OB Hemorrhage Bundle Implementation AIM Patient Safety OB Hemorrhage Bundle Implementation

How are we doing so far? 23 of 24 delivery facilities participating in the bundle implementation Kick-Off meeting March 25, 2018 with over 85 attendees Four years of baseline data entered into the AIM Data Portal Three full quarters of implementation data submitted by the participating facilities Recognized at the AIM National level for our participation rate and progress!

Bundle elements Process, Structure and Outcome measures Checklists and toolkits for facilities to reference and use Resources, references, videos, webinars and electronic modules for education Policies, forms and protocol samples for building facility specific

How does wEST vIRGINIA compare? Comparison to other state collaboratives engaged in the OB Hemorrhage Bundle Implementation

SMM among all delivering Women Outcome measure 2 – Collaborative comparison WV is compared to the other perinatal collaboratives around the country that are working on the OBH bundle.

Outcome measures Method for collection of outcome measures - Health Care Authority (sister-agency for the Office of Maternal, Child, and Family Health OMCFH) Collected through Hospital Discharge Data (HDD), as reported from HDD file Standardized ICD 9 and 10 diagnosis and procedure codes provided by Federal partners through the AIM project A crosswalk was used to compensate for the ICD transition from 9 to 10. Data based on Admission Year Hospital-level data collected using Hospital Medicare Provider numbers

Outcome measure results This is the baseline data for WV. 6 years of baseline data that demonstrates a fairly stable rate of M&M. However, a steady rate of decrease in M&M among women experiencing OB H since 2015.

SMM among all delivering Women Outcome measure 2 – WV Collaborative rate

Outcome measure 2 WV Hospital Distribution – 2017 For the participating hospitals in WV we have a distribution rate from 1.7 % to 0% for all M&M among delivering women.

SMM among all delivering Women Outcome measure 2 – WV Collaborative rate

SMM among Hemorrhage cases Outcome measure 4 This is how we compare to other collaboratives, in the area of sever Morbidity and Mortality among the women diagnosed as having experienced an OB Hemorrhage.

Outcome measure 4 WV Hospital Distribution – 2017 Among women who have experienced an OB hemorrhage, this is the distribution of Severe M&M experienced.

Process Measures

Process measure – hospital distribution Hemorrhage risk assessment – Q2 2018 The process measure asks how many women had a hemorrhage risk assessment completed? The right side of the screen indicates that of those hospitals with HRA in place, they are close to the 90-100% target. Those on the left, are still in the development and implementation phase.

Structure measures OF the two elements set as the first goals, the establishement of the hemorrhage cart is at 100%, and the policy and procedure implementation has increased from 56.5% to 65.2%. I know we have several facilities still in the writing and development phase of this policy/protocol development. This should be a stage type policy/protocol that demonstrates escalation of the response based on patient response.

Structure measure 4 Hemorrhage cart Does your hospital have OB hemorrhage supplies readily available, typically in a cart or mobile box?

Structure measure 5 Unit policy and procedure Does your hospital have an OB hemorrhage policy and procedure (reviewed and updated in the last 2-3 years) that provides a unit-standard approach using a stage-based management plan with checklists? There is animation on this slide – at first the slide will have the chart with March 2018 being shown at 56.5% - then on click the next chart will appear over it that highlights November 2018 with an in place percent of 69.6%

How do all the elements work together? Outcome measures are received directly from coding and billing process Structure measures – tangible items in place Process measures – policies, protocols, checklists, forms etc. Measure Hospital A Comp. Hospitals Outcome 6% 2.5% Process 70-70% 90 – 100% Structure 5 out of 6 6 out of 6 Each facility can compare their outcomes, process and structure measures progress to other hospitals of like size. You can compare element for element. How are you doing compared to the other facilities in the state that have a similar delivery rate?

What issues are we working on now? Quantitative blood loss Education OB Hemorrhage Staged Protocols and Policies Continue implementing the Hemorrhage Risk Assessments

Process measures – nurse and provider education The process measure for education asks if the nurses or providers have had any education related to OB Hemorrhage within the last two years. This demonstrates that we have begun to develop education for the nursing staff, but the providers are still needing quality accessible education on hemorrhage. This is a recognized barrier for most facilities.

Process measure – blood loss measurement This is one of the next goals for the implementation bundle. As you can see many facilities are already working on this and we have increased our rate of those with QBL in place from 25% to over 40%. This is wonderful news and shows a great level of motivation and interest in completing the project.

Family Support Services Patient Team Huddles Event Debriefs M&M Case Reviews Family Support Services Critical Elements Shift and team huddles to prepare for possible or current changes in patients Immediate debriefs – what went well? What could have gone better? Formal multi-disciplinary case reviews of outlier events and outcomes Support for family during and after event – explanations, education follow up

Data submission for all of 2019 When will we get there? Data submission for all of 2019 Complete all process and structure measures Celebrate at 2019 Perinatal Summit!