Central Nebraska Critical Access Hospital Network Quality Project: Core Measures

1. Central Nebraska Critical Access Hospital Network Quality Project: Core Measures Manuela Wolf RN, DON Harlan County Health System mwolf@harlancohealth.org Jeanine Kline RN, Quality/Risk Manager Gothenburg Memorial Hospital Jeanine@ghospital.org

2. Situation Inconsistent core measure scores The need to be ready for performance based reimbursement Healthcare reform will most likely add additional reporting requirements on new quality measures for CAHs ALL PATIENTS DESERVE TO RECEIVE THE RIGHT CARE EVERY TIME.

3. Background Current research supports the implementation of the core measures for community acquired pneumonia and heart failure for improved patient outcomes Changes in staffing including changes in leadership have an impact on ability to develop and sustain improvements

4. Assessment An opportunity for improvement in core measure compliance exists for the hospitals in the Central Nebraska Critical Access Hospital Network. Sharing of best practices for the core measures for community-acquired pneumonia and heart failure will result in improved compliance scores for the individual hospitals and better outcomes for the patients of Central Nebraska.

5. RECOMMENDATIONS Community- Acquired Pneumonia PN2&7- Pneumococcal /Influenza Vaccination: Use of pre-printed order sets/protocols for nurses to administer the vaccine when screen is positive Stickers for front of chart as reminder to staff and providers Screening tool (form) for communication with providers PN3- Blood Culture Before Antibiotic: Use of order sets

6. Recommendations Pneumonia (con�t) PN4- Smoking Cessation Counseling: Make standardized item on admission assessment Include in order sets Smoking cessation packet that includes resources and aids for the patient PN5- Antibiotic Timing: Antibiotics ordered as STAT on order set

7. Recommendations PN6- Initial Antibiotic Selection: Recommended antibiotics on standing order set per Specifications Manual. Educate providers regarding changes Make copies of changes in recommendations for provider reference Colored laminated sheets on charts with all appropriate antibiotics listed

8. Recommendations Heart Failure HF1- Discharge Instructions: Standardized discharge instruction sheets that include all six measures HF2- LVF Assessment: Order Sets Check past records Reminders to physicians HF3- ACEI or ARB for LVSD: Order Sets

9. Recommendation HF 4- Smoking Cessation Counseling: Make standardized item on admission assessment Include in order sets Smoking cessation packet that includes resources and aids for the patient

10. Other Recommendations Concurrent Chart Reviews Provide education and information to medical and nursing staff: ICD-9 codes Inclusion terms Medication recommendations Core measure requirements Share scores along with comparison to network facilities and statewide scores

11. Other Recommendations Provider Report Card: For education and to keep providers informed routinely on their performance on core measures Determine best way to communicate shift to shift: �Hand-off� communication to next shift Getting the right people involved in the process: Promote ownership

12. Recomendations Sharing information within our network Regular network meetings provide an opportunity for discussion and sharing. Submitting facility data which is compiled into a spreadsheet / graphs for comparison of data with peer hospitals

13. Feedback/Follow-up Continuous monitoring enables faster implementation times in which to use and evaluate tools Overall increase in scores ULTIMATELY THE RIGHT CARE PROVIDED TO EVERY PATIENT EVERY TIME