4/30/2012. Disclosure. Housekeeping. The Role of the Infection Preventionist on the Value Analysis Committee. Boyd Wilson

Transcription

1 3M Infection Prevention Learning Connection The Role of the Infection Preventionist on the Value Analysis Committee Making a Business Case for Evaluating New Products May 8, 2012 Disclosure Boyd Wilson System Director Infection Prevention & Control HealthEast Care System St. Paul, Minnesota 3M sponsored speaker Housekeeping Questions Mute feature (*7 = unmute, *6 = mute) Chat feature Technical difficulties CE credits Post session follow-up 1

2 How do I get a CE Certificate? Next week, all of today s meeting participants will be sent an containing instructions for obtaining a CE Certificate for today s meeting. The will be sent to the address you provided when you logged-in to today s meeting. If there are others listening with you today who did not log-on, you may forward the CE certificate to them. Learning Objectives Identify key considerations for product evaluation. Describe the role of the infection preventionist on the value analysis committee Discuss the importance of being able to make a business case for evaluation of a clinically relevant product to improve patient outcomes Background 2

3 Infection Prevention and Product Evaluation in the Current Era of Healthcare Reform Managed care, hospital acquired conditions, reimbursement capitation, value based purchasing.. Cost control and quality of care Federal Government, State Government, Third Party Payers Outcome focused improvement measures Infection Prevention and Product Evaluation in the Current Era of Healthcare Reform Healthcare associated infection (HAI) metrics CMS Core Measures Pneumonia Pneumococcal immunization Influenza immunization Antibiotics in the ED SCIP (Surgical Care Improvement Project) Antibiotic prophylaxis Hair removal Urinary catheter removal Post Op Day 1 or 2 Central line associated bloodstream infections Catheter associated urinary tract infections Surgical site infections 3

4 Throwing Money at a Problem Central Line Blood Stream Infections (CLABSI) Surgical Site Infections(SSI) Catheter Associated Urinary Tract Infections (CAUTI) Product Evaluation 4

5 What is Product Evaluation? A process of appraisal that considers the value and significance of quality, cost, safety and practitioner choice for product selection. Murray, M et al. Product Evaluation and Process Improvement. J Nurs Qual Products, Products, EVERYWHERE! Product Evaluation Process?! 5

6 Product Review Process Need identified Complete request form Submit to value analysis committee Reviewed by committee Crunch the numbers Communicate with other key stakeholders Conduct trial, if needed Approved or denied (more information needed; resubmit) If approved, develop implementation plan Add product to system and inventory Education/Training/Communication Key Considerations Quality Clinically Effective Evidence-based Safety Patient Safety Worker Productivity Enhanced Process Improvement Economically Efficient Inventory Management Products and Risk for Infection Many products have infection prevention considerations: Increasing/decreasing risk for infection or contamination: Design Material properties Clinical utility Ability to clean, disinfect or sterilize Reusable vs. disposable Safety 6

7 Value Analysis Programs Value Analysis Program at HealthEast 18 committees meeting regularly Review products, processes, services Network, problem solve, standardize Collaborate with other committees, councils, initiatives Focus quality and total cost Value Analysis Committees (VAC) Structure Imaging Nursery L&D Engineering Nursing EVS Lab Nutrition Pharmacy Clinics Needle Safety CVIC Vascular Access Implementation Surgery 7

8 VAC Interface and Communication 18 Specialty VACs Standard process and tools Receive requests from their stakeholders Identify opportunities, respond to regulatory changes, recalls Conduct evaluations, recommend trials, coordinate education Members accountable to their dept/unit and the VAC VAC may be accountable to system leadership group Vascular Access Nurse Practice Contract manager is liaison with other VACs Contract manager is member of Implementation VAC VAC Interface and Communication Implementation VAC Oversight for all VACs System-wide authority Big picture Problem resolution, barrier busting Standardization Approval/denial The Role of Infection Prevention 8

9 Competing Goals/Values? Collaboration! What Infection Prevention Brings to the Table Analytical ability Detail oriented and organized Evidence-based clinical literature review Ability to interpret scientific research Regulatory knowledge Quality improvement skills Clinical knowledge Global perspective (big picture) 9

10 Infection Prevention Support in the Evaluation Published studies Best practices Guidelines Regulations Policies and procedures Experiences Practice of IP colleagues Outcomes data/surveillance findings Infection Prevention Public Health Guidelines (CDC) Infection Prevention Public Health Guidelines (CDC) Strength of Evidence 10

11 Infection Prevention Professional Organization and Consensus Guidelines I. Basic/Core Strategies II. Special Approaches Recommended for use in locations and/or populations within the hospital that have unacceptably high rates despite implementation of the Basic/Core prevention strategies III. Approaches that should not be considered routine Infection Control and Hospital Epidemiology, October 2008, vol. 29, supplement 1. Regulatory Requirements Needlestick Safety and Prevention Act Revision to Bloodborne Pathogens Standard Effective April 18, 2001 Specified in greater detail the engineering controls, such as safer medical devices, which must be used to reduce or eliminate worker exposure. Document consideration and use of appropriate, commercially-available, and effective safer devices. Employers must solicit input from non-managerial employees responsible for direct patient care regarding the identification, evaluation, and selection. Must maintain a sharps injury log. Product Considerations 11

12 Revolutionary Product Kills germs you didn t even know were there Safe for the patient Safe for the user Safe for the environment ( green ) Evidence-based activity Tested on 3000 organisms Demonstrated patient outcomes Excellent shelf-life Meets ALL standards INFECT AWAY 3000 Things to Consider About a New Product/Technology Clinical effectiveness Evidence-based Patient safety User safety Compatibility with equipment/surfaces Cleaning, disinfection, sterilization requirements Disposal requirements Shelf-life/Beyond-use date Regulatory requirements (Federal, State, Local) Manufacturer instructions More things to consider Cost GPO (Group Purchasing Organization) Opportunity/Compliance Packaging Product labeling Storage space Inventory requirements Ease of implementation Process changes needed Training (Type and Time) 12

13 Business Case So, you want to get that new thing that is supposed to prevent infections? Is it evidence-based? I m sure it is too expensive. What does it replace? WHO ELSE IS USING IT? Product Request Form Requestor Name/Dept Sponsor/Clinical Champion Date of Request Name of Product Manufacturer Product description/purpose Has product been evaluated previously? Has product been introduced to other committees? What depts does this product affect? Patient charge item? Procedure codes? New product? Duplicate? Replacement? How would be stocked? Is product reusable? Disposable? Cleaning/disinfection instructions? Disposal instructions provided? MSDS provided? Product safety information provided? Clinical evidence provided? Education/training level needed? Explain problem/need that product will resolve or fill Process improved? Work time saved? Cost for evaluation? Projected annual usage? Annual usage or product replaced? Additional cost or cost savings? GPO compliance? 13

14 Product Questions & Value Analysis Will the product improve patient satisfaction? Will the product improve patient safety/clinical outcomes? Will the product improve user satisfaction? Will the product improve user safety? Will the product change/improve a process? Will the product replace an existing product or is it add on? Money Questions & Value Analysis Will the product increase supply costs? Will the product decrease costs through standardization? NOTE: need to consider total cost in the value analysis process, not just purchasing price Cost of labor Utilities and maintenance Cost avoidance (infections/injuries/exposure prevented) What is the incremental cost of the product versus the expected benefit to the patient (or user/worker) Product Standardization Eliminates unnecessary redundancy/duplication Reduces inventory/storage needs Encourages a standard procedure Can reduce education need for multiple products Can improve patient safety Saves money 14

15 Examples IV Pumps: Infection Prevention Considerations (L1) Ease of cleaning Manufacturer instructions for cleaning/disinfection IV tubing components Needless connectors IT considerations Pharmacy considerations Clinical education considerations Stores considerations Patient Safety considerations VAP Oral Care Product IP Considerations (L2) New product or replacement? VAP focus rationale: Patient Safety, Public Reporting, VBP Evidence of importance of oral care to prevent VAP Studies demonstrating VAP prevention with oral care intervention Guidelines to support product/practice Regulatory reference for product/practice Current practice for oral care Current VAP rate Clinical evidence, efficacy information, process improvement and outcomes data for product Information from other product users 15

16 VAP Oral Care Product Basic Value Analysis 1. Cost of product Annual product usage Replacement for similar product increase or decrease in cost New product increase in cost or decrease with change practice and supplies used GPO contract compliance opportunities impacting product cost 2. Attributable cost of 1 VAP (published data or internal data) Additional cost consideration length of stay 3. VAP prevention opportunity (# of VAP in past year) 4. # of VAP to prevent to help justify cost of product VAP Oral Care Product Basic Value Analysis Also consider, Length of stay impact and improved patient flow Process improvement with product change Productivity improvement with product change (RT, RN time) Staff satisfaction Patient/family satisfaction Monitor and report back after implementation HAI Cost Calculators 16

17 Vendor Supported Product vs. HAI Cost Calculators Vendor Supported Product vs. HAI Cost Calculators Product # and cost per unit CAUTIONS Manufacturer sponsored information only Shiny brochures with claims you want to read, but no real data Lack of data to support manufacturer claims In vitro data and no clinical outcomes data (may be the case for new products) Not scientifically sound Clinical evidence/efficacy data lacking Pending approval from FDA, EPA Data based only on observation and not randomized control study Compatibility not confirmed Product not used at organization that did the studies Off-label use Low cost to bring in the product and then... When HAI rate is low, it can be difficult to demonstrate impact on outcomes in the short term 17

18 Summary Value Analysis Keys to Success (Based on the HealthEast VA Experience) Clear focus (quality and total cost) Performance is measured and reported Multidisciplinary involvement Stakeholders are involved and empowered There is a tangible, visible impact It is a consistent process It is a dynamic program It has become part of our culture 18

19 Keys to Success for the Infection Preventionist Understand your Product Review/Value Analysis Process Have knowledge of supply chain management/purchasing Have a strong voice Be respected and trusted expert Flexible and open-minded Be prepared Educated and informed Evidence-based (when possible) Data-driven (when possible) Identify/collaborate with champions for your cause Be cost conscious Avoid conflict of interest Final Points Many products have infection prevention considerations. A formal structured process for product evaluation is important for effective value analysis to balance quality and cost. Infection preventionists are a critical resource and partner in the product evaluation process. Value Analysis must consider the total cost when considering impact of products on infection prevention. If you are not a regular participant of your product evaluation process at your organization, change that today! Thank You 19

20 How do I get a CE Certificate? Next week, all of today s meeting participants will be sent an containing instructions for obtaining a CE Certificate for today s meeting. The will be sent to the address you provided when you logged-in to today s meeting. If there are others listening with you today who did not log-on, you may forward the CE certificate to them. 20