AMI Talking Points. Provide appropriate treatment to Acute MI patients with these core measures:

Transcription

1 AMI Provide appropriate treatment to Acute MI patients with these core measures: Aspirin received within 24 hours of arrival or contraindication documented Primary PCI Received Within 90 Minutes of Hospital Arrival (STEMI patients) ACEI/ARB medication prescribed at discharge for LVF < 40% (LVSD), or contraindication documented Beta Blocker prescribed at discharge or contraindication documented Statin prescribed at discharge or contraindication documented Aspirin prescribed at discharge or contraindication documented Adult smoking cessation advice/counseling provided The physician should use the Acute Coronary Syndromes, STEMI, or Chest Pain admission order sets. The physician should complete the AMI Physician Documentation Form before discharging the patient. The physician should complete the Medication Reconciliation/Discharge Instructions Form completely and accurately. An evidence-based practice provides better outcomes than its alternative. Readmissions within 30 Days: Decreased readmissions within 30 days Importance for Patients and Families Giving heart attack patients the right treatment at the right time has been shown to reduce the severity of the heart attack, speed recovery, and prevent future heart attacks and hospitalizations.

2 CABG Prophylactic antibiotic received within 1 hour prior to surgical incision Prophylactic antibiotic selection for surgical patients Prophylactic abx discontinued within 48 hrs after surgery end time Cardiac Surgery Patients w/ Controlled 6 A.M. Postoperative Serum Glucose Surgery Pt on BB Therapy Received BB During Perioperative Period Surgery Patients with Appropriate Hair Removal Urinary Catheter Removed on POD 1 or POD 2 With Day of Surgery Being Day Zero Surgery Patients with Perioperative Temperature Management The physician should use the CABG Order Set. The order set is available in Formsfast An evidence based practice produces better outcomes than its alternative. Mortality : Decreased mortality Harm: Decreased harm to patient Cost of Care: Decreased cost per inpatient case Readmissions within 30 Days: Decreased readmissions within 30 days Importance for Patients and Families: Providing specific treatments to surgical patients at the right time speeds healing and prevents them from having several serious complications.

3 CAP Provide appropriate and timely treatment of community-acquired pneumonia patients with these national hospital quality measures: Blood cultures within 24 hours prior to or 24 hours after arrival to hospital for patients admitted/transferred to the ICU Blood cultures drawn prior to initial hospital antibiotic dose (if blood cultures drawn in the ED) Initial antibiotic received within 6 hours of arrival to the hospital Initial antibiotic selection for CAP in immunocompetent patient-non-icu Initial antibiotic selection for CAP in immunocompetent patient-icu Influenza screening and vaccination Pneumococcal screening and vaccination Adult smoking cessation advice/counseling provided to all smokers The ED physician should read HQI alert CXRs in a timely manner. The ED physician should use the Pneumonia Orders Screen in Emstat to order the appropriate antibiotics. The ED physician should document any delays in the diagnosis or treatment of pneumonia. The admitting physician should use the Pneumonia-Adult Admission Order Set. An evidence-based practice provides better outcomes than its alternative. Importance for Patients and Families When patients receive the right antibiotics within 24 hours of being admitted to the hospital with pneumonia that they get outside the hospital, they have increased chances of a speedy recovery and decreased chances of death.

4 CHF Provide appropriate treatment and management of Heart Failure patients with these core quality measures: Evaluation of LVS (Left Ventricular Systolic) function with results documented in the medical record every admission ACEI/ARB medication prescribed at discharge for LVF < 40% (LVSD), or contraindication documented Adult smoking cessation advice/counseling provided to all smokers Discharge Instructions provided to the patient and documented in the chart to include all of these elements: Diet, Medications, Follow-up Instructions, Activity, Symptoms Worsening and Weight Monitoring Instructions The physician should use the CHF Admission Order Set. The physician should complete the CHF Physician Documentation Form before discharging the patient. The physician should complete the Medication Reconciliation/Discharge Instructions Form completely and accurately. The physician should ensure the discharge medications on the Discharge Summary match those on the Medication Reconciliation Form exactly. An evidence-based practice provides better outcomes than its alternative. Cost of Care: Decreased cost per inpatient case Readmissions within 30 Days: Decreased readmissions within 30 days Time in ICU: Decreased time in intensive care in the last 6 months of life. No Gap by Race, Ethnicity, or Language: No gap by race, ethnicity, primary language for key measures Importance for Patients and Families When these elements of care are provided, patients with heart failure have less severe symptoms, better quality of life, and fewer readmissions to the hospital.

5 Cape Fear Valley Health System is dedicated to reducing surgical complications through compliance with the Surgical Care Improvement Project measures. These measures apply to most major surgeries. We need YOUR support and participation to prevent surgical complications related to infections, venous thromboembolism (VTE) and cardiac events. Help Us Reduce Surgical Complications Did you know? Surgical site infections account for 14 to 16 percent of all hospital acquired infections. Adverse cardiac events occur in 2 to 5 percent of non-cardiac surgery and up to 30 percent of vascular surgery patients. In the absence of prophylaxis, deep venous thrombosis occurs in 25 percent of major operations. To prevent surgical infection: Prophylactic antibiotic initiated 1 hour before surgical incision (2 hours for vancomycin or fluoroquinolone) Prophylactic antibiotic consistent with published guidelines Prophylactic antibiotic discontinued within 24 hours of anesthesia end time (48 hours for cardiac patients) Blood glucose control in patients undergoing cardiac surgery Proper hair removal Foley catheter removed by POD 2 or document reason for leaving it in place Maintenance of normothermia in surgery patients To prevention of venous thromboembolism (VTE) VTE prophylaxis ordered consistent with current guidelines or document reason for not prescribing Appropriate VTE prophylaxis administered within 24 hours before or after surgery To prevention of cardiac events Administration of peri-operative β-blockers to patients on β-blockers prior to admission For more information, contact Cathy Riddle MSN, RN x5617

6 SCIP- Hip/Knee SCIP Inf 1 - Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision - anesthesia manages this one. SCIP Inf 2 - Prophylactic Antibiotic Selection for Surgical Patients - First line is Ancef, then Cleocin if B-lactam allergy. Vancomycin is acceptable with a physician/apn/pa/pharmacist documented justification for its use. SCIP Inf 3 - Prophylactic Antibiotic Discontinued Within 24 Hours After Anesthesia End Time - the post-op order sets include the wording to assist pharmacy and nursing with this one. For physicians, when abx are continued past the 24h or if another abx is ordered after or in addition to the post-op abx, we need documentation of reason. They will not accept symptoms alone. There must be a statement that patient has an active infection or a suspected infection. SCIP Inf 6 - Surgery Patients with Appropriate Hair Removal - using clippers. SCIP Inf 9 - Urinary Catheter Removed on Postoperative Day 1 or 2 (with day of surgery being day 0) - If the catheter needs to be kept past the end of POD #2, please document a reason. The reason does not matter at this time, but there must be something documented. SCIP Inf 10 - Surgery Patients with Perioperative Temperature Management - anesthesia manages this one - making sure to maintain normothermia intraoperatively or having atleast one temp reading of 96.8 deg F recorded within the 30 minutes immediately prior to or the fifteen minutes immediately after the anesthesia end time. SCIP Card 2 - Surgery Patients on Beta-Blocker Therapy Prior to Arrival Who Received a BB During the Perioperative Period - anesthesia owns this one SCIP VTE 1 - Surgery Patients With Recommended Venous Thromboembolism Prophylaxis Ordered - prophylaxis ordered anytime from hospital arrival to 24 hours after anesthesia end time. SCIP options for prophylaxis are as follows: Elective TKA - any of the following: LMWH, Fondaparinux, Warfarin, Intermittend pneumatic compresion devices, venous foot pump Elective THA - any of the following: LMWH, Fondaparinux, Warfarin Hip Fracture Surgery - any of the following: Low-dose unfractionated heparin, LMWH, Fondaparinux, Warfarin Elective THA with a reason for not administering pharmacological prophylaxis - Intermittent pneumatic compression devices or venous foot pump Hip Fracture Surgery with a reason for not administering pharmacological prophylaxis - graduated compression stockings, intermittent pneumatic compression devices or venous foot pump. If there is a reason that pharmacological phrophylaxis can not be used, please document the reason. Likewise, if you do not wish to start the medication until after the 24h mark, please document a reason. SCIP VTE 2 - Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery - we continue to work with pharmacy and nursing to ensure that meds are scheduled correctly and given timely. We continue to work with all staff involved to ensure that patients are receiving the appropriate care. We very much appreciate everything you do to assist us!

7 SCIP/VTE Colon/Hysterectomy Surgical Site Infection Prevention Appropriate use of prophylactic antibiotics: Prophylactic antibiotic received within 1 hour prior to surgical incision Prophylactic antibiotic selection for surgical patients consistent with national guidelines (as defined in JCAHO/CMS Specification Manual and SCIP for Measure SCIP-Inf-2) Prophylactic antibiotics discontinued within 24 hours after surgery end time (48 hours for cardiac patients). Appropriate hair removal Controlled 6:00 AM postoperative serum glucose in cardiac surgery patients Urinary catheter removed on postoperative day 1 (POD 1) or postoperative day 2 (POD 2) with day of surgery being day zero Surgery patients with perioperative temperature management l Beta Blockers Continuation Beta blockers for patients on beta blockers prior to admission l Venous Thromboembolism (VTE) Prophylaxis Venous thromboembolism prophylaxis ordered Appropriate VTE prophylaxis given between 24 hours prior and 24 hours after surgery Outcomes l Mortality The physician should use the Colon/Hysterectomy Order Set. The order set is available in Formsfast An evidence based practice produces better outcomes than its alternative. Mortality (HSMR): Decreased mortality Harm: Decreased harm to patient Cost of Care: Decreased cost per inpatient case Cost of Care: Decreased cost per inpatient case Readmissions within 30 Days: Decreased readmissions within 30 days Readmissions within 30 Days: Decreased readmissions within 30 days Importance for Patients and Families: Importance for Patients and Families Providing specific treatments to surgical patients at the right time speeds healing and prevents them from having several serious complications.

8 Sepsis Establish reliable detection and treatment for severe sepsis. Implement the Sepsis Resuscitation Bundle: to be completed within 6 hours for patients with severe sepsis, septic shock and/or lactate > 4 mmol/l (36 mg/dl) Serum lactate measured. Blood cultures obtained prior to antibiotic administration. Improve time to broad-spectrum antibiotics: within 3 hours for ED admissions and 1 hour for non-ed ICU admissions. In the event of hypotension and/or lactate > 4 mmol/l (36 mg/dl): -Deliver an initial minimum of 20 ml/kg of crystalloid (or colloid equivalent). -Apply vasopressors for hypotension not responding to initial fluid resuscitation to maintain mean arterial pressure (MAP) >65 mm Hg. In the event of persistent hypotension despite fluid resuscitation (septic shock) and/or lactate > 4 mmol/l (36 mg/dl): -Achieve central venous pressure (CVP) of > 8 mm Hg. -Achieve central venous oxygen saturation (ScvO2) of > 70%. The physician should use the Sepsis Resuscitation/Maintenance Order Set. The order set is available in Formsfast An evidence based practice produces better outcomes than its alternative. Cost of Care: Decreased cost per inpatient case Time in ICU : Decreased time in intensive care in the last 6 months of life Importance for Patients and Families Sepsis can harm and kill patients if not treated quickly. Following these steps can save thousands of patients lives.

9 Stroke Provide intravenous tpa (Tissue Plasminogen Activator) within 180 minutes of onset of stroke symptoms Provide antithrombotic medication by Day Of Stay 2 Provide DVT (deep vein thrombosis) prophylaxis for patients at risk by the second hospital day Conduct a standard swallow evaluation or document that the patient has passed a bedside swallow screening prior to oral intake Prescribe antithrombotics (e.g., warfarin, aspirin, other antiplatelet drug) at discharge or document contraindication Prescribe anticoagulation therapy -- warfarin (Coumadin) or heparin/heparinoids - - at discharge to patients with atrial fibrillation unless an absolute or relative contraindication is documented Provide cholesterol-reducing drugs at discharge to patients who have LDL > or = 100 mg/dl OR who were taking cholesterol reducer prior to admission Provide smoking cessation advice or medication (e.g., Nicoderm or Zyban) at discharge The physician should use the Stroke Order Set. The order set is available in Formsfast An evidence based practice produces better outcomes than its alternative. Cost of Care: Decreased cost per inpatient case Time in ICU : Decreased time in intensive care in the last 6 months of life Importance for Patients and Families When caregivers intervene quickly, patients are less likely to experience severe complications from stroke and the possibility of long-term disability.

10 VTE Perform risk assessment on all inpatients and initiate appropriate VTE prophylaxis based on this assessment of their risk Assess all patients within 24 hours of admission for venous thromboembolism (VTE) risk Provide appropriate VTE prophylaxis including pharmaceutical and mechanical approaches based on national guidelines: o Surgical patients with procedures designated in SCIP measures o Intensive care ventilated patients as part of the Ventilator Bundle o All other patients assessed to be at risk (based on ACCP guidelines) The admitting physician should complete the VTE Risk Assessment/Order Form when admitting a patient. Surgeons should additionally complete the VTE Risk Assessment/Order Form post-operatively in PACU. Physicians should also complete the VTE Risk Assessment/Order Form when transferring a patient to or from ICU. An evidence-based practice provides better outcomes than its alternative. Harm: Decreased harm to patient Cost of Care: Decreased cost per inpatient case Readmission within 30 Days: Decreased readmissions within 30 days