MemorialCare Orange Coast: Using Innovative Technology to Improve Efficacy of Patient Repositioning

Transcription

1 MemorialCare Orange Coast: Using Innovative Technology to Improve Efficacy of Patient Repositioning Presented by: Nika Carlson, MSN, RN, Director of Clinical and Quality Improvement Jennifer Castro, MSN, RN, Clinical Quality Analyst November, 2017

2 About MemorialCare Total Assets $3.3 billion Annual Revenues $2.3 billion Bond Rating AA- stable Hospitals Patient Discharges 67,000 Patient Days 317,000 ER Visits 214,000 Babies delivered 10,500 Surgeries IP/OP 34,000 Ambulatory Access At Risk Lives/ACOs 259,000 Seaside Health Plan 39,200 Medical Group Visits 600,000 Ambulatory Surgeries 44,000 Workforce Employees 11,000 Affiliated Physicians 2,600 Employed Physicians 230

3 Creating Strategic Linkage

4 Aiming High, Aiming Wide Aim High Islands of Excellence Transformation Low Just Good Enough Incremental Improvement Unit Level System Level Breadth of Aim

5 MemorialCare s Safety Bold Goals Today, by June 2018 Reduce mortality Severe sepsis mortality by >70 % Achieve perfect care Core Measure sets all diagnoses/bundles to > 95% Medication Reconciliation metrics: all 3-90% Reduce harm to Zero Zone Hospital acquired infections (HAI) Achieve 100% hand hygiene compliance Hospital acquired pressure injuries (HAPI) Patient falls with injury Harm Across the Board by > 80% Promote Population Health NTSV C-Section rate to < 15% Medical Foundation goals to top 10 th percentile Screening breast and colorectal; diabetes care HbA1c < 8, generic prescribing rate, childhood immunizations (combo 10)

6 Target: Harm Across the Board FY 18 Goal to reduce by 80% vs 2011 baseline *See definition Updated October 2017 Current State/Graphs: MemorialCare ROLL-UP** Key Analysis and Activities: Harm Across the Board (HAB) per Hospital Engagement Network definition* reduced by 73% since 2011 Each campus showing net drop Tied to Bold Goals and campus focus Note: *Hospital Engagement Network definition includes Warfarin with INR > 6, Early Elective Delivery, Fall with Injury, Pressure Ulcer 2+, ICU Catheter Associated UTIs and Central Line Blood Stream Infections, Surgical Site Infections, Ventilator Pneumonias, and Pediatric Harm. **CHLB & MCHWHLB included in MHS roll-up What We re Working On, Will See Next: Initiative/ Tactic Who Target Action/Status INR > 6 on Warfarin (International Normalized Ratio bleeding time ) Pharmacy Value Added Team Ongoing Reviewing cases with bleeding times/inr >5-6 CALHIIN goal now for <5 73%* Early Elective Delivery (EED) Falls, Pressure Ulcers (HAPU) C. Chuen WH BPT Ongoing Hard stop implemented Reviewing fallout cases Bold Goal Ongoing See Bold Goal drilldown 220 Infections Bold Goal Ongoing See Bold Goal drilldown Blood Clots (VTE6) Bold Goal Ongoing Ongoing monitoring Quality Close and Committee Visibility Board For internal use related to quality and performance improvement purposes only.

7 Target: Stage 2+ Pressure Injury (HAPI) * Goal to achieve CALNOC best 25th Updated October 2017 Current State/Graphs: Key Analysis and Activities: Campus Lean, huddles & and Magnet focus Telesitter trial at Long Beach Pressure ULCER changed to pressure INJURY as of Jan 2017 Note: Benchmark rates from Collaborative Alliance for Nursing Outcomes coalition (CALNOC) What We re Working On, Will See Next: Initiative/ Tactic Who Target Action/Status Telesitter spreading use Long Bch CNOs Ongoing 4CQ 16 FY 18 Long Beach in place, data Saddleback launched Dec 16 Orange Coast FY 18 Wound BPT Conf D. Wynn 3CQ 17 Planning completed with BPT, hosted October 11 Reviews Best Yet! Collaboratives D. Platt Meeting Quarterly Sharing Best Practices: HAPI Improved staging Leaf mobility trial HAPI bundle data 4-eyes on data Quality Close and Committee Visibility Board For internal use related to quality and performance improvement purposes only.

8 Using Innovative Technology to Improve Efficacy of Patient Repositioning

9 Background Hospital acquired pressure injuries (HAPIs): Associated with poor patient outcomes HAPI costs can range from $2,159 - $21,410 (CALNOC, 2017) Can result in an increased length of stay MemorialCare Orange Coast: In 2016, CCU had 45 HAPI s with potential costs of $97,155 $963,450 After evaluation of our practice, the incidence of HAPIs in our CCU was above CALNOC Benchmark. Patient repositioning is the gold standard of care Does our practice of repositioning result in adequate offloading of pressure?

10 What is Leaf? Background: Wireless, wearable single-patient sensor that monitors patient movement and body position Allows caregivers to customize turn protocols for each patient Allows for Wireless data collection and transfer to central monitoring station Generates reports for data analysis Turn Frequency Turn angle Reperfusion time

11 Leaf Cost and Infrastructure Background: Leaf patient Sensor -$199 per sensor -Battery life 21 days Mesh Network of Leaf Relay Antennas (no cost) Leaf Back-end Mesh Network server software and SQL Database Leaf turn management software Training -Day and Night Shift Support (on-going) -Root Cause Analysis Reports No Monthly Service Fee

12 CALNOC CCU HAPI 3+ Incidence per 1000 days Jan 2017 June 2017

13 Pilot Outcomes Offloading Adequacy Table 1: Outcomes May 2017 Jul 2017 Aug 2017 Adequacy of 20 offloading 88% 88% 90% # of monitored patients Monitored Patients Table 2: # HAPI s May 2017 Jul 2017 Aug 2017 Unmonitored patients Monitored patients Turn compliance > 85% 0 0 0

14 HAPI and Financial Pilot Outcomes Table 3: Pilot HAPI Outcomes May, Jul, Aug 2016 May, Jul, Aug 2017 Stage I 2 0 Stage II 4 0 Stage III 0 0 DTI 2 5 Unstageable (reportable) 2 0 Total 10 5 Table 4: Pilot Financial Outcomes Dollars Unreimbursed treatment cost per HAPI (Avg) $11,784 Potential HAPI Costs ($11,784 x 5) $58,920 LEAF sensor costs (through 8/31) ($38,606) Potential Cost Savings $20,314

15 Lessons Learned Late Adopters: Big brother watching me I know how to turn my patients Light Bulb: CCU has high turn compliance Not offloading pressure at 20

16 Success and Opportunities Success Real time visual cues for adequacy of turn Daily reports that provide turn and offloading compliance Assist RN s with prioritization of workload Daily reports that can be shared with staff regarding turn and offloading compliance Ease of reporting; Real time access Potential to interface turning/repositioning in EMR Opportunities Sensor part of workflow Nurse clinical judgement for sensor placement Bariatric patients Education (staff, patient, and family) Once initiated, keep sensor on High risk areas; (bridge of nose, heels, etc)

17 Thank you.