HBIPS Psychiatric Core Measures Pilot Provider Lessons Learned

1
HBIPS Psychiatric Core MeasuresPilot Provider
Lessons Learned

• Ann Hunter, MA HealthCare Admin.
• Brooke Glen Behavioral Hospital
• Psychiatric Solutions, Inc.

2
Beginning

• Two year pilot participation began 1/06
• Study indicator definitions
• Cross reference where data is already captured
  (existing systems)
• Bring everyone on board
• Plan for who and how data will be collected
  and entered

3
Considerations

• Size- 146 bed inpatient acute psychiatric
  hospital
• Volume- Over 300 discharges per month
• Patient Base- Child, adolescents, and adults
• Acuity- Located immediately outside City of
  Philadelphia
• Resources- RM/QI, Medical Records, Social
  Services, etc.
• Record Keeping System- Manual patient records
  (not electronic)

4
Everyone On Board

• Core indicators presented to
• CEO
• Quality Council
• Social Workers
• Physicians
• Emphasize Rationale/Benefits
• Benchmarking
• Comparison data
• Internal trend study
• Joint Commission ORYX
• What reports/info do we want? Vendor software
  options (i.e. reports by physician, etc.)

5
Who? How?
Initially Brooke Glen RM/QI audited records and
entered data.

• First hand experience very beneficial
• Volume (over 300 discharges per month) not
  feasible for one person to complete

6
Medical Records

• We love our Medical Records Department!
• Medical Records reviews each chart and enters
  HBIPS outcome data at the time of chart coding
• Point Person established in the department

7
Sampling

• Some data requires 100 entry (i.e.
  restraint/seclusion)
• We found that running the optional sample after
  entering mandatory data did not work for us. A
  sample cannot be selected until mandatory data is
  entered for all charts. Therefore, re-pulling
  charts becomes necessary.
• We found sample sizes to be very large.
• We enter all indicator data for each discharged
  patient so that each chart only needs to be
  touched one time. We found this is actually a
  time saver.

8
Make it Easy!- Finding the data - Entering the
data- Having back-ups
9
Upload Demographic Data

• XML upload of patient demographic data completed
  daily (less frequent uploads prevented record
  availability and resulted in backlog entry)
• Data from HMS is uploaded in XML format into
  vendor web based system. Having pre-populated
  demographic information entered is a HUGE
  timesaver and important quality check!
• Name
• Diagnosis
• Age
• Dates of hospitalization
• Etc.

10
Data Entry Guide

• Create a paper data entry form that mirrors what
  the user will see when entering into vender
  software
• In same order that data is entered
• Identify exactly where (what document and what
  page) data is found in the chart
• Use paper data entry form for times when
  technical difficulties arise. User can easily
  return to online data entry using the completed
  form.
• Revise forms as needed to include needed data and
  match language

11
Assessment/Screening
12
Assessment/Screening
13
Finding and entering Restraint/Seclusion Data

• 100 of events reported
• Educate staff and be consistent in definition
• DON and Risk Manager reconcile reported events to
  assure accuracy
• Document restraint/seclusion events on colored
  paper (i.e. pink sheet) to assist user in
  finding restraint/seclusion events in the chart.
  
• Pink Sheet includes in/out time, behavior
  description, attempts to de-escalate, physician
  notification/orders, debriefing outcomes, etc.

14
Restraint/Seclusion Data Entry
15
Anti-psychotic

• Add list of formulary antipsychotic medications
  to the data input form to assist staff in
  identifying what is and is not an anti-psychotic
  medication
• Add to the Psychiatric Evaluation form __Yes
  __No History of unsuccessful mono antipsychotic
  medication therapy?

16
Anti Psychotic Data Entry
17
Discharge-AftercareData Entry
18
Discharge- Aftercare
19
Form to record problem records for RM/QI follow-up
20
Fruits of our labor

• Bring outcome data (discussion/action) to
• Quality Council
• Medical Staff
• Safety Committee
• Share what we learn with staff
• Safety and Quality fair
• Orientation/Training
• Looking forward to participation of more
  providers for meaningful comparison data