Safe Practice 15 Discharge Systems

1. NQF-endorsed™ Safe Practices for Better Healthcare Safe Practice 15 Discharge Systems Chapter 5: Improving Patient Safety by Facilitating Information Transfer and Clear Communication

2. Slide Deck Overview Slide Set Includes: • Section 1: NQF-endorsed™ Safe Practices for Better Healthcare Overview • Section 2: Harmonization Partners • Section 3: The Problem • Section 4: Practice Specifications • Section 5: Example Implementation Approaches • Section 6: Front-line Success Stories

3. NQF-endorsed™ Safe Practices for Better Healthcare Overview Safe Practice 15 Discharge Systems Chapter 5: Improving Patient Safety by Facilitating Information Transfer and Clear Communication

4. 2010 NQF Safe Practices for Better Healthcare: A Consensus Report • 34 Safe Practices • Criteria for Inclusion • Specificity • Benefit • Evidence of Effectiveness • Generalization • Readiness

5. Culture SP 1 2010 NQF Report

6. Culture • CHAPTER 2: Creating and Sustaining a Culture of Patient Safety (Separated into Practices] • Leadership Structures and Systems • Culture Measurement, Feedback, and Interventions • Teamwork Training and Team Interventions • Identification and Mitigation of Risks and Hazards Structures and Systems Culture Meas., FB., and Interv. Team Training and Team Interv. ID and Mitigation Risk and Hazards Consent & Disclosure Consent and Disclosure • CHAPTER 3: Informed Consent and Disclosure • Informed Consent • Life-Sustaining Treatment • Disclosure • Care of the Caregiver Informed Consent Life-Sustaining Treatment Disclosure Care of Caregiver Workforce • CHAPTER 4: Workforce • Nursing Workforce • Direct Caregivers • ICU Care Nursing Workforce Direct Caregivers ICU Care • CHAPTER 5: Information Management and Continuity of Care • Patient Care Information • Order Read-Back and Abbreviations • Labeling Studies • Discharge Systems • Safe Adoption of Integrated Clinical Systems including CPOE Information Management and Continuity of Care Patient Care Info. Read-Back & Abbrev. Labeling Studies Discharge System CPOE Medication Management • CHAPTER 6: Medication Management • Medication Reconciliation • Pharmacist Leadership Role Including: High-Alert Med. and Unit-Dose Standardized Medication Labeling and Packaging Med. Recon. Pharmacist Systems Leadership: High-Alert, Std. Labeling/Pkg., and Unit-Dose • CHAPTER 7: Hospital-Associated Infections • Hand Hygiene • Influenza Prevention • Central Venous Catheter-Related Blood Stream Infection Prevention • Surgical-Site Infection Prevention • Care of the Ventilated Patient and VAP • MDRO Prevention • UTI Prevention Healthcare-Associated Infections Hand Hygiene Influenza Prevention Central V. Cath. BSI Prevention Sx-Site Inf. Prevention VAP Prevention MDRO Prevention UTI Prevention • CHAPTER 8: • Wrong-Site, Wrong-Procedure, Wrong-Person Surgery Prevention • Pressure Ulcer Prevention • DVT/VTE Prevention • Anticoagulation Therapy • Contrast Media-Induced Renal Failure Prevention • Organ Donation • Glycemic Control • Falls Prevention • Pediatric Imaging Condition-, Site-, and Risk-Specific Practices Wrong-site Sx Prevention Press. Ulcer Prevention DVT/VTE Prevention Anticoag. Therapy Contrast Media Use Organ Donation Glycemic Control Falls Prevention Pediatric Imaging

7. Harmonization Partners Safe Practice 15 Discharge Systems Chapter 5: Improving Patient Safety by Facilitating Information Transfer and Clear Communication

8. Harmonization – The Quality Choir

9. The Patient – Our Conductor

10. The Objective Discharge Systems • Ensure that effective transfer of clinical information to the patient and ambulatory clinical providers occurs at the time of discharge from healthcare organizations.

11. The Problem Safe Practice 15 Discharge Systems Chapter 5: Improving Patient Safety by Facilitating Information Transfer and Clear Communication

12. The Problem

13. The Problem Frequency • In 2006, there were approximately 34.9 million hospital discharges • 18% of Medicare beneficiaries were 30-day readmissions • Limitations can affect the frequency of adverse events and rates of readmissions [Anthony, Re-engineering the hospital discharge: an example of a multifaceted process evaluation, 2005; The Commonwealth Fund, Commission on a High Performance Health System, 2008;Chugh, Front Health Serv Manage 2009 Spring;25(3):11-32; DeFrances, National Health Statistics Report, 2008]

14. The Problem Severity • 19% of patients experience adverse events • 75% of discharge summaries lack information on pending tests [Were, J Gen Intern Med 2009 Sep;24(9):1002-6]

15. The Problem Preventability • 66% of post-discharge adverse drug events are caused by antibiotics • Hospitals should identify the critical components of the discharge plan that pose the greatest patient safety risks [Forster, Ann Intern Med 2003 Feb 4;138(3):161-7; Williams, J Nurs Care Qual 2009 Jul 3]

16. The Problem Cost Impact • Cost of rehospitalizations has been estimated to account for 60% of hospital charges [Zook, N Engl J Med 1980 May 1;302(18):996-1002; Zook, Milbank Mem Fund Q Health Soc 1980 Summer;58(3):454-71; Jack, Ann Intern Med 2009 Feb 3;150(3):178-87]

17. Practice Specifications Safe Practice 15 Discharge Systems Chapter 5: Improving Patient Safety by Facilitating Information Transfer and Clear Communication

18. Additional Specifications

19. Safe Practice Statement Discharge • A “discharge plan” must be prepared for each patient at the time of hospital discharge, and a concise discharge summary must be prepared for and relayed to the clinical caregiver accepting responsibility for post-discharge care in a timely manner. Organizations must ensure that there is confirmation of receipt of the discharge information by the independent licensed practitioner who will assume the responsibility for care after discharge. [Jack, Ann Intern Med 2009 Feb 3;150(3):178-87; Joint Commission Resources, The Official Handbook: Standards: PC.04.01 and PC.04.02, 2010]

20. Additional Specifications • Discharge policies and procedures should be established and resourced • A written discharge plan must be provided to each patient at the time of discharge that is understandable to the patient and/or family • A discharge summary must be provided to the ambulatory clinical provider who accepts the patient’s care after hospital discharge [SHM, BOOSTing Care Transitions Resource Room, 2008; Chugh, Front Health Serv Manage 2009 Spring;25(3):11-32; Clancy, Am J Med Qual 2009 Jul-Aug;24(4):344-6; Institute for Healthcare Improvement, Medication Reconciliation At All Transitions: IHI Improvement Map, 2009; Were, J Gen Intern Med 2009 Sep;24(9):1002-6]

21. Additional Specifications • Original source documents should be in the transcriber’s immediate possession • The organization should ensure and document receipt of discharge information by caregivers who assume responsibility for post-discharge care [Zsenits, J Hosp Med 2009 May;4(5):308-12]

22. Example Implementation Approaches Safe Practice 15 Discharge Systems Chapter 5: Improving Patient Safety by Facilitating Information Transfer and Clear Communication

23. Example Implementation Approaches

24. Example Implementation Approaches • Before discharge, present a clear explanation that the patient understands to address post-discharge medications • Discharge policies and procedures should include processes for educating patients • Put in place systematic and timely processes to provide and monitor feedback to practitioners [Bergkvist, Eur J Clin Pharmacol 2009 Jun 26; Agency for Healthcare Research and Quality, National Healthcare Disparities Report, 2009; Agency for Healthcare Research and Quality, National Healthcare Quality Report, 2009]

25. Example Implementation Approaches • Careful documentation at discharge as well as proper selection of nursing home facilities can improve readmission rates • Prospectively identify and provide a mechanism to contact patients (via phone or home visit), assessing the success of the discharge plan and reinforcing its key components [Kramer, Homeward bound: nine patient-centered programs cut readmissions, 2008; Boutwell, Effective Interventions to Reduce Rehospitalizations: A Compendium of 15 Promising Interventions, 2009; Williams, J Nurs Care Qual 2009 Jul 3]

26. Example Implementation Approaches Strategies of Progressive Organizations • Provide patients with access to the entire medical record online • Monitor the quality of the discharge summaries by collecting data on whether critical elements are accurate and complete • The Care Transition Intervention provided a “transition coach” to work with discharge patients over a four-week period [Coleman, Arch Intern Med 2006 Sep 25;166(17):1822-8]

27. Front-line Success Stories Safe Practice 15 Discharge Systems Chapter 5: Improving Patient Safety by Facilitating Information Transfer and Clear Communication

28. Title of Video Insert Video this size

30. TMIT High Performer Webinar Clear Communication Practices for Safer Healthcare (Safe Practices 12-16) • This webinar addresses Safe Practices for facilitating Information Transfer and Clear Communication • Safe Practice 12: Patient Care Information • Safe Practice 13: Order Read-Back and Abbreviations • Safe Practice 14: Labeling of Diagnostic Studies • Safe Practice 15: Discharge Systems • Safe Practice 16: Safe Adoption of Computerized Prescriber Order Entry • Go to: http://www.safetyleaders.org/pages/idPage.jsp?ID=4977

31. TMIT High Performer Webinar Medication Management • This program is a webinar presentation designed to help you or your hospital team understand and implement NQF-EndorsedTM Safe Practices 14-18. Renowned educators in the field of Medication Management will guide you in special informational sessions about the importance and implementation of these revised and new Safe Practices. • Go to: http://www.safetyleaders.org/pages/idPage.jsp?ID=4803