Objectives Identify the regulatory programs rewarding or penalizing - PDF document

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Progressing toward Zero Harm “ Treating HAI as Plane Crashes instead of Car Accidents” Christopher Schmidt, ARNP, MSN, CEN Chief, Quality and Patient Experience Objectives  Identify the regulatory programs rewarding or penalizing hospitals for performance specific to Hospital Acquired Infections (HAI)  Recognize the importance of realtime monitoring and intervention (Code Rush) specific to HAI  Recognize the technological initiatives which aided Flagler Hospital in improving facility overall HAI scores  Discuss Flagler Hospital’s use of technology to improve institution wide hand hygiene compliance Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 1

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention 335 Beds 335 Beds  Opened 1890, private, NFP 335-bed acute-care community 55,000 Inpatient 55,000 Inpatient hospital serving Northeast Days Days Florida. 59,000 ER Visits 59,000 ER Visits  St Johns County only Hospital 16,000 Surgical Cases 16,000 Surgical Cases  Member, Coastal Community Health 141,000 Radiology Exams 141,000 Radiology Exams  ACO, First Coast Health 1,100,000 Lab Tests 1,100,000 Lab Tests Alliance 1,550 Babies Born 1,550 Babies Born A Focus on Clinical Excellence Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 2

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention $700K $700K HAC National Performance 6 Flagler Hospital Score: 6.94 Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 3

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention The Road to Zero Harm  Strong Leadership Support and Involvement  Emphasis on safety as an organizational priority  Adequate Financial Resources  Allow time and incentive for key players involvement in the Change process  Allow time for the project to work  Thinking outside of the box Strengths  Interprofessional team  Leadership, Physician and Nursing personnel, Medical Informatics, Infusion team, Quality Improvement personnel, Education  reviews gap analysis on HAI process and formulate action plans to be in line with best practices.  Able to leverage technology to better assist in providing transparency and clinical decision making Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 4

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Weaknesses  Lack of time and resources  Always looking at the past, waiting for reports  Addressing some problems creates others (CPOE)  Physician/nursing buy in for new protocols and equipment. HAI Rates Baseline Hospital Target Project Measure Start Date End Date Rate 9/2018 CAUTI CAUTI Rate - all except NICUs 1/15 12/15 0.65 0.52 CAUTI Rate - ICUs except NICUs 1/15 12/15 0.83 0.66 Catheter Utilization -all except NICUs* 1/15 12/15 29.22 23.38 Catheter Utilization -ICUs except NICUs* 1/15 12/15 51.32 41.06 C.difficile C. diff Rate Facility-wide-all except NICUs (per 10,000) 1/14 12/14 10.79 8.63 CLABSI CLABSI Rate - All 1/15 12/15 0.76 0.61 CLABSI Rate - ICUs 1/15 12/15 0.69 0.55 Central line utilization - All* 1/15 12/15 25.13 20.10 Central line utilization - ICUs* 1/15 12/15 41.22 32.98 MRSA Hospital-onset MRSA bacteremia events 1/14 12/14 0.05 0.04 Sepsis Sepsis Post-op Rate 12/15 9/16 10.85 8.68 Hospital-Onset Sepsis Mortality Rate 12/15 9/16 164.95 131.96 Overall sepsis mortality 12/15 9/16 73.06 58.45 SSI SSI rate, colon surgeries* 1/14 12/14 3.57 2.86 SSI rate, abdominal hysterectomy* 1/14 12/14 0.00 0.00 SSI rate, knee surgeries* 1/16 9/16 1.48 1.18 SSI rate, hip surgeries* 1/16 9/16 3.61 2.89 VAE Ventilator-associated condition rate 4/15 3/16 1.53 1.22 Infection-related ventilator-associated condition rate 4/15 3/16 1.53 1.22 Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 5

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention HAI SIR rate Hospital Start End Baseline Project Measure Target Date Date Rate 9/2018 CAUTI CAUTI SIR - all except NICUs (NHSN only)** 1/15 12/15 0.69 0.55 CAUTI SIR - ICUs except NICUs (NHSN only)** 1/15 12/15 0.80 0.64 C.difficile C. diff SIR - all except NICUs (NHSN only)** ^^ 1/15 12/15 1.14 0.91 CLABSI CLABSI SIR - all (NHSN only)** 1/15 12/15 0.93 0.74 CLABSI SIR - ICUs (NHSN only)** 1/15 12/15 0.79 0.63 MRSA SIR: MRSA bacteremia (NHSN only)** ^^ 1/15 12/15 1.17 0.94 SSI SSI SIR, colon surgeries (NHSN only)** 1/15 12/15 1.69 1.35 SSI SIR, abdominal hysterectomy (NHSN only)** 1/15 12/15 0.00 0.00 SSI SIR, knee surgeries (NHSN only)** 1/17 1/17 0.00 0.00 SSI SIR, hip surgeries (NHSN only)** 1/17 1/17 0.00 0.00 Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 6

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Code Rush  Conducting real time Root Cause Analysis (RCA) of HAI to identify underlying causes of the incident to ensure an effective solution can be identified and implemented before another incident occurs. Tenerife , Canary Islands 1977 Worst Commercial Aviation Disaster in History Objective: Predict patients at higher risk for developing CLABSI; intervene before CLABSI can develop. Based on a literary review of risk factors for CLABSI development, CMIO created an algorithm identifying patients that would benefit from close monitoring and early intervention. Since Implementation, 0 CLABSI in 11 months. Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 7

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention This reports all patients that may have a catheter in place. The order allows nursing floors, logistics and supervisors to correct documentation errors, obtain an order for the Foley if one was not place and to place the Foley if it was ordered. Process necessary to ensure documentation is accurate for another notification system alerting physicians within their progress note that a Foley has been in place for 3 days and to either discontinue or document why Foley is still necessary. Addressing Sepsis Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 8

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Clostridium difficile (C.diff.) 17 • Data demonstrates reduced C.Diff rates by 50% since 2013 FH Average Rate = 1.283 National Benchmark = 0.965 CDIFF Report Report lists patients who have an order for C. Diff stool test, but not collected. Often Often times C. diff test ordered on admission but stool not collected and sent for analysis until after 3rd day. This would occur for various reasons, but if collected beyond the 3rd day, patient reported as HAC instead of POA. Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 9

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention CDIFF (CDI) Dashboard  Pharmacists review dashboard daily which includes patients with active CDI or suspected CDI (test pending):  Contact Precautions and Isolation  De-escalation or discontinuation of broad spectrum antibiotics  Discontinuation of antacid therapy or switch PPI to H2 blocker  Appropriate treatment of CDI based on severity of infection CDI Pharmaceutical Prevention Implementation  Development of CDI Treatment and Testing Order Sets  Probiotics are an orderable option on order sets containing high risk antibiotics  Removed PPIs and H2 blockers from Admission Order Sets  Prescriber Led Review at 72 hours for discontinuation or de- escalation of antibiotics  Automatic antimicrobial discontinuation at 7 days unless otherwise specified by provider  Prospective Audit and Feedback of Target Antimicrobials  Removal of Antimicrobials from Applicable Post-Op Order Sets Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 10

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Antimicrobial Stewardship Other techniques to reduce HAC  Infra Red Technology  Hand Hygiene Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 11