Procedure Kits: Where Common Sense Makes Financial Sense

PROCEDURES WHERE KITS HELP

  • Vascular Access Devices
    • PIV Starts
    • CVC Insertion
    • PICC Lines
  • Epidurals
  • Dressing Changes
  • Surgical Procedures

In our last blog, we reviewed how standardization of procedure kits can help your facility by increasing overall compliance to best practices. Yet another advantage of procedures kits is the financial benefit. A case in point is a study of phlebitis and infiltration rates within an institution following the conversion to a standard intravenous (IV) start kit, which showed dramatic effects by not only improving outcomes but decreasing costs as well.1

Nursing departments in this 700-bed facility tested a variety of IV starter kits and determined their best choice for the study. The kit they selected featured a window dressing, a prep of 2% chlorhexidine gluconate (CHG) with 70% isopropyl alcohol, catheter securement cushions, a tape strip, a 2″ x 2″ gauze pad, a latex-free tourniquet, and an extension set with needleless valve.

Hands-on training in the appropriate use of the kit was provided to hospital staff to achieve consistent usage. Outcomes were monitored by assessing phlebitis and infiltration rates at 6-month intervals on 250 patients per assessment.

The clinical results of implementing a standardized protocol/procedure kit not only met but exceeded the hospital staff’s objectives1:

  • Phlebitis rates were virtually eliminated
  • Infiltration rates were zero
  • Dwell times were extended from 72 hours to 96 hours

Beyond the beneficial clinical results were multiple cost avoidance advantages 1:

  • Annual real cost savings of 34% ($188,640)
  • Nursing time decreased from an average of 25 to 15 minutes per procedure
  • Reducing phlebitis rates resulted in lower expenditures and fewer unscheduled restarts
  • Extending catheter dwell time protocols saved nursing time and materials
  • Standardization reduced risk of costly infections
  • No need to hire additional nursing staff

Furthermore, the study resulted in some patient benefits as well 1:

  • Increased comfort (ie, fewer site complications, skin tears, unscheduled restarts)
  • Increased safety/lower risk of infection

This study demonstrated that standardization of procedure kits can not only help with overall compliance to best practices, but provide clinical and financial benefits as well. As you determine the appropriate components for your kits (eg, gowns, masks, caps, gloves, drapes, dressings, site prep solutions, etc.), consider the inclusion of Mastisol® Liquid Adhesive and Detachol® Adhesive Remover for any kit containing wound closure tapes or dressings:

  • Mastisol® Liquid Adhesive: Reduce the risk of infection by creating a lasting occlusive dressing barrier by incorporating Mastisol®
  • Detachol® Adhesive Remover: Miniminze risk of skin injury by implementing Detachol® for safe dressing removal

There are many manufacturers that specialize in providing and customizing kits for facility-specific needs. Mastisol® and Detachol® are available components for many kit manufacturers.

For more information about Mastisol® and Detachol®, please contact your sales consultant or Eloquest Healthcare®, Inc., call 1-877-433-7626 or visit www.eloquesthealthcare.com.

Minimizing infection risk is an essential part of optimizing “The Triple Aim” of the Affordable Care Act. Eloquest Healthcare is committed to providing solutions that can help you reduce risk of conditions like a CAUTI, CLABSI, or SSI.

Come back next time for the first of a 3-part series on catheter-related bloodstream infections (CRBSIs). You won’t want to miss it!

References

  1. Penny-Timmons E. Decreased costs/improved outcomes with standardized intravenous equipment. JAVA. 2005;10(1):20-23.

Procedure Kits Help Drive Compliance Best Practices

Most likely, your practice has standard operating procedures to ensure consistency and quality of care. In fact, an article in Modern Healthcare cited that 30% of inefficiencies in our healthcare system today are driven by a lack of standardization and a lack of care coordination.1

In the pursuit of creating “best practices” in your facility, one such area to consider is how procedure kits can help improve adherence. Two important advantages of doing so are:

  • Minimizing process variance so that all staff perform the procedure exactly the same way
  • Convenience of saving steps to locate and use materials independent of the procedure

PROCEDURES WHERE KITS HELP

  • Vascular Access Devices
  • PIV Starts
  • CVC Insertion
  • PICC Lines
  • Epidurals
  • Dressing Changes
  • Surgical Procedures

The Guidelines for the Prevention of Intravascular Catheter-Related Infections from the US Centers for Disease Control and Prevention (CDC) report that the risk for infection declines following standardization of aseptic care. Moreover, the insertion and maintenance of intravascular catheters by inexperienced staff potentially increased the risk for catheter colonization and catheter-related bloodstream infection (CRBSI).2

 

Standardized kits are also available for many surgical procedures and offer many of the same benefits of their vascular counterparts. Examples of these include incision and drainage (I&D) trays, arthroscopy kits, total knee replacement packs, and C-section setup packs. As the number of surgical procedures in the U.S. and the number of patients with increasingly complex comorbidities continues to rise, the stakes are becoming even higher.3

It is evident that standardization of procedure kits can help your practice or facility by having a positive effect on overall compliance to best practices. As you determine the appropriate components for your kits (eg, gowns, masks, caps, gloves, drapes, dressings, site prep solutionsetc), don’t forget to include Mastisol® Liquid Adhesive and Detachol® Adhesive Remover for any kit containing wound closure tapes or dressings:

  • Mastisol® Liquid Adhesive:  Reduce the risk of infection by creating a lasting occlusive dressing barrier by incorporating Mastisol®
  • Detachol® Adhesive Remover: Miniminze risk of skin injury by implementing Detachol® for safe dressing removal

There are many manufacturers that specialize in providing and customizing kits for facility-specific needs. Mastisol® and Detachol® are available components for many kit manufacturers.

For more information about Mastisol® and Detachol®, please contact your sales consultant or Eloquest Healthcare®, Inc., call 1-877-433-7626 or visit www.eloquesthealthcare.com.

Minimizing infection risk is an essential part of optimizing “The Triple Aim” of the Affordable Care Act. Eloquest Healthcare is committed to providing solutions that can help you reduce the risk of conditions like a CAUTI, CLABSI, or SSI.

Join us next time to read our blog, “Procedure Kits: Where Common Sense Makes Financial Sense.”

References

  1. Standardizing care reduces costs, improves quality. Modern Healthcare. http://www.modernhealthcare.com/article/20150411/MAGAZINE/304119950. Published April 11, 2015. Accessed August 30, 2017.
  2. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the Prevention of Intravascular Catheter-related Infections. Clin Infect Dis. 2011;52(9):e162-e193.
  3. Healthcare Infection Control Practices Advisory Committee. The Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg published online May 2017. Doi:10.1001/jamasurg.2017.0904.

CAUTI Prevention: A Nurse-Driven Quality Improvement Study

As posted previously, the Affordable Care Act (ACA) established penalty measures for the performance of acute care hospitals. In fact, some measures are penalized in multiple programs1,2:

  • VALUE-BASED PURCHASING PROGRAM (VBP) – For more information about the VBP Program, see our previous blog
  • HOSPITAL-ACQUIRED CONDITIONS (HAC) REDUCTION PROGRAM – For more information about the HAC Reduction Program, see our previous blog.

According to the Centers for Disease Control and Prevention (CDC), urinary tract infections (UTIs) are the most common type of healthcare-associated infection reported to the National Healthcare Safety Network.3

Among UTIs acquired in the hospital, approximately 75% are associated with
 a urinary catheter3

What can be done?
A poster, Taking the Next Steps for Patient Safety and Excellence in CAUTI Prevention, was recently presented at the 44th Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC).The poster described a nurse-driven quality improvement initiative designed to:

  • reduce urinary device days
  • decrease the Foley Utilization Rate (FUR), which is calculated by dividing the number of Foley catheter days by the number of patient days5
  • lower the CAUTI rate

The initiative sought to determine if switching from an indwelling (Foley) catheter to a different male external continence device (ECD) could reduce the negative outcomes associated with the Foley catheters.

The results of switching to an ECD resulted in:

  • a 46% decrease in total urinary device days
  • decreased the FUR from a high of 0.41 in to a low of 0.19 (with a 0.25 average)
  • lowered the CAUTI rate to 0 (See Figure 1 below.)

Figure 1. CAUTI Rate

The poster’s author noted some important clinical implications:

  1. Adherence to appropriateness criteria for indwelling catheter placement can help prevent unnecessary risk for CAUTIs.
  2. Use of an ECD as an alternative to indwelling Foley catheters may reduce the CAUTI incidence rate.
  3. The intervention resulted in an overall decrease in total urinary device days and Foley catheter days.

The ECD used and represented by an image on the poster was the ReliaFit® Male Urinary Device marketed by Eloquest Healthcare®:

The results clearly support the poster’s title and provide impressive rationale for taking proactive steps for preventing CAUTIs in the acute care hospital setting.  Download the poster here.

Come back to read our next blog, “SSIs and Post-op dressings: What’s missing?”

References:

  1. Hospital Value-Based Purchasing. Department of Health and Human Services, Centers for Medicare & Medicaid Services. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_ Sheet_ICN907664.pdf. Published September 2015. Accessed June 1, 2017.
  2. FY 2017 HACRP Key Dates Matrix. Hospital-Acquired Condition Reduction Program (HACRP). Centers for Medicare & Medicaid Services. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/HAC-Reduction-Program.html. Accessed June 1, 2017.
  3. Healthcare-associated Infections: Catheter-associated Urinary Tract Infections (CAUTI). CDC website. https://www.cdc.gov/hai/ca_uti/uti.html. Accessed June 1, 2017.
  4. Quayle BL. Taking the next steps for patient safety and excellence in CAUTI prevention. Poster presented at: APIC 44th Annual Conference. June 14, 2017; Portland, Oregon.
  5. Urinary Tract Infection (Catheter-Associated Urinary Tract Infection [CAUTI] and Non-Catheter-Associated Urinary Tract Infection [UTI]) and Other Urinary System Infection [USI]) Events. CDC website. https://www.cdc.gov/nhsn/pdfs/pscmanual/7psccauticurrent.pdf. Published January 2017. Accessed June 1, 2017.

Hospital-Acquired Conditions (HAC) Reduction Program

Our last blog provided some background on the READMISSIONS REDUCTION PROGRAM —a three-year rolling process of reporting all-cause readmissions within 30 days of discharge, along with potential penalties.1  Today, we’ll look at the third program established by the Affordable Care Act (ACA): the HOSPITAL-ACQUIRED CONDITIONS (HAC) REDUCTION PROGRAM.

HAC REDUCTION PROGRAM allows the Centers for Medicare & Medicaid Services (CMS) to reduce payments by 1% to hospitals in the worst-performing quartile.2 The CMS reduces payments for specific safety issues and hospital-acquired infections3

  • CAUTI | Catheter Associated Urinary Tract Infection
  • CLABSI | Central Line Associated Bloodstream Infection
  • SSI | Surgical Site Infection
    • Abdominal hysterectomy
    • Colon surgeries
  • MRSA | Methicillin-Resistant Staphylococcus Aureus Bacteremia
  • CDI | Clostridium Difficile Infection

HACs are acquired by patients while receiving care and represent the most frequent adverse event affecting patient safety worldwide.4 For FY 2017, CMS estimated that overall payments to 769 hospitals would drop by roughly $430 MILLION.5

There are two domains associated with the HAC REDUCTION PROGRAM.3:

DOMAIN 1 is based on Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI) 90 Composite Component Measures and provides an overview of hospital-level quality as it relates to a set of potentially preventable hospital-related events associated with harmful outcomes for patients.6 It is weighted 15%.4

DOMAIN 2 includes standardized infection ratios (SIRs) calculated by the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) Healthcare-Associated Infection (HAI) Measures.4 It is weighted 85%.4

Domain 1 is a weighted average of the 
risk- and reliability-adjusted versions of:

  • Pressure Ulcer Rate
  • Iatrogenic Pneumothorax Rate
  • In-Hospital Fall with Hip Fracture Rate
  • Perioperative Hemorrhage or Hematoma Rate
  • Postoperative Acute Kidney Injury Rate
  • Postoperative Respiratory Failure Rate
  • Perioperative Pulmonary Embolism (PE) or
  • Deep Vein Thrombosis (DVT) Rate
  • Postoperative Sepsis Rate
  • Postoperative Wound Dehiscence Rate
  • Unrecognized Abdominopelvic Accidental
    Puncture Laceration Rate

Domain 2 is Center for Disease Control’s (CDC) calculated standardized infection ratios (SIRs) for the CLABSI, CAUTI, and SSI measures. SIRs are ratios of observed-to-predicted numbers of HAIs. The CLABSI, CAUTI, and SSI measures are risk-adjusted at the hospital level and patient-care unit level:

  • CAUTI
  • CLABSI
  • SSI
  • Abdominal hysterectomy
  • Colon surgeries
  • MRSA Bacteremia
  • CDI

If you’ve been following our blog, you’ll probably remember that measures from Domain 2, which make up 85% of the weighting, are penalized in multiple programs—here, in the HAC Reduction Program as well as in the Value-Based Purchasing Program (VBP).

What’s the impact? Consider an average 300-bed Community Hospital with 48% of their patients being Medicare beneficiaries. If they have an inpatient Medicare revenue of $26,000,000 and received a $20,000 payment reduction for a condition/diagnosis, their 1% penalty reduction would be $200. That same reduction would be applied to EVERY inpatient Medicare claim submitted during the fiscal year and could result in a penalty of $260,000.

According to the CMS, there’s good news—improvements are being made. Across the last three fiscal years, 2015, 2016, and 2017, the average performance across eligible hospitals improved for the mean Catheter-Associated Urinary Tract Infection (CAUTI) standardized infection ratio (SIR) and the mean SIR decreased from 1.12 in FY 2015 and 1.17 in FY 2016 to 0.91 in FY 2017.7

If you’d like a comprehensive overview of the Affordable Care Act as featured in our last 4 blogs, click here to download the “True Transparency in the Cost of Care” infographic.

Come back next time when we review some of the latest clinical evidence on CAUTI risk reduction presented at the APIC Annual Conference 2017.

Minimizing infection risk is an essential part of optimizing “The Triple Aim” of the Affordable Care Act. Eloquest Healthcare is committed to providing solutions that can help you reduce risk of conditions like a CAUTI, CLABSI, or SSI.

References

  1. Understanding the Hospital Readmissions Reduction Program. The Lake Superior Quality Innovation Network, Centers for Medicare & Medicaid Services Quality Improvement Organization Program. https://www.stratishealth.org/documents/Readmissions_Reduction_Fact_Sheet.pdf.  Published November 2014. Accessed January 16, 2017.

  2. Hospital-Acquired Condition Reduction Program (HACRP). Centers for Medicare & Medicaid Services. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/HAC-Reduction-Program.html. Accessed January 16, 2017.

  3. FY 2017 HACRP Key Dates Matrix. Hospital-Acquired Condition Reduction Program (HACRP). Centers for Medicare & Medicaid Services. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/HAC-Reduction-Program.html. Accessed January 16, 2017.

  4. Health care-associated infections fact sheet. World Health Organization. http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf. Accessed March 30, 2017.

  5. Haefner M. 769 hospitals see medicare payments cut over high HAC rates: 7 things to know. http://www.beckershospitalreview.com/quality/769-hospitals-see-medicare-payments-cut-over-high-hac-rates-7-things-to-know.html. Published December 22, 2016. Accessed January 16, 2017

  6. PSI 90 Fact Sheet. AHRQ Quality Indicators. Agency for Healthcare Research and Quality. https://www.qualityindicators.ahrq.gov/News/PSI90_Factsheet_FAQ.pdf. Published FY 2016. Accessed March 30, 2017.

  7. FY 2017 HACRP Fact Sheet. Hospital-Acquired Condition Reduction Program (HACRP). Centers for Medicare & Medicaid Services. https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/HAC-reduction-program.html. Accessed March 30, 2017.

Value-Based Purchasing Program

Our last post provided an overview of 3 programs created by the Affordable Care Act (ACA) to improve care, healthy people and communities, and affordable care.1 This post will focus on the Value-Based Purchasing Program.

The VALUE-BASED PURCHASING PROGRAM (VBP) is a performance-based payment strategy that links financial incentives to acute-care hospitals’ performance on a defined set of measure domains (categories) including2 :

  • CLINICAL CARE
  • EXPERIENCE OF CARE
  • SAFETY
  • EFFICIENCY/COST REDUCTION

NOTE: In fiscal year (FY) 2019, the CAUTI and CLABSI measures in the safety domain will expand beyond the ICU to “select wards” (ie, Medical/Surgical Units, etc.)

VBP is the only program established by the ACA that can reward or penalize a hospital for the quality of care they provide to Medicare beneficiaries.3 The Centers for Medicare & Medicaid Services (CMS) imposed a 2% reduction to base Diagnosis-Related Group DRG payments to create a pool for bonuses to be paid. In 2017, the payment increases added up to about $1.8 billion.3

  • the quality of care provided to Medicare patients
  • how closely best clinical practices are followed
  • how well hospitals enhance patients’ experiences of care during hospital stay

Each hospital earns 2 scores on each measure—one for achievement and one for improvement.3 The final score awarded to a hospital for each measure is the higher of the 2 scores. A part of hospitals’ Medicare payments is adjusted based on a total performance score that reflects3:

  • how well they perform compared to other hospitals, or
  • how much they improve their own performance compared to their performance during a prior baseline period

CMS bases hospital performance on an approved set of measures and dimensions grouped into specific quality domains.2 The applicable domains and their weighting changes for 2017 and 2018 and beyond are listed below:

Included in the Safety domain are the following conditions:

  • CAUTI | Catheter Associated Urinary Tract Infections
  • CLABSI | Central Line Associated Bloodstream Infections
  • CDI | Clostridium Difficile Infection
  • MRSA | Methicillin-Resistant Staphylococcus Aureus Bacteremia
  • SSI | Surgical Site Infections
    • Abdominal hysterectomy
    • Colon surgeries

What does it all mean? Let’s look at an average 300-bed Community Hospital with 48% of their patients being Medicare beneficiaries. If they have an inpatient Medicare revenue of $26,000,000 and received a $20,000 payment reduction for a condition/diagnosis, a maximum 2% penalty would be $400. That same reduction would be applied to EVERY inpatient Medicare claim submitted during the fiscal year and could result in a penalty of $520,000.

You might remember from our last blog that these measures are penalized in multiple programs—here, in VBP as well as the Hospital-Acquired Conditions (HAC) Reduction Program.

According to the World Health Organization (WHO), infections in healthcare settings are the most frequently occurring adverse event worldwide, leading to significant mortality and financial losses for healthcare systems.4

WHO reports that several factors can cause healthcare-associated infections (HAIs)4:

  • prolonged and inappropriate use of invasive devices and antibiotics
  • high-risk and sophisticated procedures.
  • immunosuppression and other severe underlying patient conditions
  • insufficient application of standard and isolation precautions

Join us for our next installment, “The Readmissions Reduction Program: How Are We Doing?”

Minimizing infection risk is an essential part of optimizing “The Triple Aim” of the Affordable Care Act. Eloquest Healthcare is committed to providing solutions that can help you reduce risk of conditions like a CAUTI, CLABSI, or SSI.

References:

  1.  Berwick, DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Affairs 27, no.3(2008):759-769. Doi: 10.1377/hlthaff.27.3.759.
  2. Hospital Value-Based Purchasing. Department of Health and Human Services, Centers for Medicare & Medicaid Services. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf. Published September 2016. Accessed January 16, 2017.
  3. Whitman E. Fewer Hospitals Earn Medicare Bonuses Under Value-Based Purchasing. Modern Healthcare. http://www.modernhealthcare.com/article/20161101/NEWS/161109986. Published November 1, 2016. Accessed January 16, 2017.
  4. Health care-associated infections Fact Sheet. World Health Organization. http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf. Accessed March 30, 2017.