HEN 2.0 Monthly Update

HEN 2.0 Monthly Update Jessica Rowden, MHA, BSN, R.N., CPHQ Director of Clinical Quality http://web.mhanet.com/quality-and-health-improvement.aspx

HEN 2.0 Monthly Webinar Agenda Data Stipend Update Reports UP Campaign Resources Checklists/Change Packages/Toolkits Site Visits Educational Scholarships Upcoming Events Case Study/Story Sharing

Data

Milestone 2 AHA/HRET As a state; we are held to milestones or contract deliverables We met the lower tier of Milestone 2 meaning: Tier One: To receive Tier One, the percentages in both baseline submission and site visits must be within the range of 70-89% of the Number of Committed Hospitals. Tier Two: To receive Tier Two, the percentages in both baseline submission and site visits must be 90% of the Number of Committed Hospitals or greater.

Data Monthly monitoring data due to HIDI Quality Collections on the Wednesday before the last Friday of the month for the performance period of the previous month Example: March data is due April 27

Stipend Update Validation of data is still occurring, in conjunction with updating reports Goal is to notify hospitals by the end of the month

Pay for Performance Model MHA Pay For Performance Model Of Stipend Distribution Based On Improvement And Data Submission Six Month Milestone Data submission to be eligible for performance stipends, Hospital must report data at 85% of required data submission totals at six months on all preferred, applicable measures Performance Stipend sliding scale Hospital achieves 17.6-39% harm reduction for at least 50-74% of the harm topics and/or achieves 10-19% readmission reduction Hospital achieves 40% harm reduction for at least 75-100% of the harm topics or maintains zero baseline and/or achieves 20% readmission reduction Twelve Month Milestone $1,500 $3,000 Data submission to be eligible for performance stipends, Hospital must report data at 85% of required data submission totals at twelve months on all preferred, applicable measures Performance Stipend sliding scale Hospital achieves 17.6-39% harm reduction for at least 50-74% of the harm topics and/or achieves 10-19% readmission reduction Hospital achieves 40% harm reduction for at least 75-100% of the harm topics or maintains zero baseline and/or achieves 20% readmission reduction $1,500 $3,000 $6,000 is maximum pay for performance amount + $2,000 for complete baseline submission = $8,000 per hospital

High Performing Hospitals Hospital Number of Topics meeting improvement Number of Applicable Topics Cooper County Memorial Hospital 5 6 St. Mary's Medical Center 7 9 Ste. Genevieve County Memorial Hospital 7 10

Data Validation and Outliers Row Labels Sum of Percent Improvement Hospital 1-71340.67 Due to an incorrect denominator Hospital 2-41098.65 Hospital 3-3776.95 Hospital 4-2469.48 Hospital 5-2218.16 Hospital 6-1664.02 Hospital 7-1663.05 Hospital 8-1154.92 Hospital 9-946.37 Hospital 10-872.42

Costs Saved and Harms Prevented HAC Description Harm Prevented Cost saved ADE - Anticoag Adverse Drug Event - Excessive anticoagulation 55 $ 165,000.00 CAUTI Catheter-associated urinary tract infection (CAUTI) rate - All Units 16 $ 16,000.00 Falls Falls With Injury (minor or greater) 117 $ 77,571.00 OB Trauma Inst OB Trauma: Vaginal deliveries w/instrument 21 $ 1,932.00 OB Trauma: Vaginal deliveries w/out OB Trauma No Inst IVAC instrument 44 $ 6,952.00 Infection-Related Ventilator- Associated Condition (IVAC) 10 $ 210,000.00 Total $ 477,455.00 Readmission Readmission within 30 days (All Cause) 203 $ 1,788,024.00

NHSN We continue to encourage all hospitals to confer NHSN rights to HIDI Instructional handouts located in the handout pod of webinar platform

UP CAMPAIGN

The UP Campaign

UP the targets

ADE Impact Airway Safety CAUTI CLABSI Get-Up Early Progressive Mobility Crosscutting Clinical Interventions Wake-Up Opioid & Sedation Mgmt. Soap-Up Hand Hygiene C. Diff. Delirium Failure to Rescue Falls Pressure Ulcers Readmissions SSI UP YOUR GAME Sepsis VAE VTE

UP YOUR GAME! Crosscutting Clinical Interventions Impact Get-Up #1 Early Progressive Mobility Delirium Falls PU Readmissions VAE VTE Wake-Up #2 Opioid & Sedation Management ADE Delirium Falls AS VTE VAE FTR Soap-Up #3 Hand Hygiene CLABSI CAUTI VAE CDI SSI Sepsis

# 1 EARLY PROGRESSIVE MOBILITY Falls PrU Delirium VAE VTE Readmissions G E T - U P

G E T Game Plan: determine the resources in your institution and how you will implement a mobility program Evaluate: (patient capabilities): Which scale/tool/evaluation method will you standardize on? Therapy: Progressive mobility - U P Unite: patients and families in mobility efforts) Engage patients, families and friends in mobility progression Promote progress: Measure and report unit mobility performance

Why GET-UP? A successful progressive mobility program will have a far-reaching effect in preventing VAE, VTE, Delirium, Falls, PrU, and Readmissions. 65% of hospitalized elderly develop weakness in their legs and dizziness upon standing and one third never regain their ability to walk after discharge (Hirsch et al 1990) In a 2004 study, 73% of patients who could walk did not walk at all while in the hospital (Callen et al 2004). Additionally it has been shown that in the hospital, older adults only take 15% of the steps they normally take at home (Choosing Wisely 2014). The results are muscle weakness, dizziness, and fluid volume loss (Kleinpell et al 2008). Progressive mobility preserves muscle strength, reduces delirium, improves lower extremity circulation and lung capacity (Vollman 2010) and reduces length of stay (Mundy et al 2003). While lack of mobility may be most dangerous for the elderly, recent studies show that even younger, healthier patients are not adequately mobilized, putting them at risk as well (Hockenberry 2011).

G Game plan determine the resources in your institution and how you will implement a mobility program: Who performs the evaluation? Which staff will participate in patient mobility? Consider acuity/location/time of day/available resources. Simple to understand and execute is better. How will you track performance? During each shift and over time. Do you have special needs for special circumstances (e.g., portable ventilators, IVs, devices/orthoses) E Evaluate (patient capabilities): Which scale/tool/evaluation method will you standardize on? Evaluate q shift (but sensitive to optimal sleep patterns) Ensure pain is managed prior to mobility Include mobility capability as a shift handoff item o Include as a whiteboard item o Record in medical record T Therapy o Progressive mobility o Bed mobility exercises for lowest capability o Transfer to chair o Guided ambulation o Lengthening distance o Record in medical record Implement minimum of every 8 hrs. (observing for optimal sleep patterns) Does support depend on specific mobility tasks (e.g., unlicensed for in bed, PT for transfers, nurse and respiratory with ventilators)?

U Unite (patients and families in mobility efforts) Engage patients, families and friends in mobility progression o Track daily performance o Overcome discouragement o Coach self-management skills o Use teach back and graded autonomy o Engage family and friends Provide appropriate assistive devices (e.g., walker, cane, elastic bands, weights) P Promote Progress Create an after-care (discharge) mobility plan (for SNF, Home Health or Self-management) o Give specific, measurable goals o Hand-off mobility progress to post-acute care and/or MD office Measure and report unit mobility performance o Stratify by severity/capability Consider recognition programs (e.g., Olympics, perpetual/rotating trophies, patient and department level) 41

# 2 OPIOID & SEDATION MANAGEMENT ADE FTR Delirium Falls AS VTE VAE W A K E - UP

W A K E - U P Warn Yourself: this is high risk Assess: use tools (STOP BANG, POSSS, RASS, PA-PSA) Know: Your drugs, Your patient Engage: Patients and Families to set realistic pain expectations, use of non-sedating analgesics, risks of opioids Utilize: dose limits, layering limits, soft and hard stops Protect: The Patient our ultimate job

WAKE - UP Why WAKE-UP? Over-sedation is a common adverse drug event that can lead to the most serious complications: coma, ICU care and death or disability. In addition, over-sedation leads to reduced mobility, resulting in increased falls, pneumonia and venous thromboembolic disease. W - Warn Sedation with opioids, anxiolytics and other medications is one of the most dangerous activities that physicians and nurses perform. Warn yourself. Be aware. Be alert. Never take sedation safety for granted. Never cut corners, skip steps, rush or be rushed by someone else. A - Assess Use established and validated patient assessment tools to identify patients at higher risk for sedation related events and to monitor patients before and after each dose STOP BANG (identifies patients at risk for obstructive sleep apnea) Pasero Opioid-Induced Sedation Scale (POSS) Richmond Agitation Sedation Scale (RASS)

K Know Your Meds; Know Your Patient Review the Pennsylvania Safety Authority Opioid Knowledge Self Assessment Test Be aware that hydromorphone is 5-7 times more potent than morphine If giving IV push sedation, wait two minutes between doses in order to accurately assess the full effect of the last dose and to avoid unplanned dose accumulation Use opioid conversion tools when changing medications or routes of administration Understand that opioids are potentiated by benzodiazepines, hypnotics, and other CNS depressants Beware of multiple opioid orders for varying pain levels Beware of the cumulative risks of layering medications one after the other for pain, anxiety or insomnia Understand that a patient is NOT opioid tolerant unless he/she has taken at least 60 mg of morphine equivalent doses daily for the last seven days Remember the elderly, those at risk for sleep apnea, and those with cardiac and pulmonary disease may be at grave risk at usual doses E Engage. Physicians, pharmacists, and nurses to educate regarding the dangers of opioids in inpatients, especially those in floor beds or on PCA s Patients and families to set proper pain expectations and promote understanding of the risks of sedation

U Utilize Dosing Limits, Layering Limits, and soft and Hard Stops Convene clinicians to join together to design hard stops that prevent simultaneous orders for multiple opioids or any single opioid in combination with a benzodiazepine Set dosing limits based on age P Protect Patients from opioid harm while inpatients Patients from opioid harm when dispensing prescriptions upon discharge: Is an opioid necessary? This much? This many? Clinicians from the emotional and career ramifications of severe over-sedation events Your hospital and your community from the heartbreak and loss of trust that arise from these avoidable events Helpful Tools and Links to Resources: https://www.sleepassociation.org/sleep-apnea-screening-questionnaire-stop-bang/ http://www.mghpcs.org/eed_portal/documents/pain/assessing_opioid-induced_sedation.pdf http://www.icudelirium.org/docs/rass.pdf http://patientsafetyauthority.org/educationaltools/patientsafetytools/opioids/documents/assessment.pdf http://www.hret-hen.org/topics/ade/13-14/2014-adechangepackage508.pdf

# 3 HAND HYGIENE CDI CAUTI SSI VAE CLABSI Sepsis S O A P - U P

S O A P Simplest way to reduce the transmission of healthcare acquired infections Own your role in preventing HAIs Address- immediately intervene if breach is observed Perform hand hygiene according to CDC guidelines - U P Utilize the correct cleaning agents. Remember soap for C. diff. Patient and families, get them involved

UP CAMPAIGN WEBINARS HEN 2.0 WAKE UP Webinar May 12 11-12 pm HEN 2.0 GET UP Webinar May 26 11-12 pm HEN 2.0 SOAP UP Webinar June 9 11-12 pm

Member Resources and Support

Monthly Newsletter

Huddle for Care Huddle for Care HELP! I need to keep my team motivated HELP! We have limited resources HELP! Our patients aren t going to follow-up appointments HELP! Our patients aren t motivated to take care of themselves Interactive platform (both website and mobile application) for individuals working in care coordination and care transitions Connect and check-in with patients after discharge Educating physicians to reduce readmissions in a rural setting Easing the discharge process through a comprehensive readmissions reduction plan

HRET List-serv http://www.hret-hen.org/inc/dhtml/listserv.dhtml Get signed up and start asking your national colleagues questions!

Aim for Excellence Award 54

The Missouri Hospital Association is pleased to announce the Aim for Excellence Award to recognize Missouri hospital s innovation and outcomes. The award will recognize up to six member organization- or team-based projects that address at least two of the three Triple Aim principles. Applications must be received by Monday, May 2. Please visit MHA s website for additional information. www.mhanet.com/afea/ 55

Categories Critical access and rural hospitals Small and large metropolitan statistical area hospitals Care collaboratives or health care systems *maximum of one application per category 56

Eligibility Project-based applications designating a team or organization Limit of one application per hospital, although a hospital also may be part of the larger comprehensive care model award Intervention must have been implemented for at least one year and have evidence of results Hospital-based applications must address at least two of the three Triple Aim principles; awards for the comprehensive care model or health system must address all three principles 57

Scoring 58

Award Timeline Action Timeline Application Release March 1, 2016 Application Due Date May 2, 2016 Awardee Notifications Beginning August 15, 2016 Awardee Announcement November 3, 2016 59

Additional Support Application or Technical Support Stacie Hollis Manager of Emergency Preparedness/Response Systems shollis@mhanet.com 573/893-3700, ext. 1321 Eligibility or Project Support Dana Downing, BS, MBA-H, CPHQ Vice President of Quality Program Development ddowning@mhanet.com 573/893-3700, ext. 1314 60

HRET Resource Links HEN 2.0 resource library Patient and Family Engagement Compendium

HRET Based Resources Readmissions Falls Sepsis CDI Pru CLABSI Airway safety Failure to Rescue Change Package and Top Ten Checklist. Iatrogenic Delirium Change Package and Top Ten Checklist. Surgical Site Infections Change Package and Top Ten Check List. Undue Exposure to Radiation Change Package and Top Ten Checklist.

HRET Based Resources Fact sheets ADE Data Collection and improvement fact sheet Excessive Anticoagulation with Warfarin Inpatients Hypoglycemia in Inpatients Receiving Insulin Adverse Drug Events due to Opioids Sepsis Data collection and improvement fact sheet Outcome measure

Improvement Based Site Visits

Case Study Template Handout template in the webinar pod Using this also as a site visit prep tool

Site Visits Still a few hospitals to finish up with an initial visit Second round of visits will focus on improvement and will be prioritized by data submission and performance By using the Case Study Template we can focus on actual improvement work at the hospital level and help identify and work through barriers

COMING SOON: Educational Scholarships

Educational Reimbursement Application development and legal approval Reimbursed for state and/or national conferences Determining amount maximum and other limitations

Upcoming Events

MHA Collaboration with Children s Mercy Hospital Thursday, May 19, Noon - 1 p.m. Recruiting Patient Advocates Register Thursday, Aug. 18, Noon - 1 p.m. Patient Advocate-Policy Design Strategies Register Thursday, Nov. 17, Noon - 1 p.m. Family-Centered Rounds Register

Strategic Quality Improvement 101 Wednesday, May 4, 8:30-4:00 Courtyard by Marriott, Columbia, Mo. Agenda Inter-relationship of Quality and Finance Quality Reporting Overview Physician Engagement in Quality Initiatives Effectively Managing the Quality Reporting Portfolio Sustaining Quality Improvement Projects Register

Put us on your calendar! MO HEN OB Harm Reduction Workshop July 28 Hilton Garden Inn Columbia Registration END of HEN Convening August 24 Courtyard by Marriott Columbia Registration Monthly HEN webinars Third Wednesday of the month, Noon to 1 p.m. Register for all webinars using this link. MHA - Monthly What s Up Wednesday First Wednesday of the month at noon Register for 2016 WUW

HRET Sponsored Webinars April HEN 2.0 EED Webinar April 21 11-12:30 pm CT HEN 2.0 VAE Webinar April 26 11-12:30 pm CT HEN 2.0 QI Office Hours April 27 11-12:30 pm CT AHA/HRET HPOE A Focus on Health Equity and Coverage April 28 3-4:30 pm CT CMS Webinar: Provider Engagement What Works? Webinar: April 21, 2016 2:00pm - 3:00pm (CST) https://secure.confertel.net/tsregister.asp?course=6860837.

HRET Sponsored Webinars May HEN 2.0 CAUTI Webinar May 3 11-12:30 pm HEN 2.0 Data Office Hours May 4 11-12 pm HEN 2.0 Rural/CAH Webinar May 9 11-12:30 pm HEN 2.0 Foundational ALF Webinar #6 May 11 11-12 pm HEN 2.0 Experienced ALF Webinar #6 May 11 12:30-1:30 pm HEN 2.0 WAKE UP Webinar May 12 11-12 pm AHA/HRET HPOE Use Realtime Health Info to Improve Patient Care: Med Rec May 16 12-1:00 pm CT HEN 2.0 C Diff May 17 11-12:30 pm HEN 2.0 ADE Webinar May 19 11-12:30 pm HEN 2.0 GET UP Webinar May 26 11-12 pm

HRET Sponsored Webinars June/July HEN 2.0 SOAP UP Webinar June 9 11-12 pm HEN 2.0 Foundational ALF Webinar #7 June 15 11-12 pm CT HEN 2.0 Experienced ALF Webinar #7 June 15 12:30-1:30 pm CT HEN 2.0 CAUTI Webinar July 12 11-12:30 pm

Questions?

Contact Information Jessica Rowden, MHA, BSN, R.N., CPHQ Director of Clinical Quality Missouri Hospital Association jrowden@mhanet.com 573/893-3700, ext. 1391 156 days left