Reduction in Hospital-Acquired Pressure Injuries: "Peer Pressure" from Successful Organizations

Transcription

1 Reduction in Hospital-Acquired Pressure Injuries: "Peer Pressure" from Successful Organizations Saleema Hashwani, PhD, MS, BScN Clinical Improvement Advisor, HSAG Tuesday, November 14,

2 Scope of the Problem > 2.5 million patients in U.S. acute care facilities develop HAPI, and more than 60,000 die from associated complications 1 One single HAPUI can cost $70,000; total cost in U.S. is $11 billion dollars annually 2 California estimated 2017 cost associated with HAPI is $3.1 billion Harms associated with HAPI Pain Increased expense (about $5000/day) Prolonged length of stay, to premature death 1. Agency for Healthcare Research and Quality (AHRQ). AHRQ Preventing Pressure Ulcers in Hospitals. A Toolkit for Improving Quality of Care. Publication: EF. Available at 2. National Pressure Ulcer Advisory Panel (NPUAP). Cuddigan J, Ayello EA, Sussman C, Editors. Pressure Ulcers in America: Prevalence, Incidence, and Implication for the Future. Reston, VA: NPUAP;

3 Causes Common are: Immobility Age Lack of sensory perception Limited alertness Excessive dryness or moisture Bowel incontinence 3

4 Number of Hospitals Reporting Pressure Ulcers Number of Hospitals Reporting Pressure Ulcer Prevalence Hospital-Acquired Stage 2+: 139 CALNOC: 103 Self Reported: 36 Number of Hospitals Reporting Pressure Ulcer Rate Stage 3+: 272 4

5 Overall HSAG HIIN Performance on Pressure Ulcer Prevalence Hospital-Acquired Stage 2+ Time Period Baseline (CY2014) Current Evaluation Period 20 Percent Goal Reduction Relative Improvement Rate Number of Participating Hospitals Reporting Data 2016Q % Q % Q % Q % 139 Source(s): Collaborative Alliance for Nursing Outcomes (CALNOC) data (N=103) and Hospital Self-Reporting data (N=36). Note: Relative Improvement Rate equals baseline minus current evaluation period divided by baseline. 5

6 Overall HSAG HIIN Performance on Pressure Ulcer Prevalence Hospital-Acquired Stage 2+ (cont.) Time Period Baseline (CY2014) Current Evaluation Period 20 Percent Goal Reduction Relative Improvement Rate Number of Participating Hospitals Reporting Data 2016Q % Q % Q % Q % 139 Source(s): Collaborative Alliance for Nursing Outcomes (CALNOC) data (N=103) and Hospital Self-Reporting data (N=36). Note: Relative Improvement Rate equals baseline minus current evaluation period divided by baseline. 6

7 Overall HSAG HIIN Performance on Pressure Ulcer Rate Stage 3+ Time Period Baseline (2015Q4-2016Q3) Current Evaluation Period 20 Percent Goal Reduction Relative Improvement Rate Number of Participating Hospitals Reporting Data 2016Q % Q % Q % 272 Source(s): Medicare s Fee-For-Service claims data Note: Relative Improvement Rate equals baseline minus current evaluation period divided by baseline. 7

8 Overall HSAG HIIN Performance on Pressure Ulcer Rate Stage 3+ (cont.) Time Period Baseline (2015Q4-2016Q3) Current Evaluation Period 20 Percent Goal Reduction Relative Improvement Rate Number of Participating Hospitals Reporting Data 2016Q % Q % Q % 272 Source(s): Medicare s Fee-For-Service claims data Note: Relative Improvement Rate equals baseline minus current evaluation period divided by baseline. 8

9 Key Lessons Identify unit champions Staging of PI (using standardized criteria) staff education Test out changes at one unit prior to rolling out at multiple units/with whole staff to increase efficacy and sustainability Perform RCAs and share timely results to the frontline staff, quality department, leadership (allocation of resources) Use interdisciplinary team s expertise for monitoring and preventing pressure injuries so that the whole responsibility does not fall on one discipline Include patient and family as partner 9

10 What Are You Going to do Differently Tomorrow? Next week? In the community? Community Acquired Pressure Injuries (CAPI) are on the rise 10

11 Thank you! Saleema Hashwani Clinical Improvement Advisor Health Services Advisory Group, HSAG HIIN Martha Ackman Clinical Improvement Advisor Hospital Quality Institute, HSAG HIIN 11