Nursing Home Walk of Fame Visiting What Really Works. Call in Number

Transcription

1 Nursing Home Walk of Fame Visiting What Really Works Call in Number

2 Enter to Win Book Giveaways! Type in a successful practice (one or two sentences) from your nursing home in the chat box. Please include your nursing home name. Winners will be announced at the end of the webinar! 2

3 Enter to Win Book Giveaways! Some topic ideas: Antipsychotics Falls Readmission reduction Pressure ulcers Physical restraints Enter your successful practice in the chat box. 3

4 Nursing Home Walk of Fame Visiting What Really Works Health Services Advisory Group, Inc. (HSAG)

5 Nursing Home All Stars Joe Bestic, NHA, BA Director Jennette Silao, MBA, MPH Associate Director Rose Chen, MPH, RD Clinical Project Manager Isela Mercado, MSHCM Clinical Project Manager Evangeline Molnar, NHA, BS Clinical Project Manager Mary Cole, RN, BSN Clinical Project Manager 5

6 Presentation Goals Review the California Nursing Home Quality Care Collaborative (NHQCC) composite score and the reductions achieved in antipsychotic medications, pressure ulcers, and physical restraints across the state. Gain insights from successful practices shared by peer nursing homes. Discuss the next steps for sustaining the progress made in the NHQCC. 6

7 National NHQCC Goals Ensure every nursing home resident receives the highest quality of care. 7

8 National NHQCC Goals (cont d) Ensure every nursing home resident receives the highest quality of care. Instill quality and performance improvement practices. 8

9 National NHQCC Goals (cont d) Eliminate healthcare acquired conditions. 9

10 National NHQCC Goals (cont d) Eliminate healthcare acquired conditions. Improve resident satisfaction. 10

11 National NHQCC Goals (cont d) Achieve a rate of six or better using the NNHQCC composite measure by July 31,

12 Implementing Quality Assurance & Performance Improvement (QAPI) Reducing antipsychotic medications 12 other quality measures Reducing readmissions to acute care 12

13 Implementing Quality Assurance & Performance Improvement (QAPI) (cont d) Reducing antipsychotic medications 12 other quality measures Reducing readmissions to acute care 13

14 NH Composite Score Measure The composite quality measure comprises 13 National Quality Forum (NQF)-endorsed long-stay quality measures: Percent of residents with one or more falls with major injury Percent of residents with a urinary tract infection Percent of residents who self-report moderate to severe pain Percent of high-risk residents with pressure ulcers Percent of low-risk residents with loss of bowels or bladder Percent of residents with catheter inserted or left in bladder Percent of residents physically restrained 14

15 NH Composite Score Measure (cont d) Percent of residents whose need for help with activities of daily living has increased Percent of residents who lose too much weight Percent of residents who have depressive symptoms Percent of residents who received antipsychotic medications Percent of residents assessed and appropriately given flu vaccines* Percent of residents assessed and appropriately given pneumonia vaccines* * The direction of the two vaccination measures are reversed because they are directionally opposite of the other measures. This is accomplished by subtracting the numerator from the denominator to obtain a new numerator. By keeping all measure directions consistent, interpretation of the composite score can be kept as: the lower, the better. 15

16 Poll Question #1 What are the top quality improvement priorities at your facility? Check all that apply. A) QAPI B) Antipsychotics C) Pressure ulcers D) Falls E) Reducing readmissions F) Other 16

17 NNHQCC Composite Rates 17

18 Windsor of North Long Beach Composite Measure Baseline score = % decrease Current score =

19 Heritage Manor Composite Measure Baseline score = % decrease Current score =

20 Certificate of Achievement 20

21 NHQCC National Rates for Antipsychotic Medications

22 Quarterly Prevalence of Antipsychotic Use for Long-Stay Nursing Home Residents 15 percent decrease 22

23 NNHQCC Antipsychotic Medication Rates August 2012 February 2014 (U.S.) 23

24 NNHQCC Antipsychotic Medication Rates August 2012 February 2014 (California) 24

25 NNHQCC Antipsychotic Medication Rates August 2012 February 2014, NH Partners 156 nursing homes that partnered with HSAG 25

26 Physical Restraints 96 nursing homes partnered with HSAG Over 1,000 restraints reduced! Goal: 3 percent 26

27 Pressure Ulcers 67 nursing homes partnered with HSAG Relative Improvement Rate Goal: 20 percent 27

28 Enter to Win Book Giveaways! Type in a successful practice (one or two sentences) from your nursing home in the chat box. Please include your nursing home name. Winners to be announced at the end of the Webinar. 28

29 Heritage Manor

30 Heritage Manor at a Glance 99-bed skilled nursing facility in San Gabriel Valley QAPI implementation and application of Root Cause Analysis Focus: Pressure ulcer prevention and healing 30

31 What Worked in Heritage Manor: Pressure Ulcer Reduction Story 1. Teamwork: Certified nursing assistants and other staff members worked together 2. Better monitoring: Management staff provided supervision 3. Great communication: Between the registered dietitian, wound consultant, and rehab staff 4. Treatment protocols developed: Low air loss bed, turning schedule, food, and fluid intake 31

32 Heritage Manor High Risk Pressure Ulcer, Baseline score = 7.8 percent 67% decrease Current score =

33 What Worked in Heritage Manor: Pressure Ulcer Reduction Story (cont d) Staff members are engaged in improvement and feel valued Attendance at California NHQCC learning sessions 33

34 Windsor Convalescent of North Long Beach

35 Enter to Win Book Giveaways! Type in a successful practice (one or two sentences) from your nursing home in the chat box. Please include your nursing home name. Winners to be announced at the end of the Webinar. 35

36 Windsor Convalescent Hospital of North Long Beach At-A-Glance 120-bed facility located in North Long Beach 42-bed secured unit Focus: Antipsychotic medication reduction using QAPI principles 36

37 QAPI Quality Assurance Reactive: Comply with regulations. Performance Improvement Proactive: Exceed standards OR address issues before non-compliance. = 37

38 Windsor s Successful Practices: Antipsychotic Medication Reduction Story QAPI Principle: Design and Scope Educate all staff members on antipsychotic medication reduction efforts. Understand the resident s background to implement person-centered care. Implement non-pharmacological interventions. 38

39 Windsor s Successful Practices: Antipsychotic Medication Reduction (cont d) QAPI principle: Governance and leadership Collaborate between the nursing home administrator and the director of nursing to work together to achieve goals. 39

40 Windsor s Successful Practices: Antipsychotic Medication Reduction (cont d) QAPI principle: Feedback, data systems, and monitoring Use tools such as the California Department of Public Health antipsychotic use surveyor tool ( and quality measure reports. 40

41 Windsor Convalescent Center of North Long Beach, NNHQCC Antipsychotic Medication Rates, August 2012 March percent decrease! 41

42 What Is Sustainability? We all use the same process all the time New skills are reinforced through regular competency training. The new way is much easier than the old way I would never go back! CMS National Nursing Home Quality Care Collaborative Outcomes Congress, National webinar June 19,

43 Poll Question #2 Have you been able to sustain improvements in any of the following? Check all that apply. A) Antipsychotics B) Physical restraints C) Pressure ulcers 43

44 The Sequence for Getting (and Sustaining) Results at Scale CMS National Nursing Home Quality Care Collaborative Outcomes Congress, National Webinar June 19,

45 Quality Improvement Language Try and adapt ideas to learn what works in your system. Test Make a change a permanent part of the day-to-day operation of the system. Implement 45

46 Testing and Implementation Establish buy-in, build consensus Create an infrastructure and support Build communication channels Cultivate leadership 46

47 Testing and Implementation (cont d) Use PDSA cycles to test implementation steps Create education and training Review policies and procedure Assign accountability CMS National Nursing Home Quality Care Collaborative Outcomes Congress, National webinar June 19,

48 More Quality Improvement Language Have individuals outside the pilot adopt (and adapt) the changes. Spread Identify and overcome the infrastructure issues that arise during spread. Scale-up 48

49 Sustainability and Reliability Exercise Pick a process that has already been taught to staff. Interview five people separately and ask them: Why is this process important? How do you do the process? Tally up your scores by counting how many people answered correctly. For example, four of five means 80 percent reliability 49

50 Questions? Enter your question in the chat box OR Press *1 to ask your question over the phone. 50

51 Celebrate! 51

52 The Collaboration Continues Photos from the latest NHQCC Learning Session in Hanford 52

53 Thank you This material was prepared by Health Services Advisory Group, Inc., the Medicare Quality Improvement Organization for California, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. CA-10SOW