Infection Control in Home Care: Developing an Infection Control Program to Effectively Help Chronically Ill Individuals Avoid Unplanned Hospitalizations

Margherita Labson, RN, MSHSA, CPHQ Executive Director, Home Care Program Ed Smith, RN, MSN Associate Director, Standards Interpretation

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Thursday, June 18, 2015

Joint Commission Program Learning Objectives

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Construct an appropriate organization-wide infection control program Determine methods to engage patients/clients in effective ways of preventing infections Examine ways to credibly evaluate the results of an infection control plan

This webinar is approved for 1.0 Continuing Education Credit from: Accreditation Council for Continuing Medical Education (ACCME) American Nurses Credentialing Center (ANCC) American College of Healthcare Executives (ACHE)

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Continuing Education Credit

Obtaining Continuing Education Credit

 Individually registered for the webinar through The Joint Commission website.  Listened to the webinar in its entirety. Only those listening live on the day of the call will be eligible to receive credit. Only Joint Commission accredited organizations will be eligible for the continuing education credit.  Completed a post-program evaluation/attestation. A link to the post-program evaluation/attestation will be sent to your registered email 24-48 hours after the webinar. After completion of the survey, you will receive a certificate available to download. 4

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CE/CME/CEU credit is available for the live audio only. Credits will not be available for webinar replays. In order to claim credit you must have:

Disclosure Statement The following staff and speakers have disclosed that neither they nor spouses/partners have any financial arrangements or affiliations with corporate organizations that either provide educational grants to this program or may be referenced in this activity:

 Edward Smith, RN, MSN, Associate Director, Standards Interpretation, The Joint Commission

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 Margherita Labson, RN, MSHSA, CPHQ, Executive Director, Home Care Accreditation Program, The Joint Commission

Stakeholder Involvement Leadership: Accountability and Commitment – Endorse resource allocation – Leverage the value of the program

Champion: Empower and Enable – Knowledgeable expert – Results oriented – Facilitator: provides roadmap for action – Representatives from all affected operational areas – Work is considered an essential component of operational readiness 6

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Cross-divisional representation

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Evaluating Risk

External Assessment: Resources

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Community Assessment – Geographic risks

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External Assessment: Resources

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Geographic risks Seasonal considerations Local partners

Internal Assessment: Resources Capitalizing on your data Vulnerabilities – Population served – Services provided – Referral sources – Behavior economics – Contracts

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Risks posed by staff

Prioritizing Risk External Environment

Patient/Client Chronically Ill Population

Patients/Client At risk

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Internal Environment

Real World Example Home Medical Equipment

Organizational Centric View

 Assumption Chronic Illness-External info – –

Driven from intake information Informed by health care industry

 Defined Attributes-Population – – –

Demographics Population characteristics External environment

– –

Payer base: HMO, PPO, FFS, Commercial Service delivery frequency and methodology

 Operational Resources-Internal info – –

Demographics of Staff Staffing capability

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 Contractual Requirements-Internal info

Analyzing Priorities  Respiratory related illness – – – –

Seasonal influenza Cold virus Pneumonia Norovirus

 Wound infection – Staph infection – Entercoccal infection – MRSA

Implications for the plan  Influenza prevention program – Vaccination program – Educational efforts – Measure and manage

 Respiratory Care Program – Staff education: PPE, time off – Recognize, respond and replace – Work with payers to promote healthy behaviors

 Control bacterial contamination – Add norovirus policy – Cleaning/disinfecting equipment

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Risks Identified

Useful Tools Securing Leadership Buy In: Opportunities and Threats      

↓rate of admission >5% = premium rates Improved resource utilization and savings Improved operational efficiency Longer length of stay for patients Compelling data to attract new customers Improved patient satisfaction and loyalty

Threats      

Readmission for pneumonia >2% =threatens contract Patient satisfaction ↓ with repeat admissions Uncompensated supply utilizations Staff at higher risk for acquired infection ↑ overtime if staff become ill More difficult contract renewal discussions

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Opportunities

Right Representation: ARMI Analysis Approver: one who can authorize and move the boulders, sponsor or business leader whose approval is required

Resource: an expert with skills/information needed for a fixed period of time

Member: full-time team members who know the Interested Party: those who have a need to know about the project

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work to be done

Designing a Plan

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Professional standards and recommendations Creating smart goals Data driven management Practical examples

A Key Component of the Triple Aim – COPD – Diabetes – Rheumatoid Arthritis – Neuromuscular disorders – Dementia spectrum – Heart Disease

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Managing Chronic Disease:

Attributes of Health Care Consumers Generational Differences: – – – –

Matures Boomers Gen Xers Millennials

Behavioral Economics Factors Influencing Engagement – Health care consumer as a partner – Redefining the role of health care provider 19

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– Purchasing power, high deductibles and co-pays – Predictive analytics

Methods of Engagement

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Patient/Client Centered Care Right Tool for the Right Job Relational vs Transactional Working with provider partners and payers

Practical Applications

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Consumer awareness linking out of pocket savings to infection prevention activities Programs w/Payers to incent patients towards infection prevention Leadership and staff accountability for infection prevention Physician-provider affiliated programs

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Evaluating Program Results

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Evaluating against the goal Reporting and trending Getting to the root cause of the issues

Summary

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Buy in is greater if plan is relevant Patient partnership Credible evaluation sustains improvement

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Questions?

Home Care Team Contacts

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Joint Commission Home Care Program Help Desk: 630-792-5070 or [email protected] www.jointcommission.org/accreditation/home_care.aspx