introduction to core measures preferred nurse staffing preferred nurse staffing

IntroductionIntroductiontoto

Core MeasuresCore Measures

Preferred Nurse StaffingPreferred Nurse Staffing

Core MeasuresCore Measures

Who is information reported to?Who is information reported to?– JCAHOJCAHO– CMSCMS– National Patient Safety FoundationNational Patient Safety Foundation

Inpatient Core Inpatient Core Measure GroupsMeasure Groups

Acute Myocardial Infarction (AMI)Acute Myocardial Infarction (AMI) Congestive Heart Failure (HF)Congestive Heart Failure (HF) Pneumonia (PN)Pneumonia (PN) Surgical Care Improvement Surgical Care Improvement

Project (SCIP)Project (SCIP)

AMI MeasuresAMI Measures

AMI 1 Aspirin w/in 24 hours of AMI 1 Aspirin w/in 24 hours of arrival*arrival*

The early use of aspirin in patients with The early use of aspirin in patients with acute myocardial infarction results in a acute myocardial infarction results in a significant reduction in adverse events significant reduction in adverse events and subsequent mortalityand subsequent mortality

AMI-2 Aspirin at discharge.*AMI-2 Aspirin at discharge.*

Studies have demonstrated that aspirin Studies have demonstrated that aspirin cancan reduce this risk by 20%


AMI-3AMI-3 ACEI or ARB for ACEI or ARB for LVSD*LVSD*

ACEI therapy reduces mortality and morbidity ACEI therapy reduces mortality and morbidity in patients with left ventricular systolic in patients with left ventricular systolic dysfunction (LVSD/EF less than 40%) after dysfunction (LVSD/EF less than 40%) after AMIAMI


AMI- 4 Smoking Cessation AMI- 4 Smoking Cessation CounselingCounseling

Smoking cessation reduces mortality and morbidity in all populations. Patients who receive even brief smoking-cessation advice from their care providers are more likely to quit


AMI-6AMI-6

Aspirin on arrival/within 24 Aspirin on arrival/within 24 hours of presentationhours of presentation

Beta Blocker on arrival/within Beta Blocker on arrival/within 24 hours of presentation24 hours of presentation


AMI-5AMI-5 Beta Blocker at Beta Blocker at discharge*discharge*

Beta blockers prescribed for patients who have suffered an acute myocardial infarction can reduce mortality and morbidity. Studies have demonstrated that the use of beta blockers is associated with about a 20% risk reduction


AMI-7 Median time to fibrinolysisAMI-7 Median time to fibrinolysis

AMI-7a Thrombolytic Agent received AMI-7a Thrombolytic Agent received within 30 minutes of arrivalwithin 30 minutes of arrival

Time to fibrinolytic therapy is a strong predictor of outcome in patients with an acute myocardial infarction. Consider that nearly 2 lives per 1000 patients are lost per hour of delay


AMI-8 Median time to PCIAMI-8a PCI received within 90 minutes of

patient arrival

The early use of primary angioplasty in patients with acute myocardial infarction who present with ST-segment elevation or LBBB results in a significant reduction in mortality and morbidity

The earlier primary coronary intervention is provided, the greater its effect

Heart Failure Heart Failure MeasuresMeasures

HF –1 Discharge InstructionsHF –1 Discharge InstructionsWritten instructions or educational material must address all of the following and must be specific to heart failure:

Activity level Diet A written list of discharge medications Follow-up appointment Weight monitoring What to do if heart failure symptoms worsen

Heart Failure Heart Failure Measures Measures

HF-2HF-2 LVF assessment*LVF assessment*

Appropriate selection of medications to reduce morbidity and mortality in heart failure requires the identification of patients with impaired left ventricular systolic function (Ejection fraction less than 40%)


HF-3HF-3 ACEI or ARB for LVSD*ACEI or ARB for LVSD*

ACEI therapy reduces mortality and morbidity in patients with heart failure and left ventricular systolic dysfunction


HF-4 Smoking HF-4 Smoking Cessation/counselingCessation/counseling

Smoking cessation reduces mortality and morbidity in all populations

Patients who receive even brief smoking-cessation advice from their care providers are more likely to quit

Pneumonia MeasuresPneumonia Measures

Community Acquired PneumoniaCommunity Acquired Pneumonia

PN-1PN-1 RetiredRetired

PN-2PN-2 Pneumococcal vaccination*Pneumococcal vaccination*

Pneumococcal vaccination is Pneumococcal vaccination is indicated for persons 65 years of indicated for persons 65 years of age and older, because it is up to age and older, because it is up to 75% effective in preventing 75% effective in preventing pneumococcalpneumococcal bacteremia and meningitis


PN-3a Blood cultures performed w/in 24 PN-3a Blood cultures performed w/in 24 hours prior to or after arrival to the ICUhours prior to or after arrival to the ICU

PN-3b- Blood cultures preformed in the PN-3b- Blood cultures preformed in the ED before the initial antibioticED before the initial antibiotic

Published treatment guidelines recommend the collection of blood cultures for all inpatients with severe pneumonia to optimize therapy


PN-4 Smoking PN-4 Smoking Cessation/counselingCessation/counseling

Smoking cessation reduces mortality Smoking cessation reduces mortality and morbidity in all populations. and morbidity in all populations. Patients who receive even brief Patients who receive even brief smoking-cessation advice from their smoking-cessation advice from their care providers are more likely to quitcare providers are more likely to quit


PN-5a – 8 hours PN-5b Initial antibiotic received

within 4 hours of arrivalPN-5c - 6 hours

… clinical evidence of an association

between timely inpatient administration of antibiotics and improved outcome among pneumonia patients


PN-6 Initial antibiotic selection for PN-6 Initial antibiotic selection for CAPCAP

PN 6a ICU patientPN 6a ICU patient

PN 6b Non- ICU patientPN 6b Non- ICU patient


PN-7 PN-7 – Pneumonia patients age ≥ 50 y.o., hospitalized

during October, November, December, January, February or March who were screened for influenza vaccine status and were vaccinated prior to discharge, if indicated.

Surgical Care Surgical Care Improvement ProjectImprovement Project

SCIP- Inf 1 SCIP- Inf 1 Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision

The risk of infection increases progressively with greater time intervals between administration and skin incision.

SCIP MeasuresSCIP Measures

SCIP-Inf 2-SCIP-Inf 2- Appropriate antibiotic selectionAppropriate antibiotic selection

SCIP-Inf 3: Prophylactic antibiotic discontinued SCIP-Inf 3: Prophylactic antibiotic discontinued within 24 hours after surgerywithin 24 hours after surgery

SCIP-Inf 6: Appropriate hair removalSCIP-Inf 6: Appropriate hair removal

SCIP-Inf 7: Perioperative normothermia among SCIP-Inf 7: Perioperative normothermia among colorectal surgical patientscolorectal surgical patients


SCIP-Card-2 Surgery Patients on SCIP-Card-2 Surgery Patients on Beta Blocker Therapy prior to Beta Blocker Therapy prior to admission who received a Beta admission who received a Beta Blocker during the perioperative Blocker during the perioperative period.period.

SCIP Pre-OpSCIP Pre-Op

Document appropriate hair removal-do Document appropriate hair removal-do not use the word not use the word shaveshave or or razorrazor in the in the recordrecord

Document any DVT prevention measures Document any DVT prevention measures applied at this point (TED’s/SCD’s)applied at this point (TED’s/SCD’s)

Antibiotic start w/in 60 min of incision Antibiotic start w/in 60 min of incision (120min for Vancomycin)(120min for Vancomycin)

Beta Blocker received & documented Beta Blocker received & documented during peri-operative period if indicated during peri-operative period if indicated (Medication Reconciliation)(Medication Reconciliation)


SCIP-VTE-1 Surgery Patients with Recommended Venous

Thromboembolism Prophylaxis Ordered

SCIP-VTE-2 Surgery Patients Who Received Appropriate VTE

Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After

Surgery

What can you do to What can you do to help?help? Be a part of this successful processBe a part of this successful process Do not underestimate your impact on Do not underestimate your impact on

patient outcomespatient outcomes Teach – provide education to your Teach – provide education to your

patients as you provide their carepatients as you provide their care Documentation – use the proper forms Documentation – use the proper forms

and order setsand order sets Talk to your peers and Talk to your peers and

co-workers/make core measures part co-workers/make core measures part of your daily vocabularyof your daily vocabulary

introduction to core measures preferred nurse staffing preferred nurse staffing

Documents

populations patients

heart failure symptoms

identification of patients

heart failure measures

effectheart failure

quitami measuresami

amiami measuresami

brief smokingcessation