We'd you really benefited from talking to a lot of different hospitals and not the same smaller Chort and we saw that work really well, which was a mess of things. We thought we'd do it this year and see how it would work for our larger facilities, as well. We'll see how it works. One of the things I wanted to do was start off with an appreciative moment. Previously we all about role call. We won't do that this time.
We're going to, today, go over some data that we have, and then we're going on to talk about what our next steps and spreading what we've learned and we'll go over the next meetings. We want to open it up for you to ask each other about barriers you might have had and how you might address that. I guarantee you in all all teach all learn philosophy, if you are struggling or need some help that somebody on this call has probably figure today out or tried something new, that might help you. So, to start it off, though, as an appreciative moment, I'd like some of you to share with us in the last month, what have you learned or what little nugget that really pushed you ahead that helped you gain some success and making care to your patien A patient safer.
Yes, ma'am, can you hear?
This is [ Inaudible ] from [ Inaudible ] in Winder, Georgia.
And what success have you had in the past month? What's one thing that you tested or tried that's worked? ?
Okay. Anybody else want to work? Looks like we've misplaced the caller.
I know you-all are doing great work so please share something that's been very positive for you.
This is Laura from Emory Johns Creek.
Hello.
We have a weekly meeting with the chief nursing officer and chief quality officer, and directors, started out as a weekly meeting to review core measure failures and started a few months back since we're doing so well in those right now we don't have to talk about as much, we started expanding it out to look at falls, which is one of our strategic objectives, to reduce our falls. So we're kind of taking the same approach.
We're looking at the falls from the previous week and we look at them individually and have the staff member come to the meeting and they bring the review they do each fall and have a discussion about why this particular fall occurred. And we have kind of found this trends in doing that and it's brought a lot of awareness to the staff having them participate in the fall by fall reviews. So, we've found some issues with bed alarms that weren't working or after the patient comes back from somewhere, it's

not turned on. We've involved the whole hospital in making sure the transport people know how to put the bed down low and make sure the alarm's on, and January,
February, March, our falls have dropped quite dramatically.
That's excellent. Great!
This is Lorita from Spalding. One new thing that we have started is a safety Huddle every day that really encompasses all. We've always had Huddles that focused on length of stay, core measures, et cetera, but this one, it's a safety Huddle for the entire hospital administration and so we have represents from every department and one section of it is truly one of those things that might cause harm today in patient-specific examples, reviewing reports, which is a little bit different than what we've done in terms of this is really focused on safety.
That's awesome.
Wow.
So you're identifying patients that could be at risk?
Yes.
Give an example of the procedure.
A procedure or medicine they were not on, a homeless patient, that everybody that needs to know, knows about it when they walk in the door rather than knowing things later and things like that.
Great! Go ahead.
This is Leanne at Tipon. We're calling it the daily safety check in, and support services check in, and daily unit services. We began in February and identified safety concerns that were resolved from a day to one week. Some of them were important things that we identified holes in our process and things that we could place barriers to protect patients from harm, and we've seen a growth in our culture.
So, it's focused on patient safety?
It is. But even from the support services side, we have identified when we have a bed alarm failure on a unit, or we've had issues with dietary orders for trays that could still effect the patient safety, but related to a support service area.
Oh, yeah. They understand their a patient role in today's society.

If it's a level 1 you know have you to resolve that or get an answer on that within two hours so there's more accountability and resolving of issues.
Awareness. Everyone's awareness is heightented as to how -- what they -- the services they provide effects the patient and it integrates with the other areas providing area.
So did you use forms or how did you prepare your directors and staff that come to these meetings to know what to talk about or how the structure worked?
Well, we provided education to the executive leaders because we have our CEO,
COO, CNO, all of the executive leadership actually host the meeting, and then they were provided education on their role. We also provided those that are coming to report on their role and what they bring. We've recognized that every unit dependent on the services they provide will have a varied type of record so we've been working to fine-tune what their report will be and they all have created their own report sheets.
In fact, our care units came up with an excellent sheet so they're able to identify their census, their fall risk, their pressure ulcers, their potential for ulcers, the Foley catheters because we're working on restraints, core measures and they have a check in sheet and we call role.
So would you be willing to send those to us so we can see them?
Yes, I'd be glad to.
Great. That is excellent. So how do you determine the level of risk? Is there a tool that you score?
Yeah, do you use a tool?
We -- we use a tool but we look at the time frame that need the follow up in terms of if we need an answer or need something done with in that 24 hours in it's a level 1, if it's about w in a couple days then it's a level 2. We just do the level 1s and 2s right now.
So two hours is a level 1, and the time limit on level two?
2 or 3 days, but not a week.
We're fascinated by this.
Yeah.

How did you come up with this, either one of you, Leann or Larissa?
I have been to several different training conferences where hospitals were using a safety Huddle. We use safety Huddles. I changed it to check in to find components of different ones. In fact I think I'm now going to barrow identifying it as a 1, 2, or 3, because technically, we recognize our start the clock issues resolved either by the set time, 2:00 or 3:00 that afternoon, or by report the next morning. But I like the idea, and thank you are for it, because I'm going to take it, on prioritizing them with a definite 1, 2, or 3.
And for Spalding, we have seen this over the last couple years. It was our administrative team saw it in another hospital they like today and I think it was a teleconference -- liked it and I think it was a teleconference they looked. As soon as you can get administrative buy in, you know, that helps a lot, as well.
Absolutely. Great. Well, I would recommend -- and we'll talk about this later -- that's all three of you that spoke up, think about applying this -- sending this in to as poster of teams Of Innovation of Professional Practice, so somebody to speak in June because this is really good information. Okay. Anybody else have anything they'd like to share? All right. Thank you then. We'll hopefully have time at the end. We'll move on then. Okay. So this is how our data snapshot and I'll let Tracy kind of speak. Do you want to switch places?
Sure. This is just a quick snapshot. And we gave these because it might be interesting you're interested in printing and passing around. But this is Georgia in particular, looking at all the measures we were looking at. We've got a lot of measures we're doing this year, and you can see that the number of hospitals reporting the measure, the rates on there, the target rates that are on there. This is a good resource for you going forward. We're going to be updating this as new data comes in and recording and bringing it back to you guys whenever we can. We'll go through the rest of the data a little bit more specific so can you see run charts and things like this. This one is a big overview of all of the same measures, but comparing us to the national rates.
Everywhere on the right side of that middle bar, we're making improvements. When we were on the left, not so much. We're actually going the wrong direction. As you can see, there are about three -- two bars actually, that are Georgia bars, which are the red bars that are showing up. On the a hand side, some of doing exceedingly well.
We've out run just about everybody in the nation up there, and a lot of the other ones are getting close to meeting targets that we're expecting to meet. The ones we do need to work on as we mentioned for the Codi rates and the SSIs related to [ Inaudible ] --
Yeah, it's [ Inaudible ] SAR.

Any way. And up there near the top, is -- nationally, Georgia's doing good with this.
But nationally, Georgia's doing much better than national rate on the birth trauma one there at the top. So, that -- any time we've got a question, your phones are not muted.
Be sure crime in and let me know what your questions are -- chime in and let me know what your questions are.
This is Jean Alred. I'd like to say if you're having an issue with your colon SSR, we are open to the -- joining the SES project with Johns Hopkins which specifically will address this, so if you want more information about that, the timeline is getting very, very close. Actually, it's today. So please let me know if you would like to participate and I'll get you the information for it.
Great.
We'll go through all the measures really quickly so can you see what the run charts are. You see the falls with injuries. As we started measuring back in January of 2014, we've done well and all the sudden kind of worked our way back up the hill in the wrong direction. So, we've got a lot more hospitals reporting than we did a year ago, so the rates are going back up. We need to continue to share with falls on injuries. Are there any hospitals that would like to chime in on barriers or things that are successful in helping them? To be honest with you, we've got a green bar. We've got a lot of hospitals reporting 0 falls and a lot of them are report -- impending the bench parks but we still have a fear number, the blue bar above the yellow bar, the hospitals still need to do some more work. Any questions there?
This is a -- basically our projection rate, what we project ourselves to be, where the benchmarks are, what they were shooting for, and as you can see, based on projections we're not going to meet the we're below our targeted -- the incline of the line there. So that shows you where -- we're doing okay but we could do better on this.
So think about some of the things that -- what causes falls in your facilities, and thinking about it more of an all cause harm basis and look at the adverse drug events that might be causing them and some of the other things that go on. Falls and traumas, this comes off you're administrative data and kind of reflects what we've seen. When we started out kind of close to where we wanted to be, but then kind of worked our way up, down, around and back up above the target rate. So continue to work on that.
We really need your help on that to make it go. States 3 and 4, which is the PSI 3 measure, take a look at that. That shows some really good interventions. The 4th quarter of 2012, and working our way forward, that shows how they've had an impact.
Looking back at the old historic data, you can see the rates in there. Something's happening to pull us downward and continuing to work on pressure ulcer risk identification first off and prevention to get this rate gone down further. This is pressure ulcer states 2 only as can you see there's -- we're down below where our

Target is on this. We're just basically able to pull data on a year, we don't have three years like we do on the other measure. Have you to identify on the risk and measure alter so you can prevent the stage 2s and 3s and stage 4s. Any comments on pressure ulcers before we move forward? Anybody doing a really innovative way of looking outside the box?
Is this why our fall rate's going up, because nobody has any comments?
On our pressure ulcer?
Yeah, pressure ulcer pressure ulcer.
This is Susan. One of our issues is ensuring there's adequate documentation on the patient admission if they were having a pressure ulcer on admission. And that is with clear documentation to show those.
How does somebody address that? I know there must be somebody on the line that's done something to help with that.
We just did -- this is just me again. We did a root cause analysis on one recently and one of the areas that we determined that needed to be changed was, we are using the braiden scale but we needed to -- Braden Scale. The nurses do their assessments of course online through our electronic medical records. But we also added a couple of additional fields. One of those was the -- we do have like malnutrition evidence of nutritional compromise is one and they're not always getting those nutrition consults like they should. But just adding a couple of additional key elements to our braid
Braden Scale assessments and addressing some of those wounds.
And Tracy had someone from Abbott talking about the nutritional component of pressure ulcer --
Prevention --
-- prevention, yes.
And the other thing, this is coming from administrative data, the pressure ulcer rates and everything. Some hospitals in Georgia, there may be some hospitals in the NQU which is prevalence rate for pressure ulcer, but if you're doing administrative data, you're data is your data. It's in your system. You can look at all the pressure ulcer by code in your system, and backtrack them to be sure that they're actually okay actually a hospital acquired compared to a person on admission. I would highly recommend doing an audit and who's in charge, present on admission, just did not get caught or

documented by the ad Mitting people and that can -- admitting people, and that can cause problems down the road, a hospital acquired pressure ulcer, and you can then do some targeted teaching for those people to try to help them to better recognize pressure ulcer that are present at admission. So any way, that's just some recommendations that are out there. Post operative, we've come down the past three quarters of data showing a downward area toward the target but target has not been met yet. Continue to work on that. That's why we picked up the VT 6 measure, as well, to be sure hospitals that are having DVTs are doing prophylactics before. It was kind of an unavoidable epicode in that case. Looking forward to doing some an 18 sis analysis on this.
We've been at the national bench mash for both the blood glucose levels less than 40 and less than 50 about the start of the middle of the last year and we just continue to work on it and continue to look at this. I know a lot of hospitals have had some Ah-ha moments. They didn't realize they had a problem still they started measuring it. I encourage you to work on that. The opiate was brand measures as far as January goes.
We've got a long way to go as far as reporting is and we don't have enough data to have trends, but here's some of the things that we've found so far, the alternative 1s,
2s, and 3s on this. We've got a rate of 4.53 for alternative one with 17 hospitals reporting that 1.02 for all tentive 2, and 19 -- alternative 2, and 19 with four hospitals reporting. To be honest with you, it's too early to tell whether these rates are outrageously high or not. Of course nobody wants an adverse event related to opiates, but until we have more data to look at nationally there's not a whole lot of data out there and it's kind of a new measure. Hopefully you're taking what you're getting, used it for you're improvement projects and looking at how some of these things cause issues with you in the first place. Because I honestly believe that -- looking at all these adverse drug events, they can lead to the DVTs, they can lead to pressure ulcers, they can lead to falls. These are more or less risk factors for all of those other prior conditions.
Absolutely.
I have a question. We don't have a lot of hospitals reporting this. I like to hear what questions hospitals might have on -- if you're not reporting, why with not, and maybe ask the other hospitals on the line who are, how they address that.
This is Larissa. We're still trying to get our arms around the data.
So pulling it out of pharmacy and things like that, other --
It would be easier if we could get it from the OR or from those special procedures, but just trying to collect the data. I'm not comfortable in the data received.

So you're saying you can't get the data from the ORs and the procedure rooms that you want to exclude?
Yes.
What system do you have, Larissa?
Now, we have Serner, and I'm working with pharmacy, and they are working on trying to get that for me, but do not have it yet.
Does anybody on the line use Serner and have been able to collect the opiate measures? Okay we'll see if we can find somebody, Larissa.
Other issues you might be having? Okay. Go on, Tracy.
This is the anticoagulant control, looking at both the levels of greater than five and greater than four. There's a few little ones that kind of jump up there really high, but for the four -- but 4s being reported is a really small number of hospitals. Don't be too concerned about that one episode or one case pore than before. It's around 0-month after month. Five, chosen, they're well below the benchmark for the target rates for this. Good work on that. Just keep up the good work on this. Ask this is the actual catheter associated of infection that needs to be talked about.
This is the half data so I'm not concerned about since it's kind of muddy now with the codes that include infectionses at the at the site so I see you are addressing it. And our class [ Inaudible ] rate gone down again. We keep can seeing this downward trend with this. So, hopefully we're addressing this. This year we also will be looking not just FCUs, but outside areas of the ICUs. We're asking to you give us at least some data from that, as well. And this is the half data for that. And again, we initially have been higher and I think we're addressing the coding issues that we had with those.
Even with the addition of another code now this year, the 599 code, we still had some decrease, and almost that target for example the half data. For Codi, we went down in the forth and just to let you know, I was on the phone with CDC yesterday and I know a lot of you went to training on that and one of the things we talked about, we were looking at some drill-down data for Coti, and we had some discussion about the yeast issue and they are looking at that. But Carolyn that was on the line, had also something to add to that, that although it may be adding to the Coti rate, it's also telling you something about what you're doing with the catheters, meaning if you're seeing more used, are you doing too many cultures, so just culturing when it may not be needed and then it's also a system of over use of antibiotics, with the antimicrobial stewardship program, and the fever whether it's directly associated with the Coti or

not which hopefully they're going to be changing, as well. Be that as it may, you can see we are seeing some decrease now even though the definition changed last year.
We should be seeing from quarter 1, 2013, I would hope to see a decrease starting with 2013 as a new baseline. So any way, keep up the good work, and still need to be addressing these infections. Lynn, talking about great work, yay.
This is from July 2012 through February 2014. We have been below our target rate of
2% for the past four months. Yay.
Let's hear a big Wahoo from everyone.
I know y'all are doing your job and you're doing a really great job, so keep it up. We want to start looking at C-section rates and seeing if there's a correlation and ICU admissions. So that one -- but that one's great.
Good job, and on -- I think there were a lot of lessons learned from that initiative that we can spill over to the other initiatives.
This is our birth trauma rate of. We went down in quarter four which I'm really glad about. I hope that's related to people reviewing their neonata injury rate to make sure the coders are not coding a neonatal injury and hopefully get back below our 40 percent reduction rate which is around 1.28.
Lynn, I had a question about that. What is a common error that people are coding that's not really a neonatal injury?
Amongolian spots, capping -- mongolian spots, capping, cervical break, cut with a scalpel, those things of things. Anything else really is not.
So if you feel like your injury rate looks high but you don't feel like it really is, you may want to go back with your coders and review that with them.
Yep.
And these are vaginal delivery without instrument and with instrument. This is related to 34-degree lacerations. We're start coming to down a little bit but you can still there's still a lot of variation with both of those. One is with an episotomy and one is with an instrument and one is not. One thing you can review with your labor and delivery nurses are techniques related to laboring down which means letting the mom, especially if she has an epidural, not having her start to push when it's really not time to push and just using that epidural or maybe even somebody who's not making progress giving them an epidural to see if that doesn't relax their bodies. So those are

some things you can do to helpy and I think I'm having a -- help, and I think I'm having a speaker at the end of the may that will be talking about things we can do to reduce this.
Great. And this is our readmission data. And we're kind of flat a little bit in the readmission hospital wide rate according to the CMS definition. When we look at
Medicare only, a slight, slight trending down, but I know that we'll talk in a minute about really focusing on this. A project read mini webinar series, and I think that is online under our readmissions topic if you missed that, kind of get jump started again.
So, wanted to review some things that are coming up that wanted to keep you aware of. The team innovations and professional practice award application is due April 21st so that's Monday and you were sent information out to -- about the application and also a template for PowerPoint on how to make a poster. And I will make that's on our
Web site. It's supposed to be but I'll make sure it's on our --
The call is not April 24th that affinity call has been canceled due to the family For
Patient Engagement and because we're having our regional meeting, it won't be until the 4th Wednesday in may.
Okay. Thanks. We're having our last PFE learning action collaborative, like they said on the 23RD, so thank you for hosting TIFT. These are for hospital who is signed the commitment form. We've had excellent response. These have been excellent learning collaboratives.
And it's not too early to sign up for the P FCC learning collaborative, but if you don't make the April 23rd meeting you won't be able to participate. And there is an incentive bonus for participating.
If you meet all the requirements. Pretty full but if somebody really wants to get in on it they can contact us.
Does anybody on the line, have they gone to the learning collaboratives either at a
Hamilton or east side and want to comment on those?
This is Vicky at Hamilton. We had a very good turn out. We had positive responses from everybody that attended.
Yes and thank you. This is Jean. Thank you for hosting. Really enjoyed it.
Thank you.
We're glad you enjoy today.

The regional meeting is out. We'll have it at the Atlanta concourse media. We'll have the working session with the gap leaked hospitals and it will just be in Atlanta so if you're a GAP relief hospital you need to attend the Atlanta session so you can attend our work session, and Joyce is leading a reducing readmissions work group, after that, too, it's separate, so if you want to -- and we're talking about their reenergizing the part work, which is -- do your part. And it's working together to reduce readmissions.
And so we were inviting case managers, care managers, the folks working on readmissions but the important part is to invite your partners in the community, home health, area aging networks, your home health, whoever your big that you transition care of your patients to. The focus will be on medications, how do you hand over you're care of that patient especially focused on whether the patient's going home or another provider regarding medications. And on may the 8th will be the second regional meeting. You only have to attend one. So the second regional meeting for those in the southern part of the state or if you couldn't attend May 1st will be at the
Macon Centroplex. They'll repeat what they did on may the first. If you can't attend on may the first, can you attend in the afternoon -- may The 1 ST. So just sign up and the registration is onlineMay the 1st, can you attend in the afternoon -- may The 1 ST. So just sign up and the registration is online. If you're not submitting everything we're asking for, in NHSN, can you do the data submission on the Nobi survey, and then
EED if applicable. And Jean, you wanted --
I was just going to say also, in June, at the nurse leadership institute, we're going to start the spread of The Left Project, so be on the look for that. We'll start spreading best practices for sepsis, CDIF and worker safety. So y'all be on the look out for those webinars and upcoming --
We'll give you the challenge about this new work. So, you'll hear a little bit more regional meeting but we do have the information out about the summer meeting it's nurse leader institute, and we ask that a quality person attend that, as well as a staff nurse and a nursing managero leader. So -- manager or leader. So be looking for that.
We'll be having our lead hospitals about how they reduce sepsis, CDIFF, and safety.
We have a call next week for the The Workers Safety Project. We have a national speaker from Asension. When you -- we're going to send out a hen alert and the call in details from from 1 to 2:00 on Thursday April 24th. So, please do invite your physical therapists to attend, whoever is going to lead the project at your hospital. I think every single hospital needs to work on safe patient handling, so we wanted to go ahead and invite everyone on that call. So look for that.

Great. And our next coaching Caldwell on June the 18th because our -- well be on
John the 18th because our regional meeting -- Jun. The 18th because our meeting will take place of that. Very quickly do you like a group call like this?
And don't forget you can add comments in the chat box if you do not want to speak out loud.
We want to really know what you think about this.
I think it's an excellent idea.
Great. Great.
Why do you think so?
I think it's just good to have everyone together to hear different opinions of what people are doing to hear, you know, what's going on from multiple organizations soy I just think the more input you have -- so I just think the more input to separate those out is really not the best way and to have them collectively gives a whole lot more idea than input.
Thank you. That's kind of what we were going for. So I appreciate that comment.
This is Eva. This is more useful if you can spotlight what one hospital is doing and have them share the hospitals doing a five-minute, 10-minute presentation like we've done in the past.
Okay.
Sometimes I'm not such an audio person so it's really good if the slides could be shown that share kind of their process, if that makes sense.
Okay.
Are you volunteering to be the first person?
No.
Oh, come on.
That way you can model what you want right?

Okay. Anybody that wants to volunteer that wants to share some of these things like
Tift or Spalding, if you want to do a little five-minute presentation.
1 or 2 slides.
I could do 1 or 2 slides on this some in things. I could do that. But the -- too me, I think it's -- to me, I think it's -- I don't know. It's more out of it than -- the little tidbits are nice but it kind of ties it all together if you can see data and actual movement if that makes sense.
Totally.
And what I like to do to be a little bit different challenge people with is not just something that we're already may have a webinar out on, but think about the safety cross the board like what we heard about today with the safety Huddles, that's safety across the board, so somebody's done something that is -- that focuses on how you change your culture or how you're using all of this as a brought sweep, that would be great, too. Use team steps our your black or green belt, whatever. That would be great.
I would be very interested in hearing someone present on the team steps andow how they implemented that.
All right. If you have -- and how they have implemented that.
If you have implemented team steps or had some issues please let Tracy or Jean or I know and we can set something up for next time because this will be Denise's last
Cohort call.
I'll be on the other side of the phone.
And she'll be spotlighted.
Do we have -- I've been looking all over to see if there's an evaluation on the win and the sign in sheet we're supposed to fax.
It's on there.
There's an evaluation.
How you do you find it?

What about the hand out for this presentation? Is it out there? We looked everywhere and couldn't find it.
Let us check Denise. We'll just check real quick and if not it will be shortly after the call, I promise. And this call will be recorded so if you want to listen to it again.
The handouts are listed under April 2nd.
Okay. This is definitely a different calendar we're using.
We'll get it straight, I promise.
Yeah, we'll get it fixed. So hospital engagement network, Cohort. So it is a combined
Cohort.
I clicked on it and didn't see the dates right now for today.
It says April 2nd, but let's see if we -- can they see this desktop? They can see it. It's the right presentation; we just have the wrong date. We'll get that fixed.
Okay. So where is the -- Think to the Evaluation?
If it doesn't pop up after this meeting Michelle will have it you up in like an hour.
Okay. And then the sign-in sheet, as well?
You don't need the sign-in sheet because we're not doing CEUs and we have a list of who called in so you'll get credit.
Hallalujuah.
We only need CEUs if we giving credit from the affinity groups. As far as knowing on the line we get a read out for the Cohort.
Now will we go to the Georgia network?
It's not up there. If you go to GHA.org 10 and to the Cohort tab and then the combined Cohorts, we'll have it put up there within the hour. If it's -- it should pop up when you close out the webinar, but if you don't, we'll have it under there for you.
All right, thank you. All right. Thank you for participating today. We appreciate everybody's interaction. Just let us know how you feel about our combined calls and thank you, Ed for your input. We'll take that.

If anybody wants to be part of the highlights for the next call, please also include that in the evaluation or shoot us an e-mail, all right?
Thank you.
Thank you --
Just before you leave, one more quick thing. Go to the Adobe right there. I'm going to tell about you this upcoming event Monday. We'll get this flyer out to you.
Medication Management and Readmissions, part of the patient family engagement master class and I highly recommend it if you have a chance to listen. They're all excellent tools for helping you help your team at your hospitals engage in how to do things well as far as readmissions goes.
And this will be a good introduction to the meetings we'll have after the regional admission.
Eval will be up by five today so you can check by tomorrow, as well, because it will be open for a week.
Thank you-all.