Advanced Total Hip and Total Knee Replacement Certification · -Working toward High Reliability Communication and Collaboration:-Communication, ... -Continuum of care contains:-physician’s

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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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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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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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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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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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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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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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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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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: Floor

Same as Core Certification Review

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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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Advertise Your Achievement

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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.

Documents

Advanced Total Hip and Total Knee Replacement Certification · -Working toward High Reliability Communication and Collaboration:-Communication, ... -Continuum of care contains:-physician’s