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 5 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infection, UTI, sepsis, and electrolyte imbalance account for 78% of 30 day rehospitalizations from SNFs” Source: Unpublished MedPAC data cited by Mor V. Health Affairs, January 2010 6 Why This Project Matters • 1-3 million serious infections annually in LTC facilities • Approximately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! 7 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) 11 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 • 13 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 14 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 15 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! 20 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) 23 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 32 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? 33