Agenda: GWTG-R tool tips and tricks Low performing measures; clinical strategies for improvement Questions and Answers

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Speaker: Tanya Truitt, RN, MS, Quality Systems Improvement Consultant: Resuscitation Agenda: GWTG-R tool tips and tricks Low performing measures; clinical strategies for improvement Questions and

2 Speaker: Tanya Truitt, RN, MS, Quality Systems Improvement Consultant: Resuscitation Agenda: GWTG-R tool tips and tricks Low performing measures; clinical strategies for improvement Questions and Answers NOTES: A pdf of this presentation is being sent to your address. If you do not receive it please contact: larissa.deluna@heart.org This call is being recorded for later viewing. Link will be given at the end of the presentation or you may contact your local representative for the link/ 10/15/ , American Heart Association 2

3 Community Page 10/15/ , American Heart Association 3

Coding Instructions Coding instruction updates occur with each PMT release Highlighted Text in the coding instruction document indicates an update since

4 Coding Instructions Coding instruction updates occur with each PMT release Highlighted Text in the coding instruction document indicates an update since the last version As a reminder, you can access the coding instructions through hyperlinks within the online form 10/15/ , American Heart Association 4

5 Patients 10/15/2013 5

through Optional 10 are text fields Optional 11 and Optional 12 are actual site-maintained code lists "My Account" tab has a link to

6 Optional Fields The Optional fields can be used to track any additional information that is not captured in the PMT. To use these, your Resuscitation team will need to decide on consistent representations for the fields you will use Optional 1 through Optional 10 are text fields Optional 11 and Optional 12 are actual site-maintained code lists "My Account" tab has a link to Manage Code Lists. For additional analytical power, you can filter reports using Optional 11 and Optional 12. Optional 13 and Optional 14 are Date/Time fields.

7 Measures Tab 10/15/ , American Heart Association 7

8 New Neonate Form Group A new form group has been created that will allow sites to specifically capture data on resuscitation provided to newly born infants who undergo CPA during transition from intrauterine to extrauterine life. This event form group will be for the newly born infant, and is intended to allow sites to capture data on CPA events in infants at the time of birth. The following data element will be used to help the site launch this form group: Was the CPA Event a neonatal delivery event? Drafts of the updates being made to the Admission & Discharge Form and the NEW Neonatal Delivery CPA Event form have been provided as supplemental exhibits. Updates are for data elements only. No measure updates have occurred for this patient population with the Fall 2013 release. All coding instructions specific to this form group will be in BLUE font

Data Download Click on the Download Tab Steps #1:

selected will appear in the Fields to Download

9 Data Download Click on the Download Tab Steps #1: Select Forms to Download #2: Select Fields to Download. All data elements within the Form you have selected will appear in the Fields to Download box. You select multiple fields by holding down the Ctrl key. Tip: Be sure to select all fields that would relate to the question you are looking to answer 10/15/ , American Heart Association 9

Please be sure to change the response as this will enable the data in the downloaded file

10 Data Download Steps Cont. #3: Select Date Range #4: Select Format for Download File. The default is set to As Codes. Most sites prefer to select As Descriptives. Please be sure to change the response as this will enable the data in the downloaded file to more easily be interpreted. #5: Click Generate Download File 10/15/ , American Heart Association 10

11 Data Download You end up with an excel file with all of your data 10/15/ , American Heart Association 11

12 Reports Measure Algorithms 10/15/ , American Heart Association 12

13 Reports 10/15/ , American Heart Association 13

14 Reports 10/15/ , American Heart Association 14

15 Achieving Recognition 10/15/ , American Heart Association 15

16 Recognition Awards These awards recognize hospitals that demonstrate at least 85 percent compliance in each of the four Get With The Guidelines-Resuscitation Recognition Measures. The different levels reflect the amount of time for which the hospital demonstrates performance. Bronze recognizes performance of 90 consecutive days. Silver recognizes performance of 12 consecutive months. A calendar year. Gold recognizes performance of 24 consecutive months or more. Two calendar years. 10/15/ , American Heart Association 16

17 Adult or Pediatric CPA: Time to first chest compressions <= 1 min in adult or pediatric patients and newborn/neonates >= 10 min old: Percent of events in adult or pediatric patients where time to first chest compressions <= 1 minute of event recognition. CPA: Device confirmation of correct endotracheal tube placement: Percent of adult or pediatric events with an endotracheal tube placement which was confirmed to be correct. CPA: Time to first shock <= 2 min for VF/pulseless VT first documented rhythm: Percent of events in adult or pediatric patients with VF/pulseless VT first documented rhythm in whom time to first shock <= 2 minutes of event recognition. CPA: Percent pulseless cardiac events monitored or witnessed: Percent of events in adult or Pediatric patients who were monitored or witnessed at the time of arrest. 10/15/ , American Heart Association 17

18 10/15/ , American Heart Association 18

19 Adult or Pediatric CPA: Time to first chest compressions <= 1 min in adult or pediatric patients and newborn/neonates >= 10 min old: Percent of events in adult or pediatric patients where time to first chest compressions <= 1 minute of event recognition. CPA: Device confirmation of correct endotracheal tube placement: Percent of adult or pediatric events with an endotracheal tube placement which was confirmed to be correct. CPA: Time to first shock <= 2 min for VF/pulseless VT first documented rhythm: Percent of events in adult or pediatric patients with VF/pulseless VT first documented rhythm in whom time to first shock <= 2 minutes of event recognition. CPA: Percent pulseless cardiac events monitored or witnessed: Percent of events in adult or Pediatric patients who were monitored or witnessed at the time of arrest. 10/15/ , American Heart Association 19

20 Device confirmation of correct endotracheal tube placement The data element of Methods of confirmation of ET placement was updated in October 2012.

21 10/15/ , American Heart Association 21

22 Adult or Pediatric CPA: Time to first chest compressions <= 1 min in adult or pediatric patients and newborn/neonates >= 10 min old: Percent of events in adult or pediatric patients where time to first chest compressions <= 1 minute of event recognition. CPA: Device confirmation of correct endotracheal tube placement: Percent of adult or pediatric events with an endotracheal tube placement which was confirmed to be correct. CPA: Time to first shock <= 2 min for VF/pulseless VT first documented rhythm: Percent of events in adult or pediatric patients with VF/pulseless VT first documented rhythm in whom time to first shock <= 2 minutes of event recognition. CPA: Percent pulseless cardiac events monitored or witnessed: Percent of events in adult or Pediatric patients who were monitored or witnessed at the time of arrest. 10/15/ , American Heart Association 22

23 2010, American Heart Association 23

24 Time to Defibrillation The peer review of these events may identify opportunities for improving processes and outcomes. These measures should help to ensure access to appropriate equipment and improve consistency of process measures. Defibrillators include stand-alone automated external defibrillators (AEDs) and AED mode in manual defibrillators. Assure that stand-alone AEDs and/or AED mode in manual defibrillators are available throughout the facility. In the event of sudden cardiac arrest a defibrillator should be available within one to two minutes. Early defibrillation should be available in geographically isolated parts of the hospital where code team response times are long. Consider placing stand-alone AEDs in non-patient-care areas. All BLS personnel must be trained to operate, be equipped with, and permitted to operate a defibrillator if in their professional duties they are expected to respond to people in cardiac arrest. 10/15/ , American Heart Association 24

25 What about patients where there was a documented medical reason why a shock was not provided within 2 minutes? Exclude pt.

26 Adult or Pediatric CPA: Time to first chest compressions <= 1 min in adult or pediatric patients and newborn/neonates >= 10 min old: Percent of events in adult or pediatric patients where time to first chest compressions <= 1 minute of event recognition. CPA: Device confirmation of correct endotracheal tube placement: Percent of adult or pediatric events with an endotracheal tube placement which was confirmed to be correct. CPA: Time to first shock <= 2 min for VF/pulseless VT first documented rhythm: Percent of events in adult or pediatric patients with VF/pulseless VT first documented rhythm in whom time to first shock <= 2 minutes of event recognition. CPA: Percent pulseless cardiac events monitored or witnessed: Percent of events in adult or Pediatric patients who were monitored or witnessed at the time of arrest. 10/15/ , American Heart Association 26

27 10/15/ , American Heart Association 27

28 CPA 5.1 Epinephrine/Vasopressin Exclude

bolus, was it administered within 5 minutes?

if eligible, was it administered within 5 minutes?

29 CPA 5.1 Epinephrine/Vasopressin Measure Updates Current Measure: For those patients that receive IV/IO Epinephrine or Vasopressin bolus, was it administered within 5 minutes? Updated Measure: For all CPA event patients, was the patient eligible to receive IV/IO Epinephrine or vasopressin bolus, and if eligible, was it administered within 5 minutes? For Adult patients, IV/IO Epinephrine or Vasopressin bolus needs to be administered within 5 minutes of the date/time pulselessness was first identified. For Pediatric and Newborn/neonate patients, IV/IO Epinephrine bolus needs to be administered within 5 minutes of the date/time the need for chest compressions (or defibrillation when initial rhythm was VF or Pulseless VT) was FIRST recognized.

30 NEW Reports Four new reporting measures will be added to better allow for sites to track length of events and response times. The measures that will be added are as follows: ARC: Length of ARC Event CPA: Length of CPA Event MET: Length of MET Event MET: MET Team Response Time

Fall Release goes live, sites will see a reminder about the need to ensure that they have

31 Benchmarking Groups A Benchmarking Group Assignment Guide will be posted to the Community Page Intent is to help facilities re-assign themselves to appropriate benchmarking groups When the Fall Release goes live, sites will see a reminder about the need to ensure that they have appropriately assigned themselves to benchmarking groups 10/15/ , American Heart Association 31

32 10/15/ , American Heart Association 32

33 Tools and Resources Updated Website Go To: 10/15/

GWTG-Resuscitation Research http://www.heart.

34 GWTG-Resuscitation Research m_ pdf 10/15/ , American Heart Association 34

35 Questions 10/15/ , American Heart Association 35

36 For more information about GWTG- Resuscitation Contact Arkansas/Oklahoma Katie Central Texas Diana Colorado/Wyoming Julie Southeast Texas Kate New Mexico/West Texas Stephanie Chapman- North Texas Shanthi To view the recording of this webinar, please visit For questions contact

Albany Medical Center:

Albany Medical Center: Time to Get With The Guidelines for Resuscitation? Mike McEvoy, PhD, RN, CCRN, NRP Chair Resuscitation Committee Albany Medical Center, NY Sr. Staff RN CTICU Albany Medical Center EMS Coordinator Saratoga