TCPS Recognizes These Hospitals for Excellence in Complete Data - - PowerPoint PPT Presentation

Tennessee Center for Patient Safety

Baptist Memorial Hospital-Calhoun Baptist Memorial Hospital-Collierville Baptist Memorial Hospital - Memphis Baptist Memorial Hospital-Golden Triangle Baptist Memorial Hospital-NE Arkansas Baptist Memorial Hospital-Union City Bristol Regional Medical Center CHI Memorial Hospital-Chattanooga CHI Memorial Hospital-Hixson Henry County Medical Center Holston Valley Medical Center Jackson-Madison County General Hospital Livingston Regional Hospital Lonesome Pine Hospital Milan General Hospital Mountain View Regional Medical Center NorthCrest Medical Center Southern Tennessee Regional Health System- Lawrenceburg Southern Tennessee Regional Health System- Pulaski Sumner Regional Medical Center University of Tennessee Medical Center Wayne Medical Center Williamson Medical Center

TCPS Recognizes These Hospitals for Excellence in Complete Data Submission for 2017

Center Staff

• Chris Clarke, Sr. VP, Clinical and Professional Practices
• Patrice Mayo, VP for Operations
• Jackie Moreland, Clinical Quality Improvement Specialist
• Rhonda Dickman, Clinical Quality Improvement Specialist
• Janet Meadows, Clinical Quality Improvement Specialist
• Jennifer McIntosh, Clinical Quality Data Manager
• Amanda Chumley, Project Manager, PSO and TSQC
• Teresa Benedetti, Executive Assistant

3

Tennessee Center For Patient Safety

THA Board Strategic Aim: Zer Zero

• Pr

Preven enta table ble Har Harm

4

• Transparency and Accountability

– Hospital-specific comparison data shared at THA Board meetings

• Data posted on TCPS Report Distributor

– Board level peer-to-peer presentations – CEO Leadership Scorecards

Leadership Commitment

• Program Areas:

– CMS Partnership for Patients

• Hospital Improvement Innovation Network (HIIN)

– Tennessee Surgical Quality Collaborative

• Enhanced Recovery After Surgery

– OB/ Maternal Care Programs with TDH

• Early Elective Delivery, Breastfeeding Promotion,

Safe Sleep – THA PSO Program

Tennessee Center for Patient Safety

TCPS Strategies and Offerings

• AHRQ Culture of Safety Survey
• TCPS Regional Education

Meetings

• Mentors program and peer

sharing

• Site visits to HIIN hospitals and

health systems

• Medication Safety Summit
• Sepsis Collaborative and

Consultations

• Patient/Family Engagement SNAP
• Health Equity Summit
• Workplace Resilience Webinar

Series

• Professional peer networking

and coalitions – Sepsis Coordinators coalition – Care Transitions coordinators coalition – Pharmacy coalition – Patient and family advisors

• Tennessee Surgical Quality

Collaborative

• Breastfeeding/OB initiatives
• THA Leadership Summit

Core HIIN Topics

• Adverse Drug Events (ADE):

– glycemic management,

• pioid safety, anticoagulant

safety

• Catheter-Associated Urinary

Tract Infections (CAUTI)

• Central-Line Associated Blood

Stream Infections (CLABSI)

• Clostridium difficile (C. diff)
• Falls with Injury
• Methicillin-Resistant Staph

Aureus (MRSA)

• Pressure Injuries
• Readmissions
• Sepsis
• Surgical Site Infections (SSI)
• Venous Thromboembolism (VTE)
• Ventilator-Associated Events (VAE)
• Worker Safety

– Patient Handling Injuries – Workplace Violence Incidents

• Culture
• Patient and Family Engagement
• Elimination of Disparities

Adverse Drug Events

• Voluntary data collection and reporting by

hospitals

• No national standardized measures
• CMS proposing new eCQM measures on

harm

– Hypoglycemia, opioid-related adverse events, hospital-acquired pressure injury, and acute kidney injury

– https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/MMS/PC-Currently-Accepting-Comments.html

– Comment period extended to March 2, 2018

• Areas of focus based on performance gaps

– Adverse Drug Events – opioids, anticoagulation, hypoglycemia – Sepsis – MDROs – MRSA and C-difficile

• Request all THA members collect and report to THA on

adverse drug event measures, falls and pressure injuries

• Share hospital–specific data with THA Board on ADEs and
• ther voluntary measures

2018 Quality and Safety Priorities

• Cross-Cutting Strategies for Hospitals

– Quality boot camp for hospital leaders – Infection control boot camp – UP campaign – Surgical ERAS/ISCR protocols – Workforce resilience webinars – Patient and family engagement – Health equity and addressing disparities

2018 Quality and Safety Priorities

Partnership Programs

• Tennessee Department of Health

– Healthcare Infection Targeted Assessment and Prevention (TAP) strategy – Antibiotic Stewardship

• Tennessee Departments of Health and Mental Health

– “Tennessee Together” Opioids Plan

• Collaborative on Prevention of Opioid Addiction
• Enhanced access to treatment services

2018 Quality and Safety Priorities

Opioid Epidemic Update

Prevention Treatment Law Enforcement Limits initial prescriptions to 5-day supply Provides over $25 million in state/federal funds Increases state funding to address illicit sale and trafficking of opioids Commission to address evidence-based competencies for medical and health practitioner schools Extends peer recovery specialists to targeted, high- need emergency rooms Updates the controlled substance schedules to address fentanyl analogues Collaborative to implement best practices around pain management Expands TennCare access to recovery services Provides state troopers with Naloxone Public awareness campaign Creates public/private treatment collaborative Education for elementary and secondary schools Treatment and recovery

• ptions tied to legal system

and corrections Prevention of Neonatal Abstinence Syndrome

Governor’s Plan TN Together

• Develop a multi-stakeholder collaborative to identify the most

significant interventions to decrease opioid abuse and support evidence-based interventions for statewide quality improvement

• Four focus areas identified at opioid conference last fall

– Prescriber Education – Patient Education – Perioperative Pain Management – Emergency Department

• Funding for 1 year in Governor’s budget proposal

TDH Opioid Prevention – Provider/Prescriber Collaborative

Opioid Light ED Pilot

• Enlist interested facilities in reducing opioids used to

treat patients in Emergency Department

• Baptist Memphis staff serving as expert faculty
• Six-month pilot
• Aim to reduce opioid use in the ED by 40% through

use of five pain pathways

• Multi-disciplinary hospital teams (physicians,

pharmacists, nurses)

• Developing toolkit and resources
• Launch April 26th at THA Medication Safety Summit

• Perioperative Pain Management

– Spread implementation of Enhanced Recovery After Surgery (ERAS) protocols with emphasis on reduction in opioid use for perioperative pain – Vanderbilt Colon ERAS project has decreased opioids by 50% with lower complications, shorter length of stay and lower costs – Goal to decrease post-operative opioid prescribing by 40% by 2019 – TSQC and TN ACS as possible leaders

Opioid Abuse Prevention Strategies

• Tennessee Surgical Quality Collaborative

– 22 hospitals that participate in ACS NSQIP – ERAS project focus for 2017/2018

• AHRQ funded Improving Surgical Care and Recovery

(ISCR) project

– American College of Surgeons/ John Hopkins faculty – Open to ANY hospital at no cost – Cohort 2 starts in March focused on orthopedics – TCPS hosting regional meeting of hospitals April 19th – Future cohorts on gyn surgery, bariatrics and emergency surgery

Opioid Abuse Prevention: Perioperative Pain Management

• IHI Open School for Health Professions -Free access
• TCPS Weekly Newsletter
• TCPS Website http://www.tnpatientsafety.com
• TCPS Report Distributor

– Data feedback and comparisons – CEO Scorecards and Board data slides

TCPS Resources for Hospitals

• Workforce Resilience Webinar Series

with Dr. Bryan Sexton

─ Offered monthly

• THA Medication Safety Summit

─ Thursday, April 26, 2018

• Breastfeeding Workshop

─ Friday, May 4, 2018

Upcoming Events

• Sepsis Readmissions Summit

─ Wednesday, May 9, 2018

• Health Equity Conference

─ Thursday, May 17,2018

Upcoming Events