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Kentucky Hospital Improvement
Innovation Network
January 2019
Donna says “Hello” from the CMS Quality Conference in Baltimore Maryland!
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Agenda
1. Welcome! And Happy New Year!
2. K-HIIN Data/Info: CDI/C. Diff/Clostridium Difficile Infection
3. Info-Nuggets: CDI
a) CDI Information from Deb Campbell
b) Hospital Highlight – Jewish Hospital
c) Hospital Highlight – Baptist Health LaGrange
d) Hospital Highlight – St. Claire Regional Medical Center
4. Pharmacy and ADE Nugget
5. Follow up Report - CPHQ Review Course
6. Upcoming Events
a) K-HIIN Webinars and Events
b) HRET HIIN Webinars
7. Questions and Wrap Up 4
CDI SIR
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C. diff SIR - all except NICUs (NHSN only)
K-HIIN Baseline (2015) HRET Baseline K-HIIN Rate HRET Rate
CDI Rate
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Clostridium Difficile Rate
K-HIIN Rate HRET Rate K-HIIN Baseline HRET Baseline K-HIIN Goal
C. diff Sprint
HRET HIIN C diff Sprint
October-November 2018
4 content webinars
Pre and post assessments
Use of a Process Discovery Tool
1-2 Coaching Calls with Deb C
Provision of supporting literature, toolkits, order set examples, etc.
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C. diff Sprint
• Participating Hospitals
–Baptist Health LaGrange
–Georgetown Community
–Kings Daughter Medical Center
–Jewish Hospital Downtown
–St. Claire Regional Medical Center
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C. diff Sprint
Kentucky CDI mini-sprint
*Invitations went out the week of 1/14/19
–Encourage use of Process Discovery Tool
–Offer support material
–Offer coaching calls/visits
–Focuses on ACTUAL gaps
– Provides documentation
of need for change9
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• What did you find from your mini-RCAs?
• What intervention(s) did you choose?
• What small test of change did you perform and what did you learn?
• Current state?
CDI Sprint Report Out – Jewish Hospital
CDI Sprint Report OutBaptist LaGrange
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• What did you find from your mini-RCAs?
– Rate was already very low. 1 in 6 months
– Aware of “test for cure” already
– Discovery tool saves a great deal of time and allows ability to focus on what factors would impact rate
• What intervention(s) did you choose?
– Worked with medical staff including physician who ordered inappropriate test
• What small test of change did you perform and what did you learn?
– Nurses empowered to “stop the line” if testing not indicated.
• Size of hospital allows intense scrutiny by IP of all testing for C diff, ability to intervene if necessary
CDI Sprint Report OutSt. Claire HealthCare
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From the HAI-CDI Sprint
• We found we did not have a standard process for testing.
We had previously implemented:
Q4H rounds to remove trash/linen from C.diff patient rooms.
Confirmed Environmental Service practices and competency skills meet current guidelines.
Surveillance rounds for hand hygiene and isolation compliance.
Antibiotic Stewardship
Swarm all HAI-CDI’s
Placing patients with diarrhea in rooms that had ante rooms.
Using a flag process so all staff entering the patient room would know to do hand hygiene with soap and water.
CDI Sprint Report OutSt. Claire HealthCare
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We were still having HAI-CDI’s!
• After Infection Prevention (IP) went through the CDI Sprint we:
Formed an interdisciplinary team to review the EBP and current standards.
• IP created a policy and nurse driven protocol to have one standard process for all patients admitted to the hospital that have diarrhea.
Upon admission days 1, 2, or 3, if patient has diarrhea, using the Bristol Stool Chart, if stool looks like #7 on the chart, the patient is tested for C.diff.
CDI Sprint Report OutSt. Claire HealthCare
On admission day 4 or after, patient has to meet certain criteria to be tested for C.diff. The criteria includes:
• Three liquid stools (type 7 on the stool chart) in a 24 hour period AND has 1 or more of the following:
oElevated WBC > 12
oAbdominal Pain
oTemperature > 38 degrees Celsius AND
o Has no other etiology or cause for diarrhea such as bowel prep, tube feedings, etc. within the last 48 hours AND
oStool has not been tested* during current admission AND
o Patient has not had a positive C.diff test in last 30 days (Do not test for cure)
• Or at any time during hospital stay per physician order.14
CDI Sprint Report OutSt. Claire HealthCare
• The policy/protocol was approved by the Infection Prevention, Acute Medical Service Line, and the Interprofessional Care Council Committee.
• The physicians and nursing staff are engaged in the new policy and protocol.
• In a retrospective review of the past four months, of the 5 patients who tested positive for C.diff and had to be counted as HAI-CDI, 4 of the 5 patients would not have been HAI-CDI but, it would have been counted present on admission, if we had been following the new policy and protocol.
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CDI Sprint Report OutSt. Claire HealthCare
• Nursing staff will have copies of the Bristol stool chart to show patients to verify the stool does conform to the shape of the container.
• We are currently educating nursing staff. Once this is completed, we will implement the policy/protocol fully.
• Our rural hospital is in Kentucky.
*If stool has been tested on this admission, the provider will be contacted to obtain an order prior to testing, if the previous test was negative and the patient is still symptomatic.
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Pharmacy/ADE News
ADE Hypoglycemia Relay Summary – Thursday January 31,
– Noon-1pm EST
– Owensboro Health
– Ephraim McDowell Regional Medical Center
– Jennie Stuart Medical Center
KHA Quality Conference, March 6-8, Holiday Inn Louisville East
– Pharmacist Panel on Friday, March 8, during lunch
– Society of Infectious Disease Pharmacists AMS Certification
• Chad Harvey-St Elizabeth Healthcare
• Larry Abplanalp-Carroll County Memorial Hospital
• Monica Zachariah-St Elizabeth Healthcare
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Pharmacy/AMS News
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Recently posted on K-HIIN AMS ListservDoes the patient have an infection that requires antibiotics?Have I ordered the appropriate cultures before starting antibiotics? What empirical antibiotics should I initiate?A day or more has passed. Can I stop antibiotics? Can I narrow therapy? Can I change from intravenous to oral therapy?What duration of antibiotic therapy is needed for this patient’s diagnosis?
**HRET HIIN webinar on Targeting Antibiotic Prescribing this Friday, February 1, 130p-230p EST. **3 part webinar series, February 14-Managing Demand; March 22-Conquering Measurement.
Pharmacy/ADE News
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ADE missing data for K-HIIN
–Report monthly in Kentucky Quality Counts
• Anticoagulation
• Hypoglycemia
• Opioid Safety
Events – CPHQ Review!
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More CPHQ pictures…
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Upcoming Events – K-HIIN and in-state
1. February 18-22, 2019 – Wound Care Certification Course, at KHA Offices, Louisville. Registration has closed.
2. February 27-28, 2019 – Kentucky IP Conference: Contemporary Topics in Infection Prevention, Hilton Lexington/Downtown, see Andrea Flinchum for details
3. March 6-8, 2019 – KHA Quality Conference, Louisville, registration is open. See Media Library for brochure and reimbursement form (up to three per hospital, travel included if >50 miles from the conference)
4. March 19-21, 2019 – CHEST Train the Trainer Course, Saint Joseph Hospital, Lexington, agenda and details coming soon, application and flyer in Media Library.
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Upcoming Events – K-HIIN and in-state
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Upcoming Events – HRET and National
1. HRET HIIN ADE Relay Summary Webinar
January 31, 12:00pm ET
2. HRET HIIN Readmissions – MVP Webinar #5
February 1, 12:00pm ET
3. Antibiotic Stewardship: Targeting Prescribing
February 1, 1:30pm ET
4. VAE Sprint Summary Webinar
February 5, 12:00pm ET
5. HRET QIN Falls and Pressure Ulcers Webinar
February 7, 3:00pm ET
6. PVAP Measure Training #1
February 8, 12:00pm ET
7. CAUTI Fishbowl #3
February 12, 12:00pm ET24
Upcoming Events – HRET and National
8. Antibiotic Stewardship: Managing Demand
February 14, 12:00pm ET
9. PVAP Measure Training #2
February 15, 12:00pm ET
Find registration links to these webinars at www.hret-hiin.org/events
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More K-HIIN Opportunities--
• TeamSTEPPS workshops are available! Contact us if you are interested in a Master Trainer Workshop or an Essentials course at your hospital!
• We haven’t had a Patient Safety Hero in a little while – who do we need to recognize??
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And speaking of TeamSTEPPS…
Which goes along with HSOPS…HRET is looking for some great stories about how you have used your patient safety scores to drive culture change!
Has your hospital achieved success in improving your patient safety culture scores on the Hospital Survey on Patient Safety Culture™ (SOPS™)? If so, the Agency for Healthcare Research and Quality (AHRQ) would like to showcase your story so that others can benefit from your experience. They are looking for examples of organizations that have successfully improved their scores on the hospital and other surveys (medical office, nursing home, pharmacy and ambulatory surgery center) on patient safety culture. They are especially interested in hearing your answers to the following questions:
– How have you used results from one of the Surveys on Patient Safety Culture to identify improvement opportunities?
– What specific initiatives or strategies did you use to improve your scores?
– How much did your patient safety culture scores improve?
– What did you learn from your improvement efforts that might benefit other organizations?
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HSOPS and TeamSTEPPS cont’d.AHRQ’s aim is to identify improvement stories that they can share through a
national webcast series or case studies on the SOPS web site.
If you have an improvement story to share, the HRET HIIN Culture of Safety Team and AHRQ would love to hear from you!
If you have any questions about the AHRQ request or an SOPS story to share, please send these by January 31 to [email protected] with “SOPS Improvement Story” as the subject line.
In addition, if your improvement story about using the AHRQ Hospital Survey on Patient Safety CultureTM (SOPSTM) describes an approach to advance both workforce and patient safety, we would encourage you to share it with the LISTSERV.
How are you working to improve key survey domains like handoffs and non-punitive response to error?
What have you done to improve psychological safety of your teams?
Please share!
Thanks in advance for your willingness to share to advance efforts in the field! 28
Kentucky Hospital Improvement Innovation Network
Thanks for being part of our team!
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Timeline and Next Steps
• Continue entering Monitoring Data into KQC
• Join the events as your schedule allows
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KEEP
CALM
AND
HIIN
ON
Questions?
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