Beginning Analysis for LTC Peg Gilbert, MS, RN, CIC, FAPIC November - - PowerPoint PPT Presentation

▶
beginning analysis for ltc
SMART_READER_LITE
LIVE PREVIEW

Beginning Analysis for LTC Peg Gilbert, MS, RN, CIC, FAPIC November - - PowerPoint PPT Presentation

Dec 16, 2022 379 likes •926 views

"The Data is In, but How does it Come Out? Beginning Analysis for LTC Peg Gilbert, MS, RN, CIC, FAPIC November 30, 2017 1 Objectives Upon completion of the program the participant will be able to: Describe the steps to ensure

slide-1
SLIDE 1

"The Data is In, but How does it Come Out?” Beginning Analysis for LTC

Peg Gilbert, MS, RN, CIC, FAPIC

November 30, 2017

1

slide-2
SLIDE 2

Objectives

  • Upon completion of the program the

participant will be able to:

  • Describe the steps to ensure data quality
  • Recognize steps to generate datasets in

NHSN

  • Interpret CDI data to prioritize

improvement efforts

2

slide-3
SLIDE 3

Quality of Reports Based on Quality of Data Entered

3

slide-4
SLIDE 4

CDI LAB ID Event

  • Numerator data (one

form for each event being recorded)

  • Collect and report

each CDI event that meets the LabID Event definition.

  • Electronic version:

http://www.cdc.gov/n hsn/PDFs/LTC/forms/5 7.138_LabIDEvent_LTC F_BLANK.pdf

4

slide-5
SLIDE 5

Entering an Event

5

slide-6
SLIDE 6

How do I know if being treated for CDI?

  • Transfer Sheet best source
  • Question on nursing admission sheet
  • Common Medications to question:
  • Oral (PO) vancomycin
  • Oral (PO) metronidazole (Flagyl);
  • Fidaxomicin

6

slide-7
SLIDE 7

UTI Event

  • Event Details
  • Fever
  • CFU count
  • 3 Definitions
  • SUTI
  • CA-SUTI
  • ABUTI

7

slide-8
SLIDE 8

Enter Denominator Data

8

slide-9
SLIDE 9

Data Quality

  • Resolve all Alerts
  • Alerts appear on NHSN

home page

  • Automatic checks that

remind you of incomplete

  • r missing data
  • Most common sources

are summary data forms and incomplete UTI events

  • Alerts must be resolved

before data are considered complete

9

slide-10
SLIDE 10

Most Common Alert

10

slide-11
SLIDE 11

Missing Event or Summary Data Alert

11

slide-12
SLIDE 12

Categorization of CDI LabID Events

  • Incident CDI LabID Event: Either the first CDI LabID Event ever

entered for an individual resident in the facility, or a subsequent LabID Event entered > 56 days (8 weeks) after the most recent CDI LabID Event reported for an individual resident while receiving care in the LTCF.

  • Recurrent CDI LabID Event: Any CDI LabID Event entered > 14

days (2 weeks) and < 57 days (8 weeks) after the most recent CDI LabID Event reported for an individual resident while receiving care from the LTCF

  • Duplicate CDI LabID Event: Any C. difficile positive laboratory

assay from the same resident following a previous C. difficile positive laboratory assay within the past two weeks (<15 Days)

12

slide-13
SLIDE 13

13

slide-14
SLIDE 14

Categorization

  • Community-onset (CO) LabID Event: Date specimen collected ≤ 3

calendar days after current admission to the facility

  • Long-term Care Facility-onset (LO) LabID Event: Date specimen

collected > 3 calendar days after current admission to the facility

  • LO Events are further sub-classified :
  • Acute Care Transfer-Long-term Care Facility-onset (ACT-LO): LTCF-
  • nset (LO) LabID event with specimen collection date ≤ 4 weeks

following date of last transfer from an Acute Care Facility

  • Hospital, long-term acute care hospital, or acute inpatient

rehabilitation facility only

Categorization is always based on date specimen is collected in relationship to date of admission

14

slide-15
SLIDE 15

Event Data

15

slide-16
SLIDE 16

Long Term Care Facility Category Labels Abbreviation Time Frames

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10

Incident First + test or > 8 Weeks Recurrent >2 Weeks or ≤8 Weeks Duplicate 14 days previous positive Acute Care Transfer- LTCF Onset ACT-LO ≤4 weeks AC transfer

Transfer

Category Labels Abbreviation Time Frames

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Community Onset CO ≤3 from Admit

Admit

Long term care Facility Onset LO > 3 days

Admit

Key Time not included in definition Time included in definition

16

slide-17
SLIDE 17

Statistics Available

  • Rate definition

17

slide-18
SLIDE 18

UTI Statistics

  • Total UTI incidence rate/1,000 resident-days = Total Number of

UTI Events (i.e., SUTI + CA-SUTI + ABUTI) / Total resident-days x 1,000.

  • Urinary Catheter Utilization Ratio = Total urinary catheters-days /

Total resident-days

  • SUTI incidence rate/1,000 resident-days = Number of SUTI Events

/ Total resident days – catheter-days x 1,000.

  • NOTE: Only SUTIs that are NOT catheter-associated will be included

in the SUTI incidence rate.

  • CA-SUTI incidence rate/1,000 catheter-days = Number of CA-SUTI

events / Catheter-days x 1,000

  • UTI treatment ratio = New antibiotic starts for UTI / Total Number
  • f UTI Events (SUTI + ABUTI + CA- SUTI)
  • NOTE: 1. When the UTI treatment ratio is 1, there are more reported

antibiotic starts for UTI than symptomatic UTI events submitted.

18

slide-19
SLIDE 19

Mechanics of the Analysis Section

19

slide-20
SLIDE 20

Generate Data Sets

20

slide-21
SLIDE 21

First Step in Analysis Function: Generating Data Sets

  • Takes a snap shot of the data
  • Organizes data into defined sets for analysis
  • Allows for quicker generation of reports
  • When analyzing data in NHSN, you are using a

copy of the data, not the live database

  • Each user has his/her own analysis datasets
  • May take several minutes to complete this process
  • You may navigate within NHSN while datasets are

generating

21

slide-22
SLIDE 22

Generate New

22

slide-23
SLIDE 23

Run Reports

23

slide-24
SLIDE 24

Reports: Open Folders

24

slide-25
SLIDE 25

Report Options

CDI UTI

25

slide-26
SLIDE 26

2 Options for Both Report Types

  • Line list
  • Allows for record-level review of data
  • Helpful in pinpointing issues in data

validity/quality

  • Rate tables – Rate calculations
  • Display a facility’s calculated rates
  • Helpful in pinpointing issues in data

validity/quality

26

slide-27
SLIDE 27

Running Reports

Choose “Modify” to customize your report

27

slide-28
SLIDE 28

“Modify” Analysis Section

28

Centers for Disease Control and Prevention. National Healthcare Safety Network Database. https://www.cdc.gov/nhsn/. Accessed 1/24/2017

slide-29
SLIDE 29

Time Periods for Reports

Specify by Date variable Beginning Ending Date Event~Date 01/01/2016 12/31/2016 Year* Event~Year 2016 2016 Half-year* Event~Yr/Half 2016H1 2016H2 Month Event~Yr/Mon 01/2016 12/2016 Quarter* Event~Yr/Qtr 2016Q1 2016Q4 *Uses calendar year. If fiscal year is needed, specify time period by date or month 29

slide-30
SLIDE 30

Filters

30

slide-31
SLIDE 31

Display Variables

Additional options with Line Listings

31

slide-32
SLIDE 32

Sort Variables

32

slide-33
SLIDE 33

Display Options

  • The “Group by”
  • ption listed within

the Modify Screen for Rate Tables has a value option called “Cumulative” which is used to obtain a set date (Fiscal year)

33

Centers for Disease Control and Prevention. National Healthcare Safety Network Quick Reference Guide . https://www.cdc.gov/nhsn/ps-analysis-resources/reference- guides.html. Accessed 7/13/2017

slide-34
SLIDE 34

Did I Enter All My Data?

34

slide-35
SLIDE 35

Did I Enter All My Data?

35

slide-36
SLIDE 36

How Was It Categorized?

  • 1. Modify
  • 2. Time Period tab
  • 3. Enter Date Variable
  • 4. Display Variables

Tab

  • 5. Select “cdi assay”
  • 6. Click on Run button

36

slide-37
SLIDE 37

Line listing with Category

37

slide-38
SLIDE 38

CDI Rate Tables

  • 1. Modify
  • 2. Time Period tab
  • 3. Enter Date Variable
  • 4. Display Options Tab
  • 5. Group by: (year, qtr)
  • 6. Click on Run button

38

slide-39
SLIDE 39

CDI Statistics

39

slide-40
SLIDE 40

Scroll for Individual Rates

40

slide-41
SLIDE 41

CDI Rate Report

  • 1. Notes after report are important
  • 2. Be sure to click on Show Descriptive Variable

Box for complete headers when modify

  • 3. Copy and Paste for reporting

41

slide-42
SLIDE 42

UTI Rate Tables

location Summ ary Yr months Uti count Num Abx start Uti Treat ment Num Res days UTI Rate Numlt uCath days CathDU

FACWI DEIN 2017 6 12 46 3.833 12,782 0.939 424 0.033

  • 1. UTI Events (SUTI + ABUTI + CA- SUTI)
  • 2. UTI treatment ratio = New antibiotic starts for UTI / Total Number of

UTI Events (SUTI + ABUTI + CA- SUTI)

  • 3. Total UTI incidence rate/1,000 resident-days = Total Number of UTI

Events (i.e., SUTI + CA-SUTI + ABUTI) / Total resident-days x 1,000.

  • 4. Urinary Catheter Utilization Ratio = Total urinary catheters-days / Total

resident-days 1 2 3 4 42

slide-43
SLIDE 43

Advanced

43

slide-44
SLIDE 44

Antibiogram

44

slide-45
SLIDE 45

Antibiogram

  • 1. Advanced
  • 2. Pathogen Level Data
  • 3. Antibiogram
  • 4. Time Frame
  • 5. Run

Event Type Event Date Pathogen Description Ampicillin Ampicillin/ Sulbactam Amoxacilli n/clavula nic acid Anidulafun gin Caspofung in Cefazolin Cefepime Cefotaxime Cefoxitin UTI Enterobacter cloacae complex - ENCCX N N N N N R S S UTI Escherichia coli

  • EC

N N N N N N N N UTI Pseudomonas aeruginosa - PA N N S

45

slide-46
SLIDE 46

Antibiotic Stewardship

46

slide-47
SLIDE 47

National Healthcare Safety Network Line Listing - LTCF Adherence to Seven Core Elements of Nursing Home Antibiotic Stewardship Program Date Range: All LTCABXSTEWARDSHIP Survey Year Leadership CE Account ability CE Drug Expertise _CE Action _CE Tracking _CE Reporting_ CE Education _CE Core Elements Met

2015 N Y N N Y Y N 3 2016 Y Y Y Y Y Y Y 7

Sorted by orgID surveyYear

  • 1. These are the seven Core Elements recommended by CDC to improve antibiotic

prescribing practices and reduce inappropriate use.

  • 2. More information about the Core Elements of Antibiotic Stewardship for Nursing Homes

can be accessed on the following link: http://www.cdc.gov/longtermcare/pdfs/core- elements-antibiotic-stewardship.pdf

  • 3. Responses in the Long-term Care Facility (LTCF) Annual Survey were used to determine

if the LTCF meets one or more of the Core Elements.

  • 4. Adherence to a Core Element is achieved with a positive ("Y") response to at least one

question within that element.

  • 5. Leadership and Drug Expertise Core Element categories were implemented in the 2016

LTCF annual survey year. For survey year 2015, adherence to these two Core Element categories will default to a negative ("N").

47

slide-48
SLIDE 48

How Many of my UTI’s had Catheters?

48

slide-49
SLIDE 49

How Many of my UTI’s had Catheters?

49

slide-50
SLIDE 50

What Should I Report to Quality/IC Committee?

  • CDI Rate tables
  • LO incident CDI rates
  • Number of residents on CDI treatment at

admission

  • Percent CDI that are LO and ACT-LO
  • UTI Rates
  • Total SUTI
  • Catheter with and without
  • Device Utilization
  • UTI Treatment Ratio

50

slide-51
SLIDE 51

Analysis Thoughts

  • Develop a timeline to regularly analyze
  • Monthly quality checks for completeness and alert monitoring
  • Generate datasets prior to any analysis and after alert

resolution

  • Read the footnotes on your reports
  • Review data for accuracy and completeness
  • Just try it
  • You won’t break the system
  • You won’t delete your data
  • You can get some really cool stuff!
  • Antibiotic stewardship
  • Measurement portion of IC plan
  • Direction for Quality Improvement
  • Surveillance Priorities

51

slide-52
SLIDE 52

References

  • Data for Action: How can NHSN Data be Used to Guide

Prevention Efforts in Long-Term Care Facilities?, Elisabeth Mungai, CDC Data Analyst, March 20, 2017

  • NHSN LTCF website:

https://www.cdc.gov/nhsn/ltc/index.html

  • NHSN Database: Screen prints

52

slide-53
SLIDE 53

Peg Gilbert, RN, MS, CIC, FAPIC

Contact Information

53