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SAFE PATIENT MOVEMENT AND HANDLING: VHA NATIONAL PERSPECTIVE STEPS. Office of Public Health and Environmental Hazards Office of Nursing Services Office of Patient Care Services Tampa PSCI. GOALS OF THIS TALK. Champion reporting to satisfy VHA CO Executive Committee

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Safe patient movement and handling vha national perspective steps l.jpg

SAFE PATIENT MOVEMENT AND HANDLING:VHA NATIONAL PERSPECTIVE STEPS

Office of Public Health and Environmental Hazards

Office of Nursing Services

Office of Patient Care Services

Tampa PSCI


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GOALS OF THIS TALK

Champion reporting to satisfy VHA CO

  • Executive Committee

  • Deputy Under Secretary for Operations and management

  • Health Systems Committee

  • Deputy Under Secretary of Health

  • Under Secretary of Health


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REPORTING NEEDS: EX COM

10/1/08 F/u on $61,000,000 funding

NRM needs for June 08 $s

12/30/08 Estimate of equipment funding

Associated FY09 NRM funds

Identification of facilities with structural assessment needs

3/331/09 Equipment and NRM funding

status

Overall progress (Tampa data)


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REPORTING NEEDS: DUSHOM

FY09/Q1 Facility-wide equipment inventory

Identification of prior expenditures

Unit-based hazard assessment

FY09/Q2 Policies, Procedures, protocols

Review of injuries

Initial peer leader training

FY09/Q3 Minimal lift policy

FY09/Q4 Facility strategic plan




And rate of incidents by skill mix from vanod asists proclarity cube on vssc l.jpg
# and Rate of Incidents by Skill Mix(from VANOD ASISTS proclarity cube on VSSC)

Yellow = Total Emp Count

Orange= # of Incidents

Blue line= Calc. Rate


Incident rate by type of incident from vanod asists proclarity cube on vssc l.jpg
Incident Rate by Type of Incident(from VANOD ASISTS proclarity cube on VSSC)


Type of incident by skill mix from vanod asists proclarity cube on vssc l.jpg
Type of Incident by Skill Mix(from VANOD ASISTS proclarity cube on VSSC)

Lifting & moving patients – most freq. reported injury






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WEAKNESSES INHERENT IN ANY BUSINESS CASE JUSTIFICATION APPROACH

  • Under-reporting of injury and disease

  • Attention and focus predict long-term consequences

  • Horse-racing effect


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SYSTEM NEEDS ASSESSMENT APPROACH

  • Data review and call to determine need

    • VSSC Review

    • DUSHOM ITEM

  • Estimation of cost per dependent

    • Ceiling lifts

    • Movable equipment

    • Supplies

  • Estimates by patient category

  • BIRN Costs




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HISTORY OF SPMH in VHA APPROACH

1998-1999 Tampa program development

1999 HSR&D Tampa SPMH grant (expert panel)

IOM Report: Safe Work in the 21st Century

2001-2003 VISN 8 Demonstration project

2001 1st Conference on SPMH

2004 VISN 1 EDM and program roll-out

Publications on economics

VHA CO staff support for roll-out

2005-2007 VISN 3, 9, 11 initiatives

2006 10N data call on implementation initiatives

2007 SPMH initiative for FY2009-11 budget series

2008 VA * OMB negotiations on 6 vs. 3 year roll-out

Concurrence

$61,500,000 distributed in June 2008


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LESSONS RFOM PROGRAM IMPLEMENTATION IN 4 VISNs APPROACH

  • 2 years of VISN-level support

  • .5 FTE facility staff support

    • Program equipment management

    • Peer safety leader leadership

  • Peer Safety Leader functionality (“back injury resource nurses”, “injury prevention nurses”)

    • Essential element

    • Issues of fiscal support (“certification” vs step increases)


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COSTS AND BENEFITS APPROACH

$150,000,000 - equipment and construction

$4,000,000 / year - facility champions

$5,000,000 / year – injury prevention nurses on each unit

$10,000,000 – data system redesign / support

ASISTS inadequate

WARIMS application to IDMC


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CONSIDERATIONS: APPROACHDecision-making criteria

  • Is program necessary: can VHA afford not to do it?

  • Does the program pay for itself (when does the program pay for itself)

  • What happens if we do not implement the program?


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CONSIDERATIONS APPROACH

  • Construction vs. medical programs (80% vs. 20%): need national assessment at facility / patient room level

  • VISN roll-out experience: 2 – 3 years of VISN support and planning

  • Facility-level program management: Staff support (program development, leading assessment, equipment maintenance, peer safety leader training and coordination)

    Likely ~$4,300,000 / year


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CONSIDERATIONS APPROACH

  • Facility level – front-line worker support – peer and coordination) (.1 peer safety leader/injury prevention nurse / shift): $~$5,000,000 / year

  • IT Support: ASISTS does not address unit level rates, instrumentation/ equipment / track intervention recommendations (Accident Review Board solutions)

  • Roll-out timing: VISN, facility staffing; facility-level assessment, equipment


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CONSIDERATIONS APPROACH

  • Prior expenditures and early adopters: reimbursement issues (10N solution: include information on actual equipment/construction expenditures)

  • Budget shifts

    • Initial estimates: no facility- or unit level coordination

    • $16,000,000 in initial draft for 3 years of unit-level peer safety leaders

    • Move to 6 years: inadequate funding


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CONSIDERATIONS APPROACH

  • First year funds expenditures:

    • Universally needed equipment (lateral sliding devices ~ $15,000,000)

    • $4,300,000 facility level staffing

    • Reimbursement (10N model)

  • Program oversight in CO

  • Future delays and reimbursement: consequences of 6-year implementation delay and impatience in the field


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OPTIONS APPROACH

  • Option 1: $30,000,000 / yr x 6

    • VHA CO staff support, national assessment, facility level support, devolution of program to 10N in ~3 years

  • Option 2: assign moneys to VISNs without oversight

  • Option 3: do nothing


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REPORTING NEEDS APPROACH

10/1/08 F/u on $61,000,000 funding

NRM needs for June 08 $s

12/30/08 Estimate of equipment funding

Associated FY09 NRM funds

Identification of facilities with structural assessment needs

3/331/09 Equipment and NRM funding

status

Overall progress (Tampa data)


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