- News from CMS: Final Rule Establishes Rural Emergency Hospitals as Medicare Provider
- Upcoming and Previous Educational Events
- Expert Insights and Resources on:
- Behavioral Health and Opioid Stewardship
- Antibiotic Stewardship
- Patient Safety
- Readmissions/Care Transitions
- Patient and Family Engagement
- Health Equity
- Violence Prevention
- Best Practices Corner
- Success Stories
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In November 2022, CMS published a final rule effective January 1, 2023, establishing initial policies for Rural Emergency Hospitals as a new Medicare provider type enacted in the Consolidated Appropriations Act of 2021. View Final Rule
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Upcoming Learning and Action Network (LAN) Events
The Core Elements for Antibiotic Stewardship in Action
Join your peers in this multi-session series to discuss the core elements and hear stories from hospitals that achieved high-performing results. View Agenda
Upcoming Sessions:
- October 24: Tracking + Reporting + Education - Register Here
- August 29: Leadership Commitment + Accountability – Recording and Slide Presentation
- September 19: Pharmacy Expertise + Action - Slide Presentation
The Power of High Reliability and Just Culture to Improve Patient Safety
Thursday, October 12, 2023, from 9 a.m. - 3 p.m.
EQIC is offering open registration for its next virtual conference! Advancing healthcare excellence: The power of high reliability and just culture to improve patient safety features national experts who will challenge conventional thinking around patient safety and invite attendees to expand their approaches to harm prevention.
All hospital staff are encouraged to attend, including executive leadership, clinical leaders, managers, quality improvement team members and bedside staff.
Note: You will need to create an account. Learn More and Register
New Sepsis Core Elements Webinar Series with Free CE
During each one-hour webinar, sepsis subject matter experts will provide an overview of the Hospital Sepsis Program Core Elements, and partners will share real-life examples, strategies, and best practices about how they have successfully implemented specific Sepsis Core Elements at their organization. Each webinar topic is independent, and all webinars will be recorded. Free continuing education will be offered upon successful completion of a post-test. Register Here
Upcoming Sepsis Core Elements Webinars:
- Leadership Commitment: October 2, 2023, at 3 p.m. ET
- Accountability and Multi-Professional Expertise: October 16, 2023, at 1 p.m. ET
- Action: November 2, 2023, at 1 p.m. ET
- Tracking and Reporting: November 16, 2023, at 1 p.m. ET
Health Equity Strategy Series: How to Make It Work for Your Hospital
Want to learn how to meet CMS and The Joint Commission (TJC) health equity requirements and improve patient outcomes for your community? This two-part series breaks down what your health equity action plans and next steps should include.
View Session 1 Presentation and Recording | View Session 2 Presentation and Recording
If Yes, Click Below.
Click here if you attended an HQIC LAN event and were able to "use tomorrow" what you heard during the webinar.
CMS hosts CoP calls on the second Thursday of each month at 1 p.m. ET | 12 p.m. CT | 11 a.m. MT | 10 a.m. PT. The calls are open to all Alliant HQIC hospitals.
Rural Governance: Activating Your Hospital Board as Partners in Improving Outcomes
Thursday, October 12
This session will feature a discussion among the Convergence and TMF HQIC teams to describe practical strategies for engaging hospital governing body members as partners in the shared goal of safe and reliable care. In addition to a discussion about steps and strategies that Rural and Critical Access Hospitals may take to improve the engagement of board members, a hospital will share the strategies they have implemented at the local level. The chief quality officer from Coryell Health in Gatesville, Texas will provide an in-depth discussion about her organization’s successful approach to building strong partnerships with their board of directors to co-design systems and processes to ensure quality and safety are prioritized in their 25-bed Critical Access Hospital.
Register Here
Building Reliable Sepsis Mortality Prevention Practices: How Does Your Organization Measure Up?
Recorded on September 21
This session featured examples of strategies for the early identification and response to sepsis, including an innovative approach using the Sepsis Honor Roll self-assessment as a driver to measure improvement. Windham Hospital in Connecticut shared tools and resources to successfully facilitate the implementation of bundles and increase staff knowledge and expectations.
View Presentation
These Office Hours are participant-driven and without slide presentations. Discussions will focus on health equity action planning and other questions from the hospitals, such as CEO engagement. The Office Hours will be held on the third Thursday of the month from 3-3:45 p.m. ET. The next office hours will take place on:
- Oct. 19, 2023
- Nov. 16, 2023
- Dec. 21, 2023
- Wednesday, October 25, from 2-2:30 p.m. ET
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Access the Alliant HQIC portal to view your assessments and measurement data, and chat with other HQIC-enrolled hospitals to share best practices, barriers and solutions. Download Portal Instructions to Get Started
Updated Patient Safety Coaching Packages
Updated coaching packages with best practice interventions and resources are now available on the HQIC website. View Coaching Packages
Behavioral Health & Opioid Stewardship
Study: Use of Medication for Opioid Use Disorder Among Adults With Past-Year Opioid Use Disorder
Many patients with opioid use disorder (OUD) do not receive medication for opioid use disorder (MOUD), including methadone, buprenorphine, or extended-release naltrexone. Data on the national prevalence of MOUD receipt among persons with OUD in the U.S. are limited. One study using 2019 data among individuals with OUD based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) criteria found that 27.8% received MOUD in the past year. Read Study
Antibiotic Stewardship
Study: Risk of Misleading Conclusions in Observational Studies of Time-to-Antibiotics and Mortality in Suspected Sepsis
A cohort study published in PubMed showed associations between time-to-antibiotics and mortality in sepsis are highly sensitive to analytic choices. Failure to adequately address these issues can generate misleading conclusions. Read Study
Adverse Drug Events
Cohort Study: “Low-Value” Glycemic Outcomes Among Older Adults With Diabetes Cared For by Primary Care Nurse Practitioners or Physicians
A study published by ScienceDirect examined patients with diabetes at high risk of hypoglycemia receiving primary care between January 2010 and January 2012, comparing patients reassigned to nurse practitioners to those reassigned to physicians after their previous physician separated from practice in an integrated United States health system. Learn More
Hospital-Acquired Infections (HAIs)
Infection Prevention Resources
Check out updated NHSN and IP training resources. View Resources
Infection Prevention Week 2023 Is October 15–21, 2023
Infection Preventionists (IPs) play a crucial role in keeping the public safe and healthy. In addition to fighting a global pandemic, the infection prevention and control community protects us from surges in healthcare-associated infections, measles outbreaks, flu season, and many other infectious battles. International Infection Prevention Week (IIPW) aims to shine a light on infection prevention every year. IIPW 2023’s theme is “Celebrating the Fundamentals of Infection Prevention,” which highlights getting back to the basics of infection prevention for everyBODY. Learn More
Strategies To Prevent Catheter-Associated Urinary Tract Infections in Acute-Care Hospitals
SHEA Compendium of strategies to prevent CAUTI Guidelines was updated to include several new essential practices for CAUTI prevention, including a discussion on urine culture stewardship and external catheter limitations. Learn More
CDC Pushing Environmental Control Reminders as Respiratory Infections Tick Upward
The CDC urges hospitals to implement broader source control measures as COVID-19 cases are spiking across the country, along with an uptick in syncytial virus (RSV). Influenza is also a concern, especially as schools are back in session. Source control measures include ensuring your facility’s air handling system is functioning properly, encouraging the use of masks with staff, patients, and visitors, and checking local data for an increase in infection rates in your area. Read More
Simplifying Discharge Instructions
Patients who do not have enough information or understand their discharge instructions have decreased treatment adherence and patient safety, increased returns to the emergency department (ED) and poor satisfaction.
In a study published by PubMed Central, a baseline review of instructions found that written discharge instructions were long and tedious (6-22 pages), important information was difficult to find, and no patient completely understood their discharge instructions. Based on patient and stakeholder interviews, the team developed a one-page simplified information page (SIP) targeted to inform patients of their most relevant discharge instructions. The SIP was tested on 118 patients to measure its effect on patient understanding. Patients across all demographic categories benefited from the SIP. Read Study
Study: Improving Discharge Procedures to Reduce Hospital Readmissions
New research highlights the important role of nurses in discharge planning and coordinating communication among providers, patients, and caregivers. Their work has been shown to not only reduce readmissions but also improve outcomes. A recent JAMA Network Open study found communication interventions at discharge are significantly associated with fewer hospital readmissions, higher treatment adherence, and higher patient satisfaction, leading to improved transitions of care. Read More
New Z Code Infographic Now Available
The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) released a new Z code infographic entitled Improving the Collection of Social Determinants of Health (SDOH) Data with ICD-10-CM Z Codes (2023). This resource aims to assist providers with understanding and using Z codes to improve the quality and collection of health equity data. Using social determinants of health, Z codes can enhance quality improvement activities, track factors that influence people’s health, and provide further insight into existing health inequities. Download Infographic
Z codes are a set of ICD-10-CM codes used to report social, economic, and environmental determinants that affect health and health-related outcomes. Nine broad categories of Z codes represent various hazardous socioeconomic and environmental conditions. Z codes can be used in any health setting and by any provider as a tool for identifying a range of issues related to education and literacy, employment, housing, ability to obtain adequate amounts of food or safe drinking water, and occupational exposure to toxic agents, dust, or radiation.
For more information, review the journey map: Using SDOH Z Codes Can Enhance Your Quality Improvement Initiatives,
Patient and Family Engagement
CMS Person and Family Engagement Strategy
CMS developed a strategy with specific, actionable goals and objectives to make people aware of and involved in person and family engagement. The Person & Family Engagement Strategy document serves as a guide for incorporating PFE principles into clinical practice, program development, community health initiatives, and other areas and provides tools and methods providers can use to engage patients and their families in their care. Download Guide
EQIC Checklist of Practice Recommendations
The Eastern US Quality Improvement Collaborative (EQIC) created a checklist of practice recommendations to provide process improvement strategies for consideration as hospitals work to implement a patient and family advisory council. View Checklist
Connecting PFE Best Practices to All-Cause Harm Reduction
The 5 PFE Best Practices resource aims to engage patients as partners with hospital staff and clinicians in reducing the risk of harm while in the hospital. This partnership occurs at the intersection of patient needs, experiences, and perspectives with clinical interventions and practices designed to reduce harm. View Resource
Integrating Patients and Families on Quality Improvement Teams
This resource will help hospital leaders and staff understand:
- How patients and family members can contribute to a QI team as advisors.
- How to recruit patient and family advisors for a QI team.
- How to prepare patient and family advisors to contribute to a QI team.
New Workplace Violence Prevention Coaching Package
Alliant's new coaching package includes best practice interventions and resources. Check out the SAVE Act, guides, staff education and case studies. Download Coaching Package
New Survey Sheds Light on Workplace Violence in Health Care Settings
A new survey polled clinical health care workers, health care administrative workers, and health care security personnel and found that 40% of health care workers experienced workplace violence in the past two years. At a time when several states are upping the penalties for assaulting health care workers, and there is currently legislation before Congress that would give health care workers the same legal protections against assault and intimidation as aircraft and airport workers, current data can arm health care leaders in advocating for change on behalf of their employees. Read More
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In September, Emanuel Medical Center in Swainsboro, Georgia, joined health care organizations around the world in recognizing Sepsis Awareness Month. Read More
How Family Members Are Filling Nursing Gaps
The national nursing shortage is prompting some states to tap family members to provide home-based care for children with complex health needs. These states are training and licensing family members as paid certified nursing assistants. Read More
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Intermountain Health started opioid stewardship work in 2016 with a deep review of the available data around opioid prescribing and opioid overdose death count and rates (particularly prescription). It included both state-level and internal system data around opioid prescribing practices. The opioid stewardship goals addressed include:
- Reduce the quantity of opioid tablets prescribed by 40% (2017- 2019)
- Reduce the co-prescribing of opioids and benzodiazepines by 10% (2018 –2019)
- Reduce the potency of opioids prescribed (2020–2021)
- Increase naloxone co-prescribing with any opioid prescription (2022 –present)
Dr. David Hasleton stated in 2019, “We knew these would be lofty goals, and we’re encouraged by the reduction in opioid tablets and the success of our other opioid-reduction efforts. We knew these were the right steps to take. We’re continuing our focus to implement appropriate evidence-based opioid treatments, provide alternative forms of pain control for our patients and educate providers and the public about the safe use of opioid medications.”
PLAN:
Intermountain Health developed a team of key behavioral health, physician, community health and other leaders to look at the available data and develop a plan to address and improve opioid stewardship within the health system. They were given the name Opioid Tiger Team (OTT). This team spearheaded the development of goals and the actions taken to achieve the goals, and is still in existence today. The team brought together key leaders who could provide valuable insight and effect change. As part of Intermountain Health’s commitment to this work, in 2021, 10 of the Intermountain Health critical access and rural facilities partnered with Comagine Health under the CMS-funded Hospital Improvement initiative (prime awardee: Alliant Health).
The Plan, Do, Study, ACT (PDSA) cycle occurred with each of the four goals listed above.
I. Reduce the quantity of opioid tablets prescribed by 40% (2017 through 2019)
- Creation of the OTT, as discussed above
- Design and establish a data analytics dashboard and designation of a data analyst for the project
- Establishment of data baseline, find target providers and service lines
- Educate providers
- Change opioid prescription defaults in the electronic health record
- Establish baseline performance
- Identify low-performing providers and service lines
- Educate providers
- Implement an electronic health record (EHR) alert
III. Reduce the potency of opioids >= 90 Morphine Milligram Equivalents (MME)/Day (2020 – 2021)
- Provider to patient opioid risk consultation
- Provider resources on opioid management and safety
- Removal of high MME order sentences from the orders catalog
- EHR alert for high MME doses and other risks
IV. Increase naloxone co-prescribing with any opioid prescription (2022–present)
- Service line leadership education and buy-in
- Provider education tools
- Electronic health record changes
The early implementation phase was to develop and implement provider education for each goal. The outcomes of the education were measured for impact.
STUDY:
Analysis of data changes showed minimal change in provider prescribing practices from education alone. Following education, the OTT moved into making changes to the EHR, such as changing the standing order catalog, removing favorites with high pill counts and instituting EHR alerts when certain prescribing thresholds are met.
ACT TO HOLD THE GAINS:
The biggest contributor to the changes Intermountain Health saw in prescribing practices has consistently been when EHR alerts were implemented. The OTT continues to monitor all four Opioid Stewardship goals and acts to make changes when needed to keep the positive momentum moving forward.
When the project began, the hospital was not meeting the measure requirements and experienced difficulty convincing providers of the importance of checking PDMP provided to their patients. Alena and the team focused on the following interventions:
- Identified a nurse champion who educated each provider and confirmed that the system was working for them
- Integrated the PDMP into the Cerner system and created a monitoring system to review compliance by the provider
- Provided follow-up to providers who demonstrated less than 100% compliance
- Shared an “achievement dashboard” via whiteboard, which created competition among the providers
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For questions or information about free technical assistance, please contact:
Donna Cohen, Director, Quality Projects
Karen Holtz, Training and Education Lead, Hospital Quality
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This material was prepared by Alliant Health Solutions, a Quality Innovation Network–Quality Improvement Organization (QIN – QIO) under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication Number: 12SOW-AHS-QIN-QIO TO3-HQIC--4627-10/04/23