Tennessee Center for Patient Safety
Center Staff • Chris Clarke, Sr. VP, Clinical and Professional Practices • Patrice Mayo, VP for Operations • Jackie Moreland, Clinical Quality Improvement Specialist • Rhonda Dickman, Clinical Quality Improvement Specialist • Jennifer McIntosh, Clinical Quality Data Manager • Teresa Benedetti, Executive Assistant 2
Tennessee Center For Patient Safety THA Board Strategic Aim: Zero Preventable Harm 3
Leadership Commitment • Transparency and Accountability – Hospital-specific comparison data shared at THA Board meetings • Data posted on TCPS Report Distributor – Board level peer-to-peer presentations – CEO Leadership Scorecards
Tennessee Center for Patient Safety • Program Areas: – CMS Partnership for Patients • Hospital Improvement Innovation Network (HIIN) – Tennessee Surgical Quality Collaborative • Enhanced Recovery After Surgery – OB/ Maternal Care Programs with TDH • Early Elective Delivery, Breastfeeding Promotion, Safe Sleep – THA PSO Program
TCPS Strategies and Offerings • AHRQ Culture of Safety Survey • Professional peer networking and coalitions • TCPS Regional Education Meetings – Sepsis Coordinators coalition • Mentors program and peer sharing – Care Transitions coordinators coalition • Site visits to HIIN hospitals and health systems – Pharmacy coalition • Medication Safety Summit – Patient and family advisors • Sepsis Collaborative and • Tennessee Surgical Quality Consultations Collaborative • Patient/Family Engagement SNAP • Breastfeeding/OB initiatives • Health Equity Summit • THA Leadership Summit • Workplace Resilience Webinar Series
Core HIIN Topics • Adverse Drug Events (ADE): • Pressure Injuries – glycemic management, • Readmissions opioid safety, anticoagulant • Sepsis safety • Surgical Site Infections (SSI) • Catheter-Associated Urinary • Venous Thromboembolism (VTE) Tract Infections (CAUTI) • Ventilator-Associated Events (VAE) • Central-Line Associated Blood • Worker Safety Stream Infections (CLABSI) – Patient Handling Injuries • Clostridium difficile (C. diff ) – Workplace Violence Incidents • Falls with Injury • Culture • Methicillin-Resistant Staph • Patient and Family Engagement Aureus (MRSA) • Elimination of Disparities
TCPS Performance with Updated Baselines Includes All TCPS Partner Hospitals 2016 2017 Topic Hospital Hospital Events SIR Outliers Events SIR Outliers CAUTI ICU 387 0.951 5 273 0.704 2 CAUTI Wards 247 0.772 3 234 0.766 1 CLABSI ICU 243 0.866 2 233 0.857 2 CLABSI Wards 198 0.708 2 183 0.659 1 SSI Colon - Complex 204 0.948 5 189 0.860 2 SSI Hysterectomy - Complex 71 1.127 2 60 1.022 1 SSI HPRO - Complex 92 1.183 3 102 1.206 2 SSI KPRO - Complex 58 0.964 1 51 0.831 1 MRSA 341 1.314 7 281 1.070 4 CDIFF 2,314 0.885 9 2,144 0.849 4 Data Source: NHSN as of July 9, 2018 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of 2011. T.C.A. 68-11-272.
TCPS Performance with Updated Baselines Includes All TCPS Partner Hospitals Events SIR Hospital Outliers Topic January-March 2018 CAUTI ICU 66 0.651 0 CAUTI Wards 50 0.666 0 CLABSI ICU 54 0.774 1 CLABSI Wards 40 0.642 0 SSI Colon - Complex 32 0.671 0 SSI Hysterectomy - Complex 10 0.785 0 SSI HPRO - Complex 20 0.993 0 SSI KPRO - Complex 14 1.005 0 MRSA 80 1.245 1 CDIFF 488 0.774 3 Data Source: NHSN as of July 9, 2018 This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of 2011. T.C.A. 68-11-272.
2018 Quality and Safety Priorities • Areas of focus based on performance gaps – Adverse Drug Events – opioids, anticoagulation, hypoglycemia – Sepsis – MDROs – MRSA and C-difficile
2018 Quality and Safety Priorities • Cross-Cutting Strategies for Hospitals – Quality boot camp for hospital leaders – Infection control boot camp – UP campaign – Surgical ERAS/ISCR protocols – Workforce resilience webinars – Patient and family engagement – Health equity and addressing disparities
2018 Quality and Safety Priorities Partnership Programs • Tennessee Department of Health – Healthcare Infection Targeted Assessment and Prevention (TAP) strategy – Antibiotic Stewardship • Tennessee Departments of Health and Mental Health – “Tennessee Together” Opioids Plan • Collaborative on Prevention of Opioid Addiction • Enhanced access to treatment services
TCPS Resources for Hospitals • IHI Open School for Health Professions -Free access • TCPS Weekly Newsletter • TCPS Website http://www.tnpatientsafety.com • TCPS Report Distributor – Data feedback and comparisons – CEO Scorecards and Board data slides
Upcoming Events • Workforce Resilience Webinar Series with Dr. Bryan Sexton Offered monthly, 2 nd Thursday • THA Leadership Summit – October 17, 2018 – Showcase hospital improvements • THA Annual Meeting – October 17-20
Hot Topics
Opioid Epidemic www.tn.gov/opioid
Governor’s Plan TN Together Prevention Treatment Law Enforcement Limits on prescriptions – Increases state funding to days and MMEs Provides over $25 million in address illicit sale and state/federal funds trafficking of opioids Commission to address evidence-based Updates the controlled competencies for medical Extends peer recovery substance schedules to and health practitioner specialists to targeted, high- address fentanyl schools need emergency rooms analogues Collaborative to implement best practices around pain Expands TennCare access to Provides state troopers management recovery services with Naloxone Creates public/private Public awareness campaign treatment collaborative Treatment and recovery Education for elementary options tied to legal system and secondary schools and corrections Prevention of Neonatal Abstinence Syndrome
OB EMTALA Citations
OB EMTALA • Eight to ten hospitals in Tennessee cited by Region 4 surveyors over the past year for OB EMTALA • Issues focused on role of the RN in performing medical screening exam and if allowed to serve as the qualified medical provider (QMP) due to language in Tennessee Nurse Practice Act, which prohibits nurses from performing medical diagnosis or medical plans of care • Issue as a result of this was interpretation by CMS surveyors and Regional 4 medical director that the OB physician must see the patient face-to-face in every medical screening exam (MSE)
OB EMTALA- Actions • Engaged EMTALA expert Dr. Robert Bitterman • Engaged TDH for support • CMS National Office meeting May 9 with David Wright, director, Clinical Standards and Kate Goodrich, M.D., CMS chief medical officer Agreed the clinical model used by hospitals with a qualified and competent obstetrical RN performing assessment of labor then contacting physician for plan of care and patient disposition was appropriate • MD serves as the QMP but MD does not have to come in to rule out labor or emergency medical condition. MD makes decisions and is accountable for care.
OB EMTALA • CMS National Office of Standards – Mr. Wright noted his office has discussed the issues with Region IV and EMTALA staff and CMS recommends that “the best course of action will be to pursue a scope of practice modification for nurses determining false labor. As we discussed, designating nurses as QMPs, without the modification, connotes an independence of action and discretion with regard to Medical Screening Examinations that may be beyond what the hospitals were intending. It is also apparently beyond the strictures of the Tennessee Nurse Practice Act.” • Tennessee Board of Nursing approved position statement on scope of practice May 17 • Memos/conference calls for members June • THA will seek to update the nursing statute next session
MRSA
Methicillin-resistant Staphylococcus aureus (MRSA) • THA hosted a “deep dive” MRSA session in July 2017 with the Tennessee Department of Health (TDH) and 20 hospitals with the most MRSA events to explore barriers to improvement and recommendations • Recommendations approved by THA board last fall • TDH conducted in-depth chart analysis of 100 MRSA cases at three facilities for CDC to better define risks • THA hosting a follow-up session Aug. 3 to share the CDC case findings and update recommendations • Webinar and promising practices to share forthcoming
CMS Hospital Compare • Public Reporting of Sepsis Bundle Data – Published to Hospital Compare on July 25, 2018 – Current reports include the first three quarters of 2017 • 4Q 2017 will be added to the reports with the October 2018 Hospital Compare update • The reports will display a rolling year thereafter, updated quarterly • Reporting overall bundle compliance
CMS Hospital Compare • Garnering media attention
CMS Hospital Compare https://www.medicare.gov/hospitalcompare/search.html • National average: 49% Highest: • Tennessee average: 50% Hawaii – 68% • Arkansas average: 47% • Mississippi average: 48% Lowest: D.C. – 35% • Virginia average: 46%
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