The NH Healthcare Quality Assurance Commission

1
The NH Healthcare Quality Assurance Commission
2
The History of the NHHCQAC

• Established as an act of House Bill 514, which
  was approved on June 21, 2005
• Purpose is to review and analyze information
  concerning medical errors.
• First meeting occurred on September 16, 2005

3
Intent

• is to enable health care providers to share
  information about adverse outcomes and prevention
  strategies in a learning environment which
  fosters candor and self-critical analysis while
  maintaining the confidentiality of the
  information submitted.

4
Membership

• One representative from each acute care hospital
  and free standing ambulatory surgical center,
  appointed by the Governor
• In NH there are 26 hospitals and 24 ambulatory
  surgical centers
• Includes a designee of the Commissioner of the
  Department of Health and Human Services
• Rachel Rowe, Associate Executive Director of the
  Foundation for Healthy Communities serves as
  administrator of the Commission

5
Meetings

• Commission met ten times over the 1st two years
• Meetings are generally held every other month,
  from 9am-12noon at the NHHA Conference Center in
  Concord
• Subcommittees meet as needed

6
Subcommittees

• Infection Measurement and Practices
• Ambulatory Surgery Center Initiatives
• Interfacility Communication
• Hand Hygiene

7
Annual Reports

• Completed and submitted by June 1st
• Mailed to all hospital CEOs
• Shared with QA Committees
• Reports are delivered to
• the Governor of NH
• the President of the Senate
• The Speaker of the House

8
Surveys Completed

• Data collection tools and error measurement
• Incidence of National Quality Forum never
  events
• Hand hygiene practices and surveillance
• Handoffs

9
Data submitted

• Pilot VAP CLBI rates (3 month period 2005)
• VAP and CLBI rates (6 month period 2006)
• VAP and CLBI rates (ongoing beginning January
  2007)
• SIP measures 1 3
• Hand Hygiene Compliance (2 month pilot period
  2007)

10
Data collection challenges

• those resulting from the small numbers associated
  with these infections
• the methodological issues regarding data
  collection that remain despite the IHI
  definitions
• variation in reported rates due primarily to
  differences in how at risk days are counted and
  how pneumonias and infections are classified

11
Data Reporting Challenges

• data not validated by an external organization
• questions regarding the meaningfulness of the
  aggregate rate given that even at the national
  level, there continue to be variation in how
  infections are defined and classified as well as
  significant variation in collection methodologies

12
Information Sharing

• Policies Shared
• Central Line Insertions
• Influenza vaccine for eligible patients
• Hand hygiene
• Best Practice presentations
• Just Culture
• Do Not Use Abbreviations
• Rapid Response Teams
• Storytelling

13
(No Transcript)
14
(No Transcript)
15
Annual Report for 2007

• Executive Summary
• Detailed Activities of the Commission
• Statewide Rates for Selected Infections
• Summary

16
Infection Prevention Strategies

• Adopt central line insertion practices
• Join Surgical Care Improvement Project (SCIP)
• Accept recommendation to vaccinate eligible
  inpatients for influenza
• Educate high risk patients about need to be
  vaccinated (ASCs)
• Adopt recommendations for prevention of surgical
  site infections (ASCs)

17
Infection Rate Collection and Reporting

• Established uniformity of data collection by
  agreeing to data definitions and collection
  points
• Submitted hospital data for VAP, CLBI and SIP to
  the Foundation for Healthy Communities, so a
  statewide rate could be calculated and reported

18
VAP Statewide Rate

• 2005 (3 months)
• 41 pneumonias
• 8.64 VAPs per 1000 ventilator days
• 2006 (6 months)
• 48 pneumonias
• 4.8 VAPs per 1000 ventilator days
• 2007 (6 months)
• 47 pneumonias
• 4.47 VAPs per 1000 ventilator days

19
CLBI Statewide Rate

• 2005 (3 months)
• 22 CLBIs
• 3.49 CLBIs per 1000 central line days
• 2006 (6 months)
• 28 CLBIs
• 2.3 CLBIs per 1000 central line days
• 2007 (6 months)
• 27 CLBIs
• 1.99 CLBIs per 1000 central line days

20
Surgical Infection Prevention Measure 1
(Antibiotic received within 1 hour of surgery)

• Year 1 76
• Year 2 85
• National Average 70

21
Surgical Infection Prevention Measure 3
(Antibiotic discontinued within 24 hours after
surgery)

• Year 1 74
• Year 2 83
• National Average 53

22
Interfacility Transfer

• Members agreed that the movement of patients
  between institutions constitutes one of the
  greatest risks to patient safety
• Subcommittee presented a revised version of the
  I Pass the Baton tool
• Form has been pilot-tested and results are
  currently being reviewed

23
Summary

• Year 2 Broad and meaningful collaboration
• Continue to share best practices stories
• Made progress in refining data definitions and
  methodology for VAP and CLBI
• Will broaden data collection for CLBI beyond
  critical care areas, implement best practices,
  focus on hand hygiene compliance, and safe
  transfer of patients between institutions in Year
  3
• ASCs will develop a data-based improvement
  initiative in Year 3