1. Quality and Patient Safety Council May 27, 2014 Presented By Susan M. Blackhurst BS, RN & Eric Jean BSN, RN, CCRN

2. Presentation Goals  Identify MMC VTE Quality Measures Initiative  CMS Specifications and ACCP Guidelines  Core Measure Data  Opportunities  Next Steps  Brief Update on IMMs/ED Throughput

3. Recommendations from American College of Chest Physicians (ACCP) For acutely and critically ill nonsurgical patients at increased risk for VTE, pharmacological prophylaxis is recommended For acutely and critically ill patients at increased risk for VTE and actively bleeding or at high risk for major bleeding, recommendation is for mechanical means over no prophylaxis; Once bleeding or risk of is no longer present, reconsideration of pharmacological prophylaxis is recommended For acutely ill medical patients at “Low Risk” for VTE, recommendation is AGAINST pharmacologic and mechanical prophylaxis Consider compliance, practicality, cost, etc… (Summary of slides from “Prevention of Venous Thromboembolism in Nonsurgical Patients” Powerpoint; Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines; 2012)

4. CMS Specifications VTE 1 Prophylaxis If neither pharmacological or mechanical means are ordered, contraindication to each must be documented explicitly by the provider Ambulation is ONLY an allowable value IF there is documentation from the practitioner that the patient is “LOW RISK FOR VTE” and ambulation is to be used for prophylaxis

5. VTE Measure Set

8. Prophylaxis N=141 ICU Prophylaxis N=17 Potentially Avoidable N=6

10. OPPORTUNITIES

11. VTE 1 and VTE 2 (ICU) Prophylaxis 14 noncompliant cases (4Q2013) for VTE 1 and VTE 2–General and ICU Prophylaxis Continued Reasons for Provider Noncompliance: There were no orders for VTE prophylaxis and/or There were no documented contraindications for both anticoagulant and mechanical means Only documenting risk-stratification at a rate of approximately 50%

12. VTE 3 Opportunities VTE-3 Overlap Therapy Ensure Warfarin Overlap Therapy is being ordered for 5 days  Pharmacy is on-board!  Charge nurses are now notifying Clinical Quality staff of confirmed VTE for concurrent monitoring of measure

13. VTE 6 Potentially Avoidable PE/DVT Evaluates VTE prophylaxis delivered between the day of admission and the day before the diagnostic test for confirmed VTE Directly correlates with providing risk assessment and appropriate prophylaxis on admission and upon changes in level of care Anticipate reduction in payment for Hospital Acquired Condition (HAC) and/or 30 day Readmission VBP and appropriate stratification pre- and post- hospitalization

14. Looking Ahead VTE Advisor Provide decision support to practitioners established by evidence-based practice guidelines iPath Project HMS (Hospitalist Medicine Safety) Consortium-VTE Registry Concurrent Monitoring

15. VTE Advisor Cerner Solution  GOAL: Provide decision support to practitioners established by evidence-based practice guidelines Physician order options based on risk stratification and contraindications Automatic ally computes standardized risk score Padua for medical patients Caprini for surgical patient Implementation TBD

16. HMS (Hospitalist Medicine Safety) Consortium-VTE Registry Goal of consortium: Improvement of quality care in patients at risk for adverse events in medically hospitalized populations Current focus is risk for VTE weighted with risk for bleeding/complications Dr. Warbasse is the Physician Champion Establishment of VTE Committee

17. iPath Enhanced ability to provide and document warfarin education in compliance with CMS guidelines Populates Discharge Mpage Generates information to be included in patient portal and hospital summary (as requirements for Meaningful Use Stage II)

18. Concurrent Project Offer dedicated support to units for VTE Quality Measures Provide written and/or verbal feedback for direction in achieving compliance delivery of quality care through evidence-based practice Ensure capture of elements on the “front end” Evaluating ALL admissions Identifying confirmed cases

20. Influenza Vaccine ***Is now Pay-For-Performance Pay Affects Medicare reimbursement beginning October 1, 2015 Performance Measured in calendar years 2012 (baseline rate 96.8%) and 2014 Need minimum 90% rate (achievement threshold) with goal of 99% Benchmark is 98.8%

21. Pneumococcal Vaccine Retired as a Core Measure as of January 1, 2014 Nursing administration and providers will still continue to ensure standard of care based on best- practice and ACIP Guidelines

23. Influenza

24. Overall Pneumococcal

26. Contact Information Eric Jean BSN, RN, CCRN RN Data Specialist Clinical Quality VTE/IMMs/ED Throughput Core Measures ejean1@mhc.net 231-392-7140 Susan M. Blackhurst BS, RN RN Data Specialist Clinical Quality HMS Registry sblackhurst@mhc.net 231-935-5876

27. Questions