- BLOODSTREAM INFECTION (BSI)
QUALITY IMPROVEMENT ACTIVITIES
AUGUST 28, 2019
Present nted d By: : Dany y Anchi hia a BSN, , RN, , CDN N Quality y Impr mproveme ment nt Dire rect ctor r
Dire rect ctor r WHO IS THE NETWORK? INFE~ DETECTION Network - - PowerPoint PPT Presentation
BLOODSTREAM INFECTION (BSI) QUALITY IMPROVEMENT ACTIVITIES Present nted d By: : Dany y Anchi hia a BSN, , RN, , CDN N AUGUST 28, 2019 ------- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- -- Quality
QUALITY IMPROVEMENT ACTIVITIES
AUGUST 28, 2019
Present nted d By: : Dany y Anchi hia a BSN, , RN, , CDN N Quality y Impr mproveme ment nt Dire rect ctor r
INFE~ DETECTION
WHO IS THE NETWORK?
Network 14 is a non-profit organization incorporated in Texas and provides services on behalf of the Centers for Medicare & Medicaid Services (CMS) to kidney patients and their providers. Our r Mission n To support equitable patient- and family-centered quality dialysis and kidney transplant health care through the provision of patient services, education, quality improvement, and information management.
~ DETECTION
Subject Matter Experts
23 3 me memb mber ers s
PATIENT ADVISORY COMMITTEE
INFE~ DETECTION
.
END STAGE RENAL DISEASE
◄ S * " 'i ►T
~
~ iNETWORK OF EXAS
.
PATIENT ADVISORY COMMITTEE
Facility’s Patient Clinic Committee members reviewing the Conversation Starter and the Lead Patient Committee member, Juan Morales, demonstrating teach back with the clinic staff.
INFE~
DETECTION~
Elimination~
DETECTION
END STAGE RENAL DISEASE
NETWORK OF TEXAS
BSI NETWORK QIA PROJECTS
As mandated by the Centers for Medicare and Medicaid Services (CMS), the bloodstream infections (BSI) and long-term catheter (LTC) quality improvement activities (QIAs) are aimed at reducing bloodstream infections and long-term catheter rates within the State of Texas (Network 14 coverage territory). Pilot Project: The ESRD Network of Texas has also been directed by CMS to collaborate with 10% of the
to achieve a 2% point decrease in the average rate of
ESRD-related hospitalizations.
INFE~ DETECTION
BSI QIA GOALS, PURPOSE, AND ACTION
Goal: : Reduce e the e national l rate e of f bloodstream m infections s (BSIs) ) in n dialysis s patients s by y 50%, , to
e the e 5 5 year r national l target t to
e health h of f all l ESRD D patients s living g in n the e US. . Purpose: : The Network is contracted to develop a plan to reduce the rates of BSIs in patients with end stage renal disease (ESRD) because of their increased vulnerability to healthcare -associated infections (HAIs). Activities s will focus on reducing BSIs by:
increase awareness of resources
encourage facilities to join Health Information Exchange (HIE)
= = =
INFE~ DETECTION
SELECTION PROCESS
For 2019, CMS directed the Network to work with at least 50% of the facilities in the Network’s service area with the highest excess infection rate and provide an increased focus on the top 20% of the selection . Goal: : Achieve a 20% or greater relative reduction in the semi -annual pooled mean rate among the 20% cohort at re -measurement (Jan-Jun
Network 14 facilities eligible to report for all of 2018 (N N 573 573) ) Facilities ranked by highest Excess BSI Rates Selection of 50% of Network 14 facilities with the highest Excess BSI Rates (N N 286 286) ) Selection of 20% 20% of Network 14 facilities with the highest Excess BSI Rates (N=115 115) ) Total number of facilities remaining in the 30% cohort (N N 171 171) )
Baseline Data: Q1/Q2 2018 (January – June) 50% Cohort Facility Average PMR: 0.68 20% Cohort Facility Average PMR: 1.03 3
2019) compared to the previous year (Jan -Jun 2018).
INFE~ DETECTION
BSI QIA GOAL
INFECTION DETECTION QIA: 2016-2019 SEMI-ANNUAL POOLED MEAN RATE (20% GROUP) 1.54 0.80 1.25 0.59 1.25 0.63 1.03
Project Goal: 20% reduction in the semi- annual pooled mean rate of the 20% cohort = 0.82
BASELINE REMEASURE BASELINE REMEASURE BASELINE REMEASURE BASELINE REMEASURE 2015 2016 2016 2017 2017 2018 2018 2019 JAN-JUN JAN-JUN JAN-JUN JAN-JUN JAN-JUN JAN-JUN JAN-JUN JAN-JUN
INFE~ DETECTION
PROJECT COMPONENTS
NHSN N Monthly ly Audits ts Pa Patient nt Engage gement ment NCC C HAI I LAN N & & HIE E CDC C Core e Intervent ntion ions s Coalit ition ion
INFE~ DETECTION
PROJECT COMPONENTS
NHSN Monthly Audits Patient Engagement NCC HAI LAN & HIE
CDC C Core e Inter ervent entions ions Coalition lition
INFE~ DETECTION
~
Making Dialysis Safer for Patients Coalition Materials
~
For Order Via CDC-INFO
Conven.at10t1 Sta,tt• r to Prh'Ml Infections 1n Ouil-,s~ Patient, 10000You Can Order 2 Ways
CLICK www.cdc.gov/ pubs si,/i,ct ·01.iys/J S•fety• r,om thi, Pr-or,,,•ms drop down mll!'n11 M'!dCIIC.lt •Go•·---
O~!~~:t\:,~'°;h:~~::•
222390 01a1vs11 StaUOn Routine Disinfection Audit Tool (O,w tNr pad With .SO ..,,..ti) 222315 Envltonmental 5urface D11Ulfec:tlon In Dialysis FaCJldles; Notes fot Cllnk• Manag..-s JOOOJI Put Together the Pieces to Prewnt Infections In OlalvMsPatlenll l:ngll1h 221571 Spanl1h JOOOJ7 Hemodlafysls lnJ•cUon Safety HedlcMlon Pt..,.rtiuon Cheddltl 222311 Hemodlalysls Injection S•f•tv Medication Adrnlnln,atlon Checldlst 300040 tnJ@Ctlon Safety Hedlc.allon Preparation a Administration Audit Tool (0.. ,_ PMI IWffl JO .,,_ti) 222JIJ Days Since Lall lntedJoft Poster a.s- x 11" 300111 11" x 17" 100200 H~odlatysls Central Yenou1 cau,ete-r Scrub•the•Hub Protocol 300031 Memodlalvsh C&theter ConnecUon ChKklb:t 222112 Hemodlalvsts CAlheter Olsconrwcllon ChKklst 222H1 Cathetef ConMCtJon IH~":d~Y-?!r•
to-.1-,»d llrlthS0.,,_1-.1 222111 CDC Dialysis lnfectM>n ~'lefltion A .. OUN:=ff CD (l1Ktto11lcW1Solcwtss
CDC COALITION
The e Coalition ’s Goals:
CDC’s core interventions
bloodstream infection prevention
share findings, stories or experiences related to bloodstream infection prevention Joining the Coalition as a member is FREE, and includes access to free resources and education! Members s include: :
...
TOGETHER LET'S KEEP~
..
DIALYSIS PATIENTS
,t. SAFE
DAYS SINCE LAST BLOODSTREAM INFECTION
Our last bloodstream infection was on To learn mOllil about dialysis $afety visit w-cdc gov/ dialysis IJIIO A
'l■OBI
ASN )1 ·~
._....
.~,..
Conversation Starter
~ lo Prnent lnf•ctlons In Dialysis Patient•'-
=:.-::::-.:.=-.:=::.:::.:-:..°:':
...·
_
.. _____
.. _c ,i ljl 11 frj,I WI iii iii lift
Q
........ ---------"'--
.. ----
,_
.. _,.._c _ _ , .. _ .. _____
, ___ __
.. _
,
_,
.. _______ _
.................. _.,,_, ___
,.. ------
·------·
.. ·-·
.. --.. ·--
_______
.. _ .._ _
INFE~ DETECTION
CDC Approach to BSI Prevention in Dialysis Facilities
(i.e., the Core Interventions for Dialysis Bloodstream Infection (BSI) Prevention)
cqcs N ticlna H5ilt care Safe(y Netw,drk (NilSN). Calculate t,,o11ty
rates and compare Ul rates n ovier HS (ac%ues, Act,vely s are results with froot- e crtn,ca stalf.For more information about the Core Interventions for Dialysis Bloodstream Infection (851) Prevention, please visit http://www.cdc.gov/dialvsis
National Center for Emetgmg ..-lid Zoonouc lnfecuous Diseases\SE
AS
CDC CORE INTERVENTIONS
INFE~ DETECTION
PROJECT COMPONENTS
NHSN N Monthly thly Audit its s
Patient Engagement NCC HAI LAN & HIE CDC Core Interventions
INFE~ DETECTION
Audit Tool: Hemodialysis hand hygiene observations Audit Tool: Hemodialysis station routine disinfection observations Audit Tool: Catheter connection and disconnection observations Audit Tool: Catheter exit site care observations
(Use a
11-/'1 if action performed correctly, a "(!)" if not performed. If not observed, leave blank)Mask worn Skin Skin
No contact. . . . . . . properly Ha_nd New dean antiseptic anti!;eptic with exit Ant1microb1al Dres~ing Gloves Ha_nd D1sc1phne , f hygiene gloves I d
11d . , ft
apphed d hygiene Comments
11performed worn app ie a owe sit4: ,a er applied aseptically remove performed required) appropriately to dry ant1seps1s) Discipline: P=physiclan, N=nurse, T"'technician, S=student, O=otbe•
Duration of
mlnutes Number of
procedures performed correctly=
I
Total r'IIJ mber of prl!lcec! url!<S observed du ring audit~ ADDITfONAl COMMENTS/ OBSERVATIONS:
CDC OBSERVATION AUDIT TOOLS
Facility staff can use these forms to observe staff, such as nurses
proper infection control steps. The 4 Audits:
Routine Disinfection
Connection/ Disconnection
Care
Checklist: Hemodialysis catheter
connection
□
Wear mask (if required)
□
Perform hand hygiene
□
Put on new, clean gloves
□
Clamp the catheter and remove caps
□
Scrub catheter hub with antiseptic
□
Allow hub antiseptic to dry
□
Connect catheter to blood lines aseptically
□
Remove gloves
□
Perform hand hygiene
Checklist: Hemodialysis catheter
exit site care
□ □ □ □ □ □ □ □ □ □
Wear mask (if required) and remove dressing Perform hand hygiene Put on new, clean gloves Apply skin antiseptic Allow skin antiseptic to dry Do not contact exit site (after antisepsis) Apply antimicrobial ointment* Apply dressing aseptically Remove gloves Perform hand hygiene
INFE~ DETECTION
Checklist: Hemodialysis catheter
disconnection
□
Wear mask (if required)
□
Perform hand hygiene
□
Put on new, clean gloves
□
Clamp the catheter
□
Disconnect catheter from blood lines aseptically
□
Scrub catheter hub with antiseptic
□
Allow hub antiseptic to dry
□
Attach new caps aseptically
□
Remove gloves
□
Perform hand hygiene Checklist: Dialysis Station Routine Disinfection
Thlsllstunbeusecllft~elsno\lls.lbleiollonsurfKHHthed~lysls51Mlon. lfYIJlblebloodorothet"50lllsD Disconnect and tak@down used blood tubtn1 and dlalyter from the dlatysh machine
Discard tublns and dlatyters In a leak-proof container'.D D D D
~k that there ls no irlsible SOol or blood on surfacH. Ensure that the priming bucket has been emptle<tl. Ensure th.it the p.itient h.is left the di;iilys,is stu~. Discard all single-use supplies. Move any reusable $Upplies to an are;1 where they will be cleaned and disinfected before being stored or returned to a dialysis nat~. Remove gloves ;1nd perfomi h•od h't'liene. PART B: Routine Disinfection of the Dialysis Station - AFTER patient has left stationD D D D
Weardeanak)ves. Appty diWlfect•nt' to all surhces1 in the d~lysis nuion IISifll a wiping motion (with friction) Ensure surfaces are visibly wet with disinfectant. AUOw surfaces t o ~r-d,Y'. OiW!fect all surfaces of the emptied priming bucker':. Allow the bucket to air-dry before reconnection 0t reuse. Keep used or potentially contaminated lterm away from the disinfected surfaces. Remove gloves and perform hand hyg)ene.EASE
XAS
CDC OBSERVATION CHECKLISTS
Facilities are recommended to involve patients with infection control observations. The CDC Observation Checklist use the same steps listed in the audit form, but offer an easy to understand format to easily share with patients. By completing infection control observations, patients learn the correct infection control steps.
BSI QIA Improvement in Successful
Prevention Process Measures (N=28'6)
94"
91%
89"
Hand f-+y'§'i e ne Catheter Con/Disc Exit Site Care Dialysis Station Success Success Success
Di sinfe cu on
Success
BSI QIA Completion of CDC Audits
11.0036 76% 77%80%
60% 40%
,
036 Jan Feb Mar Apr May June July Aug ■QIA Start
■QIA End
◄Sept
INFE~ DETECTION
.
~•!,,<ig
END STAGE RENAL DISEASE
~
~ ~ ,:NETWORK OF TEXAS
.
NHSN MONTHLY AUDIT DATA
INFE~ DETECTION
PROJECT COMPONENTS
NHSN Monthly Audits
Pa Patie tient nt Engag agemen ement t
NCC HAI LAN & HIE CDC Core Interventions
IIIIIIIIIII ..iillllllll
TOGETHER LET'S KEEP
....
~
...
DIALYSIS PATIENTS
' , SAFE
DAYS SINCE LAST BLOODSTREAM INFECTION
Our last bloodstream infection was on
INFE~ DETECTION
I,-
. __ 1()
...
.. :
INFE~ DETECTION
84.40%Patient's Average Opinion on the "Infection Prevention Station"
{February- June 2019)
■ Yes ■ Somewhat No 84.95% 79.95% 70.33%for understand format. content.
NORK OF TEXAS
INFECTION PREVENTION STATION
Patient Engagement
. =.--;i;;; Get Engaged! It's YOUR Life.
!,.\\!Jll!)Aj) Lurn1boutp•tient Putieip11•inyour Lurn1boutp1tient r11pon1ibiliti .. rHponiibiliti.. Plan of Cart muting• N;o4lillol•bHIM•it'-tl...t U,TUi18ll\ Gel .YOU/ immun1ution1 ,111H1ro•r btatth1 DECE .. HR P/1n for on~ of lilo Allo1•10Hdto oho10 ..,,,,,,h,1'INFE~ DETECTION
WHAT'S
YOUR
P L A
1\1?
~"
I .
~
.. . .
PATIENT ENGAGEMENT OPTIONS
OPTION 1 OPTION 2 OPTION 3
National Recognition Events Network’s
Facility’s
Patient
Patient
Engagement
Engagement
Calendar
Plan
Oo
PATIENT EXPERIENCE WEEK
PR 23 27 2018
~ebeiyl1nst1tute org Clean your hands and nobody gets hurt.
INFE~ DETECTION
■ HandHyglene ISep slsIT'S IN YOUR
PREVENT S EPSIS IN HEALTH C'A.llE
U.S . ANTIBIOTIC
AWARENESS WEEK November 12·18, 2018
WWW cdt.gov/MVbiOIIC·UIONATIONAL RECOGNITION EVENTS
MARCH 14
MARCH 10 16
APRIL 27 May 1
MAY 5
NOVEMBER 12 18
SEPTEMBER
OCTOBER 15
OCTOBER 14 20
Week
.A\\...E
..
~
NETWORK OF TEXASPatient Engagement Question #1
Do yo u make a listGet to know your Care Team
They are here for YOU !Learn about patient respon s ibil iti es
Do your job as a patient!AUGUST Cherish your vascular access
It 's your lifeline!Participate in your Plan of Care meetings
Nothing about me without me !SEPTEMBER Get your immuniza tions
Protect your health !DECEMBER Plan for end of life
ALL of us need to shareJANUARY
Take part in your care
It's your life! How can I increase my engdgement t his mont h? Know your !M'dicineiJANUARY
Participe en su cuidado
;Es su vida! tCOmo puedo tl!ner milyor p,1rticipKi6n este mn? Conozcil ws mediCilmeentlK~ Q
ib ta inlormocionM cru d• POR poc:i,:ntes con ENFutMWAD RUfAl OI rTAPA TERMINAL IBRDI PAJlA p< ENFERM£DAOR£NAl EH fl APA t ERMlNAl (£SRD)! P•ta prfienut .. u qucja o si tiene pre"'""'"""""'";q""H conBRONrr-ril ofTu ,o,al l ·l77..U6-44H tt,,,1ri-oj, 97l·50J.-Sll9 (fu). info.,wl4_ .,.,,.i_.,.,, le m~I). 4099 Mi::fwen Rd,. 5urle no. o . n ... TX 7U 44 o www_ .,.,,.i...,twont.o,cEND STAGE RENAL DISEASE
NETWORK OF TEXAS
NETWORK’S PATIENT ENGAGEMENT CALENDAR
INFE~ DETECTION
PROJECT COMPONENTS
NHSN Monthly Audits Patient Engagement
NCC C HAI I LAN N & H & HIE E
CDC Core Interventions
INFE~ DETECTION
ESRD NCC HAI LAN CALLS & HIE
The e ESRD D National l Coordinating g Center r (NCC) ) Health h Associated d Infection n (HAI) ) Learning g and d Action n Network k (LAN): :
centers caring for the same ESRD patients, and sharing of best practices.
Health h Information n Exchange e (HIE): ):
another evidence-based highly effective information transfer system to receive information relevant to positive blood cultures during patient’s transition of care.
STANDARDIZE UTILIZE SHARE TRANSPARENCY ACCOUNTABILITY INTEGRATION NEVER GO BACK
INFE~ DETECTION
SUSTAINABILITY
Sustain the improvements made during the project after the project has ended
with the end goal in mind
seven steps of sustainability
for each project to Network toward end of project
Role of organizational culture and leadership in successful sustainability activities
20% GROUP 1 30% GROUP ,03 1~ 7 I S t art of QIA I
0,56 b.46 0,52
Baseline Jan-19 Feb-19 2 018 May-Jul Jun-Aug Ql-Q2 2018 2018
INFE~ DETECTION
Infection Detection QIA: Quarterly Pooled Mean BSI Rate
Target 20% RI Goal, 0, 82 0,76
0,57 0,55 0.51 0,50
0,43
0.000,00 0,00,00
0, 00, 000,00,00 0,00,00 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Jul-Sep Aug-Oct Sep-Nov Oct-Dec Nov-Jan Dec-Feb Jan-Mar Feb-Apr Mar-May 2018 2018 2018 2018 2018/19 2018/19 2019 2019 2019
BSI QIA CURRENT RESULTS
B aseline: : (Jan – June 18)
% Group: : 512 2 PBC C
G oal: : 20% or greater reduction in the semi - annual PMR in the 20% cohort (N=115) by the re-measurement (Jan- June 19):
PBC or greater Results: : Reduction of 1 1 8 1 1 8 PBC Q1 (Jan – Mar 19) in 20% cohort.
PBC
% Q1 1 2019: : 127 7 PBC C
atheter
O
peration
R
eduction &
..,.....,. . Elimination
LONG TERM CATHETER QIA
D I A L Y S I S C A T H E T E R I N P L A C E > 9 0 D A Y S
Baseline e and d Goal: : 38 facilities with LTC rates >15% from the 50% BSI facilities with highest infection rates Focus facilities baseline for this project is 21% Goal: decrease LTC rate by at least 2 percentage points Best t Practices: : Facilities have been tracking LTCs monthly and reporting to the Network via Survey Monkey RCA, LTC Tracking tool, and having a designated vascular access manager have been the most helpful tools according to facilities’ feedback. Medical City Dallas - Cannulation Camp Data Validation 5 Whys for patients
18.18 8 18.7 .71 1 17.18 8 14.67 .67 15.54 .54 20.7 .74 4 20.5 .51 1 20.28 .28 20.05 .05 19.82 .82 19.59 .59 19.36 .36 19.13 3 18.9 .97 7
O
peration
R
eduction &
LTC OUTCOMES TO DATE
LTC C Cohort t 38 8 Faciliti ties es with h LTC C rate e >15% % at t baseline ne Goal l = 2 2% % reduc ucti tion n by S Septembe mber r 2019 9
20.9 .97 7 13.00 .00 14.00 .00 15.00 .00 16.00 6.00 17.00 .00 18.00 .00 19.00 .00 20.00 .00 21.00 .00 22.00 .00 % % Long g Term m Cathe theter er Rate e
Data source: National Coordinating Center (NCC), March 2019
Baselin seline e
Intervention Period (Jan 19’ – Sep 19’)
Jun June e Ja Jan-1
' Feb eb Ma Mar r Apr Apr Ma May y Jun Jun Jul Jul Aug Aug Sep p 2018 8 LTC C LTC Current R t Rate ate 2019 Mo Monthl thly Go Goal al
. E
~,.
END STAGE RENAL DISEASE
~
~ ~ ,:NETWORK OF TEXAS
.
HOSPITALIZATIONS QIA INTERVENTIONS
: 2% point decrease in the average rate of overall hospitalizations and a 10% relative decrease in ESRD -related hospitalizations
interventions to Project Facilities – Based on identified Diagnosis and RCA – Network emails, fax blast, Webpage – Webinars regarding Hospitalization and Coordination of Care – Facilities are required to complete a Monthly Survey
List t of f Interventions: : Forum of ESRD Network – Transitions of Care Toolkit KEPRO Patient Navigation Tool Hospital to Dialysis Transfer Summary Missed Treatment Workbook Network PAC Fluid Overload Patient Trifold L.A.C.E. Index Score Guidelines for Emergency Hemodialysis ZONE Tool Summer Kick-Off Lobby Day
~
Suggestions on How to Help Avoid
W7
Hospitalization ~
~
✓
Complete all t reatments
✓ Follow your flu id intake orders ✓ Follow rena I and diabetic diet ✓Keep hands and access clean
✓
Keep all appointments wit h doctors
✓ Follow medicine schedule ✓Get your vaccinations
Remember, you know your body. You are your best advocate.My Doctor's Phone Number: ___________ _ My Facility Phone Number: _ __________
_My Hospital Phone Number: ________ ___
_@
To file a griev.anc.e please contiilct Network 14 al 1-877-886-4435 and www .esrdnetwork.org ESRD Network of Tex.a.s, In c.. 4099 McEwe n Rd, Ste. 820 O.a.llas, TX 75244 972..,503-321.5 office 972-503-3219 fax.877--386-4435 to free info@ nw14.esrd .net http:/fWww .e.srdnetwork..orgf Cleated under CMS cont ract number: H:tt5M-500-2016-NW014C.Suggestions 0 ,
111 Ho,w to Hel1p
Avoid Hosp,italization
✓
Com pl etealll treatments
,/1
0:eeiP hands and access d ean/Follow
your fluid intake orders .,tke~p all appoint ents. with doctors ✓
Fo l l o wrenal and diabetic diet / f •
,tGet your vacctna
1 tioru;.
Remember, yo k110.w ymn body. Yotune your best advocate.
My Doctor's Phone Number: _________ _ My Facility Ph one Niu mber: My Hospital Phone Nlumbe ·: __..
.......
_.....,.,....
_ _ __ _
'To file a grievance•1 please contact
I Networl 1. 4 at 1·!177'~m~
~~-~
7~
972:·.SD3·321S. otooe 9, 72.503,-3219 rax 877-886-44.3.5 tall free ·llfo@nw14.esrd.net http://Www.eSl'dnetwork.org/ Cleated under CMiS. oon ract number: I HIHSM-500-2016-N1N014C.END STAGE RENAL DISEASE
NETWORK OF TEXAS
PAC SME DESIGNED INTERVENTIONS
ESR Tot
l Hospi piti tialzations ations
Faciliti ties es QIA A = = 72 2 Non n QIA A = = 162 162
0.14 4 0.15 5 0.14 4 0.14 4 0.14 4 0.14 4 0.13 3 0.14 4 0.14 4 0.14 4 0.13 3 0.14 4 0.13 3 0.14 4 0.12 2 Rat Rate e 0.110 0.15 5 0.150 0.150 0.140 0.130 QIA A Hos
p 0.160 0.120 Non Q
A Hos
p Rat Rate e 0.100 0.100 0.11 1 0.13 3 0.13 3 0.15 5 0.13 3 0.13 3 0.14 4 0.14 4 0.11 1 0.12 2 0.13 3 0.14 4 0.13 3 0.14 4 0.12 2 0.13 3 0.100 0.110 0.120 0.130 0.130 0.140 0.150 0.160
D D Related d Hospit itial alzati tions
Non Q
A ESRD SRD Rat Rate e QIA A ESRD SRD Rat Rate e
Faciliti ties es QIA A = = 72 2 Non n QIA A = = 162 162
HOSPITALIZATIONS QIA OUTCOMES
Goal l (2 2 % % point nt): ): 0.10 Goal l (10%): ): 0.099 9
HOSPITALIZATIONS QIA ICD-10 CODES
A04.7 Enterocolitis due to Clostridum difficile G40.89 Other seizures G40.802 Other epilepsy, not intractable, without status epilepticus G45.9 Transient cerebral ischemic attack, unspecified G89.29 Other chronic pain G93.40 Encephalopathy, unspecified I20.8 Other forms of angina pectoris I21.3 ST elevation (STEMI) myocardial infarction of unspecified site I21.4 NonST elevation (NSTEMI) myocardial infarction I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris. I25.708 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris I26.99 Other pulmonary embolish without acute cor pulmonale I34.1 Nonrheumatic mitral (valve) prolapse I34.2 Nonrheumatic mitral (valve) stenosis I46.9 Cardiac arrest, cause unspecified I48.0 Paroxysmal atrial fibrillation I49.9 Cardiac arrhythmia, unspecified I50.21 Acute systolic (congestive) heart failure I50.22 Chronic systolic (congestive) heart failure I50.23 Acute on chronic systolic (congestive) heart failure I50.30 Unspecified diastolic (congestive) heart failure I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure I50.9 Heart failure, unspecified I62.01 Nontraumatic acute subdura hemorrhage I63.50 Cerebral infarction due to unspecified occlusion or stenosis
I67.89 Other cerebrovascular disease I96 Gangrene, not elsewhere classified J12.9 Viral Pneumonia, unspecified J15.8 Pneumonia due to other specified bacteria J18.9 Pneumonia organism unspecified J20.9 Acute Bronchitis, unspecified J40 Bronchitis, not specified as acute or chronic J44.1 Chronic Obstructive Pulmonary Disease with acute exacerbation J44.9 Chronic obstructive pulmonary disease, unspecified J45.901 Unspecified asthma with (acute) exacerbation J45.909 Unspecified asthma, uncomplicated J98.4 Other disorders of lung K21.9 Gastroesophageal reflux disease without esophagitis K25.0 Acute gastric ulcer with hemorrhage K29.00 Acute gastritis without bleeding K31.84 Gastroparesis K56.60 Unspecified intestinal obstruction K59.00 Constipation, unspecified K62.5 Hemorrhage of anus and rectum K72.90 Hepatic failure, unspecified without coma K81.0 Acute cholecystitis K81.9 Cholecystitis, unspecified K82.9 Disease of gallbladder, unspecified K85.9 Acute Pancreatitis, unspecified K86.1 Other Chronic Pancreatitis K92.0 Hematemesis K92.1 Melena K92.2 Gastrointestinal hemorrhage, unspecified L89.309 Pressure ulcer of unspecified buttock, unspecified stage M25.569 Pain in unspecified knee M54.9 Dorsalgia, unspecified N39.0 Urinary tract infection, site not specified R00.0 Tachycaria, unspecified R00.1 Bradycardia, unspecified R10.0 Acute abdominal R18.0 Malignant ascites R19.7 Diarrhea, unspecified R41.82 Altered mental status, unspecified R42.0 Dizziness and giddiness R50.9 Fever, unspecified R58 Hemorrhage, not elsewhere classified R62.7 Adult Failure to Thrive R65.21 Severe Sepsis with septic shock R73.09 Other abnormal glucose
INFECTION RELATED
2605 2605 94% 94% 173 173 6% 6%
Feb.
9 Ad Admits its
Othe her r Adm dmits s Infe nfectio ion n Admits s
228 8 Facil cilit ities ies
2778 total hospitalizations based on CROWNWeb data
6% of these hospitalized patients reside in a nursing home/SNF
DX Admits Sepsis unspecified organism 56 Urinary tract infection 33 Infection of the skin and subcutaneous tissue 31 Infection due to other cardiac and vascular devices implants and grafts 13 Sepsis due to Methicillin resistant Staphylococcus aureus 10 Other specified bacterial agents as the cause of diseases classified elsewhere 8 Unspecified infection due to central venous catheter 5 Sepsis due to Methicillin suscepible staphylococcus aureus 4 Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere 3 Other streptococcal sepsis 3 Gram negative sepsis unspecified 2 Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere 2 Severe Sepsis with septic shock 2 Sepsis due to Enterococcus 1
E D STAGE RENAL DISEASE
NETWORK OF TEXAS
OURNETWORK PATIENTS & FAMILIES PROVIDERS Ccntmumg Educat10n Etluc Inclu:a 0.e Care End of life Vaccinations Patient- end Famiy-Cenlered c,.., Vocations/ Rehabilitation Pattent-Pro·,ider Conflict QuahtY InceutJxe Pro2ram . (QIP) NHSN Quality Impro•,·ement 5-0iamond Patient Safety p""""" HAl-l.Al'-¥ Sepsis Resources J.tane,ging Vascular Aocess OAPI Tools elld Resources CRO\\-:S.-Web Quality Imprm·ement Actn-it:l.es (QL\) Be the Voice-Be the O'lange 20U:I ICH CAHPS QIA OJJture Exchange: NHSN Dale Qua/ityQIA OepresstOn Screening QIA (PHFPO) Don't Wait, Vaocinale 2016 Vaccination QIA HomeMOOalty 2018 Home Referrals QIA 2017 Home Referrals QIA 2016 Home Referrals QIAOrientation Webinar Information Intervention Resources
CDC Resources CDC Core Interventions for Dialysis BSI Prevention QI · oays Since Last Bloodstream Infection" Poster QIEND STAGE RENAL DISEASE
NETWORK OF TEXAS
THANK YOU FOR ATTENTION
Location n of f project t materials: : http://www.esrdnetwork.org/ infection-detection
BSI I Lead: : Maryam yam Alabood
Quality Improvement Specialist 469-916-3803 malabood2@nw14.esrd.net LTC C Lead: : Dany y Anchia hia, , BSN, , RN, , CDN N Quality Improvement Director 469-916-3813 danchia@nw14.esrd.net Hospit italiz alizat ation ions s Lead: : Mary y Albin in, , BS, , CPHQ Q Executive Director 469-916-3809 malbin@nw14.esrd.net