AHRQ Safety Program for Long-term Care: HAIs/CAUTI

Cohort 4

May 6, 2015

Health Research & Educational Trust

Project Team Members

Organizational Lead Informational Webinar

DEB BOHR

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Learning Objectives

• Recognize project goals, project vitals and importance of the project in the long-term care environment

• Identify the approach to education, coaching and measuring progress

• Summarize the organizational lead responsibilities expectations in regards to recruitment

• Describe how HRET and the national project team will support lead organizations

• Recall upcoming key dates

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Agenda

Topic Presenter

Project Overview Deb Bohr

Program Interventions & Instructional Strategies Louella Hung

Measuring Progress & Data Collection Schedule AJ Rolle

HRET Support, Timeline & Key Dates Helen Plass

Organizational Lead Expectations, Recruitment & Enrollment Lindsay Kolczynski

Who to Contact, Q & A Lindsay Kolczynski

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Project Goals

Primary Goals—reduce CAUTI and improve Safety Culture• Develop/adapt evidence-based CAUTI elimination and safety practices and resources for LTCFs• Reduce CAUTIs• Improve safety culture

Secondary Goals—support expanded infection prevention efforts for C. diff, UTI, MDROs by providing education to:

• Improve hygiene practices (hand, environmental)• Promote antibiotic stewardship • Promote catheter stewardship• Reduce re-hospitalizations

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Project Vitals

Lead Organization

– Participation Period:• May 2015 – August 2016

– Activities include:• Recruitment• Engagement• Monitoring• Coaching/Support

Project Period for Cohort 4

– Participation Period:• July 2015 – August 2016

– Activities include:• 2 months of kickoff and facility

onboarding• 11 months of data collection,

educational activities and coaching

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Why This Project Matters

• 1-3 million serious infections annually in LTC facilities

• Approximately 380,000 residents die of these infections

• Urinary Tract Infection is one of the most common HAls in LTC facilities

• Infections are among the most frequent causes of transfer & readmissions from LTC facilities to acute care hospitals

• High prevalence of urinary catheters in hospital patients transferred to LTC facilities

Improving safety and quality of life for residents and their families is our overall aim!

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How will LTC Facilities Benefit from Participation

Potential to:

• Improve performance on Nursing Home Compare Quality Measures

• Enhance data collection skills and prepare for mandatory reporting of infection data (NHSN)

• Benchmark against other LTC facilities (project-level and nationally)

• Improve communication and relationships with referring hospitals

• Improve compliance with survey requirement related to quality of care, infection control, etc.

Project Partners

National Program Team (NPT)• Abt Associates• Association of Professionals in Infection Control & Epidemiology (APIC) • Baylor College of Medicine• Qualidigm • Society of Hospital Medicine (SHM)• University of Michigan

Partner Agency • Centers for Disease Control and Prevention (CDC)

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State, Regional or System-wide Lead Organizations

• Lead Organizations are key partners who are trusted by Long-term Care Facilities to lead them through a year of improvement

• Lead Organizations are subcontractors to HRET who coordinate the program in their state/region/constituents and serve as liaisons between NPT and their recruited facilities

• Examples of current Lead Organizations include: State and regional health care associations Multi-facility operators/long-term care communities Patient safety organizations Health systems QIN-QIOs

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PROGRAM INTERVENTIONS & INSTRUCTIONAL STRATEGIES

Louella Hung

How Will These Goals Be Achieved?

Clinical interventions

• Evidence-based infection prevention practices

• Indwelling catheter, UA/culture and antibiotic stewardship

• Strategies to avoid re-hospitalizations, catheter alternatives

Cultural interventions

• Learning from defects to understand and prevent adverse events

• Senior leadership engagement

• Front-line staff empowerment

• Teamwork and communication

• Regular team meetings

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Educational Sessions

In-person or virtual learning sessions: kickoff, mid-course and final• Slides, expert faculty, interactive activities, handouts, resources

Educational webinar/video series

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Name of series # of Topics Frequency What Format for Facility

Team Lead Format for Front-line Staff

Onboarding 4 Weekly Project orientation Webinar Trained by Facility Team Lead

Training Modules 4 Once every two weeks

Infection prevention Videos Videos, and trained by Facility Team

Lead

Safety Culture Survey Results Forum 1 Once Safety culture Webinar N/A

Content 9 MonthlyClinical and cultural interventions

Webinar Trained by Facility Team Lead

Education Series Schedule

Onboarding Webinar Series Date Time

1. Building a Culture of Safety Team Thursday, August 6 1:00 – 1:45 p.m. CT

2. CAUTI Definitions Thursday, August 13 1:00 – 1:45 p.m. CT

3. CAUTI Surveillance Thursday, August 20 1:00 – 1:45 p.m. CT

4. Data Collection Training Thursday, August 27 1:00 – 1:45 p.m. CT

Training Module Series Release Date

1. Hand Hygiene Week of Aug 31 N/A

2. Environment & Equipment Week of Sep 14 N/A

3. Isolation Precautions Week of Sep 28 N/A

4. Antibiotic Stewardship Week of Oct 12 N/A

Monthly Webinar Series Date Time

National Content 3rd Thursday of each month, beginning in November 11:15 a.m. – 12:00 p.m. CT

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Coaching Calls

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Ashley Hofmann, MSW

Katie Johnson, MHS

Anna Wojcik, MPH

What: State-/Region-/System-specific coaching call

When: Monthly, beginning in September

Who: Facilitated and run by the organizational lead

All facility team leads

Faculty Coach provides clinical and cultural expertise

HRET Advisor provides project management support

and technical assistance

Why: Review data and track project progress

Discuss educational webinars and project interventions

Share successes, challenges and best practices with other facilities

Ask Faculty Coach and facility teams to engage in use of project tools, resources

MEASURING PROGRESS & DATA COLLECTION SCHEDULE

AJ Rolle

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Purpose of Measurement

Measures are developed to support hard-wiring of resident safety processes with attention to the needs of the LTC environment.

Improving safety and quality of life for residents and their families is our overall aim!

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Why is Data Collection Crucial?

• Assesses the impact of the project’s clinical and cultural interventions on the

program goals to:

• Reduce urinary catheter use and CAUTIs

• Improve patient safety culture

• Guides quality improvement efforts by:

• Highlighting areas of success

• Identifying opportunities for improvement

Required Data Metrics and Schedule

Data Collected Frequency Time to Complete

Background/Cultural Measures

Registration1x to enroll 10 minutes

Facility Demographics Baseline 15 minutes

Safety Culture Survey Baseline and follow-up 10 minutes

Process Measures

Team Communication Guide Quarterly 10 minutes

Skills Questionnaire Baseline, mid-point, final 15 minutes

Outcome Measures

Catheter Utilization CAUTI rates Urine culture order rates Monthly

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Measurement Support

• Checklist tools to support awareness and adherence to evidence-based recommendations

• NHSN CAUTI definition assessment worksheet

• NHSN CAUTI definition pocket cards

• Support for survey and certification regulation compliance with:

• F-tag 315 (catheter with undocumented necessity)

• F-tag 441 (infection prevention/control failure)

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HRET SUPPORT, TIMELINE & KEY DATES

Helen Plass

How We Will Support You

Facility Recruitment & Enrollment Support• Flyer for you to customize• Facility informational webinars Weekly Updates

• Reminders, schedules, tips for success

Organizational Lead Training• Pre-training Webinar• Chicago in-person training• Organizational Lead Operations Manual

Program Website www.ltcsafety.org

Other: facility registration support; facility implementation manual; HRET advisor; subject matter experts; data support

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Cohort 4 Timeline

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Important Dates for Cohort 4

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Activity Date/TimeOrg Lead Pre-Training Webinar Thursday, May 28 at 12:00-1:30 p.m. CT

Org Lead Training Monday, June 22 in Chicago

Facility Informational Webinars Wednesday, June 3 or Thursday, June 23 at 11:00 a.m. CT

Learning Session #1 July 1-24

Registration Opens Today, Due July 24

Facility Demographics Questionnaire Opens July 1, Due July 31

Skills Questionnaire Opens July 1, Due July 31

Org Lead Subcontract June 19

Onboarding Educational Series 3rd Thursday of the Month from 1:00-1:45 p.m. CT beginning in August

Patient Safety Culture Survey Week of August 24, Due Sept 30

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ORGANIZATIONAL LEAD EXPECTATIONSRECRUITMENT & ENROLLMENT

Lindsay Kolczynski

Organizational Lead Expectations

• 25-30% FTE over a 14-15 month period

• Recruit ≥ 15 LTCFs

• Coach Facility Team Lead

• Communicate with LTCFs weekly by sharing HRET-prepared weekly updates

• Monitor LTCF engagement

• Educational activity participation

• Data submission

• Safety culture participation

• Monitor LTCF progress toward program goals

• Follow-up with struggling LTCFs

• Share successful strategies of exemplary LTCFs with HRET and national team

• Attend monthly calls with HRET/NPT and other org leads

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LTC Facility Team Lead Expectations

• 100-105 hours over a 13-14 month period (~4.5% FTE)

• Form the facility team

• Attend all educational activities

• Train staff via the train-the-trainer module on each educational module

• Ensure data collection requirements are met

• Monitor progress toward goals

• Utilize expertise of the project team and your faculty coach

• Utilize project tools and resources

• Celebrate successes with facility team

Recruitment & Registration

Recruitment Support• Template emails and program materials to customize and send to facilities• Informational slide deck; HRET team available to present• HRET-sponsored Facility Informational Webinars

Registration Support• Enrollment Packet

Facility Commitment Letter Data Use Explanation Team Roster

• Online Facility Registration

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Contact information for tips for facility recruitment strategies:David Schulkedschulke@aha.org

Deb Bohrdabohr52@gmail.com646-678-4280

Next Steps

1. Confirm participation in AHRQ Safety Program for Long-term Care: HAIs/CAUTI by contacting either

Deb Bohr dabohr52@gmail.com 646-678-4280

David Schulke dschulke@aha.org

2. RSVP to Ashley Hofmann (ahofmann@aha.org) to participate in Org Lead Training on Monday, June 22 in

Chicago by May 22

3. Email signed subcontract to Jeanette Lyons (jlyons@aha.org) by June 19

4. Ask all interested LTCFs to save-the-date for the Facility Informational Webinar on June 3 or June 23 at

11:00 a.m. CT

5. Recruit LTCFs and ensure they register by July 24

6. Identify a date and location for Learning Session #1 between July 1-24

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QUESTIONS?

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Questions