Richard Roudebush VA Medical Center

1. www.indypatientsafety.org Richard Roudebush VA Medical Center

2. SHAREDVISION & CHALLENGE COLLECTIVE ACHIEVEMENT WORKING TOGETHER >> Shared Resources >> Shared Performance Targets >> Shared Accountability >> Shared Funding >> Shared Learning Do not compete on safety! >> Outcomes: Accelerated Improvement >>Make Indianapolis & surrounding counties safest for health care “The Indianapolis Coalition for Patient Safety is a prime example of how collaboration is accelerating change…among very competitive organizations (and) is a national model for community-based process improvement…” --Don Berwick, IHI President and CEO

3. Indianapolis Coalition for Patient Safety, Inc. Table of Organization

4. What activities do we engage in? Standardizing and implementing of best known practices Developing relationships Sharing best safety practices Recognizing excellence Researching best safety practice Reporting safety performance Educating leaders, professionals, and media Sharing unique resources like simulation labs; Lean tools; clinical bundles; root cause analysis solutions.

5. Safety Improve Workgroups 2012 Heart Failure Readmissions Standardize Patient Identification Pneumonia Readmissions HYPOTHERMIA Nursing Home Handoff 2012 2011 2010 FLU VACCINATION 30 Minute Rule For Medication Administration Hydromorphone Safety Blood Safety Surgical Site Infection

6. Hospital and SNF Initiatives Expand Skilled Nursing Facility (SNF) and Hospital collaborations: • Minimum care standards for HF patients residing in SNF/LTAC • Hospital to SNF/LTAC verbal hand-off communications

7. SNF HF Care: Minimum Standards 1. Best Practices in HF Transitional Care: a. Medication Reconciliation b. Discharge Summary in chart within 72 hours of admission c. Clarification of code status within 24 hours of admission d. Initial plan of care goals within 72 hours of admission 2. Low salt diet (2 grams/day) 3. Daily weights for 30 days and then 3 times per week thereafter 4. Initial provider visit within 48 hours of admission and at least weekly follow-up visits 5. Activity as tolerated outside of therapy 6. HF champion within the facility (leads the quality improvement efforts; implements systems for patient and family HF education)

8. A Call for Commitment Letter of Invitation, Commitment & Implementation Purpose: Foster ongoing communication and collaboration between the discharging hospital and the admitting facility Expectation: The facility will review the standards with the Medical Director and adopt the standards as practice/protocol for the HF resident(s). Appoint HF Champion: An individual designated by the facility Available to serve as contact person should the hospital representative desire further information regarding a resident discharged from the hospital and admitted to a facility partner Committed to lead the quality improvement efforts for enhanced HF care and implement systems for patient and family education regarding Heart Failure

9. Pilot to Improve Nurse to Nurse Verbal Communications during Patient Transfer from Hospital to SNF

10. “Sender”/”Receiver" Survey Content • Timeliness of Communication • Content of Hand-off (relevant information) • Appropriate people involved • Setting (minimal interruptions during hand-off) • My questions/concerns were addressed • Did a “near miss” or “adverse event” occur related to this hand-off and why?

11. “Sender” (Hospital) Survey Results Hospital nurses perceive that they are communicating relevant information in a timely manner. However….

12. Patient Specific Information Needed Varies between Hospital and SNF Important to the hospital Important to the SNF Bowel Movements Transfer status Decision Making ability Last Meal • Code Status • Medication list • Diagnosis history

13. “Receiver” (SNF) Results Communication Issues:No diagnosis with meds (requirement for SNF)Missing diagnosis x 4Lack of current status x 3No code statusLack of recent changes x 3Immunizations not sentNo relay of concerns/heads up x 4Lack of plan of care x 3Inability to communicate back with sender x 3Missing key or incomplete clinical information

14. SNF Clinical Leaders Create; Hospitals/SNFs Implement “Cue Card” to Improve Hand-Off Communications from Hospital to SNF Admitting Diagnosis / Focused patient history Abnormal Labs/tests/Vitals Skin issues and treatments with frequency Current Medications Safety precautions (anticipatory concerns) Diet restrictions or feeding precautions Cognition/Behaviors Code Status Additional Family/Patient information that may affect transfer or stay