Medicare Associated Infection Paper

Introduction

The mission of Ventura County Medical Center (VCMC) is to provide quality cost effective healthcare. In order to accomplish this mission HealthCare Associated Infections (HAI) must be reduced. Ventura County Medical Center along with hospitals around the nation is required to report their HAI’s to the National Healthcare Safety Network (NHSN) which in turn reports to the Centers for Disease Control (CDC) which then reports to Centers for Medicare and Medicaid Services (CMS). The CDC states that 1 in 25 patients will get a HAI during their stay in the acute care setting of a hospital. “There were an estimated 722,000 Hospital Associated Infections in acute care hospitals in the US in 2011.” (CDC, 2015). Nine percent of patients

that acquired an HAI will die during their hospital stay. Of the 722,000 hospital acquired infections approximately 93,000 were from Urinary Tract Infections and approximately 72,000 were from Bloodstream Infections. There has been a significant reduction in Central Line Associated Blood Stream Infections (CLABSI) about 46 percent between 2008-2013 but Catheter Acquired Urinary Tract Infections (CAUTI) have increased 6 percent from 2009-2013 (CDC, 2015). These numbers represent the need for improvement of policies and procedures and enforcing such practices that will lead to a decrease in both the numbers of Central Line Associated Blood Stream Infections and Catheter Acquired Urinary Tract Infections.

HAI and Informatics: The Importance of Proper Documentation
of CLABSI’s and CAUTI’s in Data Collection

Problem Statement
In the age of informatics and the EMR, one thing is certain….”garbage in-garbage out”, reliable data is necessary for the development of policies and procedures that are evidence based. When health care staff do not document accurately the data collected is no longer valid. This project will contribute to the education and retraining of health care staff to document safe and competent care of the patient.
Evidence Based Practice
Despite the successful implementation of an electronic medical record (EMR), the data regarding proper documentation of CAUTI’s and CLABSI’s continues to be inaccurate.

The reports that should facilitate data abstraction to guide performance improvement and provider care requirements are incorrect. Documentation compliance enables the development of succinct reports that facilitate the internal needs of VCMC and supports the compliance efforts to reduce HAI’s. Documentation compliance has been monitored pre and post EMR implementation and documentation compliance post EHR has been poor. Clinical information systems like Cerner can support evidence-based nursing and become analysis tools to promote the practice of knowledge-driven nursing. Nursing evidence is embedded into an automated system assessment and documentation process to obtain immediate reports in such areas as: Compliance with core quality and clinical performance metrics, and data reported to infection control which includes how many catheter associated infections and central line associated blood stream infections there were which then facilitates the integration of patient safety measures to decrease these HAI’s.

The ability to provide accurate documentation will promote patient centered care, safe and effective care, quality improvement, and teamwork and collaboration which are four of the six domains for quality and safety in

nursing.

Mission Strategic Plan
As a county facility Ventura County Medical Center (VCMC) like most governmental agencies is here to serve the public. Their mission statement aims to provide public services that will afford all residents the opportunity to improve their quality of life and have them enjoy a safe and healthy community. The Health Care Agency focuses on health care and their mission is to ensure access to quality, cost effective, culturally sensitive health care for everyone, in particular the most vulnerable members of the community. The health care agency works hard to build public trust, be transparent, ethical and accountable to the residents of Ventura County. The mission of VCMC is to provide quality cost effective healthcare and this project will assist the organization in providing these services.
Implementation
The Ventura County Medical Center’s department of infection control has to report to the National Healthcare Safety Network all hospital acquired infections. With the implementation of the electronic health record, the data the nurses are recording in the patient’s electronic chart is done in a way that it is not capturing the information needed by infection control. Infection control cannot retrieve the reliable statistical data that they need to be able to report directly to the NHSN. A manual system has been implemented to ensure that the reports given by the EHR match the actual manual count done by staff. To date this information does not match; the project assigned will help facilitate the education and implementation of proper documentation of central lines and Foley catheters. When the correct data is documented and entered into the EHR, it will ensure that the reports are correct which will facilitate sending the information to NHSN. The data is then used to identify problem areas, measure progress of prevention efforts, and ultimately eliminate HAIs. The accuracy of this data is important because in 2009 the U.S. Department of Health and Human Services (HHS) developed a National Action Plan to Prevent Health Care-Associated Infections. Since the goal was not met, more needs to be done at every level of public health and health care to improve patient safety and eliminate infections that commonly threaten hospital patients (CDC, 2015). The project will help analyze patient care and cost outcomes using an information system database called Cerner. Assuming the role of a nurse manager, will require participation in planning the best way to collect data from the nurses that will assist in developing and then implementing changes to the nurse in the organization. Once implemented these changes will reduce the cost acquired by the hospital when reimbursement is denied for each Central Line Associated Blood Stream Infections and Catheter Acquired Urinary Tract Infections. This reduction in cost will affect the fiscal planning of the organization.

Perceived Barriers to Change
The current obstacles foreseen in implementing this project is finding the best way to teach the nurses on the floor and finding time to do so. With a tight budget and cuts being made in overtime hours the nurses do not want to come in on their days off and finding time to teach them while they are doing patient care would not be wise. This brings me to a point my preceptor made today when I asked her how health care economics affects nursing job satisfaction. She said “when there are budget cuts or when they are told no more overtime” they are always asked to do more with less”. They are told that charge nurses cannot be out of ratio but they are still required to see their share of patients plus tend to the duties of a charge nurse. They will say no more CNA’s but then the nurses have to do the work of the CNA’s. My preceptor is a consultative leader she listens to everyone’s opinion but she make the decisions but she is also a laissez-faire leader with certain staff that she feel she can trust.

Cost Benefit Analysis
Healthcare-associated infections (HAIs) in hospitals carry significant economic consequences on the nation’s healthcare system.

There are approximately 4.5 HAIs for every 100 hospital admissions; the annual direct costs on the healthcare system were estimated to be $4.5 billion dollars. Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter; between 15-25% of hospitalized patients receive urinary catheters during their hospital stay. The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter. Central line-associated bloodstream infections (CLABSIs) result in thousands of deaths each year and billions of dollars in added costs to the U.S. healthcare system, yet these infections are preventable. According to the CDC, CLABSIs cost hospitals thirty to fifty thousand dollars per infection and CAUTIs cost eight to ten thousand per infection. My project will help reduce the cost of CAUTIs and CLABSIs, by training nurses how to properly document the insertion and discontinuation of central lines and urinary catheters thus providing accurate data that can be reported to the appropriate agencies (see Appendix A). Inaccurate data causes the numbers reported to CMS to be skewed resulting in a high numbers of infections reported due to the calculations being inaccurate from improper

documentation.

Conclusion and Recommendations
The development of a competency checklist and subsequent implementation of training of new employees and retraining of current employees will be needed. Due to the fact that there are both day and night shifts there might be added measures for example a flyer on the bathroom door or a pop up on the computer to help with training.
Future recommendations are to use the data taken from the reports and use it for studies and to develop trends. Updates to the competency checklist should be done at least every year in order to maintain the most recent information and practice. They will be done by the nurse supervisor, and will be done more frequently if there is a change in science, technology, or in patient care needs and/or population.