National Nursing Home Quality Care Collaborative (NNHQCC) II and the Clostridium difficile Infection (CDI) Initiative Learning Session 3: CDI Tracer and Assessment Tool Health Services Advisory Group (HSAG) Thursday, April 19, 2018
Presenters Keith Chartier, MPH Associate Director 602.801.6906 kchartier@hsag.com Debbie Shaeffer, LPN QI Specialist 614.301.0969 dshaeffer@hsag.com Eli DeLille, RN, BSN, CIC Quality Improvement (QI) Specialist, Infection Preventionist 216.644.3998 edelille@hsag.com 2
Objectives Introduce and explain HSAG s new CDI Tracer and Assessment Tool for long-term care facilities (LTCFs). Recognize gaps in your nursing home s policies and procedures. Learn how to possibly utilize the CDI Tracer and Assessment Tool in your existing Quality Assurance & Performance Improvement (QAPI) program. 3
What is a QIN-QIO? Funded by the Centers for Medicare & Medicaid Services (CMS) Quality Innovation Network- Quality Improvement Organization (QIN-QIO) in each state Dedicated to improving health quality at the community level Ensures people with Medicare get the care they deserve, and improves care for everyone Department of Health & Human Services Centers for Medicare & Medicaid Services 4
New National QIN-QIO Structure 5
HSAG s QIN-QIO Responsibility Nearly 25 percent of the nation s Medicare beneficiaries HSAG is the Medicare QIN-QIO for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands. 6
QIN-QIO Areas of Focus
Improve Hand Hygiene and Injection Practices in ASCs* QIO Work Cardiac Health Disparities in Diabetes Adult Immunizations Transforming Clinical Practice Support of Clinicians in the Quality Payment Program Patient is at the center of care Antibiotic Stewardship in Communities Healthcare- Acquired Conditions in Nursing Homes Behavioral Health Coordination of Care *ASCs=Ambulatory Surgical Centers
Improve Hand Hygiene and Injection Practices in ASCs QIO Work Cardiac Health Disparities in Diabetes Adult Immunizations Transforming Clinical Practice Support of Clinicians in the Quality Payment Program Healthcare- Acquired Conditions in Nursing Homes Patient is at the center of care Behavioral Health Coordination of Care Antibiotic Stewardship in Communities
Improve Nursing Home Quality All nursing homes are invited to join Medicare s National Nursing Home Quality Care Collaborative (NNHQCC). An all-teach, all-learn quality improvement effort designed to ensure residents receive the highest quality of care. Collaborate with peer nursing homes and expert speakers through face-to-face meetings and webinars while earning no-cost continuing education units (CEUs). 10
Improve Nursing Home Quality The NNHQCC II CDI Initiative 11
NNHQCC II 12 *QM=Quality Measure
CDI Initiative 13 *NHSN=National Healthcare Safety Network
First, What is NHSN? National Healthcare Safety Network (NHSN) Operated by the Centers for Disease Control and Prevention (CDC) Currently utilized by hospitals Secure federal mainframe Need for Secure Access Management Services (SAMS) card 14
What Can NHSN Do For CDI? Facility s CDI rate (LTCF-Onset vs. On Admission) Identify not just residents, but units or neighborhoods with CDI issues Aggregate data from multiple facilities (need rights) 15
CDI Tracer and Assessment Tool
Fast Facts Spore forming bacteria Difficult to kill on surfaces Difficult to treat Reoccurs in about 1 in 5 patients who contract the illness People on antibiotics are 7 10 times more likely to get CDI and for 1 month post treatment Occurs most commonly in hospitals, nursing homes, and outpatient settings More than 80 percent of CDI deaths occur in people age 65 and older Prompt identification and appropriate treatment is crucial to improve outcomes 17 Source: https://www.cdc.gov/hai/pdfs/cdiff/cdiff-one-pager.pdf
Feedback From Our Partners Develop tools and resources that meet the needs of post-acute partners Assistance with NHSN reporting Provide NHSN data reports Infection prevention support for CDI Gap assessment (Tracer) Education Audit tools Training 18
Assessment and Tracer On-site visit Performed by QIO Quality improvement specialist Engages frontline staff members Tracer methodology Focuses on flow of patient Targets high-risk areas Based on the Targeted Assessment for Prevention (TAP) Strategy 19
CDI Tracer and Assessment Overview NHSN data review General interview Frontline staff member interview Pharmacy interview Lab interview Dietary interview Environmental services interview Medical record review 20
New CDI Report from HSAG NNHQCC CDI Report 21
General Interview 22
Frontline Staff Members 23
Pharmacy 24
Lab 25
Dietary 26
Environmental Services 27
Medical Record Review 28
Testing Algorithm Resource is based on feedback from multiple partners across the QIN looking at high-risk areas of opportunity. 29
Hand Hygiene Audit Tool CDC and the WHO* have hand hygiene campaign information available (posters, signs, brochures, and audit tools). 30 *WHO=World Health Organization
Resident/Staff Education Resources are up to date, easy to understand, and available for a wide variety of subjects. https://www.cdc.gov/hai/pdfs/cdiff/cdiff_tagged.pdf 31
Infection Prevention (IP) Education CMS Creating an IP course Available spring 2019 On-demand No cost Topics include: IP scope of responsibilities Infection surveillance Hand hygiene Medication safety Antibiotic stewardship 32
How Can the CDI Tracer and Assessment Tool Fit into QAPI?
Worksheet to Create a Performance Improvement Project Charter (PIP) Page 1 Name of project: Practices/protocols for CDI and outbreak control Problem(s) to be solved: Improper hand hygiene, improper cleaning protocols, improper linen handling Background: Increase in the infection rate for CDI episodes Goal: Decrease # of episodes of CDI infections within 90 days Scope: CDI cases occurring on skilled unit Worksheet available at https://www.cms.gov/medicare/provider-enrollment-and- Certification/QAPI/downloads/PIPCharterWkshtdebedits.pdf 34
Worksheet to Create a PIP Charter Page 2 Project Approach Project Phase: Dates for initiation, planning, implementation, monitoring, and closing Project Team: Not just about who, but what is their role in this PIP Worksheet available at https://www.cms.gov/medicare/provider-enrollment-and- Certification/QAPI/downloads/PIPCharterWkshtdebedits.pdf 35
Worksheet to Create a PIP Charter Page 3 Barriers: Time, lack of education, location of handwashing stations Project Approval Worksheet available at https://www.cms.gov/medicare/provider-enrollment-and- Certification/QAPI/downloads/PIPCharterWkshtdebedits.pdf 36
PIP Page 1 Worksheet available at https://www.hsag.com/contentassets/0de8e0acb3524235ab5ddc8633b0b7c5/perfor mance-improvement-plan-worksheet.pdf 37
PIP Page 1 (cont.) Worksheet available at https://www.hsag.com/contentassets/0de8e0acb3524235ab5ddc8633b0b7c5/perfor mance-improvement-plan-worksheet.pdf 38
PIP Page 2 Worksheet available at https://www.hsag.com/contentassets/0de8e0acb3524235ab5ddc8633b0b7c5/perfor mance-improvement-plan-worksheet.pdf 39
PIP Page 2 (cont.) Worksheet available at https://www.hsag.com/contentassets/0de8e0acb3524235ab5ddc8633b0b7c5/perfor mance-improvement-plan-worksheet.pdf 40
Questions????? 41
HSAG NHSN Resources www.hsag.com/nh-nhsn-resources 42
Are You Receiving Monthly Email Updates? Email us to be added! Arizona aznursinghome@hsag.com California canursinghomes@hsag.com Florida FL-NNHQCC@hsag.com Ohio ohnursinghome@hsag.com
Contact Us! Questions? Comments? Assistance? Reach out to your state QIO. Arizona aznursinghome@hsag.com California canursinghomes@hsag.com Florida FL-NNHQCC@hsag.com Ohio ohnursinghome@hsag.com 44
Thank you!
This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. QN-11SOW-C.2-04132018-01