Central Nebraska Critical Access Hospital Network Quality Project: Core Measures

1
Central Nebraska Critical Access Hospital Network
Quality Project Core Measures

• Manuela Wolf RN, DON
• Harlan County Health System
• mwolf_at_harlancohealth.org
• Jeanine Kline RN, Quality/Risk Manager
• Gothenburg Memorial Hospital
• Jeanine_at_ghospital.org

2
Situation

• Inconsistent core measure scores
• The need to be ready for performance based
  reimbursement
• Healthcare reform will most likely add additional
  reporting requirements on new quality measures
  for CAHs
• ALL PATIENTS DESERVE TO RECEIVE THE RIGHT CARE
  EVERY TIME.

3
Background

• Current research supports the implementation of
  the core measures for community acquired
  pneumonia and heart failure for improved patient
  outcomes
• Changes in staffing including changes in
  leadership have an impact on ability to develop
  and sustain improvements

4
Assessment

• An opportunity for improvement in core measure
  compliance exists for the hospitals in the
  Central Nebraska Critical Access Hospital
  Network.
• Sharing of best practices for the core measures
  for community-acquired pneumonia and heart
  failure will result in improved compliance scores
  for the individual hospitals and better outcomes
  for the patients of Central Nebraska.

5
RECOMMENDATIONS Community- Acquired Pneumonia

• PN27- Pneumococcal /Influenza Vaccination
• Use of pre-printed order sets/protocols for
• nurses to administer the vaccine
  when
• screen is positive
• Stickers for front of chart as reminder to
• staff and providers
• Screening tool (form) for communication with
  providers
• PN3- Blood Culture Before Antibiotic
• Use of order sets

6
Recommendations

• Pneumonia (cont)
• PN4- Smoking Cessation Counseling
• Make standardized item on
• admission assessment
• Include in order sets
• Smoking cessation packet that includes resources
  and aids for the patient
• PN5- Antibiotic Timing
• Antibiotics ordered as STAT on order set

7
Recommendations

• PN6- Initial Antibiotic Selection
• Recommended antibiotics on standing order set
  per Specifications Manual.
• Educate providers regarding changes
• Make copies of changes in recommendations for
  provider reference
• Colored laminated sheets on charts with all
  appropriate antibiotics listed

8
Recommendations

• Heart Failure
• HF1- Discharge Instructions
• Standardized discharge instruction sheets that
  include all six measures
• HF2- LVF Assessment
• Order Sets
• Check past records
• Reminders to physicians
• HF3- ACEI or ARB for LVSD
• Order Sets

9
Recommendation

• HF 4- Smoking Cessation Counseling
• Make standardized item on
• admission assessment
• Include in order sets
• Smoking cessation packet that includes resources
  and aids for the patient

10
Other Recommendations

• Concurrent Chart Reviews
• Provide education and information to medical and
  nursing staff
• ICD-9 codes
• Inclusion terms
• Medication recommendations
• Core measure requirements
• Share scores along with comparison to network
  facilities and statewide scores

11
Other Recommendations

• Provider Report Card
• For education and to keep providers informed
  routinely on their performance on core measures
  
• Determine best way to communicate shift to shift
  
• Hand-off communication to next shift
• Getting the right people involved in the process
  
• Promote ownership

12
Recomendations

• Sharing information within our network
• Regular network meetings provide an opportunity
  for discussion and sharing.
• Submitting facility data which is compiled into a
  spreadsheet / graphs for comparison of data with
  peer hospitals

13
Feedback/Follow-up

• Continuous monitoring enables faster
• implementation times in which to use and
  evaluate tools
• Overall increase in scores
• ULTIMATELY THE RIGHT CARE PROVIDED TO EVERY
  PATIENT EVERY TIME

14

Manuela Wolf RN, DON Harlan County Health
System mwolf_at_harlancohealth.org Jeanine Kline
RN, Quality/Risk Manager Gothenburg Memorial
Hospital jeanine_at_ghospital.org