Joint Commission Publishes new Monograph about CLABSIs

On May 16th, the Joint Commission released a new Monograph reviewing the most recent evidence and thoughts surrounding Central Line-Associated Bloodstream Infections.

The free monograph can be downloaded here: http://www.jointcommission.org/assets/1/18/CLABSI_Monograph.pdf

Below is an excerpt from the press release announcing the free monograph (emphasis added in red):


New Monograph Aims to Decrease Central Line-Associated Bloodstream Infections (CLABSIs)

The Joint Commission, in collaboration with Joint Commission Resources (JCR) and Joint Commission International (JCI), developed a new monograph containing the most current information, evidence-based guidance and resources to help health care organizations reduce the current risks and resulting harm associated with CLABSI. JCR and JCI are not-for-profit affiliates of The Joint Commission. The monograph was produced in partnership with infection prevention leaders from the Society for Hospital Epidemiology of America (SHEA), the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), the National Institutes of Health (NIH), the Infectious Diseases Society of America (IDSA), the Association for Vascular Access (AVA), and the International Nosocomial Infection Control Consortium (INICC). In addition, several other domestic and international infection prevention leaders from countries such as Argentina, Australia, Egypt, Switzerland, Thailand and Saudi Arabia have lent their expertise to the monograph.

“Recent patient safety initiatives have demonstrated how preventable CLABSIs can be when evidence-based guidelines are consistently put into practice at the bedside,” says Jerod M. Loeb, Ph.D., executive vice president, Division of Healthcare Quality Evaluation, The Joint Commission. “Our hope is that these resources will empower health care providers to implement practices that have been shown to not only improve patient safety, but also reduce costs.”

The project is supported by a research grant from Baxter Healthcare Corporation and focuses on the identification and broad dissemination of preferred practices and technological solutions to prevent CLABSI. 

At least 12 Indiana Hospitals Report Having No Central Line Infections

In early February 2012, CMS made hospital central line associated blood stream infection (CLABSI) data available on its HospitalCompare website.

Of the 125 Indiana hospitals listed in HospitalCompare, 88 were eligible for CLABSI reporting. For various reasons (small n, no ICU in hospital, etc...), no rating was provided for 65 hospitals. Of the remaining 22 hospitals, 12 reported no infections.

The 12 Indiana hospitals are:

Hospital	City
ELKHART GENERAL HOSPITAL	ELKHART
WILLIAM N WISHARD MEMORIAL HOSPITAL	INDIANAPOLIS
FRANCISCAN ST FRANCIS HEALTH - BEECH GROVE	BEECH GROVE
PORTER VALPARAISO HOSPITAL	VALPARAISO
FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES	NEW ALBANY
REID HOSPITAL & HEALTH CARE SERVICES	RICHMOND
COMMUNITY HOSPITAL EAST	INDIANAPOLIS
DEACONESS HOSPITAL INC	EVANSVILLE
INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL	MUNCIE
COMMUNITY HOSPITAL	MUNSTER
ST VINCENT HEART CENTER OF INDIANA LLC	INDIANAPOLIS

CMS published this data based on 1Q2011 only. This measure is based on the CDC's NHSN data collection protocol.

Schneck Medical Center (Seymour, IN) Named 2011 Baldrige Award Recipient

Schneck Medical Center of Seymour, Indiana, was named a 2011 Baldrige Award Recipient in the Healthcare Category. Schneck is the first organization from Indiana to receive the Baldrige Award.

Until recently, Indiana did not have a State level Baldrige-based award program. Schneck thus partnered with the Ohio Partnership for Excellence. The Ohio program has since expanded its scope and now covers the State of Indiana (as well as West Virginia). The program has now been renamed The Partnership for Excellence.

The press release announcing the other Baldrige Award winners can be found here.

The profile of Schneck Medical Center released with the announcement can be found here.

Below are excerpts from the profile of Schneck Medical Center outlining its quality performance that may be interesting to the healthcare quality professional. Note that the 50 page Baldrige application from Schneck will become public domain in a few months and thus awailable for public examination and learning. Schneck (as required by all Baldrige award winners) will also be participating in national and regional conferences where they will be sharing thier Baldrige journey.

• SMC consistently demonstrates high levels of performance in relation to patient-focused health care measures. Specifically, on 17 of 22 core measures reported for the Centers for Medicare and Medicaid Services (CMS), SMC scored 100 percent in the second quarter of 2011.
• SMC ranked second among 94 hospitals in its geographic region and outperformed all local competitors when measured for its value-based purchasing (VBP). VBP is a method that holds health care providers accountable for the quality and cost of their services through a system of rewards and consequences. Incentives discourage inappropriate, unnecessary, and costly care.
• Patient satisfaction surveys reflect SMC’s year-to-year favorable performance, meeting or exceeding top 10 percent or top 25 percent levels on nine of 10 Press Ganey (a national consulting firm focused on improving health care performance) measures, including inpatient quality of care, inpatient family support, inpatient coordination of care, and inpatient customer service. On measures of ambulatory care, including timeliness, customer service, and ambulatory education, SMC’s performance exceeds the top 25 percent level.
• SMC’s commitment to a “Patient First” culture has led to many innovative health care options. For example, to address its limited treatment options for myocardial infarctions, SMC and its largest competitor, located 25 miles away, created a collaborative initiative for coordinated handoffs of patients needing emergency cardiac catheterizations. Through this effort, “door-to-balloon” times (the critical period for assessing and diagnosing a heart attack and delivering the needed intervention) have been reduced from 120 to as low as 60 minutes, ensuring patients get the best and quickest treatment.
• SMC has achieved high performance levels in all areas measured by the Hospital Consumer Assessment of Healthcare Providers and Systems, with SMC outperforming its Indiana peers from 2008 to 2011 (year-to-date) in the areas related to the ability of nurses and physicians to listen, understand, and provide clear discharge instructions.
• SMC demonstrates role-model performance through its low overall rates of hospital-acquired infections, which have been maintained at or below 1 percent since 2008. There have been no occurrences of postoperative infections from bariatric surgeries, one of SMC’s focus areas. No patient has acquired ventilator-associated pneumonia since 2009, while central line-associated bloodstream infections have remained at low numbers since 2008, with zero cases in 2011 (year-to-date).
• SMC demonstrates excellence in measures of its operating margin, cash flow, and cash position, with its reported results comparing favorably to the Standard & Poor’s (S&P) “A-” and “AA” rated median levels. From 2008 to 2010, SMC’s gross revenue results showed growth in the organization’s strategic focus areas—women’s health, joint replacement, noninvasive cardiac care, cancer care, and bariatric surgery.

CMS Announces final details of Value Based Purchasing for Inpatient Acute Care

On April 29th, CMS announced the final rules of its upcoming Value Based Purchasing program for Inpatient Acute Care. This long anticipated program transitions the inpatient care provided to Medicare beneficaries from "pay for reporting" to "pay for performance".

The HHS press release itself is of little value to the healthcare quality professional. You can view it here: http://www.hhs.gov/news/press/2011pres/04/20110429a.html. However, it links to a CMS press release that contained more details. You can view it here: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=3947.

Although these rules become effective with fiscal year 2013, CMS also released the list of measures for 2014 as well.

The following are excerpts from the CMS press release:


PERFORMANCE SCORING:

Performance Period: CMS has established a performance period that runs from July 1, 2011 through March 31, 2012, for the FY 2013 Hospital VBP payment determination. CMS anticipates that in future program years, if it becomes feasible, it may propose to use a full year as the performance period.

Scoring Methods: CMS will score each hospital based on achievement and improvement ranges for each applicable measure. A hospital’s score on each measure will be the higher of an achievement score in the performance period or an improvement score, which is determined by comparing the hospital’s score in the performance period with its score during a baseline period.

For scoring on achievement, hospitals will be measured based on how much their current performance differs from all other hospitals’ baseline period performance. Points will then be awarded based on the hospital’s performance compared to the threshold and benchmark scores for all hospitals. Points will only be awarded for achievement if the hospital’s performance during the performance period exceeds a minimum rate called the “threshold,” which is defined by CMS as the 50th percentile of hospital scores during the baseline period.

For scoring on improvement, hospitals will be assessed based on how much their current performance changes from their own baseline period performance. Points will then be awarded based on how much distance they cover between that baseline and the benchmark score. Points will only be awarded for improvement if the hospital’s performance improved from their performance during the baseline period.

Finally, CMS will calculate a Total Performance Score (TPS) for each hospital by combining the greater of its achievement or improvement points on each measure to determine a score for each domain, multiplying each domain score by the proposed domain weight and adding the weighted scores together. In FY 2013, the clinical process of care domain will be weighted at 70 percent and the patient experience of care domain will be weighted at 30 percent.

Incentive Payment Calculations: CMS will utilize a linear exchange function to calculate the percentage of value-based incentive payment earned by each hospital. Those hospitals that receive higher Total Performance Scores will receive higher incentive payments than those that receive lower Total Performance Scores. CMS will notify each hospital of the estimated amount of its value-based incentive payment for FY 2013 through its QualityNet account at least 60 days prior to Oct. 1, 2012. CMS will notify each hospital of the exact amount of its value-based incentive payment on Nov. 1, 2012.

FISCAL YEAR 2013 MEASURES

Clinical Process of Care Measures
AMI-7a - Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival
AMI-8a - Primary PCI Received Within 90 Minutes of Hospital Arrival
HF-1 - Discharge Instructions
PN-3b - Blood Cultures Performed in the ED Prior to Initial Antibiotic Received in Hospital
PN-6 - Initial Antibiotic Selection for CAP in Immunocompetent Patient
SCIP-Inf-1 - Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision
SCIP-Inf-2 - Prophylactic Antibiotic Selection for Surgical Patients
SCIP-Inf-3 - Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time
SCIP-Inf-4 - Cardiac Surgery Patients with Controlled 6AM Postoperative Serum Glucose
SCIP-Card-2 - Surgery Patients on a Beta Blocker Prior to Arrival That Received a Beta Blocker During the Perioperative Period
SCIP-VTE-1 - Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered
SCIP-VTE-2 - Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery

Patient Experience of Care Measures (HCAHPS)
· Communication with Nurses
· Communication with Doctors
· Responsiveness of Hospital Staff
· Pain Management
· Communication About Medicines
· Cleanliness and Quietness of Hospital Environment
· Discharge Information
· Overall Rating of Hospital

ADDITIONAL MEASURES FINALIZED FOR FY2014

Mortality Measures:
· Mortality-30-AMI: Acute Myocardial Infarction (AMI) 30-day Mortality Rate
· Mortality-30-HF: Heart Failure (HF) 30-day Mortality Rate
· Mortality-30-PN: Pneumonia (PN) 30-Day Mortality Rate

Hospital Acquired Condition Measures:
· Foreign Object Retained After Surgery
· Air Embolism
· Blood Incompatibility
· Pressure Ulcer Stages III & IV
· Falls and Trauma: (Includes: Fracture, Dislocation, Intracranial Injury, Crushing Injury, Burn, Electric Shock)
· Vascular Catheter-Associated Infections
· Catheter-Associated Urinary Tract Infection (UTI)
· Manifestations of Poor Glycemic Control

AHRQ Patient Safety Indicators (PSIs), Inpatient Quality Indicators (IQIs), and Composite Measures:
· Complication/patient safety for selected indicators (composite)
· Mortality for selected medical conditions (composite)

Reducing Avoidable Hospital Readmissions

On June 4, 2010, at the Florida Hospital Association Meeting, the Health Research & Educational Trust provided this presentation, "Reducing Avoidable Hospital Readmissions," to give recent evidence of the extent and causes of avoidable hospital readmissions, describe congressional action in Patient Protection and Coverage Act, and describe support now available to help hospitals respond to heightened concern and financial pressures.

The presentation can be downloaded here: http://www.ahrq.gov/news/kt/red/readmissionslides/readmission.ppt

Within the presentation, the HRET's Health Care Leader Action Guide to Reduce Avoidable Readmissions is referenced. It can be downloaded here: http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2010/Jan/Readmission%20Guide/Health%20Care%20Leader%20Readmission%20Guide_Final.pdf

With readmission rates already being publicly reported and penalties scheduled to be imposed on hospitals with "excessive" readmission rates starting Oct 2013, now is a great time to optimize the care transition process.

Hospital Infection Rates Now Publicly Available

The Commonwealth Fund announced today that it has made hospital central line - associated bloodstream infection rates available on its www.whynotthebest.org website. The data source varies by state. Ten states have mandatory reporting. Data from other states are based on the hospital's voluntary reporting to the leapfrog group.

Specifically, a hospital specific standardized infection ratio is reported to enable comparison across hospitals.

Excerpts from the announcement is cut and pasted below:

Hospital Infection Rates Now Available on WhyNotTheBest.org
Users of WhyNotTheBest.org can now search for and compare data from more than 900 hospitals on the incidence of central line–associated bloodstream infections (CLABSIs)—one of the most lethal hospital-acquired complications. The data show wide variation in CLABSI incidence, in spite of strong evidence on how to prevent them. The data are available on WhyNotTheBest.org through a partnership among The Commonwealth Fund, The Leapfrog Group, and Consumers Union. Click here for information on how to locate hospitals reporting CLABSI data.

Recent improvements to the site make it easier to identify the time frame of performance data (by pointing to the information button above the measure names) and to view comparisons and trends (by following the links from the summary report to access "In-Depth Reports").

The goal of WhyNotTheBest.org is to foster health care quality improvement by promoting transparency and public reporting, and by providing tools and case studies to aid organizations in their own improvement efforts. According to patient safety expert Lucian Leape, M.D., public reporting and feedback are the best ways to encourage providers to deliver safer health care.

CMS to inspect 1/3 of all Ambulatory Surgery Centers this Year Regarding Infection Prevention Practices

In a press release from HHS Secretary Kathleen Sebelius on June 8, a clear signal was sent to ambulatory surgery centers that they will be receiving additional attention from CMS regarding their infection prevention and control practices.

The press release is cut and pasted here. Sections of interest to the healthcare quality professional are highlighted in red.


FOR IMMEDIATE RELEASE
Tuesday, June 8, 2010
Contact: HHS Press Office
(202) 690-6343


HHS Secretary Kathleen Sebelius Statement on Recent Study of Infection Control Practices in Ambulatory Surgical Centers

“Today, the Journal of the American Medical Association published a new study from the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS), which underscored the urgency behind the Obama Administration’s efforts to reduce healthcare-associated infections (HAIs).

The study found that among a sample of ambulatory surgical centers (ASCs) in three states, two-thirds had infection control lapses identified during routine inspections. This is concerning, because when lapses in infection control occur, in any healthcare setting, it puts patients at risk.

The good news is that we have seen progress in the reduction of HAIs in the hospital setting. Just last month, a new report from CDC demonstrated progress made in reducing HAIs in hospitals, further indicating that the steps we’re taking to reduce these often preventable infections are working. The report showed an 18-percent decrease in national central-line associated bloodstream infection incidence in hospitalized patients.

Ensuring the safety of all patients in all healthcare settings is a top priority for HHS. That’s why I announced last year that $50 million of American Recovery and Reinvestment Act funds to help states fight HAIs. Of that funding, $10 million went to states to improve the process and increase the frequency of inspections for ambulatory surgical centers.

In addition, the Affordable Care Act calls for improvements in healthcare quality and HAIs. Research shows that when healthcare facilities identify where and when infections are likely to occur and take concrete steps to prevent them, some infection rates have dropped more than 70 percent in hospitals.

We also continue to strengthen our collaborative efforts to achieve the goals in the HHS Action Plan to Prevent Healthcare-Associated Infections (http://www.hhs.gov/ophs/initiatives/hai/). In 2010, HHS will expand its Action Plan to include strategies to eliminate HAIs in ambulatory surgical centers and hemodialysis centers.

HHS’ Agency for Healthcare Research and Quality (AHRQ) is contributing to the reduction of infections in ASCs by investing in research projects to better understand the factors that lead to HAIs in ambulatory surgical settings. HHS agencies are also working together to incorporate infection control into the inspection process. CMS has committed to inspecting one-third of all ASCs nationwide this year. All ASCs have a responsibility to correct deficient practices. Failing to correct serious deficiencies will mean the risk of termination from the Medicare program.

Just because procedures are being performed outside the hospital doesn’t mean patient safety standards and attention to infection control do not need to be met. All healthcare providers and suppliers should take this as an opportunity to evaluate their current infection control policies, and more importantly, make sure their staff understand and follow them.”

To view the infection control audit tool currently used by CMS to better assess infection control practices in ambulatory surgical centers, please visit: http://www.cms.gov/manuals/downloads/som107_exhibit_351.pdf

Ventilator Bundle Adjusted: Daily Oral Care with Chlorhexidine

The following was posted on the IHI website regarding adjustments to the ventilator bundle made in May 2010. You can read the update (as well as implementation tips) in its entirity here.

You can read the updated description of the IHI Ventilator Bundle here: here



Daily Oral Care with Chlorhexidine
IHI added this element to the Ventilator Bundle in May 2010 following continued review of the literature and use of the element in the IHI Ventilator Bundle in Scotland for over a year. The recommended chlorhexidine solution strength is 0.12%.

Dental plaque biofilms are colonized by respiratory pathogens in mechanically ventilated patients. Dental plaque develops in patients that are mechanically ventilated because of the lack of mechanical chewing and the absence of saliva, which minimizes the development of biofilm on the teeth. Dental plaque can be a significant reservoir for potential respiratory pathogens that cause ventilator-associated pneumonia (VAP). Chlorhexidine antiseptic has long been approved as an inhibitor of dental plaque formation and gingivitis. As early as 1996, DeRiso and colleagues published a study that provided evidence to support the use of 0.12% chlorhexidine oral rinse as a prophylactic measure to reduce nosocomial respiratory tract infections in cardiac surgery patients. [1]

Since that time there has been much discussion about the utilization of chlorhexidine as an important adjunct to oral hygiene, but there have been few studies published that provide firm evidence that the use of chlorhexidine as a decontamination antiseptic reduces the incidence of ventilator-associated pneumonia. Chlorhexidine has been studied in two strengths: 0.12% and 0.2%. The US Food and Drug Administration recommends 0.12% oral chlorhexidine for use as mouth rinse. In a meta-analysis published in 2007 by Chan and colleagues in the British Medical Journal, eleven studies were evaluated for effect of oral decontamination on the incidence of ventilator-associated pneumonia and mortality in mechanically ventilated adults. Results of that analysis concluded that oral decontamination of mechanically ventilated adults using chlorhexidine is associated with a lower risk of ventilator-associated pneumonia. [2]

There is little if any evidence of other oral care processes having an effect on the development of VAP, but it makes sense that good oral hygiene and the use of antiseptic oral decontamination reduces the bacteria on the oral mucosa and the potential for bacterial colonization in the upper respiratory tract. This reduction in bacteria has been shown to reduce the potential for the development in ventilator-associated pneumonia for patients on mechanical ventilation.

References:

1. DeRiso AJ, Ladowski JS, DillonTA, Justice JW, Peterson AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest. 1996;109:1556-1561.
2. Chan EY, Ruest A, O’Meade M, Cook DJ. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: Systematic review and meta-analysis. British Medical Journal. 2007;10:1136.

Additional Reference:
Munro CL, Grap MJ, Jones DI, McClish DK, Sessler CN. Chlorhexidine, tooth brushing and preventing ventilator-associated pneumonia in critically ill adults. American Journal of Critical Care. 2009 Sep;18(5):428-437.

HCA achieved >96% Healthcare Worker Flu Immunization!!!

At the March 2010 meeting of the 5th Decennial International Conference on Healthcare Associated Infections, the Hospital Corporation of America reported that they were able to achieve >96% healthcare worker vaccination for seasonal influenza.

The Institute for Healthcare Improvement posted the powerpoint presentation on its website yesterday. You can find it here: http://www.ihi.org/IHI/Topics/HealthcareAssociatedInfections/InfectionsGeneral/EmergingContent/ImplementationFluVaccineStrategy.htm

The conference website has posted an abstract. It is copied and pasted below:

Abstract Title: Implementation of a Successful Seasonal Influenza Vaccine Strategy in a Large Healthcare System

Background: As part of a comprehensive seasonal influenza prevention strategy, the Hospital Corporation of America (HCA) implemented a program that required employees who could infect or become infected by a patient to receive the seasonal influenza vaccine or wear a surgical mask in patient care areas. HCA is the nation's largest provider of healthcare services, composed of locally managed facilities that include 163 hospitals, 112 outpatient centers and
368 physician practices in 20 states. The strategy was announced by the corporate CEO and Chief Medical Officer. A core group representing emergency preparedness, infection prevention, human resources, legal, pharmacy, communications, and supply was formed. This core group recommended strategy, provided tools, resources, and regular flu updates for the program. The reason for the program, as well as implementation strategies were relayed in a webcast to all facilities. Non vaccine strategies, such as cough and sneeze etiquette, proper hand hygiene, proper cleaning techniques, and hazards of Presenteeism were also introduced. Human resources policies were changed to accommodate time off needed by employees ill with the flu. Prior to the program, seasonal influenza vaccine rates for the 2008-2009 influenza season varied from a low of 20% to a high of 74% (Mean 58%).

Objective: To review the strategies and outcomes of a comprehensive seasonal influenza prevention program to include vaccination and declination rates.

Methods: Concurrent analysis. Consents and declinations were documented in a corporate wide electronic database.
Results: As of November 1, 2009, 140,599 employees were offered the seasonal influenza vaccination, with 135,584 accepting, or 96%. This correlates to clinical employees (98,067 total with 94,530 accepting.) A total of 5,015 employees declined the seasonal influenza vaccine. Reasons for declination were allergy (12%), contraindicated (7%), Fear (4%), pregnant (1%), religion (3%), and no reason given (73%).

Conclusions: The program resulted in a 65% increase in employee vaccine rates. Vaccine rates at unionized facilities were 95%; in non-unionized facilities they were 97%. A comprehensive vaccine strategy which includes vaccine or surgical mask use is successful in increasing vaccination rates.

Patient Safety ...in 3 words?

The following is cut and pasted directly from Abington Memorial Hospital's patient safety & quality web page.

You can go directly to the page here: http://www.amh.org/aboutus/patientsafetyandquality/three-words-video.aspx

You can go directly to the video here: http://amhweb.cachefly.net/Videos/aboutus/3Wordsvideo.swf

It only takes three words to tell someone how you feel, what you believe in or what’s important to you. At Abington Memorial Hospital, three words can describe our entire culture — Patient Safety First.

Patient Safety is AMH’s number one priority, and AMH employees are letting their patients, and each other, know just how important that priority is — with just three words.

Inspired by the popular Good Morning America segment, “Your Three Words,” AMH’s Center for Patient Safety and Healthcare Quality made a four-minute long video using the three-word concept. The video
features AMH employees from all departments — clinical, ancillary, support staff — offering their own personal three-word message of patient safety, while promoting safe behavior and teamwork.

AHRQ: 10 Patient Safety Tips for Hospitals

The Agency for Healthcare Research and Quality (AHRQ) recently updated their publication titled "10 Patient Safety Tips for Hospitals".

The 10 Tips are:

1. Prevent central line-associated blood stream infections.
2. Re-engineer hospital discharges.
3. Prevent venous thromboembolism.
4. Educate patients about using blood thinners safely.
5. Limit shift durations for medical residents and other hospital staff if possible.
6. Consider working with a Patient Safety Organization.
7. Use good hospital design principles.
8. Measure your hospital's patient safety culture.
9. Build better teams and rapid response systems.
10. Insert chest tubes safely.

The AHRQ publications contains links to resources supporting each of the above tips. The publication can be found here: http://www.ahrq.gov/qual/10tips.pdf.

The home page of the publication is here: http://www.ahrq.gov/qual/10tips.htm

Commonwealth Fund Highlights Accomplishments of Reid Hospital

Last week the Commonwealth Fund highlighted the SCIP achievements of Reid Hospital (Richmond, IN) by publishing a case study on both the Commonwealth Fund's website
as well as their http://www.whynotthebest.org/ website.

The case study can be download here: http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2009/Nov/1338_Edwards_Reid_Hospital_case_study.pdf

The following is the summary section of the case study with sections of interest in red.

Reid Hospital and Health Care Services is a high performer on process-of-care, or “core” measures. The measures, developed by the Hospital Quality Alliance (HQA), relate to achievement of recommended care in four clinical areas: heart attack, heart failure, pneumonia, and surgical care. This case study focuses on Reid’s achievement in providing recommended care to surgical patients in order to reduce the risk of a hospital-acquired infection.

Quality of care has been high on Reid’s agenda since the late 1990s, when the hospital began using a report card to track health care processes and outcomes. In 2004, the multidisciplinary Surgical Care Improvement Project Quality Action Team was formed, which hospital leaders’ credit with helping to achieve high performance on the surgical measures. The team is supported by:

• a strong board, administrators, and clinical leaders;
• a clinical information system that aligns physicians’ orders with hospital standards, and alerts nurses about the timing of critical care;
• physician and nurse champions;
• performance data analysis and feedback; and
• a "just do it" approach to quality improvement.
  

CDC Updates CA-UTI Prevention Guidelines

Last week the CDC released its updated CA-UTI Prevention Guidelines - last published in 1981.

The guidelines can be found here.

The following is an excerpt from the document's executive summary with sections of interest in red:

This guideline updates and expands the original Centers for Disease Control and Prevention (CDC) Guideline for Prevention of Catheter-associated Urinary Tract Infections (CAUTI) published in 1981. Several developments necessitated revision of the 1981 guideline, including new research and technological advancements for preventing CAUTI, increasing need to address patients in non-acute care settings and patients requiring long-term urinary catheterization, and greater emphasis on prevention initiatives as well as better defined goals and metrics for outcomes and process measures. In addition to updating the previous guideline, this revised guideline reviews the available evidence on CAUTI prevention for patients requiring chronic indwelling catheters and individuals who can be managed with alternative methods of urinary drainage (e.g., intermittent catheterization). The revised guideline also includes specific recommendations for implementation, performance measurement, and surveillance. Although the general principles of CAUTI prevention have not changed from the previous version, the revised guideline provides clarification and more specific guidance based on a defined, systematic review of the literature through July 2007. For areas where knowledge gaps exist, recommendations for further research are listed. Finally, the revised guideline outlines high-priority recommendations for CAUTI prevention in order to offer guidance for implementation.

This document is intended for use by infection prevention staff, healthcare epidemiologists, healthcare
administrators, nurses, other healthcare providers, and persons responsible for developing, implementing, and evaluating infection prevention and control programs for healthcare settings across the continuum of care. The guideline can also be used as a resource for societies or organizations that wish to develop more detailed implementation guidance for prevention of CAUTI.

Our goal was to develop a guideline based on a targeted systematic review of the best available evidence, with explicit links between the evidence and recommendations. To accomplish this, we used an adapted GRADE system approach for evaluating quality of evidence and determining strength of recommendations. The methodology, structure, and components of this guideline are approved by HICPAC and will be used for subsequent guidelines issued by HICPAC. A more detailed description of our approach is available in the Methods section.

Healthy People 2020 - Review Draft Objectives

Early last week the US Dept of Health and Human Services released the draft Healthy People 2020 objectives for public comments via the internet.

Historically, federal agencies have been guided somewhat by the objectives set in Healthy People. Every 10 years, the objectives are developed, reviewed, updated, and/or archived.

You can download the draft objectives here: http://www.healthypeople.gov/hp2020/Objectives/files/Draft2009Objectives.pdf

Or,...you can go to the following webpage to review the objectives and comment directly:
http://www.healthypeople.gov/hp2020/Objectives/TopicAreas.aspx

Note that Healthcare IT and Hospital Aquired Infections are established objectives in Healthy People 2020.

The entire press release from the AHRQ is below:

Opportunity for public comment on draft Healthy People 2020 objectives

The U.S. Department of Health and Human Services invites you to comment on the DRAFT set of objectives for Healthy People 2020. For three decades, Healthy People has provided a set of national 10-year health promotion and disease prevention objectives aimed at improving the health of all Americans.

Visit www.healthypeople.gov/hp2020 to
· View proposed draft objectives for Healthy People 2020
· Comment on the proposed objectives
· Comment on the topic areas
· Suggest additional objectives
· Suggest topic areas you feel are missing from the draft set

Your comments will help ensure issues important to you are included in Healthy People. Establishing objectives and providing benchmarks to track progress motivates, guides, and focuses action. Be part of the change. Comments will be accepted through December 31, 2009.

Visit www.healthypeople.gov/hp2020 today. Your feedback will help define the vision and strategy for building a healthier Nation.

AHRQ Tools and Resources to Prevent HAIs.

In early September, the AHRQ released a webpage highlighting research and resources related to the prevention of hospital acquired infections. This is an excellent site that links to tools and resources for both healthcare providers as well as healthcare consumers.

You can find the website here.

Joint Commission issues Sentinel Event Alert Regarding Leadership

On 8-27-09, the Joint Commission released a Sentinel Event Alert regarding leadership and its commitment to safety.

You can find the entire alert here.
The press release can be found here.

Within the alert are 14 recommendations for the governing body, CEO, and senior managers:

1. Define and establish an organization-wide safety culture that includes a code of conduct for all employees, including contract workers.
2. Institute an organization-wide policy of transparency that sheds light on all adverse events and patient safety issues within the organization, thereby creating an environment where it is safe for everyone to talk about real and potential organizational vulnerabilities and to support each other in an effort to report vulnerabilities and failures without fear of reprisal.
3. Make the organization’s overall safety performance a key, measurable part of the evaluation of the CEO and all leadership.
4. Ensure that caregivers involved in adverse events receive attention that is just, respectful, compassionate, supportive and timely. Also, make sure they have the opportunity to fully participate in the investigation, risk identification and mitigation activities that will prevent future adverse events.
5. Create and communicate a policy that defines behaviors that are to be referred for disciplinary action; include the timeframe that the disciplinary action should take place.
6. Regularly monitor and analyze adverse events and close calls quantitatively and communicate findings and recommendations to leadership, the board and staff. Conduct root cause analyses of adverse events. Look for patterns in root causes that identify latent hazards and weaknesses in the defenses against errors—the holes in the slices of cheese—and make sure they are addressed.
7. Regularly hold open discussions with risk management, performance improvement, physician, nursing and pharmacy leaders, and with physicians and staff caring for patients, to develop a true, unvarnished view of the safety risks and barriers to safety facing patients and staff. Patient safety rounds at the point of care could provide the ideal opportunity for these discussions, which should focus on learning and improvement, not blame or retribution.
8. Prioritize and address safety risks and barriers to safety according to a timeline, with the highest priority items getting immediate attention. Make a visible commitment of time and money to improve the systems and processes needed to defend against hazards and minimize unsafe acts. For example, some organizations create an emergency patient safety fund.
9. Establish partnerships with physicians and align their incentives to improving safety and using evidence-based medicine.
10. Add a human element and a sense of urgency to safety improvement by having patients communicate their experiences and perceptions to board members, executive leadership, medical staff, and other key leadership groups; also solicit patient input into safety design.
11. When planning and implementing safety improvements, use the expertise of front-line staff who understand the risks to patients and how processes really work.
12. Regularly measure leadership’s commitment to safety using climate surveys and upward appraisal techniques (in which staff review or appraise their managers and leaders).
13. When leaders assess managers during the annual performance review, make sure they ask about the safety issues the manager encountered, how they were handled, and the impact their actions had on reducing unsafe conditions.
14. Communicate to staff when their work improves safety. Reward and recognize those whose efforts contribute to safety.

Personal Opinion: Although senior leadership has the responsibility for creating a structure that is conducive to improving patient safety, senior leadership is also the least effective group to actually improve patient safety. It is the bedside staff that can impact patient safety the most - if allowed to by senior leadership. Maybe this list should have included more recommendations for senior leadership to empower the bedside staff to proactively assess and redesign their work flow to minimize risk factors?

2008 Indiana Medical Errors Report Released

On 8-20-09 the Indiana State Dept. of Health released its 2008 report on medical errors reported by hospitals, ambulatory surgery centers, and abortion clinics via the reporting system mandated by the Governor in 2005 to start CY2006.

The State's Medical Error Reporting System webpage is here: http://www.in.gov/isdh/23433.htm (Note: The State frequently changes its webpage urls and thus the link may become useless at any time. It was working this morning.)

The 2008 report itself can be found here: http://www.in.gov/isdh/files/2008_MERS_Report.pdf
Data Tables: http://www.in.gov/isdh/files/2008_MERS_Data_Tables.pdf
Appendix: http://www.in.gov/isdh/files/2008_MERS_Appendices.pdf

The 2008 Report also contains descriptions of patient safety improvements efforts and activities that are ongoing throughout the state.

Note that the reporting rules have changed for CY2009. Prior to 1-1-09, 27 events had to be reported. Twenty-Eight events are now covered by the reporting system. The new list is here: http://www.in.gov/isdh/files/28_REPORTABLE_EVENTS.pdf

The release of the report has been lightly covered by local media:
IndyStar: http://www.indystar.com/apps/pbcs.dll/article?AID=2009908210343
WTHR: http://www.wthr.com/Global/story.asp?s=10964770

Hospital Aquired Conditions Section @ National Guideline Clearinghouse

Most of us are probably aware of www.guidelines.gov as being a searchable clearinghouse of evidence-based clinical practice guidelines.

Did you know that there is a section specifically about preventing the hospital acquired conditions that CMS says they will no longer pay for?

http://www.guideline.gov/resources/hac.aspx


It appears that they (National Guidelines Clearinghouse (NGC), an initiative of the Agency for Healthcare Research and Quality (AHRQ)) intends to keep this page current. The most recent update was July 27th.

APIC Study Finds Hospitals Are Cutting Back on Infection Prevention???

The Association for Professionals in Infection Control and Epidemiology issued a press release on June 9th reporting its findings that hospitals are cutting back on the infection control/prevention function across the country.

You can download the press release here.

Excerpts:

The “2009 APIC Economic Survey” found that of nearly 2,000 infection preventionists who responded, 41 percent reported reductions in budgets for infection prevention in the last 18 months due primarily to the economic downturn.

According to the survey, three-quarters of those whose budgets were cut experienced decreases for the necessary education that trains healthcare personnel in preventing the transmission of healthcare-associated infections (HAIs) such as MRSA and C. difficile. Half saw reductions in overall budgets for infection prevention, including money for technology, staff, education, products, equipment and updated resources. Nearly 40 percent had layoffs or reduced hours, and a third experienced hiring freezes.

“Infection prevention departments at our nation’s healthcare facilities are severely understaffed and under-resourced,” said APIC CEO Kathy L. Warye. “Without enough trained professionals, funding and high-tech solutions that speed access to infection-related data, we are not going to continue to make progress in eliminating preventable infections. While cuts in staff, training and technology may ease budgets in the shortterm, the effect of increased infections will erode the bottom line over time, not to mention cause needless pain, suffering and death.”

The "Diff" in C. Difficile

Infectious Disease News published a story in March about a presentation by Dr. Dale Gerding at the Annual Meeting of the Society for Healthcare Epidemiology of America.

You can view the story here.

Essentially, it was reported that hand washing is not as effective as we want it to be for removing the C. Difficile spores. No usable product was found to be able to remove more than 90% of the spores. This reinforces the importance of wearing gloves.