AHRQ Safety Program for Long-term Care: HAIs/CAUTI

Cohort 5

2015

Health Research & Educational Trust

Project Team Members

Facility Informational Webinar

Agenda

Topic Presenter

Welcome and Project Overview Marcia Cooke

Achieving Project Goals Louella Hung

Measuring Success A.J. Rolle

LTC Facility Team Lead Role Lindsay Kolczynski

Timeline & Next Steps Helen Plass

Question & Answer All Attendees and Presenters

PROJECT OVERVIEW

Marcia Cooke, DNP, RN-BCDirector, Clinical Quality at HRET

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

Partnerships & DisseminationAHRQ Safety Program for Long-term Care: HAIs/CAUTI

N a ti o n a l P r o j e c t Te a mHRET UM Abt Qualidigm APIC SHM Baylor

N a ti o n a l P r o j e c t Te a mHRET UM Abt Qualidigm APIC SHM Baylor

State or Regional Lead Organizations,

Multi-Facility Operators

State or Regional Lead Organizations,

Multi-Facility Operators

FacultyFaculty

Organizational Leads

Recruitment

Organizational Leads

Recruitment

National & Regional Faculty UM, Abt, Qualidigm, APIC, SHM, Baylor

Coaching/Endorsement

National & Regional Faculty UM, Abt, Qualidigm, APIC, SHM, Baylor

Coaching/Endorsement

FacilitiesFacilities

AHRQAHRQ

HRETHRET

Program Manager

Monitoringand Support

Program Manager

Monitoringand Support

Connections for the Facility Team

H R E T P r o g ra m M a n a g e r sO r g a n i z a ti o n a l L e a d

H R E T P r o g ra m M a n a g e r sO r g a n i z a ti o n a l L e a d

FacilitiesFacilities

HRETHRET

Faculty Coach

Facility Teams

Helen Plass, MAhplass@aha.org312.422.2659

Janine Reisinger, MPHjreisinger@aha.org312.422.3111

Amanda Wilkins, MPAawilkins@aha.org312.422.2717

Causes of Re-hospitalizations From LTCFs

Top reasons for re-admission 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Source: Unpublished MedPAC data cited by Mor V. Health Affairs, January 2010

Why This Project Matters

• 1-3 million serious infections annually in LTC facilities

• Approximately 380,000 residents die of infections each year

• UTIs are one of the most common HAls in LTC facilities

• Infections are among the most frequent causes of transfer and re-admissions 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!

What’s in it for LTC Facilities?

• Improve care and resident/family satisfaction

• Align with CMS 11th SOW/QAPI and Advancing Excellence

• Strengthen all staff members’ infection prevention knowledge and skills, using evidence-based content and training materials

• Earn CNE credits

• Avoid penalties for violations of F 315 and F 441

• Reduce staff workload burden

• Maintain higher census from lower mortality, hospitalization

• Prepare for value-based purchasing

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.

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

Project Spread539 Facilities Actively Participated in Cohorts 1-4

Aim to involve all 50 states, D.C. and Puerto Rico

Cohort 1 (63 facilities)

Cohort 2 (142 facilities)

Cohort 3 (215 facilities)

Cohort 4(119 facilities and counting!)

PR

ACHIEVING PROJECT GOALS

Louella Hung, MPHSenior Program Manager at HRET

How will These Goals be Achieved?

Clinical Interventions• Evidence-based infection

prevention practices

• Indwelling catheter, UA/culture and antibiotic stewardship

• Strategies to avoid re-hospitalizations, catheter alternatives

Cultural Interventions

• Learning from defects to understand and prevent adverse events

• Senior leadership engagement

• Front-line staff empowerment

• Teamwork and communication

• Regular team meetings

Educational Sessions

Virtual learning sessions: kickoff and final• Slides, expert faculty, interactive activities, handouts, resources

Educational webinar/video series

Name of series # of Topics Frequency What Format for Facility

Team LeadFormat for Front-line Staff

Onboarding 4 Weekly Project orientation Webinar Trained by Facility

Team Lead

Training Modules 4 2 modules every 3 weeks

Infection prevention Videos Videos, and trained by

Facility Team Lead

Safety Culture Survey Results Forum 1 Once Safety culture Webinar N/A

Content 7 MonthlyClinical and cultural interventions

Webinar Trained by Facility Team Lead

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

Education Series ScheduleVirtual Learning Session Date Time

Learning Session 1a Thursday, September 10 11:30 a.m. – 1:30 p.m. CT

Learning Session 1b Thursday, September 24 11:00 a.m. – 1:00 p.m. CT

Onboarding Webinar Series Date Time

1. Building a Culture of Safety Team Thursday, October 1 1:00 – 2:00 p.m. CT

2. CAUTI Definitions Thursday, October 8 1:00 – 2:00 p.m. CT

3. Data Collection Training Thursday, October 15 1:00 – 2:00 p.m. CT

4. CAUTI Surveillance Thursday, October 22 1:00 – 2:00 p.m. CT

Training Module Series Release Date1. Hand Hygiene November 16 N/A

2. Environment & Equipment November 16 N/A

3. Isolation Precautions December 7 N/A

4. Antibiotic Stewardship December 7 N/A

Monthly Webinar Series Date Time

National Content 3rd Thursday of each month, beginning in January 11:15 a.m. – 12:15 p.m. CT

When: Monthly, beginning in November

Who: All facility team leads

HRET Program Managers facilitate and provide project management support and

technical assistance

Faculty coach provides clinical, cultural and surveillance expertise

Why: Review data and track project progress

Discuss educational webinars and project interventions

Share successes, challenges and best practices with other facilities

Ask Faculty Coach and facility teams to engage in use of project tools, resources

How: Web conference

Coaching Calls

Resources

• Your HRET Program Manager

• LTC Safety Website– username & password: ltcsafety

• Weekly Newsletters

• Expert Faculty Coaches

• Facility Implementation Guide

• Data Support

MEASURING PROGRESS

AJ Rolle, MPHProgram Manager at HRET

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!

Required Data Metrics and Schedule

Data Collected Frequency Time to Complete

Background/Cultural Measures -> Drive Change

Registration 1x to enroll 10 minutes

Facility Demographics 1x at enrollment 15 minutes

Safety Culture Survey 2x (Month 3 and 10) 10 minutes

Process Measures -> Evidence-based practice

Knowledge Questionnaire 2x (Month 1 and 8) 15 minutes

Outcome Measures –> Understand and celebrate success

Catheter Utilization CAUTI rates Urine culture order rates

Monthly

Outcome Data Definitions

Data Collection Systems

Cvent (web-based survey portal)

– Registration

– Facility Demographics

– Skills Questionnaire

– Safety Culture Survey

– Event evaluations

Comprehensive Data System(HRET’s online data portal)

– Outcome Measures*• Residents

• Residents with catheters

• New CAUTI events

• Urine culture orders

* CDC’s National Healthcare Safety Network (NHSN) can also be used to enter some of the outcome measures. Facilities must confer rights to HRET (contact HRET program manager for additional information).

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

• Data submission reports

• Results distributed within 4-6 weeks after submission deadlines

FACILITY TEAM LEAD ROLE

Lindsay Kolczynski, MBASenior Program Manager at HRET

Your Lead Organization will…– Answer any questions you have about the program prior to

registration– Guide you through the enrollment process

Your HRET Program Manager will…– Send newsletters with data submission rates, project due dates,

content information, project milestones and tips for success– Provide you with an implementation manual during Learning Session 1– Have subject matter experts available outside of content webinars– Troubleshoot any data and program implementation issues– Follow-up with you throughout the project to check on your progress

and connect you with resources

How We Will Support You

• Time Commitment: 5% FTE or 80-90 hours during the 11 month program

• 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 virtual learning sessions

• Comply with data collection and submission requirements, including the completion of the AHRQ Nursing Home Survey on Patient Safety Culture, at the beginning of the program

• Attend monthly coaching and content calls

Facility Team Expectations

• Track facility progress and meet data requirements– Submit process and outcome data– Safety culture survey at baseline

• Meet regularly with LTC facility team to monitor progress – Hold safety meetings with the team, monthly

• Ask for help on behalf of the team– Call your HRET Program Manager to discuss team and program

challenges, monthly

Facility Team Lead Expectations

TIMELINE & NEXT STEPS

Helen Plass, MAProgram Manager at HRET

Cohort 5 Timeline

September 2015Sunday Monday Tuesday Wednesday Thursday Friday Saturday

1 2 3 4 5

6 7Labor Day

8

9 10Virtual Learning Session 1a11:30 a.m.-1:30 p.m. CT

11 12

13 14 15 16 17

18DUE: Facility Registration

19

20 21

22

23 24Virtual Learning Session 1b11:30 a.m.-1:30 p.m. CT

25 26

27 28 29

30DUE: Facility Demographics DUE: Baseline Knowledge Questionnaire

Onboarding Educational Series 3rd Thursday of each week in October from 1-2 p.m. CT

QUESTIONS ABOUT ENROLLMENT?

State Organizational Lead Contact Person Email

AZ Arizona Health and Hospital Association Sandy Severson sseverson@azhha.org

OR Oregon Patient Safety Commission Mary Post mary.post@oregonpatientsafety.org

RI Healthcentric Advisors Pam Quinn pquinn@healthcentricadvisors.org

MI, MA, FL HRET Lindsay Kolczynski lkolczynski@aha.org

ND Quality Health Associates of North Dakota Michelle Alauckner mlauckner@qualityhealthnd.org

SC South Carolina Hospital Association Diana Zona dzona@scha.org

So FL South Florida Hospital and Healthcare Association Linda Quick lquick@sfhha.com

TN Tennessee Health Care Association Linda Estes lestes@thca.org

UT HealthInsight Linda Egbert legbert@healthinsight.org

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