learning session 3: cdi tracer and assessment tool€¢training 18 assessment and tracer 19 •...
TRANSCRIPT
Learning Session 3: CDI Tracer and Assessment Tool
Health Services Advisory Group (HSAG)Thursday, April 19, 2018
National Nursing Home Quality Care Collaborative (NNHQCC) II and the Clostridium difficile Infection (CDI) Initiative
Presenters
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Keith Chartier, MPH
Associate Director
602.801.6906
Eli DeLille, RN, BSN, CIC
Quality Improvement (QI) Specialist, Infection Preventionist
216.644.3998
Debbie Shaeffer, LPN
QI Specialist
614.301.0969
Objectives
• Introduce and explain HSAG’s new CDI Tracer and Assessment Tool for long-term care facilities (LTCFs).
• Recognize gaps in your nursing home’s policies and procedures.
• Learn how to possibly utilize the CDI Tracer and Assessment Tool in your existing Quality Assurance & Performance Improvement (QAPI) program.
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What is a QIN-QIO?
• Funded by the Centers for Medicare & Medicaid Services (CMS)
– Quality Innovation Network-Quality Improvement Organization (QIN-QIO) in each state
– Dedicated to improving health quality at the community level
– Ensures people with Medicare get the care they deserve, and improves care for everyone
Department of Health & Human
Services
Centers for Medicare &
Medicaid Services
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New National QIN-QIO Structure
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HSAG’s QIN-QIO Responsibility
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Nearly 25 percent of the nation’s Medicare beneficiaries
HSAG is the Medicare QIN-QIO for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands.
QIN-QIO Areas of Focus
QIO Work
Patient is at the center of care
Cardiac
HealthDisparities in
Diabetes
Transforming Clinical Practice
Antibiotic Stewardship in Communities
Coordination of Care
Behavioral Health
Healthcare-Acquired
Conditions in Nursing Homes
Support of Clinicians in the
Quality Payment Program
Adult Immunizations
Improve Hand Hygiene and
Injection Practices in
ASCs*
*ASCs=Ambulatory Surgical Centers
QIO Work
Patient is at the center of care
Cardiac
HealthDisparities in
Diabetes
Transforming Clinical Practice
Antibiotic Stewardship in Communities
Coordination of Care
Behavioral Health
Healthcare-Acquired
Conditions in Nursing Homes
Support of Clinicians in the Quality
Payment Program
Adult Immunizations
Improve Hand Hygiene and
Injection Practices in
ASCs
Improve Nursing Home Quality
• All nursing homes are invited to join
Medicare’s National Nursing Home
Quality Care Collaborative (NNHQCC).
– An “all-teach, all-learn” quality improvement effort designed to ensure residents receive the highest quality of care.
– Collaborate with peer nursing homes and expert speakers through face-to-face meetings and webinars while earning no-cost continuing education units (CEUs).
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Improve Nursing Home Quality
• The NNHQCC II
• CDI Initiative
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NNHQCC II
12 *QM=Quality Measure
CDI Initiative
13 *NHSN=National Healthcare Safety Network
First, What is NHSN?
• National Healthcare Safety Network (NHSN)
• Operated by the Centers for Disease Control and Prevention (CDC)
• Currently utilized by hospitals
• Secure federal mainframe
– Need for Secure Access Management Services (SAMS) card
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What Can NHSN Do For CDI?
• Facility’s CDI rate (LTCF-Onset vs. On Admission)
• Identify not just residents, but units or neighborhoods with CDI issues
• Aggregate data from multiple facilities (need rights)
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CDI Tracer and Assessment Tool
Fast Facts
• Spore forming bacteria– Difficult to kill on surfaces– Difficult to treat
• Reoccurs in about 1 in 5 patients who contract the illness
• People on antibiotics are 7–10 times more likely to get CDI and for 1 month post treatment
• Occurs most commonly in hospitals, nursing homes, and outpatient settings
• More than 80 percent of CDI deaths occur in people age 65 and older– Prompt identification and
appropriate treatment is crucial to improve outcomes
17 Source: https://www.cdc.gov/hai/pdfs/cdiff/CDiff-One-Pager.pdf
Feedback From Our Partners
• Develop tools and resources that meet the needs of post-acute partners
– Assistance with NHSN reporting
– Provide NHSN data reports
– Infection prevention support for CDI
• Gap assessment (Tracer)
• Education
• Audit tools
• Training
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Assessment and Tracer
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• On-site visit
• Performed by QIO
• Quality improvement specialist
• Engages frontline staff members
• Tracer methodology
• Focuses on flow of patient
• Targets high-risk areas
• Based on the Targeted Assessment for Prevention (TAP) Strategy
CDI Tracer and Assessment Overview
• NHSN data review
• General interview
• Frontline staff member interview
• Pharmacy interview
• Lab interview
• Dietary interview
• Environmental services interview
• Medical record review
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New CDI Report from HSAG
NNHQCC CDI Report
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General Interview
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Frontline Staff Members
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Pharmacy
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Lab
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Dietary
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Environmental Services
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Medical Record Review
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Testing Algorithm
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Resource is based on feedback from multiple partners across
the QIN looking at high-risk areas of opportunity.
Hand Hygiene Audit Tool
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CDC and the WHO* have hand hygiene campaign
information available (posters, signs, brochures,
and audit tools).
*WHO=World Health Organization
Resident/Staff Education
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Resources are up to date, easy to understand, and available for a
wide variety of subjects.
https://www.cdc.gov/HAI/pdfs/cdiff/Cdiff_tagged.pdf
Infection Prevention (IP) Education
CMS Creating an IP course
– Available spring 2019
– On-demand
– No cost
– Topics include:
• IP scope of responsibilities
• Infection surveillance
• Hand hygiene
• Medication safety
• Antibiotic stewardship
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How Can the CDI Tracer and Assessment Tool Fit into QAPI?
Worksheet to Create a Performance Improvement Project Charter (PIP) Page 1
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• Name of project: Practices/protocols for CDI and outbreak control
• Problem(s) to be solved: Improper
hand hygiene, improper cleaning protocols, improper linen handling
• Background: Increase in the infection
rate for CDI episodes
• Goal: Decrease # of episodes of CDI infections within 90 days
• Scope: CDI cases occurring on skilled unit
Worksheet available at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/downloads/PIPCharterWkshtdebedits.pdf
Worksheet to Create a PIP Charter Page 2
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• Project Approach
• Project Phase: Dates for initiation,
planning, implementation, monitoring, and closing
• Project Team: Not just about who,
but what is their role in this PIP
Worksheet available at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/downloads/PIPCharterWkshtdebedits.pdf
Worksheet to Create a PIP Charter Page 3
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• Barriers: Time, lack of education, location of handwashing stations
• Project Approval
Worksheet available at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/downloads/PIPCharterWkshtdebedits.pdf
PIP Page 1
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Worksheet available at https://www.hsag.com/contentassets/0de8e0acb3524235ab5ddc8633b0b7c5/perfor
mance-improvement-plan-worksheet.pdf
PIP Page 1 (cont.)
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Worksheet available at https://www.hsag.com/contentassets/0de8e0acb3524235ab5ddc8633b0b7c5/perfor
mance-improvement-plan-worksheet.pdf
PIP Page 2
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Worksheet available at https://www.hsag.com/contentassets/0de8e0acb3524235ab5ddc8633b0b7c5/perfor
mance-improvement-plan-worksheet.pdf
PIP Page 2 (cont.)
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Worksheet available at https://www.hsag.com/contentassets/0de8e0acb3524235ab5ddc8633b0b7c5/perfor
mance-improvement-plan-worksheet.pdf
Questions
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?????
HSAG NHSN Resources
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www.hsag.com/nh-nhsn-resources
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Email us to be added!
Contact Us!
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Questions? Comments? Assistance?
Reach out to your state QIO.
Thank you!
This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health
and Human Services. The contents presented do not necessarily reflect CMS policy.Publication No. QN-11SOW-C.2-04132018-01