Some is Not a Number. Soon is Not a Time.

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Some is Not a Number. Soon is Not a Time.

• Carolyn Coffey, BSN, RN, MS, CPHQ
• Critical Access Hospital
• Workshop for Nurses
• December 6, 2005

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Objectives

• Save 100,000 lives over the next 18 months
• Enroll as many as 2,000 hospitals
• Hospitals adopt 6 evidence based changes
• Build a reusable national infrastructure for
  change

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The six changes

• Deployment of rapid response teams
• Delivery of reliable, evidence-based care for
  acute myocardial infarction
• Prevention of central line infections
• Prevention of surgical site infections
• Prevention of ventilator-associated pneumonia
• Prevention of adverse drug events

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Infrastructure for change

• Nodes
• Geographic nodeWI Node
• Organizational nodesAscension Health
• Affinity nodes
• Childrens hospitals
• Rural hospitals
• Non-exclusivity
• Take all comers

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Campaign statistics

• Began December 14, 2005, 900 a.m. (ET)
• Ends" June 14, 2006, 900 a.m. (ET)
• Over 2,900 hospitals currently participating
• Over 70 Wisconsin hospitals participating

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Node responsibilities

• Disseminate improvement tools
• Provide support to health care providers
  throughout Wisconsin
• Encourage other hospitals to join the campaign
  and to participate in improvement efforts
  associated with the campaign

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Node responsibilities (cont)

• Act as a communication point between the
  hospitals in the campaign and the national
  campaign
• Respond to emerging issues during the course of
  the campaign
• Track and support hospitals in measure campaign
  progress

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Wisconsin Node activities

• Conducted survey of participating hospitals
• MetaStars assistance under its CMS contract
• MetaStars Central Line Infection Initiative
• WHA/PSW Medication Reconciliation Project
• WONE Rapid Response Team work

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Intervention Fully Implemented (6/05)
AMI Care 56
Surgical Infection Prevention 32
Medication Reconciliation 26
VAP Prevention 15
CLI Prevention 13
Rapid Response Team 9
N 52-54
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Of the six changes, establishing rapid response
teams has the potential to save the most
lives60,000 of the 100,000 livesbut has the
lowest implementation rate9 of Wisconsin
hospitals are fully implemented
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Deployment of rapid response teams (RRTs)

• Team of clinicians (doctors, nurses, respiratory
  therapists, etc.) who bring intensive care
  expertise to the patient bedside (or wherever it
  is needed).
• Goal To respond to the signs and symptoms of the
  patients worsening condition before the
  patients heart or breathing stops

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Wisconsin Node support for rapid response teams

• Led by the Wisconsin Organization of Nurse
  Executives and The Dahlen Company
• Established a steering committee
• Prepared a sample intervention timeline for
  hospitals considering starting an RRT
• Using RWHCs quality round tables to discuss
  implementation issues

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Wisconsin Node support for rapid response teams
(cont)

• Calls to hospitals by The Dahlen Company
• Posting list of hospitals that have implemented
  RRT on WI Node website
• Posting contact information for help
• Posting tips for those that are stalled

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Bundle for delivery of reliable, evidence-based
care for AMI

• Early administration of aspirin
• Aspirin at discharge
• Early administration of beta-blocker
• Beta-blocker at discharge
• ACE-inhibitor or ARB at discharge for patients
  with systolic dysfunction
• Timely initiation of reperfusion
• Smoking cessation counseling

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Whats a bundle?

• Measure of performance of evidenced based
  practices vs. opportunity
• Patient centered
• All or nothing

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WI Node support for AMI

• AMI webinar November 2006
• MetaStar work on appropriate care measures (ACM)
  aligns with 100k Lives AMI bundle
• CAH Project Planning Conference Calls
• December 5, 3-4 PM
• December 12, 12-1 PM
• Special AMI measures for CAHFall 2006
• Working to report ACM bundle on Checkpoint

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Prevention of central line infections bundle

• Hand hygiene
• Maximal barrier precautions
• Chlorhexidine skin antisepsis
• Optimal catheter site selection
• Daily review of line necessity, with prompt
  removal of unnecessary lines

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WI Node work on central line infection prevention

• MetaStars Central Line Infection Initiative
• 16 hospitals participated
• Goals
• To reduce the number of central line infections
  in participating hospitals to zero
• To understand the economic impact of central line
  infections

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MetaStar Central Line Infection Initiative (cont)

• Format
• What can you do in 90 days?
• One Learning Session June 27, 2005
• Monthly conference calls
• Process
• Adopt the central line bundle

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Prevention of surgical site infections (SSI)

• Appropriate use of antibiotics
• Appropriate hair removal
• Maintenance of postoperative glucose control for
  major cardiac surgery patients
• Establishment of postoperative normothermia for
  colorectal surgery patients

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WI Node work for SSI

• MetaStars new QIO contract aligns with 100k
  Lives Campaign goals. Project work on the
  surgical care improvement project (SCIP) aligns
  with the 100k Lives SSI
• SSIMetaStar planned webinar in January

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Prevention of adverse drug events (ADEs) by
implementing medication reconciliation

• Step 1 Verification
• Step 2 Clarification
• Step 3 Reconciliation

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WI Node work to support medication reconciliation

• Led by the Wisconsin Hospital Association and the
  Pharmacy Society of Wisconsin
• Developing tools to assist implementation
• Tools posted on WI Node website
• Developed a medication reconciliation measure for
  use with in the CheckPoint public reporting
  initiative

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Bundle for prevention of ventilator-associated
pneumonia (VAP)

• Elevation of the head of the bed to between 30
  and 45 degrees
• Daily sedation vacation and daily assessment of
  readiness to extubate
• Peptic ulcer disease (PUD) prophylaxis
• Deep venous thrombosis (DVT) prophylaxis (unless
  contraindicated)

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WI Node work on VAP

• MetaStar VAP webinar December 5, 2005, 1200
  100 p.m.
• VAP a SCIP module

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Node Communications

• E-mails
• Newsletters
• Teleconferences/Webinars
• Conferences
• Phone calls
• Speaking engagements
• Wisconsin Node website http//www.metastar.com/pr
  ofessional/IHI100kLives.asp

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Wisconsin CAH experiences on the 100k Lives
journey
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Questions?
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Contact Information

• MetaStar, Inc.
• 2909 Landmark Place
• Madison, WI 53713
• 1-800-362-2320
• www.metastar.com
• Carolyn Coffey
• ccoffey_at_metastar.com