Pamela T. Rudisill, MSN, RN, MEd, NEA-BC AONE Immediate Past-President

1. Pamela T. Rudisill, MSN, RN, MEd, NEA-BCAONE Immediate Past-President

2. Objectives: Identify National trends for patient safety & quality initiatives Define National organizations� involvement in assuring quality & patient safety Describe processes & outcomes for evidenced based metrics for the following: Central Line Associated Blood Stream Infections Catheter Associated Urinary Tract Infections Falls Pressure Ulcers

3. Landmark report �To Err is Human� (2000) called for National effort to make healthcare safe

4. What did the report accomplish? Changed viewpoint of healthcare providers about medical injury Enlisted the support of stakeholders Congress approved monies for patient safety & error prevention (Agency for Healthcare Research & Quality) Development of Roadmap of Evidenced Based Practices Change in practice Some voluntary Some regulatory

5. Regulatory: Centers for  Medicare & Medicaid,  Joint CommissionVoluntary: American Hospital  Association  Comprehensive Unit- Based Safety Program,  National Nursing  Database for Quality  Indicators

6. Non-Governmental Organizations The Joint Commission National Quality Forum (public-private partnership to develop & improve measures of quality of care Centers for Medicare & Medicaid (Federal government agency & initiated pay for performance of certain quality indicators)

7. Non-Governmental Organizations (Continued) Centers for Disease Control National Patient Safety Foundation American Hospital Association, of which AONE is a subsidiary Institute for Healthcare Improvement

8. Evidenced Based Metrics for Quality Indicators CLABSI (Central Line Associated Blood Stream Infections) CAUTI (Catheter Associated Urinary Tract Infections) Falls Pressure Ulcers

9. CLABSI Definition: Laboratory confirmed blood stream infections that develop in a patient that had a central line within 48 hours prior to infection onset

10. National Benchmark: 0.0 (25th percentile)  (Number of CLABSI Device Days x 1000)

11. Evidenced Based Processes Hand hygiene prior to line insertion Maximal barrier precautions upon insertion Chlorhexidine skin antisepsis Optimal catheter site selection Daily review of line necessity Dressing changed per policy

12. Latest National Results Results 2009: CLABSI Mean 1.7 per 1000 device days

13. CAUTI Definition: As defined criteria from CDC  using symptomatic &  asymptomatic bacteremic  criteria

14. National Benchmark: 0.0 (25th percentile) (Number of CAUTI Urinary Catheter Days x 1000)

15. Evidenced Based Processes Foley inserted using aseptic technique and sterile equipment documented Maintenance of closed drainage system Maintain unobstructed urine flow Catheter secured properly Daily review of necessity for catheter Peri-care daily Foley part of shift to shift handoff

16. Latest National Results Results 2009: CAUTI Mean 1.6 per 1000 catheter days

17. Falls Patient falls in acute care facilities a National issue The most effective fall prevention strategies are multi-factorial and interdisciplinary

18. National Benchmark <2.1 falls/1000 patient days

19. Falls Evidenced Based Risk Assessments Morse Hendrick Others

20. Evidenced Based Processes Falls risk assessment completed on admission Reassessed fall risk per policy Compliance with falls reduction measures Patient and family education Hourly Rounding Bed fall huddle (10 min) beginning of each shift Technology (tab monitor, CareView, bed alarms) on identified patients

21. Technology Bed Alarms Tab Monitors Virtual Bed Rails

23. Pressure Ulcers Definition: A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear

24. International Pressure Ulcer Classification System Stage Grade Category

25. Definitions Are Consistent! I: Non-Blanchable Erythema II: Partial Thickness III: Full Thickness Skin Loss IV: Full Thickness Tissue Loss

26. Example Evidence Risk Assessment Tool: Braden Scale

27. National Benchmark National benchmark is 2.4 Hospitals receive a National Mean Score based on unit (CCU, Med/Surg, etc.) and bed size of hospitals participating in the database

28. Problems with Benchmarking Nursing Sensitive Indicators Different size/service of hospitals Different hospitals measure within different units (Example: Critical Care only versus All Units)

29. Problems(Continued) Computer technology varied across hospitals Resources limited Lack of Evidenced Based processes to document with benchmarking

30. Currently no mandate for consistent reporting of all processes & outcomes of Nursing Sensitive Quality Indicators

31. As opposed to other Quality IndictorsCore Measures (that are very specific) AMI (Acute Myocardial Infarction Pneumonia CHF (Congestive Heart Failure) Children Asthma SCIP (Surgical Care Improvement Project) VTE (Venous Thromboembolism) Hospital Consumer Assessment of Health Plans Survey (HCAHPS)

32. Summary: Have we made progress?? Evidenced Based Practice Interdisciplinary Collaboration Evidence supports improvements in Core Measures & Nursing Sensitive Indicators

33. References Centers for Medicare & Medicaid. (Available at www.cms.gov) American Hospital Association. Retrieved September 19, 2011 from www.aha.org. Lucien Leape, MD, personal communication, March 2011. National Database of Nursing Quality Indicators. Retrieved September 11, 2011 from www.nursingquality.org. Catheter Associated UTI Event. Centers for Disease Control. August 2011. (pp 7-12). Dudeck, MA, Horan, TC, Peterson, KD, Bridson, KA, Morrell, GC, Pollock, DA, Edwards, JR. (2009). National Healthcare Safety Network Report Data Summary for 2009, Device Associated Module. Centers for Disease Control. (pp 1-40). Pressure Ulcer Prevention. (2009). European Pressure Ulcer Advisory Panel & National Pressure Ulcer Advisory Panel. (pp 1-24). Leape, L., Berwick, D. (2005). Five Years After To Err Is Human: What Have We Learned? Journal of the american Medical Association; 293(19):2384-2390. Preventing Pressure Ulcers in Hospitals. Agency for Healthcare Research & Quality. (pp 1-104).