North Dakota State of the State Update: Top Care ... · Top Care Opportunities for Improvement 2017 ASA/AHA GWTG-Stroke Awards. Mindy Cook BSN Senior Director Quality and System Improvement

North Dakota State of the State Update: Top Care Opportunities for Improvement

2017 ASA/AHA GWTG-Stroke Awards

Mindy Cook BSN

Senior Director Quality and System Improvement MN, ND, WI

American Heart Association, Midwest Affiliate

FINANCIAL DISCLOSURE:

No relevant financial relationship exists

11/22/2017 ©2010, American Heart Association 2

• AHA/ASA National Accreditation and Certification:

Acute Stroke Ready, Thrombectomy Capable, Primary and Comprehensive Level Recognition

• Advanced Stroke Care Measures

• ND Data Review and top opportunities for improvement

• ND Stroke Award Presentations

Objectives


2018 TSC

ASRH MEASURES

2 Outpatient 3 Inpatient

• STK-1: Venous thromboembolism (VTE) prophylaxis: Ischemic and hemorrhagic

stroke patients who received VTE prophylaxis or have documentation why no VTE

prophylaxis was given the day of or the day after hospital admission.

• STK -2: Discharged on antithrombotic therapy: Ischemic stroke patients

prescribed antithrombotic therapy at hospital discharge.

• STK-3: Anticoagulation therapy for atrial fibrillation/flutter: Ischemic stroke

patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at

hospital discharge.

• STK-4: Thrombolytic therapy: Acute ischemic stroke patients who arrive at this

hospital within 2 hours of time last known well and for whom IV t-PA was initiated at

this hospital within 3 hours of time last known well.

• STK-5: Antithrombotic therapy by end of hospital day two: Ischemic stroke

patients administered antithrombotic therapy by the end of hospital day 2.

PSC Measures

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• STK-6: Discharged on statin medication: Ischemic stroke patients with LDL

greater than or equal to 100 mg/dL, or LDL not measured, or who were on a lipid-

lowering medication prior to hospital arrival are prescribed statin medication at

hospital discharge.

• STK-8: Stroke education: Ischemic or hemorrhagic stroke patients or their

caregivers who were given educational materials during the hospital stay

addressing all of the following: activation of emergency medical system, need for

follow-up after discharge, medications prescribed at discharge, risk factors for

stroke, and warning signs and symptoms of stroke.

• STK-10: Assessed for rehabilitation: Ischemic or hemorrhagic stroke patients

who were assessed for

PSC Measures


• CSTK-01: National Institutes of Health Stroke Scale (NIHSS Score

Performed for Ischemic Stroke Patients)

• CSTK-02: Modified Rankin Score (mRS at 90 Days)

• CSTK-03: Severity Measurement Performed for SAH and ICH Patients

CSTK-04: Procoagulant Reversal Agent Initiation for Intracerebral

Hemorrhage (ICH)

• CSTK-05: Hemorrhagic Transformation (Overall Rate)

• CSTK-06: Nimodipine Treatment Administered

• CSTK-07: Median Time to Revascularization

• CSTK-08: Thrombolysis in Cerebral Infarction (TICI Post-Treatment

Reperfusion Grade)

CSC Measures


• The ability to perform mechanical thrombectomy for the treatment of ischemic

stroke 24/7.

• Dedicated intensive-care unit beds to care for acute ischemic stroke patients.

• The availability of staff and practitioners closely aligned with what is expected

of certified CSCs.

• The ability to perform expanded advanced imaging 24/7.

• A process to collect and review data regarding adverse patient outcomes

following mechanical thrombectomy.

• The ability to submit data for 13 standardized performance measures (eight

stroke (STK) measures and five comprehensive stroke (CSTK) measures).

• Current PSC’s are able to submit 4 months of data for each CSTK measure

TSC (Thrombectomy Capable Stroke Center)

Available 2018


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Endovascular Thrombectomy Measures

Advanced Stroke Care Measures






GWTG Achievement Measures 2016ND PSC – National PSC


GWTG Achievement Measures 2017ND PSC – National PSC

ND PSC Arrive is 2H treat by 3H


Top Opportunity for PSC Improvement

Quality Measures ND PSC vs National PSC

2016


Dysphagia ScreenIntensive Statin Therapy

Quality Measures ND PSC vs National PSC

Q1 2016- Q1 2017


Top Quality Measure Opportunities


Dysphagia ScreeningIntensive statin therapy

Most Improved: Stroke Education


Stroke Education

Risk Factors for StrokeStroke Warning Signs and SymptomsHow to activate EMS for strokeTheir prescribed medicationsWas Diabetes Teaching Provided?

GWTG Award

Achievement

Participating

• 30 patients records entered

Bronze

• 1 quarter with minimum 30 patients

• 85% compliance with all measures

Silver

• 12 months patient data 85% compliance

Gold

• 24 months patient data 85% compliance

22


Achievement Measures

All Measures must be met at 85%

Ischemic stroke patients who arrive at the hospital within 120 minutes (2 hours) of time last

known well and for whom IV t-PA was initiated at this hospital within 180 minutes (3

hours) of time last known well.

Ischemic stroke or TIA who receive antithrombotic therapy by the end of hospital day 2.

Ischemic stroke, hemorrhagic stroke, or stroke not otherwise specified who receive VTE

prophylaxis the day or the day after hospital admission.

Ischemic stroke or TIA prescribed antithrombotic therapy at discharge.

Ischemic stroke or TIA with atrial fibrillation/flutter discharged on anticoagulation therapy.

Ischemic, hemorrhagic stroke, or TIA with a history of smoking cigarettes, who are, or whose

caregivers are, given smoking cessation advice or counseling during hospital stay.

Ischemic stroke or TIA patients who are discharged on Statin medication.

5 of the 8 must be met at least 75%

Stroke patients who undergo screening for dysphagia with an evidence-based bedside

testing

protocol approved by the hospital before being given any food, fluids, or medication by mouth.

Stroke or TIA or their caregivers who were given education and/or educational

materials during the hospital stay address all of the following: personal risk factors for stroke,

warning signs for stroke, activation of emergency medical system, need for follow-up after

discharge, and medications prescribed.

Patients with stroke who were assessed for rehabilitation services.

Acute ischemic stroke patients receiving IV-tPA during the hospital stay who have a time from

hospital arrival to initiation of IV-tPA (door-to-needle time) of 60 minutes or less.

Ischemic stroke or TIA patients with a documented lipid profile.

Percent of ischemic stroke or TIA patients who are discharged with intensive statin therapy.

Percent of ischemic stroke patients who arrive at the hospital within 3.5 hours of time last

known well and for whom IV-tPA was initiated at the hospital within 4.5 hours of time

last known well.

Percent of ischemic stroke and stroke not otherwise specified patients with a score reported for

NIH Stroke Scale (initial).

Quality Measures – Plus Award

©2010, American Heart Association 24

Target Stroke Honor Roll: Time to thrombolytic therapy within 60 minutes

in 50% or more of acute ischemic stroke patients treated with IV-tPA.

Target Stroke Honor Roll Elite: Time to thrombolytic therapy within 60

minutes in 75% or more of acute ischemic stroke patients treated with IV-

tPA.

Target Stroke Honor Roll Elite Plus: Time to thrombolytic therapy within

60 minutes in 75% or more of acute ischemic stroke patients treated with

IV-tPA AND door-to-needle time within 45 minutes in 50% of acute

ischemic stroke patients treated with IV-tPA.

Target Stroke Awards


•Marketing Tools• 30 second Radio Script, Print Ad

• Promotional Blurb that may be used in enewsletters, on your website or even printed out!

• Widget/Icon for website or enewsletters

• News Release, Icons

•Silver and Gold Awards

–US News & World Report July Edition

–International Stroke Conference 2018

Nursing Symposium & Pre-Con Symposia: Jan. 23, 2018

Sessions: Jan. 24–26, 2018

Los Angeles Convention Center | Los Angeles, Calif.

Additional Recognition for Stroke GWTG


http://www.heart.org/idc/groups/ahaecc-public/@wcm/@hcm/@gwtg/documents/downloadable/ucm_461671.pdf

http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/@gwtg/documents/downloadable/ucm_427875.pdf

http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/@gwtg/documents/downloadable/ucm_427878.jpg

http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/@gwtg/documents/downloadable/ucm_427881.jpg

http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/@gwtg/documents/downloadable/ucm_440490.doc

http://www.heart.org/idc/groups/ahaecc-public/@wcm/@hcm/@gwtg/documents/downloadable/ucm_472274.jpg






CAH Focus Measures

Q1 2017 – Q3 2017

Top Opportunity: IV rt-PA Arrive by 2H treat by 3HDysphagia ScreenMost Improved: NIHSS Documentation

Top Opportunities

Dysphagia

Arrive in 2

• Increase Data Entry and Investigate IV Alteplase Eligibility• Swallow test education

The ND Stroke Taskforce Proudly Recognizes:

Mercy Hospital- Valley City, ND

Pre-Notification of Suspected Stroke by EMS

The ND Stroke Taskforce recognizes this hospital for it’s continued success in utilizing the GWTG

Stroke Program and demonstrating 100% adherence in 2016 to Pre-notification

Percent of cases of advanced notification by EMS for patients transported by EMS from scene. Thank

you for applying the most up to date evidence based treatment guidelines to improve patient care and

outcomes in the community you serve.

2017 ND ASRH Quality Excellence Award


Mercy Medical Center – Williston, ND

Door to CT < 25 min


Stroke Program and demonstrating excellent >80% adherence in 2016 to % Door To CT <= 25min

Percent of patients who receive brain imaging within 25 minutes of arrival. Thank you for applying the

most up to date evidence based treatment guidelines to improve patient care and outcomes in the

community you serve.



Heart of America Medical Center – Rugby, ND

Dysphagia Screen


Stroke Program and demonstrating 100% 2016 adherence in Dysphagia Screening; percent of Stroke

patients who undergo screening for dysphagia with an evidence-based bedside testing protocol

approved by the hospital before being given any food, fluids, or medication by mouth. Thank you for

applying the most up to date evidence based treatment guidelines to improve patient care and

outcomes in the community you serve.




Southwest Healthcare Service - Bowman ND

NIH Stroke Scale Documentation

The ND Stroke Taskforce recognizes this hospital for it’s continued success in utilizing the GWTG-Stroke

Program and demonstrating 83% adherence in 2016 in NIHSS Reported Percent of ischemic stroke and

stroke not otherwise specified patients with a score reported for NIH Stroke Scale. Thank you for applying

the most up to date evidence based treatment guidelines to improve patient care and outcomes in the

community you serve.


Tioga Medical Center – Tioga ND

IV rt-PA Arrive by 2 Hour, Treat by 3 Hour


Stroke Program and demonstrating excellence in IV rt-PA Arrive by 2 Hour, Treat by 3 Hour - Percent

of acute ischemic stroke patients who arrive at the hospital within 120 minutes (2 hours) of time last

known well and for whom IV t-PA was initiated at this hospital within 180 minutes (3 hours) of time last

known well. Thank you for applying the most up to date evidence based treatment guidelines to

improve patient care and outcomes in the community you serve.



West River Regional Medical Center – Hettinger ND

Time to Intravenous Thrombolytic Therapy - 60 min

The ND Stroke Taskforce recognizes this hospital for it’s continued success in utilizing the GWTG Stroke

Program and demonstrating excellent adherence in 2016 for eligible patients in Time to Intravenous

Thrombolytic Therapy - 60 min Percent of acute ischemic stroke patients receiving intravenous tissue

plasminogen activator (tPA) therapy during the hospital stay who have a time from hospital arrival to

initiation of thrombolytic therapy administration (door-to-needle time) of 60 minutes or less. Thank you for

applying the most up to date evidence based treatment guidelines to improve patient care and outcomes

in the community you serve.



Jamestown Regional Medical Center – Jamestown, ND

ND Critical Access Hospital Quality Measure Set

The ND Stroke Taskforce recognizes this hospital for it’s continued success in utilizing the GWTG-Stroke

Program and demonstrating excellence in Pre-Notification by EMS, Door to CT < 25 min, Dysphagia

Screening, NIHSS Reported, IV rt-PA Arrive by 2 Hour, Treat by 3 Hour, IV rt-PA Arrive by 3.5 Hour, Treat

by 4.5 Hour. Thank you for applying the most up to date evidence based treatment guidelines to improve

patient care and outcomes in the community you serve.


Mindy Cook, RN BSN

Sr. Director Quality and System Improvement

Director Mission: Lifeline North Dakota, Minnesota

American Heart Association, Midwest Affiliate Contact Information: Office: 952-278-7934 Mobile: 218-770-3305 Fax: 952.835.5828

E-mail: [email protected]

www.heart.org/NDMissionLifeline www.heart.org/missionlifelinemn

Quality of Life is why

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Documents

North Dakota State of the State Update: Top Care ... · Top Care Opportunities for Improvement 2017 ASA/AHA GWTG-Stroke Awards. Mindy Cook BSN Senior Director Quality and System Improvement