Your SlideShare is downloading. ×
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Annual ed core measures.09 10
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Annual ed core measures.09 10

1,602

Published on

September

September

Published in: Education
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,602
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
9
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. CORE MEASURES 2009
  • 2. What are “core measures”?
    • Patient groups where there is significant agreement regarding evidence-based medicine
    • Defined by CMS and Joint Commission
    • An expectation that we will follow specific ‘best practice’ guidelines in our treatment of every patient in these diagnostic groups
  • 3. Which Patient Groups Are “Core Measures”?
    • CHF - Congestive Heart Failure
    • PNE - Community Acquired Pneumonia (previously called CAP)
    • AMI- Acute Myocardial Infarction
    • SCIP - Surgical Care Improvement Project
    • PSYCH - Psychiatric measures (our choice to use these as ‘best practice’)
    • ALL – Patient Satisfaction. See module!
  • 4. What Is Expected?
    • There are specific treatment requirements for each of these patient groups.
    • We audit 100% of patients’ charts, for those patients in these groups. We then submit our data to CMS and Joint Commission.
    • All hospitals nationally participate in this process.
    • Results are compared among hospitals and published on the internet.
  • 5. What Is the Key to Improvement?
    • Identify these patients as early as possible in their care.
      • Nursing, physicians, admissions and case management all can make this identification. (Note in both StatCom and EPIC. )
    • Protocols!
      • Our physician partners have agreed on specific protocols for each of these patient groups.
    • Multidisciplinary teams:
      • Address the care these patients receive from admit to discharge.
    • Increased, prompt awareness of these patients
  • 6. Why Do We Do This?
    • Evidence shows that these measures:
      • Minimize hospital length of stay
      • Prevent development of microbial resistance
      • Reduce mortality, morbidity
      • Reduce hospital costs
    • It’s the right thing to do!
      • 2007, Up To Date ® Thomas M. File, Jr. MD
  • 7. Summary of Forms
    • AUDIT TOOL: Core Measure Check List
    • Pneumonia protocol (4 page order set)
    • CHF protocol (in development as of 8/07)
    • CHF physician discharge checklist
    • Revised medication reconciliation form
    • ACS protocol (all AMI & angina patients- 8/07)
    • ACS physician discharge checklist
    • Revised orthopedic surgery protocols
    • Revised VTE prophylaxis form
  • 8. Tools to Use in Treating Congestive Heart Failure
  • 9. What Kind of Tools?
    • Heart Failure Order Set
    • Medication Reconciliation form –
        • The physician MUST SIGN the medication reconciliation form for ALL CHF patients.
    • Physician Discharge Planning Progress Note for CHF Hospitalization.
        • The physician must complete this form prior to discharge
    • New reminder sheet for nurses!
      • A prompt and audit tool, ALL IN ONE!
  • 10. How Do I Get Started?
    • Obtain the Medication Reconciliation Form and place it on the chart for the physician to sign at discharge
      • Form # 81011
    • Place the Discharge Planning Progress Note for CHF Hospitalization on the chart
      • Form # 7680 (10/07)
    • Inform Physicians that these forms are available and where they’ll be stored
  • 11. IT’S UP TO ME TO IDENTIFY THE CHF PATIENT?
    • Yes, particularly if the diagnosis is not immediately noted on admission.
    • Clues to look for:
      • History of heart failure
      • Was the patient admitted for shortness of breath or edema ?
      • Did the patient receive any IV diuretics ?
      • Does the patient have and implantable cardiac defibrillator (ICD) or biventricular pacemaker
    • There is a CHF decision tree to help assist.. See your Clinical Educator.
  • 12. What Are the Requirements?
    • For CHF patients, we must
      • 1.Accurately identify these patients and implement the CHF teaching tool
      • 2.Give the patient a copy of the Discharge Declaration Sheet prior to discharge.
      • 3.Obtain physician signature on the medication-reconciliation form for ALL CHF patients.
      • 4.Physician must complete the Discharge Planning Progress Note for CHF
      • Hospitalization.
  • 13. Tools to Use in Treating Community Acquired Pneumonia
  • 14. How Do I Get Started?
    • Place the Pneumonia Order Set on the chart
      • Form #7900-005 (it’s four pages)
    • Inform Physicians that the form is available and where it is stored
    • Become familiar with the orders
    • Implement them promptly
  • 15. What Kind of Tools?
    • New name for CAP!
      • CAP has a new acronym: PNE or PN
    • New Protocol!
      • The “Community Acquired Pneumonia Order Set” simplifies admission orders for these patients
    • The audit sheet helps to cover all key points!
  • 16. What Are the Requirements?
    • For PN patients, we must:
      • Obtain blood cultures x 2; chart when collected
      • Start antibiotics within 6 hours of arrival (time the patient arrives, not the time of admission) – Give first antibiotic ASAP & after blood cultures are collected
      • Assess pneumonia and flu vaccine status and administer if indicated – Pneumoccal vaccine for patients >64 years, year round. Influenza vaccine for patients > 50 (October 1 through March 31)
  • 17. Tools to Use in Treating Acute Coronary Syndrome (All AMI & angina patients)
  • 18. AMI & ACS
    • ATTENTION CATH LAB AND ED
    • 90 minutes from “ED Door” to PCI!!
    • This applies to all STEMI patients (if you have a question, get the protocol!)
    • Time is measured from arrival , not admission, to time of PCI (first inflation)
    • Increases survival rates
    • New protocol for care and discharge elements for all acute coronary syndrome patients
  • 19. How Do I Get Started?
    • Use the ACS Order Set/protocol
    • Inform Physicians that this order set is available and where it will be stored
    • Become familiar with the orders
    • Implement them promptly
  • 20. Important Tools to Use in Treating The Surgical Patient (SCIP…Surgical Care Improvement Project)
  • 21. Key Documentation for All Surgery Patients
    • The correct antibiotic and means of administering it
    • Accurate surgery start time
    • Accurate surgery end time
    • Clinical trial participation: yes/no
    • Signs/symptoms of infection prior to procedure
  • 22. Which Surgical Inpatients?
    • Hysterectomy
    • CABG
    • Other Cardiac Surgery
    • Colon Surgery
    • Hip and Knee Arthroplasty
    • Vascular Surgery
    • Principal procedure only
  • 23. ANTIBIOTIC MANAGEMENT
    • #1 Right antibiotic selected
    • #2 Right Pre-Op Time - To START
    • #3 Right Post-op Time - To STOP
    • PRE-OP Nurse’s Role:
    • Send the ordered antibiotic to the OR so it may be hung at the correct time (one hour prior to the surgical incision as Administered by anesthesia)
  • 24. ANTIBIOTIC MANAGEMENT
    • POST-OP Nurse’s Role:
    • Discuss with PACU RN if antibiotic order states administration time frame exceeding 24 hours and the reason for extension
    • IF time frame not stated in the order, ask the PACU nurse to state the surgical END time and document the END TIME on the MAR. Also, include this information during shift report.
    • Night shift to carry this END TIME to 1 st day post-op MAR (1 st and 2 nd day post-op MAR for the cardiac surgical patient)
  • 25. ANTIBIOTIC MANAGEMENT
    • 1 st DAY POST-OP Nurse’s Role:
    • Obtain an order to continue antibiotics greater than 24 hours post-op
      • (48 hours for the cardiac surgical patient)
    • Order must include an indication for the lengthened administration time For Example: History of MRSA
  • 26. VTE PROPHYLAXIS
    • Applies to ALL post-surgical patients
    • OR staff to place the VTE Prophylaxis Order sheet on the medical record and recommend physician complete PRIOR to the patient leaving the operating room
    • Risk factors selected by physician:
    • One risk factor = LOW VTE RISK
    • Two – Four risk factors = MODERATE VTE RISK
    • > Four risk factors = HIGH VTE RISK
  • 27. VTE PROPHYLAXIS
    • VTE prophylaxis interventions are selected based on the RISK LEVEL
    • Immediate post-op receiving nurse, to review VTE Prophylaxis Order sheet and implement interventions selected by the physician
    • Sign off the order
    • During “hand-off” report to unit nurse, discuss RISK LEVEL and VTE prevention interventions already implemented.
  • 28. VTE PROPHYLAXIS
    • VTE prophylaxis MUST BE re-assessed AND a NEW form completed at the following points during the hospital stay:
    • WITHIN 24 hours of admission
    • Post-operatively
    • PRN
    • From transfer from one level of care to another
    • MAKE THIS PART OF YOUR HAND-OFF REPORT!
  • 29. Which Surgical Outpatients?
    • Cardiac
    • Orthopedic
    • Genitourinary
    • Gastric/Biliary
    • Gynecological
    • Head and Neck
    • Neurological
  • 30. Elements for Outpatients
    • Choice of antibiotic
    • Timeliness of antibiotic
    • Clip don’t shave
  • 31. ADDITIONAL TOOLS
    • Appropriate hair removal
    • Post-operative serum glucose control
    • Perioperative beta blocker for patients on beta blocker prior to surgery
  • 32. New Tools to Use in Treating Psychiatry Inpatients
  • 33. What are the requirements for admission screening?
    • Must be performed within 3 days of admission
    • Psychiatric Evaluation screening of:
      • Patient Strengths
      • Psychological Trauma History
      • Violence Risk to self and others over the past 6 months
      • Alcohol/Substance Abuse over the past 12 months
  • 34. What are the requirements for discharge information?
    • The Brief Referral Summary is used to document key discharge information.
    • The Brief Referral Summary must contain the:
      • Discharge diagnosis
      • Reason for hospitalization
      • Aftercare recommendations
      • Evidence that the form was sent to the next level of care provider by the 5 th post-discharge day
  • 35. What are the expectations for patients discharged on multiple antipsychotic medications?
    • Discharge medications need to be documented on the Medication Reconciliation Form
    • If patients are discharged on two or more antipsychotics, documentation on the Brief Referral Summary of:
      • A history of a minimum of three failed trials of monotherapy
      • A recommended plan to taper to monotherapy due to previous use of multiple antipsychotic medications OR documentation of a cross-taper in progress at the time of discharge (meds to increase and decrease must be documented)
      • Augmentation of Clozapine
  • 36. Final Outcome?
    • Core Measures are standards of care that improve patient outcomes.
    • Each of us plays an important role in bringing these care standards to the patients that require them.
    • 100% is the only percentage that is acceptable!
    • Is your patient covered??
  • 37. Key Points!
    • Question: When do we use core measure protocols and other tools?
      • Answer: When the patient arrives at the hospital
    • Q: Which patients require screening for core measures?
      • A: Every one of them. All.
    • Q: At what point are core measures resolved?
      • A: At discharge, when patient teaching is complete, and the Med Rec form has been faxed to the next provider of care or entered into EPIC.

×