Home Health Infection Prevention Toolkit Paula Sitzman, RN, BSN Great Plains Quality Innovation Network Judy Riggert, RN, MS Visiting Nurse Association of the Midlands
Map Great Plains Quality Innovation Network (GPQIN) includes: Quality Health Associates of North Dakota South Dakota Foundation for Medical Care Great Plains Quality Innovation Network- Nebraska Kansas Foundation for Medical Care https://greatplainsqin.org/
Great Plains QIN Partners in Healthcare Quality Improvement Mission: to use the collective knowledge and resources to achieve the aims of better healthcare, improved health, safer care and lower healthcare costs Collaborate with providers and communities on multiple quality initiatives to improve patient safety, reduce harm and improve clinical care Aspire to make health across the GPQIN the best in the nation 3
Great Plains QIN Programs for Quality Improvement Antibiotic Stewardship Cardiac Health Care Coordination Diabetes Care Health Information Technology Immunizations Medication Safety Nursing Home Care Quality Payment Program Sepsis Transforming Clinical Practice Initiative 4
Great Plains QIN Special Innovation Projects Colorectal Cancer Screening Home Health Infection Prevention and Control Reducing Sepsis Harm and Death Opioid Reduction (KS only) 5
The Issue: Infections in Home Health Care Estimates of infections occurring during home health episodes of care are as high as 1.2 million per year An initial evaluation of 2015 OASIS data was completed for 25 home health agencies across the Great Plains QIN In those 25 agencies, 24% of home health episodes of care ended with an acute care hospitalization related to respiratory, urinary tract and wound infections 6
Available Knowledge Life expectancy in the US population continues to increase and people with chronic conditions live longer Occurrence of infections in home care is an adverse event for patients and family caregivers and can potentially have a negative impact on patient outcomes 7
Home Health Infection Prevention (HHIP) Special Innovation Project (SIP) CMS special funding was received to develop home health specific infection prevention tools and resources Goals: o Adopt and/or create infection prevention and control tools, resources and best practices for the Home Health Infection Prevention Toolkit o Recruited home health agencies will test and implement tools available in the Toolkit o Achieve reduction of home health infection-related acute care hospitalizations 8
Recruitment of Home Health Agencies Across the GPQIN North Dakota 5 HH agencies South Dakota 6 HH agencies Nebraska 5 HH agencies Kansas 12 HH agencies 9
Home Health Agency Environmental Scan Conducted to identify current best practices and what was needed to reduce and manage infections in home health care Scan completed by 25 or 28 recruited home health agencies following receipt of signed participation agreements Results indicated there were opportunities for improvement 10
Development of Home Health Advisory Council Recruited Home Health Agencies participating in the Special Innovation Project Monthly Home Health Advisory Council meetings Home Health Advisory Council provided ideas, suggested tools and resources for the Home Health Infection Prevention Toolkit 11
Home Health Infection Prevention Toolkit Team Home Health Advisory Council members A representative from each state in the GPQIN Home Health Quality Improvement (HHQI) National Campaign staff 12
Coaching Calls with Recruited Home Health Agencies Monthly coaching calls with home health agencies in each state Quarterly regional coaching calls with recruited home health agencies 13
Home Health Infection Prevention Toolkit Development Identify and collect infection prevention and control resources for home health agencies GPQIN development of tools and resources that did not exist for home health agencies Assistance of the Home Health Advisory Council Input and technical expertise from staff with the HHQI National Campaign https://greatplainsqin.org/hhip 14
HHIP Initiative e-newsletter Provide participating agencies with updates on project status, upcoming WebEx education, success stories and data E-Newsletters distributed quarterly, beginning on March 1, 2017 15
CMS Home Health Quality Improvement National Campaign Provided technical expertise during development of the Home Health Infection Prevention Toolkit Best Practice Intervention Packages (BPIPs) Provides free education for home health agencies, home health aides, social work and therapy www.homehealthquality.org 16
Launch of Home Health Infection Prevention Toolkit Officially launched April 3, 2018 E-Newsletters Social Media Trade associations HHQI National Partners/Wound BPIP National HHQI Network Coordinators Call QIN Times Newsletter [June 2018] 17
Home Health Infection Prevention Toolkit Content Antibiotic Stewardship Hand Hygiene Immunizations Injection Safety Patient and Family Education Respiratory Infection Sepsis Urinary Tract Infection Disaster Preparedness Home Health Aide Infection Precautions Nursing Bag Technique QAPI Risk Assessment & Surveillance Teach-Back Wound Infection 18
HHIP Learning and Action Network (LAN) Events in HHIP Toolkit Infection Prevention and Control Strategies Related to C. difficle, Norovirus and MRSA The Next Big Adventure: Prevention of Pneumonia in the Home Utilizing Your Home Health CASPER Report in the QAPI Process: Focus on ACH Utilizing You Home Health CASPER Report to Succeed in a Value- Based Purchasing Environment: Focus on Immunizations Utilizing Agency Data to Reduce ACH: Focus on Infection Control No Longer Baptism by Fire : Developing An Infection Control Plan in the Home Environment No Longer Baptism by Fire : Implementation of the Infection Prevention and Control Plan: Part 2 19
Partnerships Home Health Agencies Home Health Advisory Council Home Health Quality Improvement National Campaign Team State Home Health Care Trade Associations 20
Visiting Nurse Association of the Midlands Home Health Services Nursing Physical, Occupational and Speech Therapy Medical Social Work Registered Dietitian Home Health Aide Volunteer Care Transitions Coach Telemonitoring Pharmacy Services Hospice & Palliative Care also includes the following services: Physician Bereavement Chaplain Service Areas Nebraska: Douglas, Sarpy, Washington, Burt; parts of Cass and Saunders Counties Iowa: Pottawattamie, parts of Mills and Harrison Counties 21
VNA Assessment and On-Going Risk Assessment Tool Monitoring Tools Hand Hygiene Nurse Bag Technique & Equipment Management Competency 22
VNA 2018 Risk Assessment 23
Hand Hygiene Competency 24
Bag Technique and Equipment Management Competency 25
VNA Patient/Caregiver and Staff Education Signs of Infection & Sepsis in the Home Fluid Needs of Adults C Diff Laundry and Cleaning Teach-Back 26
Signs of Infection and Sepsis at Home 27
Fluid Need of Adults 28
C Diff Laundry and Cleaning 29
As part of a pilot initiative to identify and develop infection prevention tools and resources for HHAs; 2 years We were one of 28 agencies throughout 4 states; Kansas Nebraska North Dakota South Dakota Access the Toolkit at https://greatplainsqin.org/hhip
Opportunities for Improvement The initiative, led by the Great Plains QIN, worked towards reducing Acute Care Hospitalizations related to wound, urinary tract and respiratory infections Greatest opportunity was to reduce hospitalizations due to UTI s VNAM Baseline 6.36% in 2015 Q1 2016 we were at 4.71% Q1 2017 we were at 6.77% We were specifically tasked with reducing our Q1 2017 results by 5%, from 6.77% to at least 6.44% Achieved a Q1 2018 rate of 2.76% (with a rolling year rate of 5.0%)
Greatly exceeded results for state and combined members in the GPQIN group I do think we will see a slight increase in our Q2 results [perhaps around 4%[, but still significantly below where we were - 6.44%, which means we need to continue to stay focused on hydration, early recognition of s/s and care team collaboration for our highest risk patients.
Home Health Agency Successes The Home Health Infection Prevention Toolkit has been extremely helpful. We have utilized the documents under Risk Assessment and Surveillance, specifically the Risk Assessment template. During our last Joint Commission Survey, we were told that we need to be using a template very similar to the tool included in the toolkit. Honestly, the Risk Assessment template from the Home Health Infection Prevention Toolkit is more comprehensive than the example provided to us by the JC surveyor. - North Dakota We have been working on falls/ambulation along with reducing Urinary Tract Infections (UTIs). The Toolkit has helped to have PT/OT at least do an evaluation for mobility issues. The nurses are focused on the patient s hydration and any UTI symptoms at each skilled nursing visit. We have not had a fall or UTI in over a month. We are going over the items in the Toolkit weekly and having a weekly focus of one of the issues. We have found the Toolkit very helpful. - Kansas 33
Successes From Other organizations I showed some of the Toolkit patient education resources to a few physicians in our antibiotic stewardship committee and they were very impressed and requested copies to hand out to their patients from the clinic. They especially liked the Cleaning the Nebulizer and CPAP Machine tools but were impressed with many of the resources. - South Dakota GPQIN team member We really like the patient and family education tools in the Toolkit, especially the ones for Cleaning the Nebulizer and CPAP Machine. We will use these when we discharge patients from our facility. We see some very dirty Nebulizers and CPAP machines at admission; it s no wonder they have pneumonia. - Nebraska SNF 34
Home Health Infection Prevention Process Measures Agencies utilize CASPER data to track ACH and ED visits related to respiratory, urinary and wound infections Agencies implement at least two best practices/tools from the HHIP Toolkit Agencies implement an agency-wide Infection Prevention Program in their QAPI Plan Agencies participate in the HHIP WebEx training Agencies participate in HHIP Coaching Calls 35
Home Health Infection Prevention Number and rate of: Outcome Measures acute care hospitalizations respiratory infections related acute care hospitalizations urinary tract infections related acute care hospitalizations wound infections related acute care hospitalizations 36
Clinical Improvement the Data Quarter 1 2018 results reflect an overall increase from recent quarters in acute care hospitalizations related to the three identified infection measures combined. This was, in large part, due to the noted increase in respiratory-specific infections which is consistent with the time of year and what was noted in Quarter 1 2017 (12.5%). Quarter 1 2018 results for urinary tract and wound infections was noticeably decreased (improved) with both results exceeding the 5% goal (7.5% and 6.1% respectively) 37
Overall Acute Care Hospitalization Rates 38
Respiratory Infection Acute Care Hospitalization rates 39
Urinary Tract Infection Acute Care Hospitalization Rates 40
Wound Infection Acute Care Hospitalization Rates 41
Acknowledgement of HHIP Toolkit Team The 28 Home Health Agencies across the Great Plains QIN GPQIN Quality Improvement Advisors and Leaders GPQIN Communication and IT Staff CMS Home Health Quality Improvement Staff 42
Summary of HHIP Special Innovation Project Reduce infections occurring in the home health care setting Develop infection prevention tools, resources and best practices for home health agencies Develop infection prevention tools and resources for patients and families 43
Resources Great Plains QIN Home Health Infection Prevention Toolkit https://greatplainsqin.org/hhip Great Plains Quality Innovation Network https://greatplainsqin.org/ Home Health Quality Improvement National Campaign www.homehealthquality.org Centers for Disease Control and Prevention www.cdc.gov Association for Professionals in Infection Control and Epidemiology https://apic.org/ 44
Questions? 45
How to Get Involved 46
Contact Information Paula Sitzman, RN, BSN paula.sitzman@area-a.hcqis.org P: 402.476.1399; Ext 512 Judy Riggert, RN, MS jriggert@thevnacares.org P: 402-930-4261 This material was prepared the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, 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. 11S0W-GPQIN-NE-C3-122/0918