AHRQ Safety Program for Long-term Care: HAIs/CAUTI
Facility Informational Webinar
Cohort 4
June 3, 2015
Health Research & Educational Trust
Project Team Members
Agenda
Topic
Presenter
Welcome and Project Overview
Marcia Cooke
Achieving Project Goals
Amanda Wilkins
Measuring Success
A.J. Rolle
LTC Facility Team Lead Role
Louella Hung
Timeline & Next Steps
Helen Plass
Question & Answer
All Attendees and Presenters
2
Marcia Cooke, RN-BC, MSN, PhD
Director, Clinical Quality at HRET
PROJECT OVERVIEW
3
Objectives
• Recognize project goals and why the project matters
• Identify the approach to education, coaching and measuring progress
• Summarize Facility and Facility Team Lead responsibilities
• Describe how HRET and the National Project Team will support facilities
• Recall upcoming key dates
4
Partnerships & Dissemination
AHRQ
HRET
UM
N a t i o n a l P r o j e c t Te a m
Abt
Qualidigm
APIC
SHM
Baylor
State or Regional Lead
Organizations, Multi-Facility
Operators
Faculty
Organizational Leads
National & Regional Faculty
UM, Abt, Qualidigm, APIC,
SHM, Baylor
Recruitment/Coaching/
Project Liaison
Coaching/Endorsement
Facilities
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Causes of Re-hospitalizations from LTCFs
Top reasons for readmission from LTC facility to a community hospital:
a.
CHF 31%
b.
UTI 28%
c.
Renal Failure 27%
d.
Pneumonia 23%
e.
COPD 23%
Source: Ouslander JG. Journal of the American Medical Directors Association, March 2011.
“CHF, respiratory infection, UTI, sepsis, and electrolyte imbalance account for 78% of
30 day rehospitalizations from SNFs”
Source: Unpublished MedPAC data cited by Mor V. Health Affairs, January 2010
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Why This Project Matters
• 1-3 million serious infections annually in LTC facilities
• Approximately 380,000 residents die of infections each year
• Urinary Tract Infection is one of the most common HAls in LTC facilities
• Infections are among the most frequent causes of transfer & readmissions from
LTC facilities to acute care hospitals
• High prevalence of urinary catheters in hospital patients transferred to LTC facilities
Improving safety and quality of life for residents and their families is our overall aim!
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What’s in it for LTC Facilities?
• Improved care and resident/family satisfaction
• Alignment with CMS 11th SOW/QAPI and Advancing Excellence
• Apply evidence-based train-the-trainer modules to strengthen front-line staff
knowledge and skills on infection prevention
• Earn CNE credits
• Avoid penalties for violations of F 315 (unnecessary urinary catheter) and F 441
(infection prevention and control)
• Reduced staff workload burden
• Maintain higher census from lower mortality, hospitalization
• Prepare for value-based purchasing
8
How will LTC Facilities Benefit from Participation
Potential to:
• Improve the Nursing Home Compare Quality Measures
• Enhance data collection skills and prepare for mandatory reporting of infection
data (NHSN)
• Benchmark against other LTC facilities (project-level and nationally)
• Improve communication and relationships with referring hospitals that may
results in reduced readmissions
• Improve compliance with survey requirements related to quality of care,
infection control, etc.
9
Project Goals
Primary Goals—reduce HAIs/CAUTI and improve safety culture
•
Develop/adapt evidence-based CAUTI elimination and safety practices and resources
for LTCFs
•
Reduce CAUTIs and HAIs
•
Improve safety culture
Secondary Goals—support expanded infection prevention efforts for C. diff, UTI,
MDROs, etc. by providing education to:
•
Improve hygiene practices (hand, environmental)
•
Promote antibiotic stewardship
•
Promote catheter stewardship
•
Reduce re-hospitalizations
10
Project Spread
420 Active Facilities in Cohort 1, 2 & 3
Aim to involve all 50 states, D.C. and Puerto Rico
Cohort 1
(63 facilities)
Cohort 2
(152 facilities)
Cohort 3
(203 facilities)
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Amanda Wilkins, MPA
Program Manager at HRET
ACHIEVING PROJECT GOALS
12
How will These Goals be Achieved?
Clinical Interventions
Cultural Interventions
•
Evidence-based infection prevention
practices
•
Learning from defects to understand
and prevent adverse events
•
Indwelling catheter, UA/culture and
antibiotic stewardship
•
Senior leadership engagement
•
Front-line staff empowerment
Strategies to avoid re-hospitalizations,
catheter alternatives
•
Teamwork and communication
•
Regular team meetings
•
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Educational Sessions
In-person or virtual learning sessions: kickoff, mid-course and final
•
Slides, expert faculty, interactive activities, handouts, resources
Educational webinar/video series
Name of series
# of
Topics
Frequency
What
Format for Facility
Team Lead
Format for Front-line Staff
Onboarding
4
Weekly
Project
orientation
Webinar
Trained by Facility Team
Lead
Training Modules
4
Once every
two weeks
Infection
prevention
Videos
Videos, and trained by
Facility Team Lead
Safety Culture Survey
Results Forum
1
Once
Safety culture
Webinar
N/A
Content
~10
Monthly
Clinical and
cultural
interventions
Webinar
Trained by Facility Team
Lead
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Education Series Schedule
Onboarding Webinar Series
Date
Time
1. Building a Culture of Safety Team
Thursday, August 6
1:00 – 2:00 p.m. CT
2. CAUTI Definitions
Thursday, August 13
1:00 – 2:00 p.m. CT
3. CAUTI Surveillance
Thursday, August 20
1:00 – 2:00 p.m. CT
4. Data Collection Training
Thursday, August 27
1:00 – 2:00 p.m. CT
Training Module Series
Release Date
1. Hand Hygiene
Week of Aug 31
N/A
2. Environment & Equipment
Week of Sep 14
N/A
3. Isolation Precautions
Week of Sep 28
N/A
4. Antibiotic Stewardship
Week of Oct 12
N/A
Monthly Webinar Series
Date
Time
National Content
3rd Thursday of each month, beginning in
November
11:15 a.m. – 12:15 p.m. CT
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Support for Education Components
• Train-the-Trainer Guide
• Core Team Training Materials
• Webinar Recording
• Core Team Presentation Slides
(Chat Summary and Q&A)
• Supplemental Materials
• All Staff Training Materials
• Video and Facilitator Slides
• Discussion Guide/Activity
• Event Evaluation Template
• Certification of Completion Template
• Additional Resources
16
Coaching Calls
What:
State/Region-specific coaching call
When:
Monthly, beginning in September
Who:
All facility team leads
Facilitated and run by the organizational lead
Ashley Hofmann, MSW
Faculty coach provides clinical and cultural expertis
HRET advisor provides project management support and technical assistance
Why:
Review data and track project progress
Discuss educational webinars and project interventions
Katie Johnson, MHS
Share successes, challenges and best practices with other facilities
Ask Faculty Coach and facility teams to engage in use of project tools, resources
Anna Wojcik, MPH
17
Resources
• Your Organizational Lead
• LTC Safety Website
username & password: ltcsafety
• Weekly Newsletters
• Expert Faculty Coaches
• Facility Implementation Guide
• Data Support
18
AJ Rolle, MPH
Program Manager at HRET
MEASURING PROGRESS
19
Purpose of Measurement
Measures are developed to support hard-wiring of resident safety
processes with attention to the needs of the LTC environment.
Improving safety and quality of life for residents and their families is
our overall aim!
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Required Data Metrics and Schedule
Data Collected
Frequency
Time to Complete
Background/Cultural Measures -> Drive Change
Registration
1x to enroll
10 minutes
Facility Demographics
Baseline
15 minutes
Safety Culture Survey
Baseline and follow-up
10 minutes
Team Communication Guide
Quarterly
10 minutes
Skills Questionnaire
Baseline, mid-point, final
15 minutes
Process Measures -> Evidence-based practice
Outcome Measures –> Understand and celebrate success
Catheter Utilization
CAUTI rates
Urine culture order rates
Monthly
21
Outcome Data Definitions
22
Data Collection Systems
Cvent
Comprehensive Data System
(web-based survey portal)
(HRET’s online data portal)
– Registration
– Team Communication
– Facility Demographics
– Outcome Measures*
– Skills Questionnaire
• Residents
– Safety Culture Survey
• Residents with catheters
– Event evaluations
• New CAUTI events
• Urine culture orders
*CDC’s National Healthcare Safety Network (NHSN) can also be used for the outcome measures.
Facilities must confer rights to HRET (instructions to follow)
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Measurement Support
• Checklist tools to support awareness and adherence to evidence-based
recommendations
• NHSN CAUTI definition assessment worksheet
• NHSN CAUTI definition pocket cards
• Data collection tools
• Reports distributed within 4-6 weeks after submission deadlines
• Support for survey and certification regulation compliance with F-tag 315 and F-tag
441
24
Louella Hung, MPH
Senior Program Manager at HRET
FACILITY TEAM LEAD ROLE
25
How We Will Support You
Your Lead Organization will…
• Guide you through the enrollment process
• Monitor your progress and assist you with local implementation
• Send you short electronic weekly updates about upcoming project milestones,
reminders and tips for success
HRET and Other Members of the National Program Team will…
• Provide you with an implementation manual at your kick-off meeting
• Have subject matter experts available outside of content calls
• Troubleshoot any data and program implementation issues
26
Facility Team Expectations
• Promote the project goals
• Learn and implement the clinical and cultural improvement tools
• Participate in monthly team safety huddles to review outcome, process, and
teamwork and communication data
• Attend three face-to-face or virtual learning sessions in your area
• Comply with data collection and submission requirements, including the
completion of the AHRQ culture survey, Nursing Home Survey on Patient
Safety Culture, at the beginning and end of the program
27
Facility Team Lead Expectations
• Time Commitment: 5-7% FTE or 110-135 hours during the 13-14-month
program
• Promote project goals
• Lead the facility’s technical & cultural interventions
• Attend all educational sessions:

3 in-person meetings (kick-off, mid-year, final)

2.5 months of monthly onboarding webinars and training modules

10 months of monthly content webinars

10 months of coaching calls
• Train front-line staff in 10-15 minute modules (provided by HRET)
28
Facility Team Lead Expectations
Track facility progress and meet data requirements:
 Submit process and outcome data
 Safety culture survey (twice: baseline and re-measurement)
Meet regularly with LTC facility team to monitor progress
 Complete teamwork and communication tool, monthly
 Hold safety meetings with the team, monthly
Ask for help on behalf of the team
 Call your organizational lead to discuss team and program challenges, monthly
29
Helen Plass, MA
Program Manager at HRET
TIMELINE & NEXT STEPS
30
Cohort 4 Timeline for Facilities
31
Important Dates for Cohort 4
Activity
Date/Time
Learning Session #1
July 1-24
Registration
Due July 24
Onboarding Educational Series
3rd Thursday of each month from 1:00-2:00 p.m. CT,
beginning in August
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State
Organization
Organizational Lead
Email
Multi-state
The Joint Commission
Beth Ann Longo
BLongo@jointcommission.org
Multi-state
Leading Age
Carol Scott
cscott@leadingage.org
CA
Plum Healthcare, for California Association
of Health Facilities
Anna Soliven
anna@plumh.com
LA
eQ Health Solutions – Quality Insights
Julie Kueker
Beth Hoover
jkueker@eqhs.org
bhoover@eqhs.org
MN
Minnesota Hospital Association
Tania Daniels
Susan Klammer
tdaniels@mnhospitals.org
sklammer@mnhospitals.org
NJ
New Jersey Hospital Association
Patricia Dimino
pdimino@njha.com
ND
Quality Health Associates of North Dakota
Michelle Lauckner
mlauckner@qualityhealthnd.org
QUESTIONS ABOUT ENROLLMENT?
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