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Advanced Total Hip and Total Knee Replacement
Certification: Lessons Learned from
the First Year of On-Site Reviews
David Eickemeyer, MBAHeather Martin, RN, MSN, MBA
Robin S. Voss, RN, MHA, TNCC-I
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This webinar is approved for 1.5 Continuing Education Credits from:• Accreditation Council for Continuing Medical Education (ACCME)• American Nurses Credentialing Center (ANCC)• American College of Healthcare Executives (ACHE)• California Board of Registered Nursing• International Association for Continuing Education and Training
(IACET)
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CE/CME/CEU are available for the live audio only. Credits will not be available for webinar replays. In order to claim credits you must have: • 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. This is an educational program being offered to our accredited hospitals and nursing care centers only.
• 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. The survey link will expire two weeks from today.
Continuing Education Credit:
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Disclosure StatementThe following staff and speakers have disclosed that neither they nor their 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:
• David Eickemeyer• Heather Martin• Robin Voss
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Learning Objectives:At the end of this webinar, participants will be able to:1. Explain the differences between core and advanced
expectations2. Describe the on-site experience, including how
communications are reviewed across the continuum3. Identify the challenges seen in the reviews
conducted to date4. Describe proactive steps to prepare effectively for
the review
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Certified Programs (as of 2/28/17)
3,549 certified programs in all categories31 Advanced Total Hip & Knee Replacement
– In fifteen states– 28 hospital programs, 3 ambulatory surgery centers
956 ‘Core’ Joint Replacement– 462 knee, 455 hip, 38 shoulder, 1 ankle
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Key Program Components
Guidelines
Sa
MeasuresStandardsClinicalPractice
Guidelines
Performance Measures
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Heather Martin, RN, MSN, MBAAssociate Project Director, Standards and Survey Methods
Key comparisons between core program and new advanced program.
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Core/Advanced Comparison GridCore Advanced
Hospital or Ambulatory Surgery Center only.
Physicians office(s), inpatient/hospital based outpatient/ambulatory surgery center and post follow up care organizations.
Core certification options for organization:-Core Hip Certification-Core Knee Certification*Two certification decisions for the combined Core Hip and Core Knee Certification*Must perform surgeries based on Core Program(s) chosen
Advanced certification for organization:-Must perform both Total Hip Replacement and Total Knee Replacement*One certification decision for the whole Total Hip and Total Knee Replacement program
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Core Advanced
Tracer Sites:-Hospital-Ambulatory Surgery Center
Tracer Sites:-Physician office visit and/or direct communication with office staff-Hospital-Ambulatory Surgery Center
Review Days:-Core Hip Certification-Core Knee Certification
Review Days:-Two-day intense review of entire total hip and total knee replacement program
Core Standards Disease Specific Care
Core Standards Disease Specific Care + Advanced Standards for Advanced Certification for Total Hip and Total Knee Replacement
Core/Advanced Comparison Grid
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Core/Advanced Comparison GridCore Advanced
Surgical Tracer:-visit and communication with peri-operative team
Surgical Tracer:-Surgical observation and conversation with entire peri-operative team-observation of handoffs between each care area**arrange for reviewer to observe either a total hip or total knee replacement Day 1 or Day 2 of review
Hand Off:-Discussion with staff regarding hand offs
Hand Off:-Direct Observation of hand-off communications throughout entire care continuum
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Core/Advanced Comparison GridCore Advanced
Communication and Collaboration:-Team within the hospital-Working toward High Reliability
Communication and Collaboration:-Communication, collaboration, and shared decision making throughout the entire continuum of care-Continuum of care contains:
-physician’s office visit to preoperative area, preoperative area to intraoperative area, intraoperative area to postoperative area, postoperative area to patient care unit, patient care unit to discharge, discharge to physician’s office for follow-up care, and any post discharge care-Includes handoffs/transitions within care areas-consensus among practitioners to limit variation using concepts of High Reliability
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Core/Advanced Comparison GridCore Advanced
Uniformity:-Program in the hospital or ambulatory surgery center
Uniformity:-Across the entire care continuum
-physician office(s),inpatient/hospital based outpatient/ambulatory surgery center, and post discharge-Consistency of all physicians in the program. No significant outliers in physician practice
Order Sets:-Movement toward standardized order sets for all physicians
Order Sets:-Consistent use of standardized order sets for all physicians
Preoperative Evaluation:-Notes regarding this being completed
Preoperative Optimization:-All notes need to be available from providers as part of the medical record
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Core/Advanced Comparison GridCore Advanced
Standardization:-Clinical Practice Guidelines -Order Sets
Standardization:-Clinical Practice Guidelines
-follow the entire scope of the program (ie, preoperative assessment and testing, perioperative procedures, postoperative pain management, antibiotics, mobility, DVT prophylaxis)-Order Sets
-among physician(s) inpatient/hospital based outpatient/ambulatory surgery center across the care continuum from office(s) through follow up visit-Specific guidelines for both hip and knee
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Core/Advanced Comparison GridCore Advanced
Physician Engagement:-Physician champion/Medical director identified, involved in program initiatives
Physician Engagement:-Medical Director identified-Surgeon(s) involvement (ie, program initiatives, team meetings, data analysis, performance improvement, staff in-service and education)
Patient Education:-Content review of preoperativeeducation (ie, joint class)
Patient Education:-Content review of preoperative education (ie, joint class)-Direct observation of a portion of the class (no minimum class number required), perioperative patient interviews, therapy sessions, patient discharge teaching, or other patient education
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Core/Advanced Comparison GridCore Advanced
Post Discharge:-Review hospital/ambulatorysurgery center discharge process
Post Discharge:-Review discharge process-Review data-communication from post discharge entities to see engaged tracking through patient follow up visit
Functional Outcomes:-Should be considering, if not implementing, some form of functional outcome measures
Functional Outcomes:-Should have strong functional outcome data
Performance Measures:-Four performance improvement measures of organization(s) choice (two of four must be clinical)
Performance Measures:-four performance improvement measures of organization(s) choice (two of four must be clinical)-consider outcome measures-projected implementation date for standardized measures first quarter 2018
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Advanced Certification - the On-Site Experience
Robin S. Voss, RN, MHA, TNCC-I Field Director for Disease Specific Care Certification
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THKR Two-Day Agenda Opening Conference Planning Meeting Patient Tracers
– Intraoperative– Visit or Conference calls with orthopedic surgeon
office staff, MD, PA, NP– Patient education, interview, or observation; such
as, joint class, therapy session observation, discharge instructions, etc.
Data Tracers Competency and Privileging Issue Resolution Closing Conference
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Review Process: Opening Conf.
Just like Core :– Introductions and Program Overview– Program Design & Composition– Committed Leadership– Team Composition– Use of CPG’s and Best Practices To
Validate Program Components
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Review Process: Opening Conf.
With Attention To:– Shared Decision Making
–Addressing Roles, Procedures, Discussion of Goals With The Patient Throughout The Continuum Of Care
– Patient Education – Throughout Continuum of Care
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Review Process: Opening Conf.
Attention to:– Consistent Communication and
Collaboration Throughout Continuum of Care
– Ongoing Quality Improvement Processes–Uses Data and Information to Improve
or Validate Care, Treatment, or Services Provided Throughout Continuum of Care
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Review Process: Planning Session
Review Organization’s – List of In-patients & Surgery Schedule– THKR Program Policies– Clinical Practice Guidelines– Team Member Responsibilities
Schedule– Flexible!!!!!!
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Review Process: SchedulePlan to Cover:
– Physician - Patient Shared Governance– Total Joint Class, Pre-op Testing – Medical Optimization– Patient Tracers– PT / Rehab– Pre-op / Block Room– Operating Room– PACU
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Review Process: Schedule
Plan To Cover:– Discharge Planning – Throughout
Continuum of Care– Post Discharge – Through physician follow
up visit
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Review Process
Individual Tracer Activity:– Minimum of 6 Patients Traced
–3 THR / 3 TKR–1 Tracer = Peri-operative Experience
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Review Process Individual Tracer Activity:
– Observations: preoperative assessment/testing/classes, therapy sessions, discharge teaching
– Care team member interviews– MD office visit or Conference Call
–Discuss preoperative and follow-up visit process within the program
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Review Process: Physician ChampionShared Decision MakingStandardization & SafetyOrder-sets
Medical Optimization Implant ChoiceDriving Uniformity across Continuum of CareConsensus Amongst Practioners to Limit
Variation in Practices Using the Concepts of High Reliability
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Review Process:TJR Class / Pre-Op Testing
General EducationPresence Of A Coach Infection Prevention & DVT ProphylaxisDischarge PlanningPre-op TestingMedical OptimizationAnesthesia EvaluationPre-Op Home Assessment
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Review Process:Pre-Op/Block Areas - OR - PACU
Interview Anesthesia, Nursing in all areas & Patient
Observe– Use of Blocks– Use of Spinal
Observe Hand offs to next patient destinationOperative Report - Implants
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Review Process: Discharge Plan
– When is decision made / by whom– Discharge class– Identification of support structure
–H/H and H/PT– Rehab / SNF
–Follow up calls–Relationship & who controls
– Final hand-off
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Review Process: Post Discharge
Return to Office?Follow-Up Phone CallReport of ComplicationsReport of Functional Scores
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Review Process:System Tracers / PI’s
Just Like Core but With Focus on Functional Outcomes
Publishing of DataFuture of Uniform / Standard PI’s
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Review Process:Competency Session & Close
Same as CoreClose – One Report
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Best Practices for a Successful Review
Assure a THR and/or TKR procedure being performed the afternoon of Day 1 (after opening conference) OR Day 2
The agenda is used as a guide - FlexibilityHave all documents ready
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Best Practices for a Successful Review
Assure staff / providers on units are prepared to discuss delivery of care and PI activities
If you use EMR, have someone who can navigate the record
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Application Timetable
Think ahead – by what date do you want certification achieved?
Submit application 5-6 months before your desired date.– Tell The Joint Commission what month
you want review done
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Scheduling Challenges for Advanced CertificationOn-site review will be two days instead of oneRequirement that at least one day have
scheduled proceduresWhat to do if procedures are canceled during
scheduling process
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Benefits of Certification Builds the structure required for a systematic approach
to clinical care Reduces variability and improves the quality of patient
care Pushes you to look at yourself more closely Creates a loyal, cohesive clinical team Promotes a culture of excellence across the
organization Provides an objective assessment of clinical excellence Promotes achievement to your marketplace
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Questions
David [email protected]
Heather [email protected]
Robin [email protected]
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The Joint Commission Disclaimer
These slides are current as of 2/1/17. The Joint Commission reserves the right to change the content of the information, as appropriate.
These slides are only meant to be cue points, which were expounded upon verbally by the original presenter and are not meant to be comprehensive statements of standards interpretation or represent all the content of the presentation. Thus, care should be exercised in interpreting Joint Commission requirements based solely on the content of these slides.
These slides are copyrighted and may not be further used, shared or distributed without permission of the original presenter or The Joint Commission.