1. CUSP for Mechanically Ventilated Patients
Strategies for Collecting and Entering Daily Early Mobility Measures
Sean Berenholtz, MD, MHS, FCCM
Program support provided by MHA Keystone Center.
Scientific expertise and educational presentations provided by Harvard Medical School.
November 9, 2018

2. Objectives
Review and discuss Early Mobility data elements and definitions.
Review strategies that other ICUs have used to collect the data elements.
Discover the different data reports that you can download and share with your team.

3. Objectives
Review and discuss Early Mobility data elements and definitions.
Review strategies that other ICUs have used to collect the data elements.
Discover the different data reports that you can download and share with your team.

4. November 9, 2018

5. November 9, 2018

6. Polling Question
Have you begun using the Daily Early Mobility Measures Form?
Yes No
Unsure
This question is not applicable to me
November 9, 2018

7. Fill out for all beds Track by bed, not by patient Complete Bed number
Whether the patient in that bed was intubated or trached and on mechanical ventilation at the time of observation
Y = Yes
N = No
E = Empty bed
November 9, 2018

8. Date of intubation Enter the date the patient was intubated
If the date is not available*, enter admission date (either to the unit or to the hospital)
If the patient is extubated and re-intubated within 24 hours, use the original date
*i.e., when from an outside institution
November 9, 2018

9. Sedation Scale RASS = Richmond Agitation Sedation Scale
SAS = Riker Sedation-Agitation Scale
NU = Unit uses neither RASS or SAS
If NU, skip to Delirium Assessment
November 9, 2018

10. Sedation Scale If you entered ‘RASS’ Target Actual
What is the target RASS or SAS score for this patient?
Actual
What is the actual RASS or SAS score for this patient?
November 9, 2018

11. Delirium Assessment CAM-ICU = Confusion Assessment Method for the ICU
ASE = Attention Screening Exam
NU = Unit uses neither CAM-ICU or ASE
If NU, skip to SAT
November 9, 2018

12. Confusion Assessment Method for the ICU (CAM-ICU)
November 9, 2018

13. Confusion Assessment Method for the ICU (CAM-ICU)
The Society of Critical Care Medicine’s 2013 pain/agitation/delirium (PAD) clinical practice guidelines recommend the CAM-ICU or the Intensive Care Delirium Screening Checklist (ICDSC) as the most valid and reliable delirium screening tools, and that moderate to high risk patients be screened at least once per nursing shift.
November 9, 2018

14. Delirium Assessment - Attention Screening Exam (ASE)
November 9, 2018

15. Delirium Assessment - Attention Screening Exam (ASE)
ASE is feature 2 of the CAM-ICU.
ASE is a second test.
The goal of ASE is to determine if a patient can follow a simple command (pay attention) for that period of time.
Inattention is the cardinal feature of delirium and must be present to diagnose delirium.
November 9, 2018

16. Delirium Assessment - Attention Screening Exam (ASE)
If the CAM-ICU is not yet feasible in your unit, we recommend that patients at least undergo the ASE once per nursing shift.
For centers not using the full CAM-ICU, conducting the ASE is a good barometer of the presence or absence of delirium. This test may be abnormal due to disease, drugs or other causes.
November 9, 2018

17. Delirium Assessment - Attention Screening Exam (ASE)
The exam consists of the provider reading the following sequence of letters:
‘S A V E A H A A R T’ or ‘C A S A B L A N C A’ or ‘A B A D B A D D A Y’
The patient is told to squeeze the provider’s hand when the letter ‘A’ is stated.
An error is defined as no squeeze with letter ‘A’ or a squeeze on a letter other than ‘A’. The number of errors is counted. Inattention is present if the patient commits more than 2 errors. If the patient squeezes on every letter or doesn’t squeeze on any letter, then assign an error count of 10.
November 9, 2018

18. Polling Question Which delirium assessment does your ICU use? CAM-ICU
ASE
Both CAM-ICU and ASE
Neither
I don’t know
This question is not applicable to me
November 9, 2018

19. Mobility Highest Level of Mobility
What was the highest level of mobility achieved by the patient in the last 24 hours?
November 9, 2018

20. November 9, 2018

21. Mobility Perceived Barrier to Achieving a Higher Level of Mobility
What prevented the patient from being mobilized to a higher level?
November 9, 2018

22. Enter the code associated with the answer.
Perceived barrier codes are listed on the back of the data collection sheet.
Enter the code associated with the answer.
If multiple codes apply to a patient, please select the LOWEST number.
November 9, 2018

23. Mobility – PT/OT Physical Therapy Occupational Therapy:
Did the physical therapist evaluate or treat the patient within the last 24 hours?
Occupational Therapy:
Did the occupational therapist evaluate or treat the patient within the last 24 hours?
November 9, 2018

24. Events
Did the patient have an “event” (as defined on the back of the data collection sheet) while being mobilized within the last 24 hours?
Event codes are listed on the back of the data collection sheet
November 9, 2018

25. November 9, 2018

26. Objectives
Review and discuss Early Mobility data elements and definitions.
Review strategies that other ICUs have used to collect the data elements.
Discover the different data reports that you can download and share with your team.

27. Discussion
Since our last our May 14th Early Mobility Data Collector Training, where have you been able to find these data?
Ideas?
Suggestions?
Barriers?
November 9, 2018

28. Next Steps Where will you find your data? Look for data sources
Make plans for data collection processes
Practice collecting data for next call
November 9, 2018

29. Going Forward
After you have found your data sources and data collection has officially started
Collect data daily
Enter the data at least weekly
November 9, 2018

30. Homework
Explore with IP, RT, Hospital Executive, and Analytics teams how to access Early Mobility data
Collect and enter daily early mobility measures into the online data portal.
Download and review your data reports
November 9, 2018

31. Objectives
Review and discuss Early Mobility data elements and definitions.
Review strategies that other ICUs have used to collect the data elements.
Discover the different data reports that you can download and share with your team.

32. Have you reviewed any of your data reports?
Yes!
No, but I plan to.
No – we have data reports?
This question does not apply to me.
November 9, 2018

33. CUSP 4 MVP-VAP Daily Early Mobility
May 8, 2014
Kelsey Edwards
Dhwani Shah
Program support provided by MHA Keystone Center.
Scientific expertise and educational presentations provided by Harvard Medical School.
November 9, 2018

34. Call Objectives
Describe how to download/view performance your teams’ Daily Early Mobility measures through reports
Describe the steps to access data reports.
Explain what the different data reports mean.

35. Generating and Reading “My Reports”
Daily Early Mobility
Generating and Reading “My Reports”
Sample Hospital A
Sample Hospital B
Sample Hospital C

36. Generating and Reading “My Reports”
Daily Early Mobility
Generating and Reading “My Reports”
Project  “CUSP4MVP-VAP”
Tool Daily Early Mobility
Network
Report  Measures / Missing Data Report

37. Measures and Missing Data Reports: Delirium Assessment Mobility
Daily Early Mobility
Types of Reports
Measures and Missing Data Reports:
Delirium Assessment
Mobility
Sedation Scale
Sedation Scale Distribution
Mobility Bar Charts and Tables
Missing Data Report

38. Generating and Reading “My Reports”
Daily Early Mobility
Generating and Reading “My Reports”
Format  Excel/PDF

39. Daily Early Mobility Excel Format
Can be used for: Delirium Assessment, Mobility, Sedation Scale and Missing Reports
Filter  determines how results are sorted in the spreadsheet
Select Date Range  To and From
Generate Report  \

40. Daily Early Mobility Sample Excel Reports Delirium Assessment:
Sedation Scale:

41. Daily Early Mobility PDF Format
Can be used for: Delirium Assessment, Mobility, Sedation Scale and Missing Reports
Select Date Range  Exact Date Range, Monthly Report, Quarterly Report, Yearly Report
Exact Date Range:
Monthly Report:

42. Daily Early Mobility PDF Format
Can be used for: Delirium Assessment, Mobility, Sedation Scale and Missing Reports
Select Date Range  Exact Date Range, Monthly Report, Quarterly Report, Yearly Report
Generate Report
Quarterly Report:
Yearly Report:

43. My Rate = Numerator Divided by Denominator
Daily Early Mobility
Sample PDF Reports
My Rate = Numerator Divided by Denominator
Improvement Score = Denominator Subtracted By Numerator
Goals = depend on measure (ie. Higher Compliance Rate, but Lower % of Incorrect Reporting)

44. Average Performance – of the comparison group
Daily Early Mobility
Sample PDF Reports
Average Performance – of the comparison group
Above or Below Average Performance Group

45. Daily Early Mobility PDF Format
Can be used for: Sedation Scale Distribution, Mobility Bar Charts and Tables
Select Date Range  Choose Month and Year
Generate Report

46. Sample PDF Reports – Sedation Scale Distribution
Daily Early Mobility
Sample PDF Reports – Sedation Scale Distribution
Get distribution of selected month, a few months prior to the selected month and overall distribution

47. Sample PDF Reports – Mobility Bar Charts and Tables
Daily Early Mobility
Sample PDF Reports – Mobility Bar Charts and Tables
Get distribution of selected month, a few months prior to the selected month and overall distribution

48. Questions??

49. Early Mobility- Historical Performance Monitor Reports

50. Early Mobility- Historical Performance Monitor Reports

51. Early Mobility- Historical Performance Monitor Reports

52. Early Mobility- Historical Performance Monitor Reports
5 Measures:
Delirium Assessment
Mobility
Sedation Scale
Sedation Scale and Distribution
Mobility Bar Charts and Tables

53. Trending - quick snap shot of rate changes
Early Mobility- Historical Performance Monitor Reports

54. Early Mobility- Historical Performance Monitor Reports
Interactive chart that allows selection of your comparators and time periods
Early Mobility- Historical Performance Monitor Reports
Ability to download PDF
Ability to turn comparators ON and OFF
Hover over data point to display your rate and the comparators

55. Early Mobility- Historical Performance Monitor Reports
My Rate: shows your performance rate as well as an indicator of “Higher/Lower is Better”for the ideal value of the measure.
Early Mobility- Historical Performance Monitor Reports

56. Early Mobility- Historical Performance Monitor Reports
Improvement Opportunities: displays the number of events, which if eliminated, improve your measure value
Early Mobility- Historical Performance Monitor Reports

57. Early Mobility- Historical Performance Monitor Reports
Average Performance displays the mean for all the other participants in VAP.
My Percentile shows what percentile your rate is versus all other participants in VAP

58. Early Mobility- Historical Performance Monitor Reports

59. Early Mobility- Historical Performance Monitor Reports
Mobility Bar Charts and Tables:
PT/OT Compliance Rate
PT/OT Compliance Rate(non-intubated)
Distribution of Highest Level of Mobility
Distribution of Highest Level of Mobility(non-intubated)

60. Early Mobility- Historical Performance Monitor Reports

61. Questions??

62. Reminders

63. Next Steps for Data Collection
Unit Lead completes Structural Assessment
Unit staff complete HSOPS
Unit Lead/Data Facilitator enters Daily Process Measures
Unit Lead/Data Facilitator enters monthly VAE rates
Unit Lead/Data Facilitator enters Early Mobility Measures
Unit staff complete Exposure Receipt Assessment via survey link
Data Facilitator contemplates next steps for collecting Objective Outcomes Measures
Unit Lead/Data Facilitator pulls data reports from the data portal and share the feedback with your frontline staff
November 9, 2018November 9, 2018

64. Next Steps for CUSP Conduct a culture assessment (HSOPS)
Establish an interdisciplinary CUSP team
Partner with a Senior Executive
Review the Science of Safety training
Identify defects
Download results from your culture assessment (HSOPS) and share with team
Meet regularly with your CUSP team
Use the Daily Goals tool in your ICU
November 9, 2018November 9, 2018