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

Cohort 4

June 23, 2015

Health Research & Educational Trust

Project Team Members

Facility Informational Webinar

Agenda

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Topic Presenter

Welcome and Project Overview Marcia Cooke

Achieving Project Goals Louella Hung

Measuring Success A.J. Rolle

LTC Facility Team Lead Role Louella Hung

Timeline & Next Steps Helen Plass

Question & Answer All Attendees and Presenters

PROJECT OVERVIEW

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Marcia Cooke, RN-BC, MSN

Director, 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

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

Nat iona l Pro jec t TeamHRET UM Abt Qualidigm APIC SHM Baylor

Nat iona l Pro jec t TeamHRET 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/Coaching/Project Liaison

Organizational Leads

Recruitment/Coaching/Project Liaison

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

SHM, Baylor

Coaching/Endorsement

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

SHM, Baylor

Coaching/Endorsement

FacilitiesFacilities

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AHRQAHRQ

Connections for the Facility Team

State Organizational Lead Contact Person

Multi-state

The Joint Commission Beth Ann Longo

Multi-state

Advancing Excellence Carol Scott

CA Plum Healthcare, for California Association of Health Facilities

Anna Soliven

LA eQ Health Solutions – Quality Insights Julie KuekerBeth Hoover

MN Minnesota Hospital Association Tania DanielsSusan Klammer

NJ New Jersey Hospital Association Patricia Dimino

ND Quality Health Associates of North Dakota

Michelle Lauckner

Organiza t iona l LeadOrgan iza t iona l Lead

FacilitiesFacilities

HRETHRET

Faculty Coach

Facility Teams

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

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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!

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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

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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

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Project Spread421 Active Facilities in Cohort 1, 2 & 3

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Cohort 1 (63 facilities)

Cohort 2 (152 facilities)

Cohort 3 (207 facilities)

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

ACHIEVING PROJECT GOALS

Louella Hung, MPH

Senior Program Manager at HRET

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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

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Educational Sessions

In-person or virtual learning sessions: kickoff, mid-course and final• Slides, expert faculty, interactive activities, handouts, resources

Educational webinar/video series

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Name of series # of Topics Frequency What Format for Facility

Team LeadFormat for Front-line Staff

Connecting the Dots 1 Once Optional Office Hours Webinar N/A

Onboarding 4 Weekly Project orientation Webinar Trained by Facility Team Lead

Training Modules 4 2 modules every 4 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 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

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Education Series Schedule

Office Hours Date Time

Connecting the Dots: Education, Data and Implementation of the CAUTI-LTC Program Thursday, July 30 1:00 – 2:00 p.m. CT

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. Data Collection Training Thursday, August 20 1:00 – 2:00 p.m. CT

4. CAUTI Surveillance Thursday, August 27 1:00 – 2:00 p.m. CT

Training Module Series Release Date

1. Hand Hygiene Week of Sep 21 N/A

2. Environment & Equipment Week of Sep 21 N/A

3. Isolation Precautions Week of Oct 19 N/A

4. Antibiotic Stewardship Week of Oct 19 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

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Coaching Calls

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Ashley Hofmann, MSW

Katie Johnson, MHS

Anna Wojcik, MPH

What: State/Region-specific coaching call

When: Monthly, beginning in September

Who: All facility team leads

Facilitated and run by the organizational lead

Faculty coach provides clinical and cultural expertise

HRET advisor provides project management support and technical assistance

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

Resources

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• Your Organizational Lead

• LTC Safety Websiteusername & password: ltcsafety

• Weekly Newsletters

• Expert Faculty Coaches

• Facility Implementation Guide

• Data Support

MEASURING PROGRESS

AJ Rolle, MPH

Program Manager at HRET

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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!

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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

Process Measures -> Evidence-based practice

Team Communication Guide Quarterly 10 minutes

Skills Questionnaire Baseline, mid-point, final 15 minutes

Outcome Measures –> Understand and celebrate success

Catheter Utilization CAUTI rates Urine culture order rates

Monthly

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Outcome Data Definitions

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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)– Team Communication

– Outcome Measures*• Residents

• Residents with catheters

• 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)

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

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FACILITY TEAM LEAD ROLE

Louella Hung, MPH

Senior Program Manager at HRET

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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

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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

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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)

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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

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TIMELINE & NEXT STEPS

Helen Plass, MA

Program Manager at HRET

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Cohort 4 Timeline for Facilities

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Important Dates for Cohort 4

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Activity Date/Time

Learning Session #1 July 1-24

Registration Due July 24

Facility Demographics Due July 31

Optional Office Hours Thursday, July 30 from 1:00-2:00 p.m. CT

Onboarding Educational Series 3rd Thursday of each month from 1:00-2:00 p.m. CT, beginning in August

QUESTIONS ABOUT ENROLLMENT?

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State Organizational Lead Contact Person Email

Multi-state The Joint Commission Beth Ann Longo BLongo@jointcommission.org

Multi-state Advancing Excellence 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 KuekerBeth Hoover

jkueker@eqhs.orgbhoover@eqhs.org

MN Minnesota Hospital Association Tania DanielsSusan Klammer

tdaniels@mnhospitals.orgsklammer@mnhospitals.org

NJ New Jersey Hospital Association Patricia Dimino pdimino@njha.com

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