Transcript HEN Readmission Affinity Call

Intermountain-led
CMS Hospital Engagement Network
Pressure Ulcer Prevention
June 24, 2014
Affinity Call
Marlyn Conti , BSN, MM, CPHQ
Patient Safety Initiatives Manager
Intermountain Healthcare
Outline for Discussion
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Review of the HEN Pressure Ulcer work
“Just-one-thing” Recommendations
High performers
2014 plans for improvement:
Overall Progress Through Q1 2014
Intermountain HEN 2012-Q1 2014
Pressure Ulcer PSI 3
Intermountain HEN 2012-Q1 2014
Pressure Ulcer PSI 3
Intermountain HEN 2012-Q1 2014
Pressure Ulcer >= Stage 3
Intermountain HEN 2012-Q1 2014
Pressure Ulcer >= Stage 3
Intermountain HEN 2012-Q1 2014
Pressure Ulcer >= Stage 2
Intermountain HEN 2012-Q1 2014
Pressure Ulcer >= Stage 2
Intermountain HEN 2012-Q1 2014
Pressure Ulcer Prevalence
Intermountain HEN 2012-Q1 2014
Pressure Ulcer Prevalence
Just One Thing Matrix
Recommendations
Getting Started
Working Harder
Ahead of the Curve
Appoint a leadership
supported team or
work group to drive
improvement &
education SWAT (or
champion) teams that
includes unit nurse.
(moderate-high level of
evidence)
Adopt decision
algorithms for nursing
staff to select
appropriate surfaces ,
physical therapy and
dietary referrals
(moderate-high level of
evidence)
Establish monthly
prevalence studies or
collect incidence data
from electronic medical
records, then feed that
data back to the SWAT
teams.
(moderate-high level of
evidence)
High Performing Hospital Highlight…
Pressure Ulcer PSI 3
Most Improvement
Lowest Rates
BAYLOR MEDICAL CENTER AT WAXAHACHIE
PROVIDENCE PORTLAND MEDICAL CENTER
THE HEART HOSPITAL BAYLOR PLANO
SUTTER MEDICAL CENTER OF SACRAMENTO
BAYLOR MEDICAL CENTER AT CARROLLTON
BAYLOR ALL SAINTS MEDICAL CENTER AT FW
BAYLOR MEDICAL CENTER AT IRVING
DENVER HEALTH MEDICAL CENTER
BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE
MILLS PENINSULA HEALTH SERVICES
BAYLOR MEDICAL CENTER AT GARLAND
BAYLOR MEDICAL CENTER AT IRVING
BAYLOR ALL SAINTS MEDICAL CENTER AT FW
BAYLOR MEDICAL CENTER AT GARLAND
DENVER HEALTH MEDICAL CENTER
BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE
PROVIDENCE SEASIDE HOSPITAL
BAYLOR REGIONAL MEDICAL CENTER AT PLANO
PROVIDENCE PORTLAND MEDICAL CENTER
EDEN MEDICAL CENTER
High Performing Hospital Highlight…
Pressure Ulcers >= Stage 3
Most Improvement
Lowest Rates
BAYLOR MEDICAL CENTER AT IRVING
UTAH VALLEY REGIONAL MEDICAL CENTER
THE HEART HOSPITAL BAYLOR PLANO
MCKAY DEE HOSPITAL CENTER
HILLCREST BAPTIST MEDICAL CENTER
DIXIE REGIONAL MEDICAL CENTER
SANPETE VALLEY HOSPITAL - CAH
LDS HOSPITAL
BAYLOR REGIONAL MEDICAL CENTER AT PLANO
AMERICAN FORK HOSPITAL
BAYLOR UNIVERSITY MEDICAL CENTER
RIVERTON HOSPITAL
HEBER VALLEY MEDICAL CENTER
VALLEY VIEW MEDICAL CENTER
SEVIER VALLEY MEDICAL CENTER
BAYLOR MEDICAL CENTER AT IRVING
PARK CITY MEDICAL CENTER
ALTA VIEW HOSPITAL
THE ORTHOPEDIC SPECIALTY HOSPITAL
PRESBYTERIAN HOSPITAL
High Performing Hospital Highlight…
Pressure Ulcers >= Stage 2
• *Most Improvement
– Only 2 Hospitals have
Reported Q1 2012 and
Q 1 2014 data
Lowest Rates
THE HEART HOSPITAL BAYLOR PLANO
BAYLOR MEDICAL CENTER AT WAXAHACHIE
PROVIDENCE WILLAMETTE FALLS MEDICAL CENTER
PROVIDENCE MEDFORD MEDICAL CENTER
BAYLOR HEART AND VASCULAR HOSPITAL
PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL
BAYLOR MEDICAL CENTER AT IRVING
BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE
PROVIDENCE PORTLAND MEDICAL CENTER
BAYLOR UNIVERSITY MEDICAL CENTER
High Performing Hospital Highlight…
Pressure Ulcers Prevalence – All stages
Most Improvement
Lowest Rates
BAYLOR HEART AND VASCULAR HOSPITAL
THE HEART HOSPITAL BAYLOR PLANO
BAYLOR MEDICAL CENTER AT WAXAHACHIE
BAYLOR MEDICAL CENTER AT WAXAHACHIE
THE HEART HOSPITAL BAYLOR PLANO
ST PATRICK HOSPITAL
DENVER HEALTH MEDICAL CENTER
UPPER CONNECTICUT VALLEY HOSPITAL
CASSIA REGIONAL MEDICAL CENTER
SCOTT & WHITE HOSPITAL-ROUND ROCK
DELTA COMMUNITY MEDICAL CENTER
BAYLOR HEART AND VASCULAR HOSPITAL
SANPETE VALLEY HOSPITAL - CAH
SCOTT & WHITE CONTINUING CARE HOSPITAL
BAYLOR MEDICAL CENTER AT IRVING
THE ORTHOPEDIC SPECIALTY HOSPITAL
LDS HOSPITAL
HEBER VALLEY MEDICAL CENTER
BAYLOR REGIONAL MEDICAL CENTER AT PLANO
DELTA COMMUNITY MEDICAL CENTER
Practice Survey
• Do you have a pressure ulcer prevention
team? Yes/No
– If yes, Is your team multidisciplinary? Yes/No
– If yes, how frequently do they meet?
– Do they have resources to collect/interpret/review
data?
• Comments (free text)
• What tools do you use to assess and properly
stage a pressure ulcers? (free text)
– Posters, fact sheets, etc, other (free text)
Practice Survey
• Do you have skin and/or pressure ulcer assessment
prompts embedded in your EMR? Yes/No
– If yes, how often are they reported or prompted
• Who receives the reports
• What are the expected actions
– To determine if reassessing patients at established
frequencies
• What is the one intervention that has had the most
impact in reducing pressure ulcers? (free text)
• What is the most innovative approach to reducing
pressure ulcers?
Pressure Ulcer Scenario
9 M/O female infant with congenital anomalies
requiring tracheostomy with an un-cuffed trach
placed. Secretions were very difficult to manage
and the MD indicated that re-intubation would be
‘impossible’ for this baby.
Trach ties were very tight in order to hold the tube
in place.
The first trach change was performed 7 days after
the initial placement and a stage IV pressure ulcer
was found from the trach ties.
What could have been done??
Pressure Ulcer Scenario
40 Y/O male, admitted with altered level of
consciousness related to hepatic encephalopathy,
hypotension and abdominal ascites. Patient had
several large volume paracentesis performed with
rapid re-accumulation of fluid.
The decision was made by the physician and the
patient's mother to provide comfort measures only
and the patient was transferred to inpatient
hospice. 4 days after hospice transfer, a stage III
pressure ulcer was found on his coccyx.
– What this preventable?
– What would you have done??
2014 plans for improvement
• Collect and share best practices across our network
hospitals & system in a single document
• Share practice bundles?