welcome and instructions - k (hen · wound care education institute training 8. timeline and next...

Welcome and Instructions

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1

Welcome to the Kentucky Hospital Improvement

Innovation Network -May Update

Agenda1. Data and Info Nuggets – CAUTI, CLABSI, SSI, & VAE

2. Ky. Quality Counts Update

3. Kentucky Milestone Program

4. Survey re: Evaluation for HEN 2.0

5. Hospital Highlight – Ephraim McDowell Regional Medical Center – Regina Rice

6. Upcoming HRET Events

7. Upcoming K-HIIN Events1. Webinars

2. Wound Care Education Institute Training

8. Timeline and Next Steps

3

DATA UPDATE

4

5

CAUTI-All Tracked UnitsBaseline Period: 2015

0.83 0.920.64 0.7

0.440.57

0.95

2.28

2.69 2.78 2.72

1.64

0

0.5

1

1.5

2

2.5

3

Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17

CAUTI-2a Rate - All Tracked Units

K-HIIN Rate HRET Rate K-HIIN Baseline HRET Baseline

0

5

10

15

20

25

30


Catheter Utilization Ratio - All Tracked Units

K-HIIN Baseline HRET Baseline K-HIIN Rate HRET Rate

6

CAUTI ICU OnlyBaseline Period: 2015

0

20

40

60

80


Catheter Utilization Ratio - ICU Only


0.92 1.07

0.460.74

0.410.61

2.782.57

2.35

1.62 1.53

0.87

0

0.5

1

1.5

2

2.5

3


CAUTI-2b Rate - ICU


Info Nuggets – CAUTI

• The Culture of Culturing –

Dr. Fakih

More unnecessary cultures=more unnecessary antibiotics=more C diff and MDRO development AND other side effects, allergic reactions, GI upset, etc.

1) Discontinue screening cultures

Why would we document Foley POA?

2) Educate NO urine cx unless patient is symptomatic (exceptions: pregnancy, very sick and NON-historians)

7

Info Nuggets – CAUTI

• **NO culture for foul odor

cloudy appearance, sediment, hematuria, change in color

• Technique matters

• Collection

• Mid-stream clean catch

• Foley pts-sampling port and transfer device

• Timely transport and processing

• 2 hours MAX from collection to processing

**Studies have shown contamination rates of 27-48%, half received ABX.

8

9

CLABSI-All Tracked UnitsBaseline Period: 2015

0.22

0.74

0.52 0.54

0.14

0.56

0.730.8 0.78

0.72 0.740.68

0

0.2

0.4

0.6

0.8

1


CLABSI Rate - All Tracked Units


16

17

18

19

20

21


Central Line Utilization Ratio


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CLABSI ICU OnlyBaseline Period: 2015

0.1

0.4

0.57

0.92

0.21 0.19

0.9 0.94

0.81 0.85 0.82 0.8

0

0.2

0.4

0.6

0.8

1

1.2


CLABSI-2b Rate - ICU


0

10

20

30

40

50


Central Line Utilization Ratio - ICU Only


Info Nuggets –CLABSI

Progress report:

• Not perfect, but successful initiatives around insertion bundle compliance and decreasing line days

• Where are we with decreasing unnecessary line entries?

• Unnecessary lab draws

• No longer needed or so close together we don’t have results communicated before getting another set

• Meds IV that could be PO

• Observations of line entries, bag and tubing changes

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12

SSI – Colon/HysterectomyBaseline Period: 2014

2.76 3.033.45

1.43

3.13 3.43

4.5 4.45 4.68 4.574.02 3.91

0

1

2

3

4

5

6

7

8


SSI-2a Rate - Colon Surgeries


1.08

0.770.66

1.85

1.23

0.37

1.211.37

0.94

1.31 1.241.08

0

0.5

1

1.5

2


SSI-2b Rate - Abdominal Hysterectomies


13

SSI – Total JointsBaseline Period: 2014

0

2.14

1.83

1.06 0.970.85

0.56 0.56 0.630.49 0.43 0.41

0

0.5

1

1.5

2

2.5


SSI-2c Rate - Total Knee Replacement


0

2.79

1.42

2.3

0.76

0

0.921.14

0.841.04 0.97

0.65

0

0.5

1

1.5

2

2.5

3


SSI-2d Rate - Total Hip Replacement


Info Nuggets – SSI

• Peri-operative practices

– Observations- Is the fox watching the hen house??

• Time-outs

• Preps

• Intra-operative sterile technique

• OR room entries, etc.

• Attire

• Room cleaning for turnover and at end of schedule

• Innovative Solution- Remote Monitoring with Real Time Feedback

14

15

VAE – VAC/IVACBaseline Period: 2015

4.013.75

2.872.5

3.8

2.14

4.934.47

5.05 4.854.59 4.66

0

1

2

3

4

5

6


VAE-1 Ventilator-Associated Condition


0.6 0.59

0.961.07

0.4

0.97

1.52

1.3

1.52 1.52

1.13

1.43

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17

VAE-2 Infection-Related Ventilator-Associated Complication


Info Nuggets- VAE

•Not required at this time, but…• New measure

• In the validation process

• Why should I collect it then? I haven’t had a VAP in a

long time!

• Helps with validation process

• Allows you to provide input on revisions

•Provides information you

probably didn’t have before

•Remember-VAE>VAP16

Info Nuggets- VAE

•From Cindy Gross at CDC• “Remember VAC stands for vent-associated conditions rather

than complications. Research on definitions similar to the VAC definition shows that most VACs represent pneumonia, ARDS, atelectasis, and pulmonary edema. These are all significant clinical conditions that may be preventable. If you are interested in learning more, see Klompas M et al., PLoSONE 2011 http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0018062).

17

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0018062

Info Nuggets- VAE

•Why do we include it for HIIN?

•One of the main purposes of VAE surveillance is to identify areas for improvement of care and management of patients receiving ventilator support. Infections are not the only potentially preventable complications of mechanical ventilation. 18

Milestone Program

You all hitting your “milestone” goals helps us hit our milestone goals also!

• Milestone 1 – Commitment Letter/Participation to us by 12/31/16

• Milestone 2 – Baseline data by 1/31/17

• Milestone 3 – Monthly Monitoring data thru February 2017 in to KQC by 4/28/17

• Milestone 4 – Monthly Monitoring data thru May 2017 in to KQC by 9/1/17 19

Survey re: HEN 2.0

The Partnership for Patients Evaluation Contractor will be surveying hospitals who participated in HEN 2.0 to:

• Assess the impact the program had on reducing hospital-acquired conditions by 40% and readmissions by 20% from 2010 to the end of 2016;

• Identify changes in hospital safety practices that occurred as a result of program participation.

Hospitals will receive an online survey that needs to be filled out – this information is essential for evaluation of the success of the program. - Survey was sent to hospital CEO’s on 5/24/17

- Hospitals have 3 weeks to complete the survey 20

Hospital Highlight

Ephraim McDowell Regional Medical Center

Danville, KY

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Upcoming Events - HRETHRET HIIN Physician Inclusion Virtual Event ,

May 31, from 12 – 1 p.m. EST

HRET HIIN Antibiotic Stewardship Program– The Secret of Getting Ahead is Getting Started, June 1, from 12 –

1 p.m. EST

HRET HIIN ICU Care Virtual Event – A Team Sport,

June 6, from 12- 1 p.m. EST

HRET HIIN Readmissions Event: Reduce Readmissions Fishbowl Series 2,

June 15, from 12 – 1 p.m. EST

http://www.hret-hiin.org

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http://www.hret-hiin.org/

Upcoming Events - HRET

Adaptive Leadership in Medicine Training – August 2-3, Chicago, IL

• Opportunity for physician and administrator from the same organization to join together and gain valuable leadership tools

• HIIN Hospitals eligible to receive a scholarship that includes training, hotel, and airfare

• Details forthcoming – but at time of registration will be required to identify the physician/leader dyad

• * this is an HRET-sponsored event, not an HRET HIIN event 23

Upcoming Events – K-HIIN

K-HIIN Care of the Hospitalized Elderly Patient/Delirium webinar series Part V – Progressive Early Mobility


K-HIIN Monthly Webinar for June,


www.k-hen.com

24

http://www.k-hen.com/

Timeline and Next Steps

• Continue entering Monitoring Data into KQC

25

KEEP

CALM

AND

HIIN

ON

Questions?

26

welcome and instructions - k (hen · wound care education institute training 8. timeline and next...

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