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Some is Not a Number. Soon is Not a Time. Carolyn Coffey, BSN, RN, MS, CPHQ Critical Access Hospital Workshop for Nurses December 6, 2005. Objectives. Save 100,000 lives over the next 18 months Enroll as many as 2,000 hospitals Hospitals adopt 6 evidence based changes

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some is not a number soon is not a time

Some is Not a Number. Soon is Not a Time.

Carolyn Coffey, BSN, RN, MS, CPHQ

Critical Access Hospital

Workshop for Nurses

December 6, 2005

objectives
Objectives
  • Save 100,000 lives over the next 18 months
    • Enroll as many as 2,000 hospitals
    • Hospitals adopt 6 evidence based changes
  • Build a reusable national infrastructure for change
the six changes
The six changes
  • Deployment of rapid response teams
  • Delivery of reliable, evidence-based care for acute myocardial infarction
  • Prevention of central line infections
  • Prevention of surgical site infections
  • Prevention of ventilator-associated pneumonia
  • Prevention of adverse drug events
infrastructure for change
Infrastructure for change
  • Nodes
    • Geographic node—WI Node
    • Organizational nodes—Ascension Health
    • Affinity nodes
      • Childrens’ hospitals
      • Rural hospitals
  • Non-exclusivity
  • Take all comers
campaign statistics
Campaign statistics
  • Began December 14, 2005, 9:00 a.m. (ET)
  • “Ends" June 14, 2006, 9:00 a.m. (ET)
  • Over 2,900 hospitals currently participating
  • Over 70 Wisconsin hospitals participating
node responsibilities
Node responsibilities
  • Disseminate improvement tools
  • Provide support to health care providers throughout Wisconsin
  • Encourage other hospitals to join the campaign and to participate in improvement efforts associated with the campaign
node responsibilities cont
Node responsibilities (cont)
  • Act as a communication point between the hospitals in the campaign and the national campaign
  • Respond to emerging issues during the course of the campaign
  • Track and support hospitals in measure campaign progress
wisconsin node activities
Wisconsin Node activities
  • Conducted survey of participating hospitals
  • MetaStar’s assistance under its CMS contract
  • MetaStar’s Central Line Infection Initiative
  • WHA/PSW Medication Reconciliation Project
  • WONE Rapid Response Team work
slide11

Of the six changes, establishing rapid response teams has the potential to save the most lives—60,000 of the 100,000 lives—but has the lowest implementation rate—9% of Wisconsin hospitals are fully implemented

deployment of rapid response teams rrts
Deployment of rapid response teams (RRTs)
  • Team of clinicians (doctors, nurses, respiratory therapists, etc.) who bring intensive care expertise to the patient bedside (or wherever it is needed).
  • Goal: To respond to the signs and symptoms of the patient’s worsening condition before the patient’s heart or breathing stops
wisconsin node support for rapid response teams
Wisconsin Node support for rapid response teams
  • Led by the Wisconsin Organization of Nurse Executives and The Dahlen Company
  • Established a steering committee
  • Prepared a sample intervention timeline for hospitals considering starting an RRT
  • Using RWHC’s quality round tables to discuss implementation issues
wisconsin node support for rapid response teams cont
Wisconsin Node support for rapid response teams (cont)
  • Calls to hospitals by The Dahlen Company
  • Posting list of hospitals that have implemented RRT on WI Node website
  • Posting contact information for help
  • Posting tips for those that are stalled
bundle for delivery of reliable evidence based care for ami
Bundle for delivery of reliable, evidence-based care for AMI
  • Early administration of aspirin
  • Aspirin at discharge
  • Early administration of beta-blocker
  • Beta-blocker at discharge
  • ACE-inhibitor or ARB at discharge for patients with systolic dysfunction
  • Timely initiation of reperfusion
  • Smoking cessation counseling
what s a bundle
What’s a bundle?
  • Measure of performance of evidenced based practices vs. opportunity
  • Patient centered
  • All or nothing
wi node support for ami
WI Node support for AMI
  • AMI webinar November 2006
  • MetaStar work on appropriate care measures (ACM) aligns with 100k Lives AMI bundle
  • CAH Project Planning Conference Calls
    • December 5, 3-4 PM
    • December 12, 12-1 PM
  • Special AMI measures for CAH—Fall 2006
  • Working to report ACM bundle on Checkpoint
prevention of central line infections bundle
Prevention of central line infections bundle
  • Hand hygiene
  • Maximal barrier precautions
  • Chlorhexidine skin antisepsis
  • Optimal catheter site selection
  • Daily review of line necessity, with prompt removal of unnecessary lines
wi node work on central line infection prevention
WI Node work on central line infection prevention
  • MetaStar’s Central Line Infection Initiative
  • 16 hospitals participated
  • Goals:
    • To reduce the number of central line infections in participating hospitals to zero
    • To understand the economic impact of central line infections
metastar central line infection initiative cont
MetaStar Central Line Infection Initiative (cont)
  • Format
    • What can you do in 90 days?
    • One Learning Session: June 27, 2005
    • Monthly conference calls
  • Process
    • Adopt the central line bundle
prevention of surgical site infections ssi
Prevention of surgical site infections (SSI)
  • Appropriate use of antibiotics
  • Appropriate hair removal
  • Maintenance of postoperative glucose control for major cardiac surgery patients
  • Establishment of postoperative normothermia for colorectal surgery patients
wi node work for ssi
WI Node work for SSI
  • MetaStar’s new QIO contract aligns with 100k Lives Campaign goals. Project work on the surgical care improvement project (SCIP) aligns with the 100k Lives SSI
  • SSI—MetaStar planned webinar in January
prevention of adverse drug events ades by implementing medication reconciliation
Prevention of adverse drug events (ADEs) by implementing medication reconciliation

Step 1: Verification

Step 2: Clarification

Step 3: Reconciliation

wi node work to support medication reconciliation
WI Node work to support medication reconciliation
  • Led by the Wisconsin Hospital Association and the Pharmacy Society of Wisconsin
    • Developing tools to assist implementation
    • Tools posted on WI Node website
  • Developed a medication reconciliation measure for use with in the CheckPoint public reporting initiative
bundle for prevention of ventilator associated pneumonia vap
Bundle for prevention of ventilator-associated pneumonia (VAP)
  • Elevation of the head of the bed to between 30 and 45 degrees
  • Daily “sedation vacation” and daily assessment of readiness to extubate
  • Peptic ulcer disease (PUD) prophylaxis
  • Deep venous thrombosis (DVT) prophylaxis (unless contraindicated)
wi node work on vap
WI Node work on VAP
  • MetaStar VAP webinar December 5, 2005, 12:00 – 1:00 p.m.
  • VAP a SCIP module
node communications
Node Communications
  • E-mails
  • Newsletters
  • Teleconferences/Webinars
  • Conferences
  • Phone calls
  • Speaking engagements
  • Wisconsin Node website: http://www.metastar.com/professional/IHI100kLives.asp
contact information

Contact Information:

MetaStar, Inc.

2909 Landmark Place

Madison, WI 53713

1-800-362-2320

www.metastar.com

Carolyn Coffey

ccoffey@metastar.com