Introduction to Core Measures

1. IntroductiontoCore Measures Preferred Nurse Staffing

2. Core Measures • Who is information reported to? • JCAHO • CMS • National Patient Safety Foundation

3. Inpatient Core Measure Groups • Acute Myocardial Infarction (AMI) • Congestive Heart Failure (HF) • Pneumonia (PN) • Surgical Care Improvement Project (SCIP)

4. AMI Measures AMI 1 Aspirin w/in 24 hours of arrival* The early use of aspirin in patients with acute myocardial infarction results in a significant reduction in adverse events and subsequent mortality AMI-2 Aspirin at discharge.* Studies have demonstrated that aspirin canreduce this risk by 20%

5. AMI Measures AMI-3 ACEI or ARB for LVSD* ACEI therapy reduces mortality and morbidity in patients with left ventricular systolic dysfunction (LVSD/EF less than 40%) after AMI

6. AMI Measures AMI- 4 Smoking Cessation 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 toquit

7. AMI Measures AMI-6 Aspirin on arrival/within 24 hours of presentation Beta Blocker on arrival/within 24 hours of presentation

8. AMI Measures AMI-5 Beta Blocker at 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

9. AMI Measures AMI-7 Median time to fibrinolysis AMI-7a Thrombolytic Agent received within 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

10. AMI Measures AMI-8 Median time to PCI AMI-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

11. Heart Failure Measures HF –1 Discharge Instructions Written 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

12. Heart Failure Measures HF-2 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%)

13. Heart Failure Measures HF-3 ACEI or ARB for LVSD* ACEI therapy reduces mortality and morbidity in patients with heart failure and left ventricular systolic dysfunction

14. Heart Failure Measures HF-4 Smoking Cessation/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

15. Pneumonia Measures Community Acquired Pneumonia PN-1 Retired PN-2 Pneumococcal vaccination* Pneumococcal vaccination is indicated for persons 65 years of age and older, because it is up to 75% effective in preventing pneumococcalbacteremia and meningitis

16. Pneumonia Measures PN-3a Blood cultures performed w/in 24 hours prior to or after arrival to the ICU PN-3b- Blood cultures preformed in the ED before the initial antibiotic Published treatment guidelines recommend the collection of blood cultures for all inpatients with severe pneumonia to optimize therapy

17. Pneumonia Measures PN-4 Smoking Cessation/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

18. Pneumonia Measures PN-5a – 8 hours PN-5b Initial antibiotic received within 4 hours of arrival PN-5c - 6 hours … clinical evidence of an association between timely inpatient administration of antibiotics and improved outcome among pneumonia patients

19. Pneumonia Measures PN-6 Initial antibiotic selection for CAP PN 6a ICU patient PN 6b Non- ICU patient

20. Pneumonia Measures • 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.

21. Surgical Care Improvement Project 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.

22. SCIP Measures SCIP-Inf 2-Appropriate antibiotic selection SCIP-Inf 3: Prophylactic antibiotic discontinued within 24 hours after surgery SCIP-Inf 6: Appropriate hair removal SCIP-Inf 7: Perioperative normothermia among colorectal surgical patients

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

24. SCIP Pre-Op • Document appropriate hair removal-do not use the word shaveor razorin the record • Document any DVT prevention measures applied at this point (TED’s/SCD’s) • Antibiotic start w/in 60 min of incision (120min for Vancomycin) • Beta Blocker received & documented during peri-operative period if indicated (Medication Reconciliation)

25. SCIP 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

26. What can you do to help? • Be a part of this successful process • Do not underestimate your impact on patient outcomes • Teach – provide education to your patients as you provide their care • Documentation – use the proper forms and order sets • Talk to your peers and co-workers/make core measures part of your daily vocabulary