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 Medicine’s 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 ( cont’d)

 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 ICU’s ( 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 <10% of VTE’s were preventable  Found that orders were being placed appropriately  Initiated early mobilization protocols Venous thromboembolism ( VTE) Part 2

 Improvement needed  20% of patients are readmitted within 30 days  Annual cost $15 billion  75% are preventable  Goal is to reduce readmission rates by 20% Preventable readmissions

 What we have done  Initiated phone calls within 48 hours of discharge  Offered to make follow up appointments  Formed group of members  Home care  Acute rehab  Long term care  Hospice  Meet quarterly to improve process Preventable readmissions

 What we have done  Added readmission icon to ED record keeping  Automatic consult  Case management  Social worker  Attending physician  IST to establish automatic scheduling of patients who need follow ups Preventable readmissions

 What we have done  Patient and family engagement  We have not supported the continuum of care in the past  Promote patient and family advocacy  Strengthen communication among family members and caregivers Preventable readmissions

 Web portals provide specific resources for patient and family (PF)  Clinician access from patient and family  is encouraged and safe  PF serve as educators/faculty for clinicians and other staff  PF access to and encouraged to use resource rooms  Careful collection and measurement by race, ethnicity, language  PF provided timely access to interpreter services Information / Education

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