Home Health Infection Prevention Toolkit

Paula Sitzman, RN, BSNGreat Plains Quality Innovation Network

Judy Riggert, RN, MSVisiting Nurse Association of the Midlands

Great Plains Quality Innovation Network (GPQIN) includes:

• Quality Health Associates of North Dakota

• South Dakota Foundation for Medical Care

• Great Plains Quality Innovation Network-Nebraska

• Kansas Foundation for Medical Care

https://greatplainsqin.org/

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Great Plains QIN – Partners in Healthcare Quality Improvement

• Mission: to use the collective knowledge and resources to achieve the aims of better healthcare, improved health, safer care and lower healthcare costs

• Collaborate with providers and communities on multiple quality initiatives to improve patient safety, reduce harm and improve clinical care

• Aspire to make health across the GPQIN the best in the nation

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Great Plains QIN Programs for Quality Improvement

• Antibiotic Stewardship• Cardiac Health• Care Coordination• Diabetes Care• Health Information

Technology• Immunizations

• Medication Safety• Nursing Home Care• Quality Payment

Program• Sepsis• Transforming Clinical

Practice Initiative

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Great Plains QIN Special Innovation Projects

• Colorectal Cancer Screening

• Home Health Infection Prevention and Control

• Reducing Sepsis Harm and Death

• Opioid Reduction (KS only)

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The Issue: Infections in Home Health Care

• Estimates of infections occurring during home health episodes of care are as high as 1.2 million per year

• An initial evaluation of 2015 OASIS data was completed for 25 home health agencies across the Great Plains QIN

• In those 25 agencies, 24% of home health episodes of care ended with an acute care hospitalization related to respiratory, urinary tract and wound infections

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Available Knowledge

• Life expectancy in the US population continues to increase and people with chronic conditions live longer

• Occurrence of infections in home care is an adverse event for patients and family caregivers and can potentially have a negative impact on patient outcomes

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Home Health Infection Prevention (HHIP) Special Innovation Project (SIP)

• CMS special funding was received to develop home health specific infection prevention tools and resources

• Goals: o Adopt and/or create infection prevention and control

tools, resources and best practices for the Home Health Infection Prevention Toolkit

o Recruited home health agencies will test and implement tools available in the Toolkit

o Achieve reduction of home health infection-related acute care hospitalizations

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Recruitment of Home Health Agencies Across the GPQIN

• North Dakota – 5 HH agencies• South Dakota – 6 HH agencies• Nebraska – 5 HH agencies• Kansas – 12 HH agencies

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Home Health Agency Environmental Scan

• Conducted to identify current best practices and what was needed to reduce and manage infections in home health care

• Scan completed by 25 or 28 recruited home health agencies following receipt of signed participation agreements

• Results indicated there were opportunities for improvement

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Development of Home Health Advisory Council

• Recruited Home Health Agencies participating in the Special Innovation Project

• Monthly Home Health Advisory Council meetings

• Home Health Advisory Council provided ideas, suggested tools and resources for the Home Health Infection Prevention Toolkit

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Home Health Infection Prevention Toolkit Team

• Home Health Advisory Council members

• A representative from each state in the GPQIN

• Home Health Quality Improvement (HHQI) National Campaign staff

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Coaching Calls with Recruited HomeHealth Agencies

• Monthly coaching calls with home health agencies in each state

• Quarterly regional coaching calls with recruited home health agencies

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Home Health Infection Prevention Toolkit Development

• Identify and collect infection prevention and control resources for home health agencies

• GPQIN development of tools and resources that did not exist for home health agencies

• Assistance of the Home Health Advisory Council

• Input and technical expertise from staff with the HHQI National Campaign

https://greatplainsqin.org/hhip

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HHIP Initiative e-Newsletter

• Provide participating agencies with updates on project status, upcoming WebEx education, success stories and data

• E-Newsletters distributed quarterly, beginning on March 1, 2017

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CMS Home Health Quality Improvement National Campaign

• Provided technical expertise during development of the Home Health Infection Prevention Toolkit

• Best Practice Intervention Packages (BPIPs)

• Provides free education for home health agencies, home health aides, social work and therapy

www.homehealthquality.org

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Launch of Home Health Infection Prevention Toolkit

• Officially launched April 3, 2018• E-Newsletters• Social Media• Trade associations• HHQI National Partners/Wound BPIP• National HHQI Network Coordinators Call• QIN Times Newsletter [June 2018]

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Home Health Infection Prevention Toolkit Content

• Antibiotic Stewardship• Hand Hygiene• Immunizations• Injection Safety• Patient and Family

Education• Respiratory Infection• Sepsis• Urinary Tract Infection

• Disaster Preparedness• Home Health Aide• Infection Precautions• Nursing Bag Technique• QAPI• Risk Assessment &

Surveillance• Teach-Back• Wound Infection

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HHIP Learning and Action Network (LAN) Events in HHIP Toolkit

• Infection Prevention and Control Strategies Related to C. difficle, Norovirus and MRSA

• The Next Big Adventure: Prevention of Pneumonia in the Home• Utilizing Your Home Health CASPER Report in the QAPI Process:

Focus on ACH• Utilizing You Home Health CASPER Report to Succeed in a Value-

Based Purchasing Environment: Focus on Immunizations• Utilizing Agency Data to Reduce ACH: Focus on Infection Control• No Longer “Baptism by Fire”: Developing An Infection Control Plan

in the Home Environment• No Longer “Baptism by Fire”: Implementation of the Infection

Prevention and Control Plan: Part 2

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Partnerships

• Home Health Agencies

• Home Health Advisory Council

• Home Health Quality Improvement National Campaign Team

• State Home Health Care Trade Associations

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Visiting Nurse Associationof the Midlands

Home Health Services• Nursing• Physical, Occupational and

Speech Therapy• Medical Social Work• Registered Dietitian• Home Health Aide• Volunteer• Care Transitions Coach• Telemonitoring• Pharmacy Services

Hospice & Palliative Care also includes the following services:• Physician • Bereavement• Chaplain

Service Areas• Nebraska: Douglas, Sarpy,

Washington, Burt; parts of Cass and Saunders Counties

• Iowa: Pottawattamie, parts of Mills and Harrison Counties

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VNA Assessment and On-Going Monitoring Tools

• Risk Assessment Tool

• Hand Hygiene

• Nurse Bag Technique & Equipment Management Competency

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VNA 2018 Risk Assessment

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Hand Hygiene Competency

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Bag Technique and Equipment Management Competency

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VNA Patient/Caregiver and Staff Education

• Signs of Infection & Sepsis in the Home

• Fluid Needs of Adults

• C Diff Laundry and Cleaning

• Teach-Back

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Signs of Infection and Sepsis at Home

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Fluid Need of Adults

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C Diff Laundry and Cleaning

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• As part of a pilot initiative to identify and develop infection prevention tools and resources for HHAs; 2 years

• We were one of 28 agencies throughout 4 states; • Kansas• Nebraska• North Dakota• South Dakota

• Access the Toolkit at https://greatplainsqin.org/hhip

• The initiative, led by the Great Plains QIN, worked towards reducing Acute Care Hospitalizations related to wound, urinary tract and respiratory infections

• Greatest opportunity was to reduce hospitalizations due to “UTI’s” • VNAM Baseline 6.36% in 2015• Q1 2016 we were at 4.71%• Q1 2017 we were at 6.77%

• We were specifically tasked with reducing our Q1 2017 results by 5%, from 6.77% to at least 6.44%

• Achieved a Q1 2018 rate of 2.76% (with a rolling year rate of 5.0%)

Opportunities for Improvement

• Greatly exceeded results for state and combined members in the GPQIN group • I do think we will see a slight increase in our Q2 results [perhaps around 4%[, but still

significantly below where we were - 6.44%, which means we need to continue to stay focused on hydration, early recognition of s/s and care team collaboration for our highest risk patients.

Home Health Agency Successes

“The Home Health Infection Prevention Toolkit has been extremely helpful. We have utilized the documents under Risk Assessment and Surveillance, specifically the Risk Assessment template. During our last Joint Commission Survey, we were told that we need to be using a template very similar to the tool included in the toolkit. Honestly, the Risk Assessment template from the Home Health Infection Prevention Toolkit is more comprehensive than the example provided to us by the JC surveyor.”- North Dakota

“We have been working on falls/ambulation along with reducing Urinary Tract Infections (UTIs). The Toolkit has helped to have PT/OT at least do an evaluation for mobility issues. The nurses are focused on the patient’s hydration and any UTI symptoms at each skilled nursing visit. We have not had a fall or UTI in over a month. We are going over the items in the Toolkit weekly and having a weekly focus of one of the issues. We have found the Toolkit very helpful.”- Kansas

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Successes From Other organizations

“I showed some of the Toolkit patient education resources to a few physicians in our antibiotic stewardship committee and they were very impressed and requested copies to hand out to their patients from the clinic. They especially liked the Cleaning the Nebulizer and CPAP Machine tools but were impressed with many of the resources.” - South Dakota GPQIN team member

“We really like the patient and family education tools in the Toolkit, especially the ones for Cleaning the Nebulizer and CPAP Machine. We will use these when we discharge patients from our facility. We see some very dirty Nebulizers and CPAP machines at admission; it’s no wonder they have pneumonia.”- Nebraska SNF

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Home Health Infection Prevention Process Measures

• Agencies utilize CASPER data to track ACH and ED visits related to respiratory, urinary and wound infections

• Agencies implement at least two best practices/tools from the HHIP Toolkit

• Agencies implement an agency-wide Infection Prevention Program in their QAPI Plan

• Agencies participate in the HHIP WebEx training• Agencies participate in HHIP Coaching Calls

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Home Health Infection Prevention Outcome Measures

Number and rate of:• acute care hospitalizations• respiratory infections related acute care

hospitalizations• urinary tract infections related acute care

hospitalizations• wound infections related acute care

hospitalizations

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Clinical Improvement…the Data

Quarter 1 2018 results reflect an overall increase from recent quarters in acute care hospitalizations related to the three identified infection measures combined. This was, in large part, due to the noted increase in respiratory-specific infections which is consistent with the time of year and what was noted in Quarter 1 2017 (12.5%). Quarter 1 2018 results for urinary tract and wound infections was noticeably decreased (improved) with both results exceeding the 5% goal (7.5% and 6.1% respectively)

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Overall Acute Care Hospitalization Rates

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Respiratory Infection Acute Care Hospitalization rates

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Urinary Tract Infection Acute Care Hospitalization Rates

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Wound InfectionAcute Care Hospitalization Rates

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Acknowledgement of HHIP Toolkit Team

• The 28 Home Health Agencies across the Great Plains QIN

• GPQIN Quality Improvement Advisors and Leaders

• GPQIN Communication and IT Staff

• CMS Home Health Quality Improvement Staff

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Summary of HHIP Special Innovation Project

• Reduce infections occurring in the home health care setting

• Develop infection prevention tools, resources and best practices for home health agencies

• Develop infection prevention tools and resources for patients and families

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ResourcesGreat Plains QIN Home Health Infection Prevention Toolkit https://greatplainsqin.org/hhip

Great Plains Quality Innovation Networkhttps://greatplainsqin.org/

Home Health Quality Improvement National Campaign www.homehealthquality.org

Centers for Disease Control and Preventionwww.cdc.gov

Association for Professionals in Infection Control and Epidemiology https://apic.org/

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Questions?

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How to Get Involved

Contact Information

Paula Sitzman, RN, BSNpaula.sitzman@area-a.hcqis.org

P: 402.476.1399; Ext 512

Judy Riggert, RN, MSjriggert@thevnacares.org

P: 402-930-4261

This material was prepared the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11S0W-GPQIN-NE-C3-122/0918