1. PfP 2014: Priorities and Expectations

2. Agenda Welcome new Oregon hospitals Provide overview of 2014 PfP activities and programs – AHA/HRET Improvement Leader Fellowship – Patient/Family Engagement Data expectations and measures Oregon Lean Other resources – Listserv update – Optional topics Travel funds 2

3. New hospitals: Welcome! Ashland Community Kaiser Westside Pioneer Heppner St Anthony West Valley Vibra 3

4. 2014 Oregon PfP Map + Improvement Advisors 4

5. PfP Overview 5

6. Partnership for Patients Goal: 40% Reduction in Preventable Hospital Acquired Conditions Goal: 20% Reduction in Hospital Readmissions Ultimately to provide safer care and decrease cost 6

7. Oregon PfP working together to achieve a bold aim On our way to the 40/20 goal by Dec 2014 2014 year focus: – Reporting and analyzing data for all applicable areas – Patient and family engagement (PFE) – Leadership support – Healthcare disparities – Teamwork and communication 7

8. National HEN Targeted Harms Adverse drug events OB Adverse Events Elimination of Early Elective Deliveries Central line-associated blood stream infections Catheter-acquired urinary tract infections Falls with injury Surgical infections and complications Venous thromboembolism Pressure ulcers Readmissions Ventilator-associated events 8

9. PfP Option Year: 2014 ADE + (at minimum) opioid safety, anticoagulation safety, and glycemic management CAUTI + all hospital settings, including avoiding placement of catheters in the ER CLABSI + all hospital settings (not just ICU) OB Adverse Events + Management of postpartum hemorrhage and pre-eclampsia (probably obstetric hypertension) VTE + all surgical settings VAP/VAE + Infection-related Ventilator-Associated Complications (IVAC) and Ventilator-Associated Pneumonia (VAP) SSI + multiple classes of surgeries Falls, HAPU, Readmissions Same focus

10. Overview of PfP activities and programs National: – Boot camps – Webinars State: – CAUTI program Feb. 27,2014 @ the Grand Hotel Bridgeport – State meetings: Friday April 4 th, Portland Fall 2014, Medford 10

11. Resources Updated change packages and checklists for all CORE topics will be reflected in the AHA/HRET HEN website (www.hret-hen.org) by early February. The website will also include new sections for information and resources regarding all OPTIONAL topics. Make sure to review the topics Resource sections to find tools, checklists and other resources shared on topic- specific LISTSERVs 11

12. AHA/HRET Improvement Leader Fellowship 12

13. Fellows Across the Country 13

14. Delivering the Fellowship 14 In-Person Regional Meetings 22 different state meetings March through November On site meetings specifically designed to combine clinical knowledge with improvement techniques Monthly Live Streamed Meetings Fellowship Topics: 1:00 – 3:00 PM CST every third or fourth Wednesday of the month

15. In-Person Regional Meetings Promote shared discussion and learning All Fellows in one room Didactic Hospital story sharing Coaching Topic Specific Mini Collaborative: led by Cynosure IA Fellowship Topic: led by IHI faculty Oregon PfP: our state meeting is being scheduled for this spring 15

16. Tracking & Evaluating Participation Attendance – 1 in-person meeting – 8 out of 10 virtual meetings Commitment to the Program (endorsed by Sr. Leader at their organization) Harm Across the Board (HAB)completion Pre-work assignments Specific requirements for each Fellowship Level: Junior, Senior, and Champion Open School module completion 16

17. No More Progress Reports! HAB will replace the monthly progress reports. HAB is being revised to include 6 slides – Webinar in Feb. 2014, date TBA Complete a Harm Across the Board (HAB) report by March 31, 2014 HAB report due quarterly to your IA 17

18. Patient & Family Engagement (PFE) The AHA/HRET HEN team will collaborate with Institute for Patient- and Family-Centered Care (IPFCC) to provide: Six educational webinars will take place in: February, March, April, June, August and October Each webinar will be approximately one hour, and will incorporate two hospitals (focused on their PFE actions) 30-minute Office Hours In-state PFE Roadshows Monthly content for the Weekly SHA Newsletter 18

19. Data and Measurement 19

20. Measures We are ahead of many states since we already had aligned measures Some changes plus additions necessary due to push to reach PfP goals Baseline data needed for all new measures – Preferably 2013 data; could use Jan 2014 if necessary – Indicate baseline time frame. Notify your IA. 20

21. Adverse Drug Events  2014 Oregon PfP focus 21 CategoryMeasure NameDefinitionNumeratorDenominatorSource ADE Hypoglycemia in inpatients receiving insulin Hypoglycemia in inpatients receiving insulin or other hypoglycemic agents Hypoglycemia in inpatients receiving insulin or other hypoglycemic agents (e.g. hypoglycemia defined as plasma glucose concentration of 50 mg per dl or less) Inpatients receiving insulin or other hypoglycemic agents ASHP Safe Use of Insulin ADE Excessive Anticoagulation with Warfarin All inpatients who had excessive anticoagulation with warfarin Inpatients experiencing excessive anticoagulation with warfarin (e.g. INR > 6) Inpatients receiving warfarin anticoagulation therapy ISMP ADE ADEs due to opiods Naloxone reverses opioid intoxication. For this reason, naloxone administration can be used to identify patients who may have experienced an adverse drug event due to an opioid. Number of patients treated with opioids who received naloxone during the review period. Number of patients who received an opioid agent during review period. ISMP and PA-HEN

22. Catheter Associated Urinary Tract Infection (CAUTI)  2014 Oregon PfP focus 22 CategoryMeasure NameDefinitionNumeratorDenominatorSource CAUTI Catheter-Associated Urinary Tract Infections Rate - All Tracked Units (CDC NHSN) Rate of patients with a catheter-associated urinary tract infections per 1000 urinary catheter days- all tracked units Catheter-associated urinary tract infections based on CDC NHSN definition (all tracked units) Total number of urinary catheter days for all patients that have an indwelling urinary catheter in all tracked units CDC NHSN CAUTI *OPTIONAL* CAUTI-ED Emergency Department CAUTI Measure/s- TBD TBD CUSP: CAUTI

23. Central Line Associated Blood Stream Infection (CLABSI) 23 CategoryMeasure NameDefinitionNumeratorDenominatorSource CLABSI CLABSI Rate - All Tracked Units (Device Days) CLABSI rate (healthcare- associated primary bloodstream infection (BSI)) in a patient that had a central line within the 48-hour period before the development of the BSI and that is not related to an infection at another site The Primary Bloodstream Infection (BSI) form (CDC 57.108) is used to collect and report each CLABSI that is identified during the month selected for surveillance Number of all units device days (Central line days) CDC NHSN  2014 Oregon PfP focus

24. Falls  2014 Oregon PfP focus 24 CategoryMeasure NameDefinitionNumeratorDenominatorSource Falls Falls With Injury (minor or greater) (NSC-5) All documented patient falls with an injury level of minor or greater Total number of patient falls of injury level minor or greater (whether or not assisted by a staff member) during the calendar month. Patient daysNQF

25. OB Adverse Events  2014 Oregon PfP focus 25 CategoryMeasure NameDefinitionNumeratorDenominatorSource OB Elective Deliveries at >= 37 Weeks and < 39 Weeks (JC PC- 1) Patients with elective vaginal deliveries or elective cesarean sections at ≥ 37 and < 39 weeks of gestation completed Patients with elective deliveries Patients delivering newborns with ≥ 37 and < 39 weeks of gestation completed Joint Commission OB C-Section Delivery Rate (JC PC-2) Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean section Patients with cesarean sections Nulliparous patients delivered of a live term singleton newborn in vertex presentation Joint Commission OB- Hemorrhage Total OB blood transfusions Total number of blood products used per 100 women giving birth Total number of units of blood products (RBCs, FFP, Platelet packs, Cryo) All women giving birth ≥20 weeks (birth hospitalization) ACOG and CMQCC OB- preeclampsia Timely treatment for severe hypertension Treatment within 60 minutes per 100 mothers with preeclampsia and severe hypertension (either Systolic >=160 OR Diastolic >=110) Women who are treated within 60 minutes with first- line medications (IV labetalol or IV hydralazine or PO nifedipine if IV access has not been established) All women giving birth ≥20 weeks (birth hospitalization) with a diagnosis of Severe Preeclampsia (Eclampsia (642.6x), Severe Preeclampsia (642.5x), or Preeclampsia superimposed on pre-existing HTN (642.7x)) AND who had severe hypertension (either Systolic ≥160 OR Diastolic ≥110) Exclusions: women with gestational hypertension or chronic hypertension without superimposed preeclampsia (642.0x, 642.1x, 642.2x, or 642.3x) CMQCC

26. Hospital Acquired Pressure Ulcers  2014 Oregon PfP focus 26 Category Measure Name DefinitionNumeratorDenominatorSource PU Pressure Ulcer (MCR FFS) (CMS HAC) Number of occurrences with a Hospital Acquired Pressure Ulcer at Stage III or IV Number of occurrences with Pressure ulcer stages III and IV (707.23 (MCC)707.24 (MCC)) as a secondary diagnosis (diagnoses 2-9 on a claim) with a POA code of ‘N’ or ‘U’ Number of acute inpatient discharges CMS HAC

27. Need to expand to include more classes of surgeries Adding procedures: – CABG – Colon – Hysterectomy We will be asking you to continue to confer rights in NHSN. 27 Surgical Site Infections (SSI)

28.  2014 Oregon PfP focus 28 CategoryMeasure NameDefinitionNumeratorDenominatorSource SSI Total Hip Procedures - SSI (in-hospital) (CDC NHSN subset) Surgical site infection rate among total hip replacement procedures Total number of total hip surgical site infections based on CDC NHSN definition All patients having total hip replacement operative procedures CDC NHSN SSI SSI Total Knee Procedures - SSI (in-hospital) (CDC NHSN subset) Surgical site infection rate among total knee replacement procedures Total number of total knee surgical site infections based on CDC NHSN definition All patients having total knee replacement operative procedures CDC NHSN SSI SSI Colon SSI CDC NHSN SSI SSI Hysterectomy SSI CDC NHSN SSI SSI Cardiac/CABG SSI CDC NHSN SSI

29. Venous Thromboembolism (VTE)  2014 Oregon PfP focus 29 Category Measure Name DefinitionNumeratorDenominatorSource VTE Potentially Preventable VTE (VTE-6) The number of patients diagnosed with confirmed VTE during hospitalization (not present at admission) who did not receive VTE prophylaxis between hospital admission and the day before VTE diagnostic ordering date Patients who received no VTE prophylaxis prior to the VTE diagnostic test order date Patients who developed confirmed VTE during hospitalization Joint Commission Specifications Manual for National Hospital Inpatient Quality Measures

30. Ventilator Associated Pneumonia/ Ventilator Associated Events (VAP/VAE)  2014 Oregon PfP focus 30 CategoryMeasure NameDefinitionNumeratorDenominatorSource VAP Ventilator-Associated Pneumonia Rate - All Units (CDC NHSN) Pneumonias that are ventilator- associated (i.e. patient was intubated and ventilated at the time of, or within 48 hours before, the onset of the event) Ventilator-associated pneumonia rate (incidence of VAP) Number of ventilator days (collected daily) CDC NHSN VAP VAE VAC Rate- All Units (CDC NHSN) Ventilator-Associated Condition (VAC); including those that meet the criteria for IVAC and Possible/Probable VAP rate Number of events that meet the criteria of Ventilator-Associated Condition (VAC); including those that meet the criteria for IVAC and Possible/Probable VAP rate Number of ventilator daysCDC NHSN VAE VAE VAC Rate- All ICU Units (CDC NHSN) Ventilator-Associated Condition (VAC) in ICU units; including those that meet the criteria for IVAC and Possible/Probable VAP rate Number of events that meet the criteria of Ventilator-Associated Condition (VAC) in ICU units; including those that meet the criteria for IVAC and Possible/Probable VAP rate Number of ventilator days in the ICU CDC NHSN VAE VAE Possible/Probable VAP Rate- All Units (CDC NHSN) Possible/Probable VAP rateNumber of events that meet the criteria of Possible/Probable VAP Number of ventilator daysCDC NHSN VAE VAE Possible/Probable VAP Rate- All ICU Units (CDC NHSN) Possible/Probable VAP in ICU units rate Number of events that meet the criteria of Possible/Probable VAP in ICU units Number of ventilator days in the ICU CDC NHSN VAE VAE IVAC Rate- All Units (CDC NHSN) Infection-Related Ventilator- Associated Condition (IVAC); including those that meet the criteria for Possible/Probable VAP rate Number of events that meet the criteria of Infection-Related Ventilator-Associated Condition (IVAC); including those that meet the criteria for Possible/Probable VAP Number of ventilator daysCDC NHSN VAE VAE IVAC Rate- All ICU Units (CDC NHSN) Infection-Related Ventilator- Associated Condition (IVAC) in ICU Units; including those that meet the criteria for Possible/Probable VAP rate Number of events that meet the criteria of Infection-Related Ventilator-Associated Condition (IVAC) in ICU Units; including those that meet the criteria for Possible/Probable VAP Number of ventilator days in the ICU CDC NHSN VAE

31. Readmissions  2014 Oregon PfP focus 31 CategoryMeasure NameDefinitionNumeratorDenominatorSource READ Potentially Preventable Readmissions (PPR) As calculated by Apprise Health Insights, using 3M algorithm Number of readmission chains Number of at-risk readmissions State-defined measure (Apprise Health Insights) READ Readmission within 30 days (All Cause) Inpatients who were readmitted within 30 days for any reason Inpatients returning as an acute care inpatient within 30 days of date of discharge Total inpatient discharges (excludes expired patients) Based on CMS Hospital Compare measure

32. Possible Advanced Options  Things to think about….. 32 Severe Sepsis/Septic Shock C-Diff including antibiotic stewardship Hospital Acquired Acute Renal Failure Airway Safety Iatrogenic Delirium Procedural harm (pneumothorax, blood) Undue Exposure to radiation Failure to Rescue Culture of Safety (patient/ worker) Expanding outreach to community for all topics

33. Optional Sustainability Measures New sustainability measures are available These optional measures may be valuable for: – CAHs – Rural Hospitals – Hospitals that have sustained 0’s for extended periods of time – Any organization interested in tracking their progress 33

34. Oregon Lean  We are offering Lean in 2014 through Purdue Healthcare Advisors Additional green belt training (2 days) New! Black Belt training (1 day)  Monthly Lean webinars  Monthly office hours with Purdue trainers 34

35. Other Resources Resources coming later to address – Disparities – Optional topics – Listserv updates 35

36. Resources HRET – HEN website: www.hret-hen.org including private side www.hret-hen.org – Top Ten Process Checklists/posters – HRET PfP Change packages – HRET webinars/boot camps OAHHS – OAHHS improvement advisor – PfP advisory committee – PfP newsletter – PfP website: www.oahhs.org/quality/initiatives/partnership-for-patients www.oahhs.org/quality/initiatives/partnership-for-patients 36

37. Travel Funds We will provide assistance for travel to in- state PfP & Improvement Leader Fellowship meetings Details pending 37

38. Next Steps Submit your 2014 commitment form ASAP Submit baseline data for new measures Continue to submit data on all harms monthly Continue improvement work in all areas to strive for the 40/20 goal 38

39. OREGON PFP LEADERSHIP TEAM: Diane Waldo, director of quality and clinical services diane.waldo@oahhs.orgdiane.waldo@oahhs.org503.479.6016 Jodie Elsberg, associate director of quality jelsberg@oahhs.orgjelsberg@oahhs.org503.479.6028 Lyndsey Shaver, quality coordinator lyndsey.shaver@oahhs.orglyndsey.shaver@oahhs.org503.479.6022 39