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 • Claudette Fergus, Clinical Quality Improvement Specialist • Lizzy Adeyemi, Infection Preventionist • Jennifer McIntosh, Clinical Quality Data Manager • Kari Ellis, Project Manager • Teresa Benedetti, Executive Assistant 2
Tennessee Center For Patient Safety THA Board Strategic Aim: Zer Zero o Pr Preventa entable ble Ha 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 – Sepsis Coordinators Meetings coalition • Mentors program and peer – Care Transitions sharing coordinators coalition • Site visits to HIIN hospitals and – Pharmacy coalition health systems • – Patient and family advisors Medication Safety Summit • • Sepsis Collaborative and Tennessee Surgical Quality Consultations Collaborative • • Workplace Resilience Webinar Breastfeeding/OB initiatives Series • THA Leadership Summit
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 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 • June 21 - Sepsis Workshop hosted by Cookeville Regional Medical Center • June 27 - Readmissions Reduction Workshop at THA • August 14 - Workplace Violence Workshop hosted by West Tennessee Healthcare • August 29 - Structured Mobility Workshop at THA
Upcoming Events • Workforce Resilience Webinar Series with Dr. Bryan Sexton • THA Leadership Summit – October 16, 2019 – Showcase hospital improvements • THA Annual Meeting – October 16-18
Take a picture with the banner in your hospital and send it to Elizabeth Walker at ewalker@tha.com. Please include your hospital name.
Living Patient Safety
TCPS Recognizes These Hospitals for Excellence in Complete HIIN Data Submission October 2016 – December 2018 Baptist Memorial Hospital – Carroll County Baptist Memorial Hospital – Collierville Baptist Memorial Hospital - Memphis Blount Memorial Hospital Bolivar General Hospital Bristol Regional Medical Center Hardin Medical Center Henry County Medical Center Holston Valley Medical Center Maury Regional Medical Center So. TN Regional Health System – Sewanee
THA Partner Hospitals’ Performance – Tennessee Only Hospital Hospital Events SIR Outliers Events SIR Outliers Topic 2017 2018 CAUTI ICU 268 0.701 2 260 0.697 1 CAUTI Wards 225 0.745 0 194 0.700 1 CLABSI ICU 220 0.828 1 188 0.728 1 CLABSI Wards 178 0.649 1 143 0.574 0 SSI COLO 180 0.856 2 174 0.788 1 SSI HYST 59 1.078 1 39 0.749 0 SSI HPRO 101 1.202 2 88 1.004 2 SSI KPRO 50 0.837 0 62 1.037 2 MRSA 268 1.054 4 335 1.280 4 CDI 1,983 0.838 4 1,537 0.674 0 Data Source: NHSN as of April 9, 2019 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.
HHS 2020 Goals for Infection Reduction • Current SIR (standardized infection ratio) uses 2015 national data to create the “expected” value for comparison • Goal is a SIR less than 1 to be “better than expected” • However, HHS set more aggressive goals as the target SIR to achieve by 2020 for each infection measure
THA Partner Hospitals’ Performance – Tennessee Only Compared to HHS 2020 Goal Events SIR Events SIR HHS 2020 Topic 2017 2018 Goal CAUTI ICU 268 0.701 260 0.697 0.75 CAUTI Wards 225 0.745 194 0.700 0.75 CLABSI ICU 220 0.828 188 0.728 0.50 CLABSI Wards 178 0.649 143 0.574 0.50 SSI Colon - Complex 180 0.856 174 0.788 0.70 SSI Hysterectomy - Complex 59 1.078 39 0.749 0.70 SSI HPRO - Complex 101 1.202 88 1.004 0.70 SSI KPRO - Complex 50 0.837 62 1.037 0.70 MRSA 268 1.054 335 1.280 0.50 CDIFF 1,983 0.838 1,537 0.674 0.70 Data Source: NHSN as of April 9, 2019 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.
MRSA Call to Action
Hospital-Onset MRSA • In 2018, Tennessee reported 336 cases of HO MRSA ▪ 77 patient deaths estimated (23% mortality estimate) ▪ $11.64 million in estimated costs ($34,657 per case) Source of cost and mortality estimates: Infection Control and Hospital Epidemiology, April 2010
MRSA – Underlying Sources • Indwelling Devices – 88% – 72% had a central venous catheter • Intensive Care Units – 46% – And Step Down units 20% • Wounds – 79% • Surgery – 32% • Dialysis – 18% • History of MRSA -19%
MRSA Improvements Key lessons from successful hospitals, Saint Thomas Midtown Hospital and Methodist University Hospital • Leadership support – Leadership rounding, huddles, staff accountability and feedback – Invest resources for infection prevention and auditing of practice • Clinical practice – Focused interventions within high-risk, targeted units – Increased focus on infection prevention practices with audits of compliance – Increased use of Chlorhexidine baths in high-risk populations – Renewed focus on central line infection prevention bundles
MRSA Recommendations • Updated recommendations were approved by THA Board of Directors last fall • Webinar education for hospitals and best practice sharing provided • TCPS plans to survey hospitals in late spring to assess the level of adoption of the updated practices • CDC testing new interventions with Tennessee and Kentucky Dept. of Health and five hospitals that participated in chart audits last year • THA board demonstrate leadership and commitment to MRSA prevention strategies by fully implementing recommendations
THA Board Directive • Develop a targeted action plan to address MRSA with specific outline and communication to CEOs – Share individual data with CEO if high events. Call them and do site visits if needed. – Specific list of steps to address. Request to get prescriptive on what is expected and measure accountability. – Consider a state campaign to get everyone on board like THA early elective delivery project. Get physicians/hospitals on board together to a focused goal.
Updated CDC Recommendations • CDC March 2019 Vital Signs report on staph infections • New Resource: Strategies to Prevent Hospital-onset Staphylococcus aureus Bloodstream Infections in Acute Care Facilities https://www.cdc.gov/hai/prevent/staph- prevention-strategies.html
Strategies to Prevent Hospital- onset MRSA Bloodstream Infections in Acute Care Settings https://www.cdc.gov/hai/prevent/staph-prevention- strategies.html
Implement Core Infection Control Practices • Hand hygiene • Standard precautions • Environmental cleaning and disinfection • Personal protective equipment • Antibiotic stewardship program • Develop infrastructure support – Develop multidisciplinary infection prevention workgroup – Use data to identify and target high-risk units and populations – Routinely audit and conduct competency based assessments for infection control practices.
Strategies Targeted at Device and Procedure Related HAIs • Follow core practices to prevent CLABSI, SSI, Hemodialysis, VAP, non-VAP • Evidence-based guidance for practices available at cdc.gov, SHEA • Implement supplemental strategies for high-risk patients and high-risk procedures – Intranasal antistaphyloccal antibiotic/antiseptic – Daily chlorhexidine wash or wipes
Source Control Strategies for High-risk Patients • Decolonization for ICU patients • Decolonization for patients all patients with CVC or midline (including non-ICU patients)
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