CSI: Care Scene Innovations

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CSI Care Scene Innovations

• October 14, 2008
• By Shari Ward, RN, CPHQ, CDONA/LTC
• Patient Safety Interventionist

This material was prepared by CFMC, the Medicare
Quality Improvement Organization for Colorado,
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. PM-110-080 CO 2008
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(No Transcript)
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9th SOW

• August 1, 2008 July 31, 2011
• Patient Safety
• Beneficiary Protection
• Prevention
• Care Transitions

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Patient Safety

• MRSA
• Pressure Ulcers
• SCIP
• Leadership and Culture Change
• Public Reporting
• Physical restraints
• Nursing Home In Need
• Drug Safety

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MRSA

• National initiative to decrease the incidence of
  MRSA in hospitals
• In 1974 MRSA accounted for only 2 of the total
  number of staph infections
• What do you think it is today?
• In 2004 what do you think the costs per patient
  are?

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PRESSURE ULCERS
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Pressure Ulcer Causes
Tissue ischemia or damage due to Prolonged
pressure which depends on Duration and intensity
of pressure Location of pressure on
body ischemia (isch- is restriction, hema is
blood)
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Why Focus on Pressure Ulcers?

• 1.3 billion National cost to treat pressure
  ulcers in 1994 1
• Mean hospital cost doubles 2
• Hospital Length of Stay (LOS) increases 5x 2
• 1 Clinical Practice Guideline Number 15.
  Treatment of Pressure Ulcers Guideline Panel
  Treatment of Pressure Ulcers. Rockville, MD
  Agency for Healthcare Policy and Research, Public
  Health Service, US Department of Health and Human
  Services 1994. AHCPR Publication 95-0652.
• 2 Allman RM. Pressure ulcer prevalence,
  incidence, risk factors, and impact. Clin
  Geriatri Med 199713421-36.

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Further reasons to focus on Pressure Ulcers

• They are common 8 Nationally excluding
  admission assessments
• They are mostly preventable
• They may be associated with mortality
• They are a source of litigation
• We arent getting any better with this
• They are a publicly-reported measure
• They are now a GPRA goal
• National Patient Safety Goal
• Panel for the Prediction and Prevention
  of Pressure Ulcers in Adults, AHCPR 92-0047, 1992
• Berlowitz et al. Effect of pressure
  ulcers on the survival of long-term care
  residents. J Gerontol A Bio Sci Med Sci, 1997

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Best Treatment Option

• AVOIDANCE!

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Other Causes of Skin Breakdown

• Friction
• Shear
• Moisture

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Pressure Ulcers

• F 314 for Nursing Homes
• Conditions of Participation for Hospitals
• Hospital Acquired Conditions
• Oct 1, 2008
• Stage III and IV

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Physical Restraints
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Statistics

• Fall-related injuries recently accounted for 6
  of all medical expenditures for persons age 65
  and older
• Fall-related injuries may cost up to 20 billion
  dollars/year in acute care and institutionalizatio
  n
• 40 of nursing home admissions are at least in
  part related to falls

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Management of Falls Restraints

• Fall prevention management and restraint
  reduction go hand in hand.
• Management and leadership need to be committed to
  improving QMs for both falls and restraints.
• Begin with an assessment of where your facility
  is now, where the gaps are, and how you will
  implement the first phase of your program (use
  facility and systems checklists).

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The Joint Commission2008 National Patient Safety
Goal Hospital Program

• Goal 9 Reduce the risk of patient harm resulting
  from falls.
• 9B Implement a fall reduction program including
  an evaluation of the effectiveness of the
  program.
• JCAHO, 2008

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National QIO Falls Management Program

• Has many downloadable forms, including policies
  and procedures
• Can be easily adapted or customized to your
  facility
• www.qualitynet.org (Enter falls management
  program as a search term)

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Regulations

• JCAHO Patient Safety Goal 9
• 481.13\(e\) Condition of Participation for
  Hospitals
• Standard Restraint or Seclusion
• LTC F323 Accidents Supervision

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Drug Safety
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Drug Safety

• Project will focus on DDIs and PIMs
• Start in early 2009
• Website
• Other resources
• Results will be shared with state

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Leadership
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Leadership

• Surveys/Organizational Culture
• Why
• What
• When

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Organizational Culture

• Healthcare organizations
• Staff engagement
• Outcomes
• Patient Safety Projects

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Surgical Care Improvement Project
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Public Reporting
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Beneficiary Protection

• Review quality of care provided to beneficiaries
• Review beneficiary appeals of certain provider
  notices
• Review potential anti-dumping cases
• Implement quality improvement plans as a result
  of case review activities

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Prevention

• Improve the quality and frequency of preventive
  health care services in physician offices
• Three focus areas
• Core Prevention all QIOs
• Cancer screening (mammography/colorectal)
• Immunizations (influenza and pneumococcal)
• Diabetes Disparities up to 33 QIOs
• Chronic Kidney Disease up to 13 QIOs

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Care Transitions
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Beneficiary Protection

• Review quality of care provided to beneficiaries
• Review beneficiary appeals of certain provider
  notices
• Review potential anti-dumping cases
• Implement quality improvement plans as a result
  of case review activities

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Dont work in a vacuumCOLLABORATE!

• Rapid rate of improvement
• Teamwork
• Within organizations
• Among organizations
• Measurable results

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Colorado Foundation for Medical
Care www.cfmc.org Shari Ward, Patient Safety
Interventionist Sward_at_coqio.sdps.org 303-669-9581
Laura Koski-Mankin, Project Assistant Lkoski_at_coqi
o.sdps.org 303-695-3300, ext. 3345 For
Additional Clinical Information www.qualitynet.org
/MedQIC
www.nhqualitycampaign.org