Transcript HEN Readmission Affinity Call

Intermountain-led
CMS Hospital Engagement Network
Preventing Pressure Ulcers
October 22, 2013 Affinity Call
• Marlyn Conti - Intermountain, Patient Safety Coordinator
• Gina Honermann-Garinger—Baylor Scott & White Health,
Center for Clinical Innovation
Outline for Discussion
• HEN Pressure ulcer data
• What have you implemented this past year?
• What are your challenges?
• What’s next for your facility/system?
Intermountain HEN 2012-13
submitting Hospitals
Braden Risk Assessment
Intermountain HEN
Rate going up. Braden & Skin Assessment required within 24 Hours of admit
Ulcers below national best practice benchmark and trending down
Is this coding artifact? Are we charting better?
Intermountain HEN PrU =>3
HEN Pressure Ulcer Measures
• Metric specification resource manual
http://www.henlearner.org/wpcontent/uploads/2012/03/HEN_measure_Feb5.pdf
• Submission schedule:
– November 20, 2013: for data through September 2013
Intermountain PrU Prevalence Trends
Intermountain Pressure Ulcer Prevalence Rate per 100
Patients Surveyed 2004-2013
14
Hospital Acquired
12.8
12
Linear (Hospital
Acquired)
Required education
10.3
10.3
10
9.8
Mattress purchase
8.8
8
8.3
7.8
7.9
Ulcer Teams
7.4
6.8
6.7 6.8
6
4.5
Mattress
Inspections
4.6
4
2
3.5 3.6
4.0
3.9
3.2
3.4
3.1
2.3
2.7 2.6 2.5 2.9
1.6
0
All stages per quarterly prevalence survey, 22 hospitals
2.0
2.4 2.4
2.4
1.8
2.7
2.4
2.0 2.1 2.2
1.5 1.5
Intermountain Hospitals
Intermountain Hospitals
Intermountain Hospitals
Call drill down to the patient and do cause analysis
Working Harder
Intermountain Hospitals
Pressure Ulcer Prevention Tools
• Care plan for kardex
• Bed & surface
algorithm
• Skin care product
posters
• Patient fact sheets
Baylor All Saints
Hospital Acquired Pressure Ulcers
PUT new data here please
January 2013
February 2013
March 2013
4
0
0
155
162
0
0.0258065
0
0
Baylor All Saints
Pressure Ulcers > Stage 3
2013 Q1 & June Comparison Run Chart
January 2012
February 2013
March 2013
1
0
0
155
162
0
0.0064516
0
0
Baylor All Saints
AHRQ PSI #3
2013 Q1 & June Comparison Run Chart
January 2013
February 2013
March 2013
0
0
0
365
288
298
0
0
0
Participant Poll
System
What have you
implemented
Pressure ulcer bundles
Hard coding
interventions in
Intermountain computer charting
areas needing
most
based Identify
on Braden
scores
attention & appoint a
leadership supported “lead” to
Pressure
What to
Injuries
do
drive improvement
&
Getting Started
for:
education SWAT (or
champion) teams that includes
unit nurse/
Baylor
Participants
Policy & procedures to
back-up protocol
Bedside reporting
Trial of iPad app for
picture documentation
in EHR
What are your challenges
‘Getting to Zero’
Complacency
Known complication
Competing priorities
Adopt decision algorithms for
RNs to select appropriate
surfaces make decisions
independently
surface
WorkingofHarder
decisions.
Present on admission
reporting is improving
What’s next
Bundle compliance
tracking
Establish monthly
prevalence studies or
incidence rates from
electronic
records
Aheadmedical
of the Curve
then feed that data back to
the SWAT teams.
EHR support for risk
assessment
Documentation of
present on admission
Pressure Ulcer Elimination
“Bundle” = SKIN (Ascension Health)
S
K
I
N
Selection of Appropriate Support Surfaces
Keep Patients Moving
Manage Incontinence
Manage Nutrition and Hydration
Tissue injury can be more
than skin deep…
19
Getting Started
Getting Started
Access Available Tool Kits
• Preventing Pressure Ulcers
in Hospitals: A Toolkit for
Improving Quality of Care
http://www.ahrq.gov/resea
rch/ltc/pressureulcertoolkit/
• National Pressure Ulcer
Advisory Panel
http://www.npuap.org/
• http://www.Henlearner.org
• AHRQ PSNet
http://www.psnet.ahrq.g
ov/
• AHRQ Web M&M
http://www.webmm.ahrq
.gov/
• AHRQ Health Care
Innovations Exchange
http://www.innovations.a
hrq.gov/
Next Affinity Call Pending
• What questions or topics would you like
addressed?
• Send questions to [email protected]
• Access HEN webinars and resources at
http://www.henlearner.org/