAP a SCIP module

MetaStar 2005 Node Communications  s  Newsletters  Teleconferences/Webinars  Conferences  Phone calls  Speaking engagements  Wisconsin Node website:

MetaStar 2005 Wisconsin CAH experiences on the 100k Lives journey

MetaStar 2005 Questions?

MetaStar 2005 Contact Information: MetaStar, Inc Landmark Place Madison, WI www.metastar.com Carolyn Coffey