AHRQ Safety Program for Long-term Care: HAIs/CAUTI Cohort 4 June 3, 2015 Health Research & Educational Trust Project Team Members Facility Informational Webinar

Agenda 2 TopicPresenter Welcome and Project OverviewMarcia Cooke Achieving Project GoalsAmanda Wilkins Measuring SuccessA.J. Rolle LTC Facility Team Lead RoleLouella Hung Timeline & Next StepsHelen Plass Question & AnswerAll Attendees and Presenters

PROJECT OVERVIEW 3 Marcia Cooke, RN-BC, MSN, PhD Director, Clinical Quality at HRET

Objectives Recognize project goals and why the project matters Identify the approach to education, coaching and measuring progress Summarize Facility and Facility Team Lead responsibilities Describe how HRET and the National Project Team will support facilities Recall upcoming key dates 4

Partnerships & Dissemination National Project Team HRET UM Abt Qualidigm APIC SHM Baylor National Project Team HRET UM Abt Qualidigm APIC SHM Baylor State or Regional Lead Organizations, Multi-Facility Operators Faculty Organizational Leads Recruitment/Coaching/ Project Liaison Organizational Leads Recruitment/Coaching/ Project Liaison National & Regional Faculty UM, Abt, Qualidigm, APIC, SHM, Baylor Coaching/Endorsement National & Regional Faculty UM, Abt, Qualidigm, APIC, SHM, Baylor Coaching/Endorsement Facilities 5 AHRQ

Causes of Re-hospitalizations from LTCFs Top reasons for readmission from LTC facility to a community hospital: a. CHF 31% b. UTI 28% c. Renal Failure 27% d. Pneumonia 23% e. COPD 23% Source: Ouslander JG. Journal of the American Medical Directors Association, March “CHF, respiratory infection, UTI, sepsis, and electrolyte imbalance account for 78% of 30 day rehospitalizations from SNFs” Source: Unpublished MedPAC data cited by Mor V. Health Affairs, January

Why This Project Matters 1-3 million serious infections annually in LTC facilities Approximately 380,000 residents die of infections each year Urinary Tract Infection is one of the most common HAls in LTC facilities Infections are among the most frequent causes of transfer & readmissions from LTC facilities to acute care hospitals High prevalence of urinary catheters in hospital patients transferred to LTC facilities Improving safety and quality of life for residents and their families is our overall aim! 7

What’s in it for LTC Facilities? Improved care and resident/family satisfaction Alignment with CMS 11 th SOW/QAPI and Advancing Excellence Apply evidence-based train-the-trainer modules to strengthen front-line staff knowledge and skills on infection prevention Earn CNE credits Avoid penalties for violations of F 315 (unnecessary urinary catheter) and F 441 (infection prevention and control) Reduced staff workload burden Maintain higher census from lower mortality, hospitalization Prepare for value-based purchasing 8

How will LTC Facilities Benefit from Participation Potential to: Improve the Nursing Home Compare Quality Measures Enhance data collection skills and prepare for mandatory reporting of infection data (NHSN) Benchmark against other LTC facilities (project-level and nationally) Improve communication and relationships with referring hospitals that may results in reduced readmissions Improve compliance with survey requirements related to quality of care, infection control, etc. 9

Project Goals Primary Goals—reduce HAIs/CAUTI and improve safety culture Develop/adapt evidence-based CAUTI elimination and safety practices and resources for LTCFs Reduce CAUTIs and HAIs Improve safety culture Secondary Goals—support expanded infection prevention efforts for C. diff, UTI, MDROs, etc. by providing education to: Improve hygiene practices (hand, environmental) Promote antibiotic stewardship Promote catheter stewardship Reduce re-hospitalizations 10

Project Spread 420 Active Facilities in Cohort 1, 2 & 3 11 Aim to involve all 50 states, D.C. and Puerto Rico Cohort 1 (63 facilities) Cohort 2 (152 facilities) Cohort 3 (203 facilities)

ACHIEVING PROJECT GOALS Amanda Wilkins, MPA Program Manager at HRET 12

How will These Goals be Achieved? Clinical Interventions Evidence-based infection prevention practices Indwelling catheter, UA/culture and antibiotic stewardship Strategies to avoid re-hospitalizations, catheter alternatives Cultural Interventions Learning from defects to understand and prevent adverse events Senior leadership engagement Front-line staff empowerment Teamwork and communication Regular team meetings 13

Educational Sessions In-person or virtual learning sessions: kickoff, mid-course and final Slides, expert faculty, interactive activities, handouts, resources Educational webinar/video series 14 Name of series# of Topics FrequencyWhatFormat for Facility Team Lead Format for Front-line Staff Onboarding4WeeklyProject orientation WebinarTrained by Facility Team Lead Training Modules4Once every two weeks Infection prevention VideosVideos, and trained by Facility Team Lead Safety Culture Survey Results Forum 1OnceSafety cultureWebinarN/A Content~10MonthlyClinical and cultural interventions WebinarTrained by Facility Team Lead

Education Series Schedule Onboarding Webinar SeriesDateTime 1. Building a Culture of Safety TeamThursday, August 61:00 – 2:00 p.m. CT 2. CAUTI DefinitionsThursday, August 131:00 – 2:00 p.m. CT 3. CAUTI SurveillanceThursday, August 201:00 – 2:00 p.m. CT 4. Data Collection TrainingThursday, August 271:00 – 2:00 p.m. CT Training Module Series Release Date 1. Hand HygieneWeek of Aug 31N/A 2. Environment & EquipmentWeek of Sep 14N/A 3. Isolation PrecautionsWeek of Sep 28N/A 4. Antibiotic StewardshipWeek of Oct 12N/A Monthly Webinar SeriesDateTime National Content 3 rd Thursday of each month, beginning in November 11:15 a.m. – 12:15 p.m. CT 15

Support for Education Components Train-the-Trainer Guide Core Team Training Materials Webinar Recording Core Team Presentation Slides (Chat Summary and Q&A) Supplemental Materials All Staff Training Materials Video and Facilitator Slides Discussion Guide/Activity Event Evaluation Template Certification of Completion Template Additional Resources 16

Coaching Calls 17 Ashley Hofmann, MSW Katie Johnson, MHS Anna Wojcik, MPH What :State/Region-specific coaching call When :Monthly, beginning in September Who :All facility team leads Facilitated and run by the organizational lead Faculty coach provides clinical and cultural expertis HRET advisor provides project management support and technical assistance Why :Review data and track project progress Discuss educational webinars and project interventions Share successes, challenges and best practices with other facilities Ask Faculty Coach and facility teams to engage in use of project tools, resources

Resources 18 Your Organizational Lead LTC Safety Website username & password: ltcsafety Weekly Newsletters Expert Faculty Coaches Facility Implementation Guide Data Support

MEASURING PROGRESS AJ Rolle, MPH Program Manager at HRET 19

Purpose of Measurement Measures are developed to support hard-wiring of resident safety processes with attention to the needs of the LTC environment. Improving safety and quality of life for residents and their families is our overall aim! 20

Required Data Metrics and Schedule Data CollectedFrequency Time to Complete Background/Cultural Measures -> Drive Change Registration1x to enroll10 minutes Facility DemographicsBaseline15 minutes Safety Culture SurveyBaseline and follow-up10 minutes Process Measures -> Evidence-based practice Team Communication GuideQuarterly10 minutes Skills QuestionnaireBaseline, mid-point, final15 minutes Outcome Measures –> Understand and celebrate success Catheter Utilization CAUTI rates Urine culture order rates Monthly 21

Outcome Data Definitions 22

Data Collection Systems Cvent (web-based survey portal) – Registration – Facility Demographics – Skills Questionnaire – Safety Culture Survey – Event evaluations Comprehensive Data System (HRET’s online data portal) – Team Communication – Outcome Measures* Residents Residents with catheters New CAUTI events Urine culture orders 23 * CDC’s National Healthcare Safety Network (NHSN) can also be used for the outcome measures. Facilities must confer rights to HRET (instructions to follow)

Measurement Support Checklist tools to support awareness and adherence to evidence-based recommendations NHSN CAUTI definition assessment worksheet NHSN CAUTI definition pocket cards Data collection tools Reports distributed within 4-6 weeks after submission deadlines Support for survey and certification regulation compliance with F-tag 315 and F-tag

FACILITY TEAM LEAD ROLE Louella Hung, MPH Senior Program Manager at HRET 25

How We Will Support You Your Lead Organization will… Guide you through the enrollment process Monitor your progress and assist you with local implementation Send you short electronic weekly updates about upcoming project milestones, reminders and tips for success HRET and Other Members of the National Program Team will… Provide you with an implementation manual at your kick-off meeting Have subject matter experts available outside of content calls Troubleshoot any data and program implementation issues 26

Facility Team Expectations Promote the project goals Learn and implement the clinical and cultural improvement tools Participate in monthly team safety huddles to review outcome, process, and teamwork and communication data Attend three face-to-face or virtual learning sessions in your area Comply with data collection and submission requirements, including the completion of the AHRQ culture survey, Nursing Home Survey on Patient Safety Culture, at the beginning and end of the program 27

Facility Team Lead Expectations Time Commitment: 5-7% FTE or hours during the month program Promote project goals Lead the facility’s technical & cultural interventions Attend all educational sessions:  3 in-person meetings (kick-off, mid-year, final)  2.5 months of monthly onboarding webinars and training modules  10 months of monthly content webinars  10 months of coaching calls Train front-line staff in minute modules (provided by HRET) 28

Facility Team Lead Expectations Track facility progress and meet data requirements:  Submit process and outcome data  Safety culture survey (twice: baseline and re-measurement) Meet regularly with LTC facility team to monitor progress  Complete teamwork and communication tool, monthly  Hold safety meetings with the team, monthly Ask for help on behalf of the team  Call your organizational lead to discuss team and program challenges, monthly 29

TIMELINE & NEXT STEPS Helen Plass, MA Program Manager at HRET 30

Cohort 4 Timeline for Facilities 31

Important Dates for Cohort 4 32 ActivityDate/Time Learning Session #1July 1-24 RegistrationDue July 24 Onboarding Educational Series3 rd Thursday of each month from 1:00-2:00 p.m. CT, beginning in August

QUESTIONS ABOUT ENROLLMENT? 33 StateOrganizationOrganizational Lead Multi-stateThe Joint CommissionBeth Ann Multi-stateLeading AgeCarol CAPlum Healthcare, for California Association of Health Facilities Anna LAeQ Health Solutions – Quality InsightsJulie Kueker Beth Hoover MNMinnesota Hospital AssociationTania Daniels Susan Klammer NJNew Jersey Hospital AssociationPatricia NDQuality Health Associates of North DakotaMichelle