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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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!!!

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

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

21. 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 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 /1000 vent days

22. 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!

23. 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.

24. 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

25. QUESTIONS 19