Organizational Strategic Plan Angela Dushane Carola Schlatter Cheryl

Organizational Strategic Plan Angela Dushane, Carola Schlatter, Cheryl Veres, Jamie Ziemba, Kaylee Sullivan, Tonya Allendorfer, and Tracy James

Quality Improvement Education Program (QIEP) Spectrum Health Butterworth Hospital NEW Hospital-Affiliated Service

What is QIEP all about? Primary Focus Heart Failure treatment and rehabilitation through education to improve client outcomes and prevent hospital readmissions

Why QIEP? “Heart failure (HF) is a major clinical and public health problem, and leading cause of hospitalization and health costs in the United States” (AHRQ, 2013).

Forces and Trends In 2010, “the Patient Protection and Affordable Care Act 25 authorized financial penalties for hospitals with the highest risk-adjusted readmission during the first 30 days after discharge” (AHRQ, 2013). ● 20% of hospitalized clients with heart failure are readmitted ● Heart Failure is the most common discharge diagnosis for Medicare clients. ● By 2025, over 18% of the population will be over 65 years of age ● Research and Evidence-Based Practice reveals new ways to treat heart failure.

What’s different about QIEP? Quality Improvement Education Program is disease-specific. Flat Organizational Structure ❖ Hospitalist Physician Group ❖ Director of Nursing ❖ QI Nurse Manager ❖ QI Nurse Educators ❖ Administrative Assistant

QIEP Mission Statement The Quality Improvement Education program’s purpose is to begin EDUCATING CLIENTS with HF prior to discharge from the acute care setting. Our commitment is to INDIVIDUALIZE THE PLAN OF CARE for our clients and their family support. It is designed to follow the guidelines of the American Heart Association and the American College of Cardiology.

QIEP Philosophy Our program values competent, high-quality care that is delivered in a safe and comfortable environment for our clients. We are confident that the key to the success of our program will be from early follow up and frequent education from our Quality Improvement nursing staff.

Primary Organizational Goals ● ACUTE CARE SETTING - prior to discharge ○ Initiate QIEP protocol ○ Assess client motivation and support person(s) ○ Discharge instructions to include follow-up appts ● CLIENT HOME ENVIRONMENT ○ Home safety inspection & HF kit evaluation ○ Weekly visits X 4 wks - individualized plan of care ● TELEPHONE INTERVIEWS ○ weekly phone calls X 4 weeks to reinforce teaching ● BI-MONTHLY SUPPORT GROUP MEETINGS ○ For all heart failure clients ○ To promote community awareness

Primary Organizational Objectives ● To reduce readmission rates within 30 days for greater than 20% of clients discharged with a diagnosis of heart failure. ● To educate clients on reducing own risk factors for heart failure prior to hospital discharge. ● To promote self care as evidenced by client’s daily documentation of weight, HR, BP, and I/O during home visits. ● To have clients verbalize daily regimen and heart failure zones weekly for 4 -week duration of rehabilitation period.

Quality Improvement Nurse Educator Are you ready to take your nursing career to the next level? If you want to work in a fulfilling and dynamic environment providing quality care and education to patients we would love for you to join our team today. Position Overview: To promote education for self-care in Heart Failure (HF) treatment regimen. Nursing process will be utilized through collaboration with physicians to prevent hospital readmissions.

QIEP Service Implemented Focus of Education - Heart Failure Zones (to include daily regimen, green/yellow/red zones) Daily Regimen ****** ● Weight before breakfast, documented and compared to yesterday’s weight. ● Take medication as directed. ● Check for swelling to feet, ankles, legs, and stomach. ● Eat a low sodium diet, and follow fluid restriction. ● Balance rest and activity.

Green Zone SYMPTOMS UNDER CONTROL o No shortness of breath o Weight gain of less than 2 lbs. /day o No swelling or chest pain o Able to do normal activities

Yellow Zone WARNING - CALL DR. IF: o Weight gain > 2 lbs/day or more than 5 lbs/wk o Increased shortness of breath. o More swelling of feet, ankles, legs, or stomach. o Feeling more tired or no energy. o Dry, hacking cough. o Dizziness. o More difficulty breathing with lying down, or need to sleep in chair.

Red Zone EMERGENCY - GO TO EMERGENCY ROOM OR CALL 911 IF: o Struggling to breathe. o Chest pain, tightness, or pressure. o Confusion or can’t think clearly.

What’s the bottom line? Our budget is simple………. . We need 2 good nurses, a basic office, and a few supplies.

Budget Proposal

Revenue - Hospital Reimbursement QIEP will indirectly increase revenue and HCAHPS scores. ● Centers for Medicare & Medicaid Services (CMS) Medicare hospital inpatient prospective payment systems (IPPS) under the Affordable Care Act states that “these changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule” (CMS, 2013). QIEP innovative service will help Spectrum Health stay ahead of the curve. “Many third-party payers are following the CMS lead in withholding payment for preventable complications of care” (Yoder-Wise, 2011, p. 404).

References Agency for Healthcare Research and Quality [AHRQ]. (2013, June 10). Evidence-based Practice Center Systematic Review Protocol. Retrieved November 30, 2013, from http: //effectivehealthcare. ahrq. gov/ehc/products/510/1409/heart-failure-readmission-protocol-130610. pdf Centers for Medicare & Medicaid Services [CMS]. (2013, August 19). Acute Inpatient PPS. Baltimore, MD. Retrieved November 15, 2013, from http: //www. cms. gov/Medicare-Fee-for-Service-Payment/Acute. Inpatient. PPS/FY-2014 -IPPS-Final-Rule-Home-Page. Items/FY-2014 -IPPS-Final-Rule-CMS-1599 -F-Regulations. html Heart Failure Poster. (n. d. ) Retrieved November 30, 2013, from https: //www. google. com/search? q=heart+failure&source=lnms&tbm=isch&sa=X&ei=q 4 ic. Usb 6 PKWGy. AGF 54 Co. Cw&sqi=2&ve d=0 CAc. Q_AUo. AQ&biw=1280&bih=6 Heart Failure Zones. (2012). Retrieved October 9, 2013, from http: //www. stmarys. org/documents/Heart_Failure_Packet. pd Job Advertisement Image. (n. d. ) Retrieved November 30, 2013, from https: //docs. google. com/a/ferris. edu/document/d/1 xo. Tr. HF_l. Ou 3 yt 0 cj 5 TQ 0 b. QIL 388704 LGPFe. YFV 3_IX 0/edit

References Cont’d. . . Spectrum Health Butterworth Hospital. (n. d. ) [photographs of entrance and lobby. ] Retrieved November 30, 2013, from https: //www. google. com/search? q=spectrum+health+butterworth&source=lnms&tbm=isch&sa=X&ei=w. YGc. Utnk. Fq. Swy. QGz_IC o. DA&ved=0 CAc. Q_AUo. AQ&biw=1280&bih=665 Traffic Light. (n. d. ) Retrieved November 30, 2013, from https: //www. google. com/search? q=traffic+light+invention&stick=H 4 s. IAAAAAGOovnz 8 BQMDAy 8 Hix. Knfq 6&source=lnms&tbm=isch&sa=X&ei=AZOf. Uulmy. Ij. IAdj 9 gcg. E&ved=0 CAk. Q_AUo. AQ&biw=1280&bih=638&dpr Yoder-Wise, P. S. (2011). Leading and managing in nursing (5 th ed. p. 404). St. Louis, MO: Elsevier

Social and Cultural Forces and Trends ● Increasing consumer attention to disease prevention and promotion of health. ● Research and Evidence-Based Practice reveals new ways to treat heart failure. ● Demand for Patient Satisfaction -- Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).

Other External Factors ● By 2025, over 18% of the population will be over 65 years of age, and the rate of those older than 80 is rapidly increasing. ● Up to 20% of hospitalized clients with heart failure are readmitted, and the disease is the most common discharge diagnosis for Medicare clients. ● In 2010, “the Patient Protection and Affordable Care Act 25 authorized financial penalties for hospitals with the highest risk-adjusted readmission during the first 30 days after discharge” (AHRQ, 2013).

How does QIEP differ from existing services? Quality Improvement Education Program is disease-specific. Similar Health Care Providers ● Grand Rapids Transitional Care services ○ Visiting Nurse Association ○ Palliative Care

Flat Organizational Structure ● Spectrum Health Butterworth Physician Hospitalist Group ○ Leadership ○ Source of collaboration for EBP measures ● Director of Nursing ○ Head of Patient Services Division ● Quality Improvement Nurse Manager ○ Oversees quality improvement initiatives ○ Supervises Nurse Educators that provide direct client

Spectrum Health Butterworth Hospital