Long-term care facilities and nursing homes often treat the most vulnerable and complex patient populations. These facilities must address patients’ quality of care and quality of life, often while struggling with workforce shortages. In 2016, Rochester Regional Health committed to achieving continuous quality improvement at its skilled nursing facilities.
Rochester Regional Health’s “High Five: Achieving Continuous CMS 5 Star Quality Measures” program monitors, analyzes, manages and supports quality improvement projects in real time. High Five supports nurses with a performance improvement coordinator who presents care quality data in an actionable way to help clinical teams improve care. The Long Term Care Division implemented Lean and Six Sigma methodologies to identify the root causes driving unfavorable trending within targeted quality measures. A “Spotlight” program monitors and manages quality measure reviews weekly within each SNF, governed by an interdisciplinary care team. The interdisciplinary team holds monthly quality management reviews at each facility. Additionally, monthly and quarterly quality measure reports are shared with the division’s executive leadership.
From these efforts, best practices were developed and all six skilled nursing facilities achieved 13 consecutive quarters of improvement. Five out of six facilities within the division achieved four stars for the Centers for Medicare and Medicaid Services Nursing Home Compare Five-Star Quality Ratings. This successful model was replicated in a partnered facility outside Rochester Regional Health.
For this successful program, Rochester Regional Health was recognized with HANYS’ 2019 Pinnacle Award for Quality and Patient Safety. Watch our video for a more in-depth look at Rochester Regional Health’s program and its results.
For more information, contact Richard Sweet-Keech, MAOL, BBA, LSSGB, performance improvement coordinator, at (585) 368-3956 or email@example.com.
Catheter-associated urinary tract infections are the most common healthcare-associated infection, leading to substantial morbidity and increased healthcare costs. Central line-associated blood stream infections result in thousands of deaths each year and billions of dollars in added costs to providers. Hoping to lessen instances of these preventable HAIs in their facility, Long Island Community Hospital began a team-based reduction initiative.
Using baseline data collection, team members determined the most effective way to eliminate HAIs was to reduce the use of the catheters and central lines. To achieve this, the team started reviewing device utilization daily, discussing opportunities with nurse managers and front-line staff, educating staff and empowering them to initiate nurse-driven protocols and escalating barriers to removal of devices through continuous monitoring.
The hospital achieved a 22% reduction in utilization of Foley catheters in the medical/surgical and step down units and a 6% reduction in the intensive care units between 2017 and 2018, reaching their goal of 7% of admitted patients with Foley catheters (65% below the national utilization rate). Device utilization of central lines was reduced by 30% in the medical/surgical and SD units and 40% in the ICUs.
For more information, contact Doreen Virgil, MSN, RN, CIC, manager, infection control, at (631) 654-7758 or firstname.lastname@example.org.
Provider efforts to curb opioid addiction while still offering effective pain management services are increasingly complicated. Noting that it was seeing more patients admitted to Upstate University Hospital’s pain service who were concurrently suffering from opioid addiction, Upstate University Hospital addressed this treatment obstacle by creating a new position: opioid use/IV drug use nurse practitioner, currently filled by Theresa Baxter, NP.
The position assists Upstate’s medical staff with identifying opioid addiction, managing medication and helping coordinate long-term treatment options. Patients who might have opioid use disorder are evaluated and may be able to receive buprenorphine while in the hospital to curb opioid withdrawal symptoms. Post-hospitalization, Upstate secures outpatient treatment plans for these patients and connects them with peer support specialists through Helio Health and Onondaga County Peer Specialists. Peer support specialists are in long-term recovery from substance use disorder and have had special training to work with people with substance use disorder, providing support and connections to treatment, housing, insurance and more.
This specialty care has helped decrease length of stay and readmissions while improving long-term outcomes at Upstate, according to Ms. Baxter. Since starting the position, she has seen more than 100 patients – many of whom have entered long-term recovery.
For more information, contact Emily Kulkus, assistant director, public and media relations, at email@example.com.
According to CDC, at least 1.7 million adults in the U.S. develop sepsis and nearly 270,000 die as a result each year. In 2014, Mercy Medical Center (of the Catholic Health Services of Long Island system) formed a sepsis committee made up of medical staff from various departments. The team evaluated timely nursing assessment, early identification of barriers, improving caregiver education and the addressing of medical record challenges.
The sepsis committee took data from the evaluations and developed a Mercy Sepsis Program that implemented an intensive and multidisciplinary education program for clinical staff and their patients. The plan evaluated the most at-risk patients based on extensive data review, customizing the existing sepsis protocol and outlining opportunities on how to reduce the risk of sepsis. Additionally, the plan highlighted the importance of patient engagement and empowerment, The Program requires clinical staff to participate in annual multilevel sepsis education. It also:
In 2018, Mercy was recorded in the 97th percentile for three-hour bundle compliance and in the 98th percentile for the composite bundle adherence. Their sepsis order set usage increased from 36.6% in 2015 to 95.1% in 2018. The current median time to antibiotic is 33 minutes with a mean of 48 minutes.
For more information, contact Alida Almonte, director, public relations, at firstname.lastname@example.org or at (516) 705-1871.
Healthcare-associated infections kill more than 72,000 patients yearly in the U.S. The Centers for Disease Control and Prevention states that the most effective way to stop the spread of infection is to ensure that caregivers have clean hands, but monitoring care providers is tedious and limited, leaving staff and patients exposed to a higher risk of infection transmission.
In 2018, SUNY Downstate Medical Center launched a novel initiative to improve hand hygiene with the new, state-of-the-art BioVigil system to prevent HAIs and increase hand hygiene compliance. The colored lights on the BioVigil badge visually communicate hand hygiene compliance. Red is stop and wash hands; yellow is a reminder; green means hands are clean. This provides reassurance to patients and families that their care provider has clean hands and helps providers track their hygiene. One patient’s family member, after noticing a BioVigil badge, commented that he was “very impressed and had a huge sense of comfort not to worry about germs and diseases being transmitted because of bad [hand] hygiene.”
In less than eight months, Downstate recorded nearly six million hand hygiene occurrences, roughly 803 an hour. In addition to increasing patient quality and satisfaction, hand hygiene compliance increased by 200% and the numbers are still climbing. Cross-contamination events were reduced by 50%.
For more information, contact Robert Gwizdala, MPH, RN, director, epidemiology and infection control, SUNY Downstate Medical Center, at (718) 270-2344 or at email@example.com.