Gold STAMP Tools, Resource Guide and Performance Improvement Model

Transcription

1 Gold STAMP Tools, Resource Guide and Performance Improvement Model 1

2 Gold STAMP Cross-setting Tools and Resources Organizational self-assessment of the processes of care for pressure ulcers A resource guide for the assessment, management, and prevention of pressure ulcers in all settings Education and information on the use of these resources Performance improvement strategies to create cross-setting partnerships and improve communication about pressure ulcers Statewide cross-setting collaboratives with onsite facilitation and training for implementing Gold STAMP 2

3 Gold STAMP Organizational Profile 3

4 Gold STAMP Organizational Profile Self-Assessment of Key Processes Related to Pressure Ulcer Prevention and Management Designed to support provider assessment of current program, policies and procedures Assist in identifying opportunities to strengthen current internal systems and processes Facilitate interdisciplinary review and implementation of improvement strategies Support implementation of cross-setting information sharing and care coordination 4

5 Gold STAMP Organizational Profile Design and Development MedQIC Organization Assessment Checklists for Pressure Ulcers NYS DOH Facility Profile: Self Assessment of Key Processes Related to Pressure Ulcer Prevention and Healing Gold STAMP Clinical Work Group direct care provider expertise Review and feedback from Gold STAMP Steering and Full Committee membership Pilot test of tool by acute care hospital, skilled nursing facility and home health provider setting representatives 5

6 Gold STAMP Organizational Profile 6

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10 Gold STAMP Organizational Profile Clinical Pilot Test Acute Care Hospital Setting Jody Scardillo MS, RN, ANP-BC, CWOCN Clinical Nurse Specialist Albany Medical Center Skilled Nursing Facility Setting Cindy Labish, RN, MS, CWOCN, Director of Nursing Services Wesley Health Care Center Home Health Setting Lori Stiles, RN, BS, Supervising Public Health Nurse Saratoga County Public Health 10

11 Pilot Test Feature Settings Hospital Users 30+ interdisciplinary team members Venue Wound Care Meeting Nursing Home/ Assisted Living Administrator, Director of Nursing, Assistant Director of Nursing, PT, RD, CNA, 8 Charge RNs, Dir. Assisted Living Quality Improvement Meeting Home Health Agency Director, 2 Supervisors, 1 Public Health Nurse, 1 Home Health Aide Process Improvement Meeting Completion Time 30 minutes 40 minutes 45 minutes

12 Pilot Test: Cross-Setting Feedback Questions Were users able to understand the questions as worded? Were there any settingspecific issues that you feel were overlooked on the self -assessment? Was the tool user-friendly? Will the tool will be useful in your care setting to assess policies & protocols related to pressure ulcer care? Answers Hospital NH HHC Assisted Living Yes Yes Yes No No No Yes Yes Yes Y es Yes Yes

13 Pilot Test: Tool Strengths Multiple domains Risk assessment & skin inspection Contributing Risk factors Enhanced interventions based on Braden score & identification of additional factors( fever, advanced age, PVD, OR time > 4hrs, diast BP<60) Assess tools in place for assessment, tracking, documentation

14 Areas for Improvement Acute Care Setting Emphasize policy re: commitment to pressure ulcer prevention & management. Add consumer & family education to pressure ulcer risk, prevention & management Braden Q for Pediatrics Formalize, standardize, enhance, educate, interdisciplinary team Pursue a cross-setting collaborative or partnership Nursing Home /Assisted Living Setting Need organizational commitment to prevention and management Need skin inspection & risk assessment at regular intervals Need protocols for non-healing pressure ulcers Add pressure ulcers to change of condition protocol Turn and position q 2 hrs - guideline or standard?? Home Health Setting Coordinate with residential settings based on resident needs Need to communicate resident refusals/change in risk to physician/pcp Priority of resident/family education re: prevention, risks, and interventions Add contributing factors to assessments

15 All Testers: Lessons Learned Leadership support is vital Ongoing work in progress project Must look at processes and not blame Every patient, every nurse/caregiver, every day Be proactive for non-healing wounds Documentation and Communication Change culture Celebrate success!

16 Staff Education Ideas Orientation Continuing Education Nursing newsletter/unit web sites Mandatory education National Database of Nursing Quality Indicators (NDNQI) website Quarterly skin fairs Mentoring for unit skin champions

17 Gold STAMP Organizational Profile Organizational Self Assessment Tool will serve as a first step for comprehensive review of current pressure ulcer assessment, prevention and treatment programs Once completed, discuss all no responses with your interdisciplinary leadership team and utilize the Gold STAMP Pressure Ulcer Resource Guide to provide guidance on recommended practices and supporting evidence tools and resources to support performance improvement strategy implementation 17

18 Gold STAMP Pressure Ulcer Resource Guide 18

19 Gold STAMP Pressure Ulcer Resource Guide Represents the vision, goals and methodology of this initiative to reduce the incidence and prevalence of pressure ulcers across the health care continuum Incorporates information gathered from research and practice and offers strategies and actions to improve assessment, care management and consumer health care pressure ulcer outcomes 19

20 Gold STAMP Pressure Ulcer Resource Guide Design and Development Easy to use resource guide with electronic link to access Web site where resource/tool is housed Organized by Domains: Care Management Quality Improvement & performance Measurement Organizational Systems Prevention Leadership Treatment Modalities Communication Documentation Education Regulatory Information 20

21 Gold STAMP Pressure Ulcer Resource Guide Introductory Section incorporates: Gold STAMP Overview Pressure Ulcers: Patient Safety Issue Guidance on how to use the Resource Guide Application of the Performance Improvement Model Quality Improvement Action Plan Template Provides description of each of the tools/resources Incorporates a cross walk with Self Assessment Tool questions so providers can easily search topic specific resources 21

22 Gold STAMP Pressure Ulcer Resource Guide 22

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25 Gold STAMP Pressure Ulcer Resource Guide Implementation Ongoing living document with any identified updates incorporated on a quarterly basis Housed electronically on Gold STAMP partner Web sites Empire Quality Partnership GNYHA HANYS IPRO s Joint Effort New York website NYSHFA NYS Department of Health 25

26 Application of the Performance Improvement Model 26

27 Performance Improvement Model Integral component for success and sustainability Series of steps that assist in identifying opportunities for improvement and implementing changes to improve patient outcomes Provides a systematic way for providers to conduct an internal assessment to identify changes in care practices, processes and protocols to demonstrate improvement 27

28 Performance Improvement Model Form an Interdisciplinary Team People who are involved in directly impacting pressure ulcer assessment, management and prevention Involve direct care staff from different shifts, units, departments and disciplines, as well as the In-service Educator and a senior leadership representative Team Leader - guides the team to achieving established goals & objectives, keeps the team on track according to the defined action plan Team Facilitator - focuses on promoting effective group dynamics Members - contribute information, share knowledge and their expertise to drive decision making and change 28

29 Performance Improvement Model Effective Team Strategies Use agendas and stick to them Assign a recorder for each meeting Maintain accurate meeting minutes with distribution to all members of the team Focus on fixing problems and not people no blaming! Use data and the facts to drive solutions Develop a work plan for the team and review and update it at each meeting 29

30 Performance Improvement Model Define a Clear Aim Statement Clearly define the specific outcome(s) the team wishes to accomplish Be clear, realistic, and include measurable performance indicators The following is an example of an Aim Statement: To reduce pressure ulcers for all nursing home residents so that: X % will have been assessed at admission X% of patients at risk for pressure ulcer will have an individualized care plan within 24 hours of admission 30

31 Performance Improvement Model Establish Measures of Success Ongoing internal monitoring to ensure that the plan has been implemented and the changes put into place are effective improvements Baseline period Re-measurement period Include both outcome measures (doing the right things) and process measures (doing things right) Example Process Measure: % of patients with risk assessment upon admission Example Outcome Measure: % of patients with pressure ulcer at discharge 31

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33 Performance Improvement Model Use the Plan-Do-Study-Act (PDSA) Cycle as a trial & learning method to test changes on a small scale to determine the impact and outcome of the change 33

34 Cross-Setting Partnerships 34

35 Health Care Reform: Providers Call To Action State Medicaid Redesign Team (MRT) Reforms - reduce costs and increase quality and efficiency in the Medicaid program for the Fiscal Year Move All Medicaid beneficiaries into Managed Care better performance = better rate negotiations Federal Health Homes Medical Homes Accountable Care Organizations Bundled payments CMS Partnership for Patients Community-Based Care Transitions Program 35

36 "Teamwork divides the task and multiplies the success. Author Unknown 36

37 Questions Feedback Sharing 37