1. Intermountain-led CMS Hospital Engagement Network Pressure Ulcer Prevention June 24, 2014 Affinity Call Marlyn Conti, BSN, MM, CPHQ Patient Safety Initiatives Manager Intermountain Healthcare

2. Outline for Discussion Review of the HEN Pressure Ulcer work “Just-one-thing” Recommendations High performers 2014 plans for improvement:

3. Overall Progress Through Q1 2014

4. Intermountain HEN 2012-Q1 2014 Pressure Ulcer PSI 3

6. Intermountain HEN 2012-Q1 2014 Pressure Ulcer >= Stage 3

8. Intermountain HEN 2012-Q1 2014 Pressure Ulcer >= Stage 2

10. Intermountain HEN 2012-Q1 2014 Pressure Ulcer Prevalence

12. Just One Thing Matrix Recommendations Getting StartedWorking HarderAhead of the Curve Appoint a leadership supported team or work group to drive improvement & education SWAT (or champion) teams that includes unit nurse. (moderate-high level of evidence) Adopt decision algorithms for nursing staff to select appropriate surfaces, physical therapy and dietary referrals (moderate-high level of evidence) Establish monthly prevalence studies or collect incidence data from electronic medical records, then feed that data back to the SWAT teams. (moderate-high level of evidence)

13. High Performing Hospital Highlight… Pressure Ulcer PSI 3 Most Improvement BAYLOR MEDICAL CENTER AT WAXAHACHIE THE HEART HOSPITAL BAYLOR PLANO BAYLOR MEDICAL CENTER AT CARROLLTON BAYLOR MEDICAL CENTER AT IRVING BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE BAYLOR MEDICAL CENTER AT GARLAND BAYLOR ALL SAINTS MEDICAL CENTER AT FW DENVER HEALTH MEDICAL CENTER PROVIDENCE SEASIDE HOSPITAL PROVIDENCE PORTLAND MEDICAL CENTER Lowest Rates PROVIDENCE PORTLAND MEDICAL CENTER SUTTER MEDICAL CENTER OF SACRAMENTO BAYLOR ALL SAINTS MEDICAL CENTER AT FW DENVER HEALTH MEDICAL CENTER MILLS PENINSULA HEALTH SERVICES BAYLOR MEDICAL CENTER AT IRVING BAYLOR MEDICAL CENTER AT GARLAND BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE BAYLOR REGIONAL MEDICAL CENTER AT PLANO EDEN MEDICAL CENTER

14. High Performing Hospital Highlight… Most Improvement BAYLOR MEDICAL CENTER AT IRVING THE HEART HOSPITAL BAYLOR PLANO HILLCREST BAPTIST MEDICAL CENTER SANPETE VALLEY HOSPITAL - CAH BAYLOR REGIONAL MEDICAL CENTER AT PLANO BAYLOR UNIVERSITY MEDICAL CENTER HEBER VALLEY MEDICAL CENTER SEVIER VALLEY MEDICAL CENTER PARK CITY MEDICAL CENTER THE ORTHOPEDIC SPECIALTY HOSPITAL Pressure Ulcers >= Stage 3 Lowest Rates UTAH VALLEY REGIONAL MEDICAL CENTER MCKAY DEE HOSPITAL CENTER DIXIE REGIONAL MEDICAL CENTER LDS HOSPITAL AMERICAN FORK HOSPITAL RIVERTON HOSPITAL VALLEY VIEW MEDICAL CENTER BAYLOR MEDICAL CENTER AT IRVING ALTA VIEW HOSPITAL PRESBYTERIAN HOSPITAL

15. High Performing Hospital Highlight… Pressure Ulcers >= Stage 2 Lowest Rates THE HEART HOSPITAL BAYLOR PLANO BAYLOR MEDICAL CENTER AT WAXAHACHIE PROVIDENCE WILLAMETTE FALLS MEDICAL CENTER PROVIDENCE MEDFORD MEDICAL CENTER BAYLOR HEART AND VASCULAR HOSPITAL PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL BAYLOR MEDICAL CENTER AT IRVING BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE PROVIDENCE PORTLAND MEDICAL CENTER BAYLOR UNIVERSITY MEDICAL CENTER *Most Improvement – Only 2 Hospitals have Reported Q1 2012 and Q 1 2014 data

16. High Performing Hospital Highlight… Most Improvement BAYLOR HEART AND VASCULAR HOSPITAL BAYLOR MEDICAL CENTER AT WAXAHACHIE THE HEART HOSPITAL BAYLOR PLANO DENVER HEALTH MEDICAL CENTER CASSIA REGIONAL MEDICAL CENTER DELTA COMMUNITY MEDICAL CENTER SANPETE VALLEY HOSPITAL - CAH BAYLOR MEDICAL CENTER AT IRVING LDS HOSPITAL BAYLOR REGIONAL MEDICAL CENTER AT PLANO Pressure Ulcers Prevalence – All stages Lowest Rates THE HEART HOSPITAL BAYLOR PLANO BAYLOR MEDICAL CENTER AT WAXAHACHIE ST PATRICK HOSPITAL UPPER CONNECTICUT VALLEY HOSPITAL SCOTT & WHITE HOSPITAL-ROUND ROCK BAYLOR HEART AND VASCULAR HOSPITAL SCOTT & WHITE CONTINUING CARE HOSPITAL THE ORTHOPEDIC SPECIALTY HOSPITAL HEBER VALLEY MEDICAL CENTER DELTA COMMUNITY MEDICAL CENTER

17. Practice Survey Do you have a pressure ulcer prevention team? Yes/No – If yes, Is your team multidisciplinary? Yes/No – If yes, how frequently do they meet? – Do they have resources to collect/interpret/review data? Comments (free text) What tools do you use to assess and properly stage a pressure ulcers? (free text) – Posters, fact sheets, etc, other (free text)

18. Practice Survey Do you have skin and/or pressure ulcer assessment prompts embedded in your EMR? Yes/No – If yes, how often are they reported or prompted Who receives the reports What are the expected actions – To determine if reassessing patients at established frequencies What is the one intervention that has had the most impact in reducing pressure ulcers? (free text) What is the most innovative approach to reducing pressure ulcers?

19. Pressure Ulcer Scenario 9 M/O female infant with congenital anomalies requiring tracheostomy with an un-cuffed trach placed. Secretions were very difficult to manage and the MD indicated that re-intubation would be ‘impossible’ for this baby. Trach ties were very tight in order to hold the tube in place. The first trach change was performed 7 days after the initial placement and a stage IV pressure ulcer was found from the trach ties. What could have been done??

20. Pressure Ulcer Scenario 40 Y/O male, admitted with altered level of consciousness related to hepatic encephalopathy, hypotension and abdominal ascites. Patient had several large volume paracentesis performed with rapid re-accumulation of fluid. The decision was made by the physician and the patient's mother to provide comfort measures only and the patient was transferred to inpatient hospice. 4 days after hospice transfer, a stage III pressure ulcer was found on his coccyx. – What this preventable? – What would you have done??

21. 2014 plans for improvement Collect and share best practices across our network hospitals & system in a single document Share practice bundles?