Hospital Improvement Innovation Network. Amanda Keilholz, Program Manager February 27, 2018

Hospital Improvement Innovation Network Amanda Keilholz, Program Manager February 27, 2018 1

Agenda Workplace Violence in Missouri Hospitals HIIN Regional Bootcamps Milestone 6 HIIN project updates HRET virtual events HIIN fellowship events Upcoming events Resources 2

Violence in Missouri Hospitals February 27, 2018

Welcome 4

S.A.F.E.R. Framework Safe Culture of Zero Violence Approaches to Safe Care (Evidence-based) Facts to Drive Decisions Educate using Evidence and Best Practices Regulatory Reform to Support Safe Workplaces 5

Workplace Violence Defined Workplace violence is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide. It can affect and involve employees, clients, customers and visitors. Occupational Safety and Health Administration (OSHA) 6

Types of Workplace Violence Perpetrators No relationship to workplace Customers, clients, or patients Employment relationship (current or former) Relationship with employee 7

Assessment 8

2017 Listening Tour: Demographics Eight sessions between August and October 225 participants Community: 60 percent rural Hospital size: equal distribution Organizational structure: equal distribution Position by function: 75 percent operational 9

Identified Threats in Ranked Order 1. Behavioral health patient boarding in nonpsychiatric facilities (more prevalent in rural settings) 2. Violent patient encounters 3. Law enforcement drop-offs that create holding and/or elopement concerns 4. Search and confiscation of narcotics 5. Search and confiscation of weapons 6. Law enforcement presence to execute warrants of patients/visitors on site 10

Thematic Outcomes Identification and dissemination of bestpractice policies related to: Warrantless blood draws Use of security/law enforcement worn body cameras Appropriate and permissible use of TASERs (Thomas A. Swift s Electric Rifle) Reporting violent incidents to law enforcement Data to monitor trends and evaluate initiatives 11

Thematic Outcomes Development of education and training related to: De-escalation programs for different patient and visitor profiles Management of substance-related encounters with patients and their visitors Prevention of sexual violence against health care employees Incorporating security personnel into the care team Improve staff awareness and competency of organizational procedures 12

Scenario One: Lock Down Small, rural hospital No security staff, no metal detectors Aggressive visitor Leaves to obtain firearm in vehicle Response: Lock down Requires staff awareness, quick action Relationship with responding law enforcement agencies 13

Scenario Two: De-Escalation Mid-size hospital, suburban with security staff Agitated patient, verbal abuse, becomes aggressive Response: Activate de-escalation response Initiated by care team, includes security staff Minimal level of intervention to de-escalate situation Response is outlined in policy Appropriate staff are trained 14

Scenario Three: Engagement with Law Enforcement Large, metropolitan trauma center Patient presents to emergency department for treatment, possession of controlled substances Law enforcement called, placed in custody, outstanding warrant Response: Patient treated Integrate law enforcement Chain of custody 15

Prevalence Hazard vulnerability assessment 54 percent of Missouri hospitals report workplace violence and violent intruders as their top three internal threats 15 percent report these threats as their primary Cybersecurity events in the past 12 months impacted organizational risk assessments MHA Annual Preparedness and Safety Survey, December 2017, n 123 hospitals 16

Environmental Scan 59 percent (72 hospitals) employ security workforce as hospital personnel 21 percent (26 hospitals) provide dedicated security in the ED 24/7 38 percent (47 hospitals) have armed security officers 35 percent (23) firearm 54 percent (35) TASER 20 percent (13) pepper spray 45 percent (29) baton 89 percent (109 hospitals) don t use metal detectors 96 percent of hospital leadership teams review security event reports MHA Annual Preparedness and Safety Survey, December 2017, n 123 hospitals 17

Approach Advocacy Immediate and Long-term - Federal - State Program Development Long-term - Criteria to evaluate safety programs - Policy repository - Resources to integrate and empower security personnel - Data collection for benchmarking of de-escalation programs Education Long-term - Webinars - Presentations to targeted groups - On-demand education for front-line staff Collaboration Long-term - Regional meetings with law enforcement for shared education - Engage with statewide public safety leaders - Multi-disciplinary summit 18

Advocate Against Workplace Violence Inform leaders Letter campaign to Gov. Greitens 24 letters sent Advocate for balanced surveys Meeting with CMS Administrator Seema Verma Successful acknowledgement with federal officials Requirement to terminate staff Psychiatric holds against will February meeting with David Wright, CMS Director of Survey and Certification Engaging AHA and other state hospital associations 19

Divergent Missions CMS OSHA CMS Mission: To ensure that the voices and needs of the populations we represent are present as the agency is developing, implementing, and evaluating its programs and policies. Vision: All CMS beneficiaries have achieved their highest level of health, and disparities in health care quality and access have been eliminated. OSHA With the Occupational Safety and Health Act of 1970, Congress created OSHA to assure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance. https://www.osha.gov/about.html https://www.cms.gov/about-cms/agency- Information/OMH/about-cms-omh/mission-vision-ourwork.html 20

Zero Harm Culture: Reduce Violence Partner with state agency directors from health, social services, mental health and public safety DHSS evaluate the survey process DMH expand their ASIP training DPS engage law enforcement DSS explore 21

Evidence-Based Practice Changes Spring regional workshops four locations Joint regional training with EMS and law enforcement covering HIPAA, EMTALA and Chain of Custody requirements Education De-escalation skills training for front-line staff four offerings Keynote presentations during upcoming MHI programming Web-based offerings to broaden awareness of established resources 22

Resources Policy and procedure repository Call for approved policies Guidance from Healthcare Services Group Categorized by demographics Statewide data collection for benchmarking Occurrence of violent incidents Incidents de-escalated through staff response 23

Discussion Are there violence-related issues you have had that we have not captured? What other messages should we convey to: Elected state officials CMS administrators Other influencers Do you have any suggestions to improve our approach of advocacy? 24

Contact Information Jaclyn Gatz, MPA CHEP Missouri Hospital Association Vice President of Grant Management and Safety jgatz@mhanet.com 573/893-3700, ext. 1330 25

HIIN Regional Bootcamps To Increase Worker s Safety 26

What to expect Attendees will be taught and have the opportunity to demonstrate: De-escalation management. Crisis intervention training to supplement the de-escalation techniques with a focus on mental health populations Components of rape aggression defense training will be taught to offer realistic, selfdefense tactics and techniques. 27

What to expect A holistic approach to reducing both the risk and anxiety surrounding violence in healthcare. Excellent supplement to existing safety programs already in place at your organizations. Offered at no cost to Missouri HRET-HIIN hospitals. Audience: front line staff in all care units (ED, critical care and medical-surgical units) safety and security personnel. 28

Locations and times Workplace safety Blue Springs April 11, 2018 at the Courtyard Marriott Adams Pointe Conference Center Springfield April 25, 2018 at the Oasis Hotel and Convention Center St. Charles May 2, 2018 at the Embassy Suites Hotel Cape Girardeau May 9, 2018 at the Drury Plaza Hotel Conference Center

Milestone 6 30

Milestone 6 85 percent data submission on all applicable measures Monitoring data October 2016 October 2017 Readmissions October 2016 September 2017 $475 stipend going out Mid-March 100% of data submitting hospitals met the Milestone 31

HIIN Project Updates 32

Data Due Dates HIIN Project Year 2 HIIN Data Due Dates Year 2 Task Deadline For Hospital to Submit Data Data Included in Deadline Monthly Monitoring Data 20-Nov Oct 16 - Oct 17 Monthly Monitoring Data 20-Dec Oct 16 - Nov 17 Milestone 6 19-Jan Hard deadline for ALL data Oct 16 - Oct 17 Monthly Monitoring Data 24-Jan Oct 16 - Dec 17 Monthly Monitoring Data 21-Feb Oct 16 - Jan 18 Monthly Monitoring Data 23-Mar Oct 16 - Feb 18 Monthly Monitoring Data 23-Apr Oct 16 - Mar 18 Monthly Monitoring Data 23-May Oct 16 - April 18 Milestone 7 11-Jun Hard deadline for ALL data Oct 16 - Mar 18 Monthly Monitoring Data 22-Jun Oct 16 - May 18 Monthly Monitoring Data 24-Jul Oct 16 - June 18 Milestone 8 21-Aug Hard deadline for ALL data Oct 16 - May 18 Monthly Monitoring Data 24-Aug Oct 16 - July 18 Monthly Monitoring Data 21-Sep Oct 16 - Aug 18 33

MHA Zero Heros Club MHA congratulates the following HIIN-participating hospitals with the most zero harm measures reported. These organizations have either achieved and/or sustained a zero rate of harm, and are in the top 10 percent of HIIN-participating hospitals. Congratulations to the Zero Heros for the month of September! Carroll County Memorial Hospital Harrison County Community Hospital Iron County Medical Center Osage Beach Center for Cognitive Disorders Pike County Memorial Hospital Southeast Health Center of Ripley County Southeast Health Center of Stoddard County Sullivan County Memorial Hospital 34

SPAM Email from HEN or HIIN Finance PLEASE IGNORE If you receive an email asking you to pay your invoice via a link, please ignore and permanently delete. Do not click on the link in the email. The email may come from different email addresses, but is titled as HEN/HIIN Finance or HRET HIIN, similar to what is pictured below. AHA s IT department investigated the emails and discovered they were generated by groups from Germany and Switzerland. AHA recommends that your IT department block emails from these two countries, unless you do business with them. 35

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Hospital Leadership and Quality Assessment Tool The tool measures board members, C-suite executives and management/supervisors on how well they are implementing evidence-based practices shown to support a culture of safety and high performance in clinical quality measures. No front-line staff survey component Survey content FAQ 37

HLQAT Survey MHA is providing this complimentary opportunity for all HIIN hospitals to access and utilize this survey. Two options: Phase I Completed Phase II April through August 2018 Available to all HIIN hospitals previous participation not required. Phase I hospitals may participate in phase II if desired. Intent to participate materials will be sent to HIIN contacts soon. 38

Qualaris Audit Tool Projects Hand Hygiene Culture of Safety Rounding Sepsis Readmissions/Care Transitions 39

Qualaris New Tools Qualaris has new tools to assist users with coordinating successful improvement projects Tracking project outcomes alongside process measures Real-time dashboards inclusive of both outcomes and process measures Documenting PDSAs Click here to view the Qualaris improvement projects and outcomes demo. These tools require a short setup webinar session with Qualaris. Readmission Immersion Project participants should contact support@qualaris.com Use the Qualaris virtual chat support for next steps. 40

Sepsis: Early Recognition and Intervention Immersion Project Cohort 2 Project launched November 29, 2017 through September 18, 2018 Hospitals committed 11 Focused on three- and sixhour bundles (EMS, Emergency and Inpatient) Citizens Memorial Hospital Liberty Hospital Mercy Hospital St. Louis Missouri Delta Mosaic Life Care Nevada Regional Medical Center Ozarks Medical Center Poplar Bluff Regional Medical Center Saint Francis Healthcare System Southeast Health Center of Ripley County Southeast Hospital 41

LEAN Six Sigma Green Belt Project Project launching March 13, 2018 through November 30, 2018 Hospitals committed 20 Topic-focused Patient throughput ICU harm reduction Errors in medication reconciliation Capital Region Medical Center Carroll County Memorial Hospital Cass Regional Medical Center Cox Medical Center Fitzgibbon Hospital Golden Valley Memorial Healthcare Hannibal Regional Hospital Lafayette Regional Health Center Lake Regional Health System Liberty Hospital North Kansas City Hospital Ozark Medical Center Perry County Memorial Hospital Saint Lukes Health System Saint Luke's Hospital, Kansas City Scotland County Hospital Southeast Missouri Hospital St. Mary's Medical Center Ste Genevieve County Memorial Hospital Western Missouri Medical Center 42

NHSN Reporting Facilities The January 23rd release of the NHSN 8.8.1 application will introduce an updated NHSN Agreement to Participate and Consent for current NHSN facility users who enrolled in NHSN prior to December 2, 2017. Facilities that enrolled in NHSN on or after December 2, 2017, have already accessed this new Consent and will not need to accept it again if they have already done so. Primary Contacts or Facility Administrators should agree to this updated Consent form for each component by April 14th, 2018, or risk losing access to NHSN. An alert will appear on all NHSN component home pages, and primary contacts and facility administrators will receive an email notification. Additional information, including Frequently Asked Questions and the updated NHSN purposes, are available on CDC's NHSN website: https://www.cdc.gov/nhsn/about-nhsn/index.html. If you have any questions, please send an email to NHSN@cdc.gov with the subject line NHSN Reconsent. 43

NHSN Reporting Facilities The NHSN team has published some informational guidance on our website to assist users with completion of the updated NHSN Agreement to Participate and Consent. A 5-minute video informs users of the new Consent purposes and the simple process for accepting the Consent electronically. Furthermore, a step-by-step guidance document provides detailed instructions and screen shots for what Facility Administrators and Primary Contacts can expect to see when they begin the re-consent process in the NHSN application. A link to the video and the guidance document can both be found in the FAQs About NHSN s Agreement to Participate and Consent. In addition to the re-consent process, facilities also must complete the Patient Safety Component Annual Survey and submit it to NHSN by March 1, 2018. If this survey is not submitted by that date, facilities will be unable to complete and edit monthly reporting plans. 44

Patient Safety Awareness Week March 11 17 HRET is asking for hospital stories and photos on how you are dedicated to improving patient safety and patient engagement Submit story submission form with photos to your IA by March 5. Your submission will be featured on HRET s Twitter page 45

Sepsis Readmissions Fishbowl Recruitment for the fishbowl series is now underway. We are recruiting three to five hospitals who are interested in testing new strategies to reduce their sepsis readmissions. The purpose of the series is to provide customized continuous improvement coaching in an engaging format to the hospitals that are participating in the fishbowl to help reduce sepsis readmissions. The series will consist of five webinars starting in April and go through August. Dates are included in the attached document. submit an application A one -pager document that outlines the objectives of the fishbowl, key dates, and participant expectations is located in the handout pod 46

HRET Virtual Events 47

NDC Pacing Event Restoring Joy and Preventing Burnout March 1, 2018 12:00-1:00 p.m. CT Register here. This Pacing Event will explore the role of joy in work and its contribution to satisfaction in the workplace. A sense of contribution, accomplishment, and pride impacts the care provided, and hence, the patient experience. Channeling the inner sense of commitment can ultimately reduce the sense of exhaustion and overwhelm that exists for many care providers. This session will engage HIINs and hospitals in a discussion about the evidence around the role of joy and burnout in patient safety, as well as provide guidance on where to begin in assessing and addressing these concepts. The presentations will include resources and strategies for improving joy and reducing burnout, as well as discuss examples of the impact these strategies have on a culture of safety. 48

Assessing, Addressing and Responding to Social Determinants of Health in Vulnerable Communities March 6, 2018 1:00-2:00 p.m. CT Register here. What exactly are the social determinants of health? How do you incorporate health equity in managing the care of patients? How do you look beyond an individual and look at the community as a whole? By attending this webinar you will gain the following: Understand the concepts of social determinants of health and health equity Recognize how assessing and addressing social determinants of health is critical to improving health Learn to think beyond the individual and focus on community concerns and interests Knowledge on innovative protocols employed by systems to manage the care and needs of people 49

AHA/HRET Social Determinants of Health Webinar Series: Health Behaviors and the Role of Hospitals March 6, 2018 2:00-3:00 p.m. CT Register here. As hospitals and health systems are addressing more population health issues, unhealthy behaviors such as excess alcohol intake, smoking, drug abuse, irregular diet and low physical activity have been identified as significant influencers of poor health in individuals and communities. Changing health behaviors is not an easy task, but Tanner Health in Georgia and Mt. Ascutney Hospital and Health Center in Vermont have taken monumental steps toward decreasing risky behaviors and encouraging engagement in safer, healthy behaviors. Learning Objectives: Learn what healthy behaviors are and their impact on health Outline strategies to identify patients engaging in risky behaviors Learn evidence-based approaches developed to improve healthy behaviors in communities Explore the opportunities to change healthy behaviors into habits 50

Vizient HIIN Community Knowledge Network Malnutrition 3-Part Series, Part 3: Recognizing Malnutrition March 7, 2018 11:30 a.m. 12:30 p.m. CT Register here. Note: HRET HIIN's malnutrition work will be highlighted during this event. It is estimated that about one-third of patients who enter the hospital are malnourished, with even more becoming malnourished during their stay. Poor nutrition status, or malnutrition, among patients impacts both health and economic outcomes. This Vizient Hospital Improvement Innovation Network (HIIN) Community Knowledge Network (CKN) three-part learning series covers malnutrition. In the first webinar held January 2018, attendees learned about the burden of malnutrition on the healthcare system and how to build a business case for screening and identifying malnutrition in your organization. In the second webinar held in February, attendees learn from hospitals that have implemented efforts to screen, identify and diagnose malnutrition and heard about their struggles and successes. Stay tuned for part three of this webinar series. 51

IHI Engaging Patients and Providers: Speaking up for Patient Safety March 12, 2018 12:00-1:00 p.m. CT Register here. Earlier this year, the IHI/NPSF Lucian Leape Institute worked with NORC at the University of Chicago to conduct a nationwide survey of more than 2,500 adults regarding their experiences with and perceptions of medical error. Results of the survey show that about 1 in 5 Americans report experiencing a medical error in their own care, and one-third report being closely involved in the care of someone else who experienced an error. The good news is that nearly half of those who say they experienced a medical error spoke up about it to a medical professional or someone else on the staff of the facility where they received care. Of those who did not speak up, most said they did not think it would do any good or they did not know how to report the error. The survey findings demonstrate the importance of patient and family participation in care, but they also point to an opportunity for improvement.similarly, clinicians and staff feel empowered to speak up when they work in an organization that endeavors to create a culture of safety. During this webcast, held as part of Patient Safety Awareness Week 2018, speakers will discuss the importance of speaking up from the perspective of clinicians, staff, and patients and families. 52

HRET HIIN SCRIPT UP Virtual Event Recap On January 30, HRET launched the SCRIPT UP campaign with a webinar titled: Optimizing Patient Medications Minimizing Adverse Events. This is the newest addition to the UP Campaign and focuses on appropriate medication use with emphasis on antibiotic stewardship and Beers criteria. Beers criteria focuses on medications to avoid in elderly patients. During this informative webinar, Cynosure Improvement Advisors, Dr. Steve Tremain and Pat Teske, gave an overview of the UP Campaign and ways to reduce harms. Our guest speaker, Tim Perlick of Desert Regional Medical Center discussed real world approaches to implementing the SCRIPT Up Must Do's in hospitals. For more information on the UP campaign please click here. 53

HIIN Fellowship Events 54

QI Fellowship Virtual Events HRET HIIN QI Fellowship Foundations for Change Call #4 11 a.m. Wednesday, February 28 Register here. HRET HIIN QI Fellowship Accelerating Improvement Call #4 12:30 p.m. Wednesday, February 28 Register here. 55

QI Fellowship Virtual Events HRET HIIN QI Fellowship Open Office Hours #3 11 a.m. Wednesday, March 7 Register here. 56

QI Fellowship Virtual Events HRET HIIN QI Fellowship Foundations for Change Call #5 11 a.m. Wednesday, March 14 Register here. HRET HIIN QI Fellowship Accelerating Improvement Call #5 12:30 p.m. Wednesday, March 14 Register here. 57

QI Fellowship Virtual Events HRET HIIN QI Fellowship Foundations for Change Call #6 11 a.m. Wednesday, March 28 Register here. HRET HIIN QI Fellowship Accelerating Improvement Call #6 12:30 p.m. Wednesday, March 28 Register here. 58

Upcoming Virtual Events 59

HIIN Huddles 2 p.m. Tuesday, March 27 Readmissions Case Study Register here. 2 p.m. Tuesday, April 24 TeamSTEPPS Tools Register here. 2 p.m. Tuesday, May 22 HAIs/Soap Up Register here. 60

Aim for Excellence Webinar Series Formerly known as What s up Wednesdays Noon Wednesday, March 7 Aim for Excellence Award Application Presented by Leslie Porth, Senior Vice President of Strategic Quality Initiatives Register here. 61

Upcoming Events 62

Missouri HIIN Conference 2018 Wednesday, June 6 and Thursday June 7, 2018 Courtyard by Marriott in Columbia, Missouri. Complimentary registration for Missouri hospitals. Register on or before Wednesday, May 23. 63

Missouri HIIN Conference 2018 Keeping the Behavioral Health Patient Safe Joel A. Dvoskin, Ph.D; ABPP Chair, Nevada Behavioral Health and Wellness Council Forensic and Clinical Psychologist 64

Missouri HIIN Conference 2018 65

Hotel Information Missouri HIIN Conference Block of rooms reserved Calling to book: HIN Online booking: King bed: HINA Two queen beds: HINB Courtyard Marriott 573-443-8000 66

Upcoming Events 15th Annual Health Care Leadership Series 2017-2018* The Health Care Leadership Series consists of eight, one-day training sessions that will be held monthly on Fridays, September through May. There will be no session in December. Sessions will be held at the Courtyard by Marriott in Columbia, Missouri. Dates Session 1 Sept. 8, 2017 Session 2 Oct. 6, 2017 Session 3 Nov. 10, 2017 Session 4 Jan. 12, 2018 Session 5 Feb. 9, 2018 Session 6 Mar. 9, 2018 Session 7 Apr. 13, 2018 Session 8 May 11, 2018 *Events are not paid through HIIN. We encourage HIIN-participating hospitals to use HIIN stipends to assist in payment. 67

Upcoming Events Annual MAHA Spring Conference and Legislative Update Thursday, March 29 Courtyard by Marriott, Columbia, Mo Register on or before March 15 MAHA Member: $125 The Missouri Association of Hospital Auxiliaries, in conjunction with the MHA Health Institute, is pleased to announce a new one-day format for the 40th Annual MAHA Spring Conference and Legislative Update. Designed specifically for the education of hospital auxilians and volunteers, the program will feature sessions on workplace violence, stroke rehabilitation and more. Please join us as we celebrate the 40th anniversary of this event! 68

Upcoming Virtual Events What OCR Expects in a HIPAA Risk Analysis 9:30 a.m. Thursday, March 1 Audience: Compliance officers, privacy/security officers, legal counsel, health information management, information security, board members, C-suit executives, CMOs and CNOs Thirty-nine of 52 OCR Corrective Action Plans/Resolution Agreements to date involved ephi and, therefore, required risk analysis and risk management. Ninety percent of these organizations failed to complete a HIPAA Risk Analysis and 85 percent failed to complete a HIPAA Risk Management that meets OCR s increasingly more stringent standard of care. Organizations struggle to fully comprehend the scope of an OCR Quality Risk Analysis. Simply put, an accurate and complete HIPAA Risk Analysis must include all information assets in all lines of business in all facilities and in all locations. If that sounds like lot, it is. Attend this live web event, and learn a step by step methodology based on OCR and NIST guidance, aided high performing software. 69

Upcoming Virtual Events Change and How to Deal With It 11:30 a.m. - 1 p.m. Wednesday, March 7 8 Audience: administrative support staff in all health-related organizations The only thing constant in life is change. Change is something that excites people who love opportunities for growth, to see and learn about new things or who like to shift the status quo. Some changes, however, are harder to adjust to and lead to expressions of resistance and anger. We can take concrete steps to make change more palatable by understanding people s hesitation, enlisting the help of others, setting up plans and managing stressors. These steps also can ensure desired changes are implemented successfully. During this webinar, you ll learn how to manage and cope with change, and how to help those around you, too. CHNA 11 a.m. Tuesday March 20 70

Educational Resources Provided by MHA Health Institute For additional webinar/seminar opportunities click here. 71

Resources 72

SME Monthly Spotlights Adverse Drug Events Opioid Safety in the Hospital Falls Prevention Hospital Acquired Infections Patient and Family Engagement Pressure Ulcer VTE Prevention and Management 73

Eliminating Harm, Improving Patient Care: A Trustee Guide These resources were designed to illustrate the important role that trustees play in the journey to improve patient care. They serve as a tool for all trustees to use as they work towards the goals of improving quality within their organizations and improving the health of their patients and communities they serve. Four new video modules and a discussion guide have been developed, as well as a self-assessment tool for boards. Topics include: The Importance of Ongoing Board Education Boards can Influence Quality Through a Focus on Population Health Clinician Engagement is Crucial to Improving Quality The Importance of Patient and Family Engagement in Improving Quality 74

To care is Human Collectively Confronting the Clinician-Burnout Crisis From the New England Journal of Medicine Physician burnout remains a critical threat to physician well-being and patient safety. In this commentary, leaders of the National Academy of Medicine, Association of American Medical Colleges, and Accreditation Council for Graduate Medical Education describe their crosscutting collaborative to understand burnout, teach about its dangers, and foster meaningful solutions. 75

HRET HIIN Opioid Resource The HRET HIIN would like to share an article recently released entitled, Addressing the Prescription Opioid Crisis: Advancing Provider Education and Collaborating with All Stakeholders. This article highlights key factors in combating the opioid crisis including advancing provider education, screening patients, prescribing appropriately, expanding access to naloxone, improving access to treatment and understanding bias and stigma. In addition, we encourage review of the recent release of AHA s opioid toolkit, Stem the Tide: Addressing the Opioid Epidemic. 76

Opioid Crisis At a Glance This new infographic from the National Institute for Health Care Management (NIHCM) Foundation shows data on opioid-related emergency room visits and inpatient stays, data on opioid overdose deaths, data on states increasingly responding to the opioid crisis, and more. 77

NEW!!! STOP to START Improve Falls Nine myths about falls are busted Six practices we must STOP doing are listed with replacement interventions and strategies to START doing Links are provided to the articles with evidence to support the STOPS and STARTS Links to tools and resources to support evidence based, patient centered fall injury prevention practices and strategies including: Patient Centered Care / Injury Prevention Safe Mobilization Delirium Assessment Medication Review Patient Family Engagement Interdisciplinary Resources 78

Communities Driving Health Equity A Spotlight Video Series The National Academy of Medicine is proud to present a documentary video series. Spotlight local organizations across the U.S. advancing health equity for their communities by addressing the environmental, social, economic, and structural challenges that may impact residents' health. While challenges are numerous, progress is possible when community members, organizations, funders, and policy makers work together to drive local-level solutions that improve health equity and well-being for all. 79

HRET Harm Topics Information regarding harm Change package Checklists Fact sheets Additional resources Webinar recordings Podcasts 80

Change Packages These change packages are a summary of themes from the successful practices of high performing health organizations across the country. They have been developed through clinical practice sharing, organization site visits and subject matter expert contributions. These change packages include a menu of strategies, change concepts and specific, actionable items that any hospital can implement based on need or for purposes of improving patient quality of life and care. The change packages are intended to be complementary to literature reviews and other evidence-based tools and resources. Adverse Drug Events Airway Safety Catheter-Associated Urinary Tract Infection C. difficile Infection Central Line-Associated Bloodstream Infection Culture of Safety Delirium Exposure to Radiation Falls Multi-Drug Resistant Organisms Pressure Ulcers Readmissions Sepsis Surgical Site Infection Ventilator-Associated Event VTE Change Package Malnutrition 81

ListServ Get access to other hospitals, subject matter experts and other resources to avoid reinventing the wheel. Listserv sign-up open through the duration of the HIIN. Sign up today! 82

Monthly Quality Newsletter Click here for past issues. 83

MHA Trajectories ED Utilization: Right Care. Right Place. Right Time Click here for December Trajectories. 84

Questions? 85

Missouri HIIN Team Jessica Stultz Amanda Keilholz Toi Wilde Mary Shackelford Jessica Stultz, RN, BSN, MHA, CPHQ Director of Clinical Quality 573/893-3700, ext. 1391 jstultz@mhanet.com Amanda Keilholz, CPHQ HIIN Program Manager 573/893-3700, ext. 1405 akeilholz@mhanet.com Toi Wilde, RN, BSN, MBA, CPHQ HIIN Program Manager 573/893-3700, ext. 1406 twilde@mhanet.com Mary Shackelford, RN, BSN Improvement Advisor mshackelford@mhanet.com 86