Foundation for Healthy Communities NH Partnership for Patients Hospital Improvement & Innovation Network (HIIN) 2.0

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1 Foundation for Healthy Communities NH Partnership for Patients Hospital Improvement & Innovation Network (HIIN) 2.0 Hospital NHSN Workshop February 22, 2017 Greg Vasse Anne Diefendorf Our charge is clear: reduce all cause harm by 20% and readmissions by 20% by September 2018.

2 Affordable Care Act: The PATIENT $ to CMS/CMMI Medicare Trust Fund Hospital Engagement Networks: HEN HEN AHA /HRET Hospital Improvement Innovation Network HIIN - 16 FHC NH Partnership for Patients State HAC Teams Hospital HAC teams Clinician NH Eliminate Harm The Patient

3 Partnership for Patients HEN /1/ /8/2014 HIIN 9/28/2016-9/27/2018 HEN 2.0 9/24/2015-9/23/2016

4 New Hampshire hospitals collectively avoided over 5,041 adverse events for a combined savings of more than $41.3Million

5 Network Resources Webinars / ListServs / QI and PFE Fellowships / SMEs and Improvement Advisors

6 HRET Webinars

7 HRET Webinars

8 ListServ

9 ListServ HRET HIIN LISTSERV Sign Up Form HRET HIIN uses the LISTSERV platform to encourage peer-to-peer networking and best-practice sharing. To limit unnecessary traffic, the LISTSERVs are moderated. HIIN participating hospitals are welcome to join any or all of the LISTSERVs described below. Please allow 5 business days for your request to be processed. Thank you. * address: * Full Name: *What state or territory that participates in HRET HIIN do you reside in? * Hospital or Organization: * Position: * Topics:

10 ListServs Adverse Drug Events (Warfarin, Insulin, Opioids) Data Analytics Health Care Disparities Hospital-Wide Topics - Culture of Safety/Worker Safety, Falls, Pressure Injuries/Ulcers, Venous thromboembolism (VTE) Diagnostic Error, Malnutrition, Undue Radiation Exposure ICU - Ventilator-Associated Events (VAE), Delirium, Airway Safety Infections - Antibiotic Stewardship, CAUTI, CLABSI, C. difficile Infection, MDROs, Surgical Site Infections Patient & Family Engagement Readmissions - Please note this will be a Discussion Forum through Huddle for Care, an interactive community innovating care transition solutions Rural/Critical Access Hospitals Sepsis

11 ListServ From: HRET HIIN Data Analytics ListSERV(R) On Behalf Of YOUR NAME HERE Sent: Saturday, February 04, :08 PM To: Subject: CLABSI questions Hello We are implementing CLABSI bundle items and have encountered questions around two areas: 1. Is implementing a no blood draws from a central line best practice for any facility, regardless of size or acuity level? 2. Should inserting providers always try to use a sutureless device? Is there evidence based practice data on improved outcomes? Thank you. YOUR NAME AND CONTACT INFORMATION

12 ListServ Response Sent on Monday, 2/6/2017 from : JRET HIIN Data Analytics Lis CDC recommends suture-less devices to reduce CLABSI =rja&uact=8&ved=0ahukewjexprn5_vrahvl- 2MKHbmyB9IQFggjMAE&url=https%3A%2F%2Fwww.jointcommission.org%2F assets%2f1%2f18%2fclabsi_monograph.pdf&usg=afqjcne3yqn0tjfwr0ib 8MeAi_IV16S_IQ Lev Baesh, RN, BSN, CHPN, CLNC, JD Project Improvement Manager Texas Hospital Association Foundation 1108 Lavaca, Suite 700 Austin, Texas Phone: lbaesh@tha.org

13 ListServ Response Sent Monday, 2/6/2017 Hi, Alex! I have not seen evidence that making a complete ban on using the CVL for blood draws would be appropriate for every area. Pt factors should be the impetus for policies around that, IMHO. The CDC did mention sutures as being a possible element in CVL insertion site infections and, as a result, we created a policy some years ago (for the large tertiary care hospital where I worked at that time) that if an LIP decided to suture they had to state in their procedure note why they were doing so. We did reduce our CLABSIs to zero for over a year and then after 1 aberrant infection, over a year again. This was, of course, not the only change we made during that improvement project. Deb Deborah R. Campbell, RN-BC, MSN, CPHQ CCRN alumna Infection Prevention Improvement Advisor Ky-Hospital Improvement Innovation Network Kentucky Hospital Association 2501 Nelson Miller Parkway Louisville, Ky

14 Fellowships

15 Quality and Infection Prevention staff conducted observations in the OR Suite to determine compliance with Surgical bundles- Olathe Health System 32% Decrease in Severe Sepsis and Septic Shock Mortality rate Lovelace Women s Hospital Development of walk in the patient s shoes simulation for all staff. 40% reduction in all cause falls Health Central Fellowship 2016 Project Highlights SIRS Screens, MD notification, Laboratory Alert and Triage process improved to comply with 6 hour sepsis bundle Coast Plaza Hospital Added F/u discharge call to include an additional call 14 days post discharge. Monroe County Tested Early warning risk of sepsis predictive tool Orlando Health Screened pre-op neurosurgery patients for MRSA at consult visit. Patients cleansed with CHG 3 days prior to surgery and nares swabbed with betadine on day of surgery Kaiser Sunnyside Medical Center 49% Decrease in Urinary Catheter Usage in all Med- Surg patients Field Health System Introduced IV Acetaminophen, decreased Opioid Usage and ADE Naloxone rate Labette Health

16 SME Site Visit Data Analysis / Who, What, Where, When and Why harm is occurring Hour 1 Our Story What improvement are you proud of that have been sustained? What do you want to accomplish now? What is standing in your way? What do you already have in place to help you get the outcome you want? What have your tried? What did you learn? Our data What are you learning from your data? What data are you collecting? Review Top 10 Checklist Tool for gap analysis and opportunities Cross Pollination of best practices gathered from around the HEN Tools and Resources Building reliability into design. Moving beyond staff education Hour 2 Tracer Activities in the patient care areas depending upon their challenges and opportunities. Conduct tracers with front line staff to assess care processes. Hour 3 Debrief Resources and more cross pollination Next steps

17 HRET HIIN UP Campaign Anne Diefendorf Greg Vasse Hospital NHSN Workshop February 22,

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26 Why the UP Campaign? Increases impact on harm reduction Generates momentum in your organization Focuses support from leadership Engages front-line staff Connects the dots Creates a vision Applies throughout organization Simplifies patient safety implementation Helps patients recover faster and with fewer complications 10

27 Can we streamline and simplify to make it easier for front-line staff and still improve safety? 11

28 #1 Opioid & Sedation Management ADE Failure to Rescue Delirium Falls Airway Safety VTE VAE W A K E UP 12

29 #2 Early Progressive Mobility Falls HAPU Delirium CAUTI VAE VTE Readmissions G E T U P 13

30 #3 Hand Hygiene CDI CAUTI SSI VAE CLABSI Sepsis MDRO S O A P U P 14

31 Handwashing an OLD Intervention Since 1847 we have understood that hand hygiene (HH) makes a difference in the spread of infections Dr. Ignaz Semmelweis in Vienna Childbed fever Dr. Lister OR 1980 s concepts of hand hygiene in health care emerged 2002 alcohol based hand rub adopted WHO Global Clean Hands initiative Yet, the average HH compliance is 48 percent 15

32 Observation and surveillance of hand hygiene is the best way to ensure appropriate compliance. Schedule an unscheduled observation by trained observers. Intervene immediately if a breach in HH is observed. Provide scripts for reminding peers to perform HH. Promote culture of safety. What Works? 16

33 We Need to Get It Right! Protect our patients from health care-associated infections (HAIs) by performing HH. Promote patient and family engagement and give them permission to speak up for clean hands. Promote patient HH for patients. 17

34 Must Do's 18

35 SOAP UP Must Do s beyond your current plan 1. Prompt peer performance 2. Track quietly and trend loudly 3. Drive drift down 19

36 Must Do #1 Prompt Peer Performance 20

37 Must Do #2 Track Quietly and Trend Loudly Hand hygiene vs Hospital Acquired Infections 21

38 Track Quietly & Trend Loudly SOAP UP started 22

39 Must Do #3 Drive Drift Down 23

40 The Right Balance Person model System model Important to get the balance right; both extremes have their pitfalls. 24

41 Up Campaign Resources 25

42 Thank You! Find more information on our website: Questions or Comments: 26