Addressing Healthcare-Associated Infections in Nursing Homes Using Quality Assurance and Performance ImprovementHealth Services Advisory Group
Performance Improvement
February 25, 2016
Tara Rhone, BS, MPH
Associate Director
813.865.3196 | JBukovinsky@hsag.com
Associate Director
813.865.3188 | GZeya@hsag.com
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Florida, Ohio, and the U.S. Virgin Islands.
Objectives
• Describe the epidemiology and burden of healthcare-associated infections (HAIs) in nursing homes (NHs).
• Identify challenges for implementing infection prevention programs in NHs.
• Explore key strategies for preventing transmission of HAIs within NHs using Quality Assurance & Performance Improvement (QAPI).
• Discuss next steps.
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• Ensure every NH resident receives the highest quality of care.
• Instill quality and performance improvement practices .
• Support the implementation of QAPI. • Eliminate hospital-acquired conditions (HACs). • Eliminate HAIs. • Improve resident satisfaction. • Help NHs achieve a Nursing Home Quality
Measure Composite Score of 6% or lower by January 2019.
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What Are HAIs?
• Infections people acquire while receiving treatment for another condition in a healthcare setting
• HAIs can be acquired anywhere healthcare is delivered: – Nursing homes
– Hospitals
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Impact of HAIs
• Considerable suffering for residents in long-term care facilities (LTCFs) – 1 to 3 million serious
infections occur every year in these facilities*
– Major cause of hospitalization and death; as many as 380,000 people die from HAIs every year
– Increased cost for the healthcare system
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HAIs: Causative Agents
– Bacteria
– Fungi
– Viruses
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Use of indwelling medical devices such as bloodstream, endotracheal, and urinary catheters
Surgical procedures
residents and healthcare workers
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Complications from treatments
Symptoms of infections may be absent or present in a vague or atypical mannerUnderreporting of
signs and symptoms
Inappropriate antibiotic use
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Background
• Proposed new Centers for Medicare & Medicaid Services (CMS) rules for LTCFs
– Infection control and surveillance
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Clostridium difficile
infections (CDIs)
Lower respiratory
tract infections
• Significant morbidity – 30 percent of hospital readmissions
within 30 days
• Differential diagnosis: Asymptomatic bacteriuria and symptomatic UTI
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Lower Respiratory Tract Infections
• Common cause of hospitalization and death among people over 65 years old
• Pneumonia: fifth leading cause of death
• Streptococcus pneumoniae (pneumococcus)
• Coexisting conditions
• NH residents are of notable risk
• Influenza outbreak
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• Number one cause of diarrhea in NH residents
• Hospitalizations and deaths are higher among individuals over the age of 65
• Antibiotic monitoring
Skin, Soft Tissue, and Wound Infections
• Pressure ulcers and cellulitis are the most common types of soft tissue infections
• Group A Streptococcus (GAS)
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• Scientific literature on the prevalence of HAIs and evidence-based prevention practices in these settings is limited
• No standardized system for HAI surveillance has been adopted nationally
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Inter-facility Transfers
• Residents may transfer in and out of NH care with some frequency
– Lack of communication
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QAPI Background
• F520 (OBRA 1987)–Quality Assessment and Assurance (QAA) – Purpose: To provide a framework for facilities to
evaluate their systems in order to prevent deviation and correct inappropriate care processes
– Focus: Meeting the minimum requirements
• Section 6102(c) of Affordable Care Act (2010) – Purpose: Strengthen a facility’s capacity for data
collection and analysis, strategy development, and action plans
– Focus: Proactive effort to improve performance (Unified Agenda and Regulatory Plan)
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• Each facility’s infection prevention control program (IPCP) includes an antibiotic stewardship program – Revise antibiotic use protocols – Antibiotic monitoring
• The regulatory description of the infection control program to include – Infection prevention – Identification – Surveillance – Antibiotic stewardship
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• Include at minimum
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“Transforming the lives of nursing home residents through continuous attention to
quality of care and quality of life”
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Quality of Care, Quality of Life,
Resident Choice
HAI Performance Improvement Project (PIP)
Conduct an HAI PIP to improve care or services in areas relevant for your residents.
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• Analyze current processes.4
• Conduct a root cause analysis (RCA).5 • Develop and implement quality
initiatives.6 • Test and implement changes using the
plan-do-study-act (PDSA) method.7 • Monitor the QI plan to sustain the
improvement.8
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Identify Areas for Improvement
• Number of reported HAIs – Do we have an issue with HAIs?
– How effective are our systems for tracking HAIs?
• Scope of the problem – Which type of HAI is our
biggest challenge?
– Which residents are most at risk for infections, and why?
– Are there environmental factors associated with our infection rates?
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• Interdisciplinary members
– NH administrators
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• Determine which measures are important to your organization
• Choose one or more HAIs to monitor progress over time
– Outcome measures • Percentage of residents
with influenza
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• Process measures
– Percentage of residents and staff members who receive a flu vaccine annually
– Staff member compliance with hand hygiene protocols
– Staff member compliance with environmental cleaning procedures
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Analyze Current Processes
• Policies and procedures
– What processes do we have in place to prevent the spread of influenza?
– What system do we use to conduct surveillance for influenza?
– Do we produce influenza data feedback reports?
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– Are we good stewards of influenza vaccines?
– Are we having employee absences due to influenza?
– Are employees washing their hands at all appropriate times?
– Do environmental cleaning services meet our expectations?
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• Education
– Hand hygiene
• System changes
• Policy changes
Assessment, Recommendation (SBAR)
– Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS)
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Test Changes Using the PDSA Cycle
• During a PIP, attempt some changes and then see whether or not they made a difference in the area you were trying to improve using the PDSA cycle
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• Data feedback reports
• Monitor adherence to personal protective equipment (PPE)
• Monitor influenza vaccination rates among staff members and residents
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Infection Surveillance
• The U.S. Department of Health and Human Services (HHS) has developed a strategy to address infections in LTCFs in Phase 3 of the National Action Plan to Prevent HAIs: Roadmap to Elimination
• Phase 3 – LTCFs – Commitment—reducing
the national rate of HAIs
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QAPI at a Glance • Step-by-step guide to implementing QAPI,
including the steps to write a QAPI plan • Excellent problem-solving models (e.g., RCA)
outlined in this resource
Change Package • Menu of strategies, change concepts, and
actionable items that will be helpful in finding solutions to challenge areas
• A great reference during QAPI PIP meetings when trying to problem solve and/or look for ideas
Both documents available at: http://go.cms.gov/Nhqapi
Addressing HAIs in NHs Using QAPI
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• CMS QAPI Web site: http://go.cms.gov/Nhqapi
• HSAG: http://hsag.com
• Institute for Healthcare Improvement: www.ihi.org
• Agency for Healthcare Research and Quality: www.ahrq.gov
• Pioneer Network: www.pioneernetwork.net
• The Institute for Health Care Improvement’s Model for Improvement: www.ihi.org/resources/Pages/HowtoImprove/default.aspx
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Health Services Advisory Group
Ohio Florida James Barnhart, BHS, LNHA
NNHQCC Team Quality Improvement Project Lead FL-NNHQCC@hsag.com 614.307.5475
JBarnhart@hsag.com
Clinical Project Manager Associate Director 602.801.6906 818.265.4676
KChartier@hsag.com JSilao@hsag.com
Health Services Advisory Group
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We appreciate your feedback on today’s webinar. Please complete the survey linked below.
https://www.surveymonkey.com/r/HAIs022516
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Insights for Improving Your Pain Quality Measures
Tuesday, March 29, 2016
Noon to 1:15 p.m. (AZ)
2:00 p.m. to 3:15 p.m. (ET)
Register at: https://goo.gl/RVlWHA
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This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Arizona, California, Florida, Ohio, and the U.S. Virgin
Islands, 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. Publication No. QN-11SOW-C.2-02222016-01
Structure Bookmarks
Presented by the Florida NNHQCC Team
HSAG: Your Partner in Healthcare Quality
HSAG: Your Partner in Healthcare Quality
Objectives
Background
Background
Slide
Diagram
UTIs
Challenges
Diagram
Diagram
Analyze Data and Set Goals (cont.)
Analyze Current Processes
Analyze Current Processes
Conduct an RCA
Develop and Implement Quality Initiatives (cont.)
Test Changes Using the PDSA Cycle
Test Changes Using the PDSA Cycle
Monitor the QI Plan to Sustain Improvement
Resources
QAPI Resources
QAPI Resources
QAPI Resources
Don’t Forget to Take the Survey!
Don’t Forget to Take the Survey!
Register Now for This Upcoming Webinar!