Introduction Introduction to to Core Measures Core Measures Lynn Benson Lynn Benson Preferred Nurse Staffing Preferred Nurse Staffing
IntroductionIntroductiontoto
Core MeasuresCore Measures
Lynn BensonLynn Benson
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
ACM MeasuresACM Measures
Ten Appropriate Care Measures Ten Appropriate Care Measures (ACM) are designated by an (ACM) are designated by an asterisk*. asterisk*.
Asks: has a patient received all the care Asks: has a patient received all the care he or she was eligible to receive based on he or she was eligible to receive based on ten-measures (5 AMI, 2 HF, and 3 PN)? ten-measures (5 AMI, 2 HF, and 3 PN)?
Measures how often the hospital “gets it Measures how often the hospital “gets it right.” right.”
Focuses on providing “the right care for Focuses on providing “the right care for every person every time.”every person every time.”
Core MeasuresCore Measures
Public has access to quality Public has access to quality information through the Internetinformation through the Internet– How does Riley Hospital measure How does Riley Hospital measure
up??up??– Check it out at Check it out at
http://www.hospitalcompare.hhs.govhttp://www.hospitalcompare.hhs.gov
Core MeasuresCore Measures
Topics focus on health problems most Topics focus on health problems most common to the Medicare populationcommon to the Medicare population
Effective interventions have been Effective interventions have been shown to reduce disability and save shown to reduce disability and save liveslives
Based on national data, many Based on national data, many Medicare patients do not receive Medicare patients do not receive important therapies known to important therapies known to decrease morbidity and mortalitydecrease morbidity and mortality
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) Childhood Asthma PreventionChildhood Asthma Prevention
Core MeasuresCore Measures
Based on large scale scientific studies with Based on large scale scientific studies with proven efficacyproven efficacy
Scientific studies have been incorporated into Scientific studies have been incorporated into guidelines developed by professional guidelines developed by professional organizationsorganizations
Consensus of national experts panel for each Consensus of national experts panel for each measuremeasure
Proven to be measurable and reliable Proven to be measurable and reliable measures of the quality of caremeasures of the quality of care
Focus on clinical processes: all patients, Focus on clinical processes: all patients, without contraindicationswithout contraindications, should be , should be considered candidates for therapiesconsidered candidates for therapies
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 MeasuresAMI Measures
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 MeasuresAMI Measures
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 MeasuresAMI Measures
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 MeasuresAMI Measures
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 MeasuresAMI Measures
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%)
Heart Failure Heart Failure MeasuresMeasures
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
Heart Failure Heart Failure MeasuresMeasures
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
Pneumonia MeasuresPneumonia Measures
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
Pneumonia MeasuresPneumonia Measures
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
Pneumonia MeasuresPneumonia Measures
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
Pneumonia MeasuresPneumonia Measures
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
Pneumonia MeasuresPneumonia Measures
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 MeasuresSCIP Measures
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 MeasuresSCIP Measures
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