Risk-Quality-Safety Management Reporting and the Healthcare SafetyZone Portal

Transcription

1 Risk-Quality-Safety Management Reporting and the Healthcare SafetyZone Portal Heather Annolino, RN, MBA, CPHRM Director, Risk-Quality-Safety Consulting Services Clarity Group, Inc. 04/22/15 1

2 04/22/15 2

3 Overview of the Changing Healthcare Landscape Shift from Volume to Value as a basis of reimbursement Pay for performance ACO quality metrics Value Based Purchasing Reduced or denied reimbursement 04/22/15 3

4 The audience will be able to: Highlight the importance of incident reporting Recognize event reporting data as a way to: Drive quality improvement Decrease risk exposures Identify some proactive risk management strategies 04/22/15 4

5 Important Differences Demographics Income, education, insurance status Health behaviors Population density Healthcare availability Volume, case and service mix 04/22/15 5

6 Risk Managers In the Business of Managing the Future 04/22/15 6

7 Purpose of Risk Management To identify risks in a systematic multi-disciplinary To determine the most effective way to manage identified risks To monitor the effectiveness of the risk management process 04/22/15 7

8 Conventional Risk Management Analyze Evaluate Identify Manage 04/22/15 8

9 Risk Management BUSINESS PATIENT/ RESIDENT/ FACILITY CLINICAL OPERATIONAL 04/22/15 9

10 Conventional Risk Management Insurance purchasing function Functional categories of risk exposures Professional liability Workers compensation General liability Property Fleet Directors and Officers Employment practices liability Errors and omissions Risk activities across the organization conducted in isolation Future loss through reactive loss control 04/22/15 10

11 Risk Identification Methods Methods of Identifying Exposures Formal Methods Incident reports Methods of Identifying Exposures Informal Methods Prior claims Patient complaints Standardized surveys and questionnaires Other records and files Personal inspections Experts Hotline 04/22/15 11

12 What is Enterprise Risk Management? Enterprise Risk Management (ERM) utilizes a process or framework for assessing, evaluating and measuring all of an organization s risks. ERM quantifies risks to assist in prioritizing significance, groups them into components or domains looking for inter-dependency and devises strategies to manage each across the enterprise. 04/22/15 12

13 Enterprise Domain Human Capital Establish workforce to meet service demands Staffing levels in all areas are appropriate Staff recruitment and retention programs are established Compensation Morale Ensure hiring practices are proactive and conform to legal requirements Verify Criminal background Professional credentials Require drug/substance abuse testing Upon hire For cause 04/22/15 13

14 Enterprise Domain Human Capital Clearly define and disseminate employment practice policies Termination Diversity Confidentiality Harassment/abusive behavior Promote a safe workplace environment Ensure insurance coverage for employment practices liability exposures 04/22/15 14

15 Enterprise Domain Clinical Risk Establish processes for initial and ongoing evaluations of patients/residents Appropriate level of care Services meet social, medical, emotional and spiritual needs of patients Prepare patient/resident/family for movement within the continuum Expedites transfers to appropriate level of care Sets reasonable expectations Assess staff competencies Skill-based job descriptions and performance reviews Competency fairs Develop policies, procedures and protocols that reflect current standards 04/22/15 15

16 Enterprise Domain Operational Formalize credentialing process for all levels of independent practitioners Verify primary source of professional licenses and certifications Arrange for peer and/or performance review Implement a communication process Set expectations for services and outcomes Monitor documentation practices Establish protocols for use of Internet as communication tool with families Establish policies and procedures Reflect actual practice Comply with current clinical standards 04/22/15 16

17 Enterprise Domain Operational Establish a program to monitor and improve quality outcomes Include clinical and ancillary services Clinical outcomes Services provided by vendors Create a safe environment of care Periodic internal and external safety rounds Preventive maintenance program Life safety program Evaluation and maintenance of fire detection and suppression systems Quarterly fire and evacuation drills all shifts Emergency preparedness program Bioterrorism Natural disaster Develop a workplace violence prevention program Monitor compliance with infection control practices 04/22/15 17

18 Enterprise Domain Customer and Community Relations Conduct routine community needs assessment Ensure marketing materials convey realistic expectations and services Evaluate patient, resident, family and employee satisfaction annually Establish policy for media control Participate in community outreach education 04/22/15 18

19 Enterprise Domain Technology Establish procedures to integrate new technologies into the organization Due diligence Staff training and competencies Preventive maintenance Determine protocols for use of new technology services Ensure processes are in place to manage, store and maintain electronic data 04/22/15 19

20 Enterprise Domain Legal/Regulatory Establish medical information privacy protocols Confidentiality statements Use of facsimiles Communication via Internet Disclosure of patient identifiable information Comply with regulations related to employment practices, billing practices and financial reporting requirements Anti-kickback regulations Environment (Occupational Safety and Health Administration) Fulfill licensure requirements 04/22/15 20

21 Risk Management Pitfalls Failure to appreciate a problem/situation Failure to monitor appropriately Failure to observe and report Failure to perform or follow-up Poor processes for decision making Poor processes for resolving disagreements Poor planning Losing focus on the patient 04/22/15 21

22 Risk Reduction Process Identify events Determine cause Implement changes Evaluate outcomes Track, trend, analysis Communicate to team 04/22/15 22

23 Risk Identification Incident Reporting Concurrent mechanism/ early warning capabilities Staff participation and accountability Protection and discoverability Computerization Analysis 04/22/15 23

24 HRSA Meaningful Use and CAHS From a December 2010 HRSA Report on Meaningful Use and CAHs Advances in information technology hold great promise for helping rural residents and rural providers. 95% of critical access hospitals use administrative health IT systems but less than one-third use health IT for clinical care. HIT are tools to facilitate a culture of health data management and sharing hospital-wide, coordinated change to move from paper to digital records and information sharing can affect a tremendous impact on patient care and outcomes. 04/22/15 24

25 Paper vs. Electronic Reporting Paper Store paper forms in accessible place Handwritten sometimes illegible Requires 15 min to write Must be routed via interdepartmental mail Copies made so that various persons can add comments Requires classification into several general categories Must be stored in secure place Must be kept confidential Does not lend itself to trending Must wait for forms to be completed and signed before combining for reporting purposes Electronic No storage accessible from all computers Electronic, always legible Can be completed in < 5 min Automatically notifies as soon as completed No copies. No limit to how many comments can be made Can be classified into multiple categories at multiple levels Electronic, no storage necessary Electronic password protections Trended immediately Can be reported on immediately even before investigation is complete 04/22/15 25

26 Risk-Quality-Safety Management Continuous RQS Improvement / Quality Enhancement Focus on each aspect Awareness Modified Risk Exposure, Enhanced Quality And Safety Intervention Create a Spiral of Positive Change 04/22/15 26

27 Communication-Increase Awareness Goals Align expectations with deliverables Create trust Inspire positive perceptions Remove barriers to event reporting 04/22/15 27

28 Working Towards a Just Culture Non-punitive Meaningful feedback Proactive risk prevention Monitor for effectiveness in risk identification 04/22/15 28

29 Benchmark for Excellence in Patient Safety Quarterly Webinar Presented by Clarity Group, Inc /22/15 29

30 QCR Data to Date Reporting includes 69 facilities across 13 states 4 new facilities Historical July 2011 December 2014 Over 29,000 events reported through program Falls Medication Infections 04/22/15 30

31 Falls National Benchmark Fall Events Reported Q Q Q Q Q Q Q Q Q Q Q Q Q Q /22/15 31

32 Aggregate Data - Falls 04/22/15 32

33 Aggregate Data - Falls 04/22/15 33

34 Falls Risk Assessments 04/22/15 34

35 DEEP DIVE 04/22/15 35

36 Fall Prevention Strategies/Ideas Effective assessment tools for toileting behavior Timely reassessments Involve the patient and family; patient preferences, reasonable interventions, patient fall contracts Assessment of medications/iv therapy that may impact toileting schedules; consider rescheduling diuretics, bowel programs for optimal timing Sitters? 04/22/15 36

37 Med Events & Harm\Severity Historical average: 12% 04/22/15 37

38 Med Events & Harm\Severity 04/22/15 38

39 Types of Errors Associated with Medication Processes 04/22/15 39

40 Wrong Does Type North Dakota - Wrong Dose Type 4% 7% 13% 19% 57% Extra dose Omission Overdose Underdose Unknown Q Q Average 04/22/15 40

41 Medication Errors are Complex Medication administration complex, involves both technology and provider interactions and is complicated by human related factors Medication errors increase 12.7% with EACH interruption according 2012 ISMP Medication Safety Alert Took a deeper look at one quarter data to see how human factors may have impacted reported events 04/22/15 41

42 Review of Over 130 Events; Patterns Emerged 04/22/15 42

43 Dosing Recommendations: Risk reduction strategies that do not rely on memory Simplify processes Avoid dispensing different route meds using similar equipment Screen unit providers for suggestions Involve patients and families 04/22/15 43

44 Near Miss Events IV events that stood out were pharmacy stocking processes: IV fluids were stocked in the wrong bins Incorrect high risk IV medications were stocked in the wrong medication dispensing bin Two concentrations of the same high risk IV medications were stocked in the same medication dispensing bin 04/22/15 44

45 RISK ANALYSIS HOW CAN IT BE PREVENTED FROM HAPPENING AGAIN? 04/22/15 45

46 Any questions? 04/22/15 46

47 Thank you! Heather Annolino, RN, MBA, CPHRM Director, Risk-Quality-Safety Consulting Services Clarity Group, Inc. Chicago, IL /22/15 47