safe patient movement and handling: vha national perspective steps office of public health and...
TRANSCRIPT
SAFE PATIENT MOVEMENT AND HANDLING:
VHA NATIONAL PERSPECTIVE STEPS
Office of Public Health and Environmental Hazards
Office of Nursing Services
Office of Patient Care Services
Tampa PSCI
GOALS OF THIS TALK
Champion reporting to satisfy VHA CO
• Executive Committee
• Deputy Under Secretary for Operations and management
• Health Systems Committee
• Deputy Under Secretary of Health
• Under Secretary of Health
REPORTING NEEDS: EX COM
10/1/08 F/u on $61,000,000 funding
NRM needs for June 08 $s
12/30/08 Estimate of equipment funding
Associated FY09 NRM funds
Identification of facilities with structural assessment needs
3/331/09 Equipment and NRM funding
status
Overall progress (Tampa data)
REPORTING NEEDS: DUSHOM
FY09/Q1 Facility-wide equipment inventory
Identification of prior expenditures
Unit-based hazard assessment
FY09/Q2 Policies, Procedures, protocols
Review of injuries
Initial peer leader training
FY09/Q3 Minimal lift policy
FY09/Q4 Facility strategic plan
Injury Rates by SIC Codes
02468
101214161820
pre1
987*
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Construction Nursing & Personal Care Farmers HospitalsVHA
Injury Type by Fiscal Year
0
5000
10000
15000
20000
25000
30000
Fiscal Year
N
ASSAULT CUMULATIVE TRAUMA MATERIAL HANDLING
LIFTING/REPOSITIONING PATIENTS SLIP/TRIP/FALL STRUCK BY/AGAINST
OTHER TB/PPD CONVERSION LATEX REACTION/ALLERGY
ENVIRONMENTAL/TOXIC EXPOSURE HOLLOW BORE NEEDLESTICK SHARPS EXPOSURE
EXPOSURE TO BODY FLUIDS/SPLASH SUTURE NEEDLESTICK NON PATIENT CARE
NOT ELSEWHERE CLASSIFIED 99
# and Rate of Incidents by Skill Mix(from VANOD ASISTS proclarity cube on VSSC)
Yellow = Total Emp CountOrange= # of IncidentsBlue line= Calc. Rate
Incident Rate by Type of Incident (from VANOD ASISTS proclarity cube on VSSC)
Type of Incident by Skill Mix (from VANOD ASISTS proclarity cube on VSSC)
Lifting & moving patients – most freq. reported
injury
TOTAL AND PATIENT TRANSFER INJURIES BY GENDER
0
2
4
6
8
10
12
14
16
18
20
FY2002 FY2003 FY2004 FY2005 FY2006
Inju
ries
/ 100
FT
E
Female PTI Female TI Male PTI Male TI
PATIENT TRANSFER INJURY RATES BY GENDER AND NURSING LEVEL
0
1
2
3
4
5
6
7
8
9
10
FY2002 FY2003 FY2004 FY2005 FY2006
Inu
ires
/ 10
0 F
TE
Female RN Male RN Female LPNMale LPN Female NA Male NA
0
5
10
15
20
25
30
35
FY2002 FY2003 FY2004 FY2005 FY2006
Inju
ries
per
100
FT
E
Female RN Male RN Female LPNMale LPN Female NA Male NA
TOTAL INJURY RATES BY GENDER AND NURSING LEVEL
Patient Transfer Injury Rates and Age
0
50
100
150
200
250
300
350
400
< 25years
25 to34
years
35 to44
years
45 to54
years
55 to64
years
>= 65years
TOTAL
FY2002
FY2003
FY2004
FY2005
FY2006
WEAKNESSES INHERENT IN ANY BUSINESS CASE
JUSTIFICATION APPROACH
• Under-reporting of injury and disease
• Attention and focus predict long-term consequences
• Horse-racing effect
SYSTEM NEEDS ASSESSMENT
• Data review and call to determine need– VSSC Review– DUSHOM ITEM
• Estimation of cost per dependent– Ceiling lifts– Movable equipment– Supplies
• Estimates by patient category• BIRN Costs
Per Bed Unit Costs
$0.00
$10,000,000.00
$20,000,000.00
$30,000,000.00
$40,000,000.00
$50,000,000.00
$60,000,000.00
$70,000,000.00
Cost by$6,000 per
bed
Cost by$7,000 per
bed
Cost by$8,000 per
bed
Costs Per Unit
Co
sts
SCI
NHC
MSU
CCU
DIA
OR
BUSINESS CASE DEFINITIONSConservative
scenarioDocumented costs and benefits in VISN 8
More likely scenario
Doubling costs (medical, wage loss) because of under-reporting (2001 AES) and 10% retraining / administrative costs
More Likely Scenario with .1BIRN FTE
Doubling costs (medical, wage loss) because of under-reporting (2001 AES) and 10% retraining / administrative costs and .1 FTE BIRN per high-risk unit over 10 years
High Cost Scenario
Medical and wage costs tripled (common private sector assumption
BUSINESS CASE CONSIDERATIONS: CALCULATIONS
Payback period
Net Present Value Internal Rate of Return
Conservative scenario
4.13 yrs $1.4M 20%
More likely scenario
3.39yrs $2.0 M 27%
More Likely Scenario with .1BIRN FTE
3.50yrs $1.19M 25%
High Cost Scenario
2.71yrs $2.6M 33%
HISTORY OF SPMH in VHA1998-1999 Tampa program development1999 HSR&D Tampa SPMH grant (expert panel)
IOM Report: Safe Work in the 21st Century2001-2003 VISN 8 Demonstration project2001 1st Conference on SPMH2004 VISN 1 EDM and program roll-out
Publications on economicsVHA CO staff support for roll-out
2005-2007 VISN 3, 9, 11 initiatives2006 10N data call on implementation initiatives2007 SPMH initiative for FY2009-11 budget
series2008 VA * OMB negotiations on 6 vs. 3 year roll-
outConcurrence$61,500,000 distributed in June 2008
LESSONS RFOM PROGRAM IMPLEMENTATION IN 4 VISNs
• 2 years of VISN-level support• .5 FTE facility staff support
– Program equipment management– Peer safety leader leadership
• Peer Safety Leader functionality (“back injury resource nurses”, “injury prevention nurses”)– Essential element– Issues of fiscal support (“certification” vs step
increases)
COSTS AND BENEFITS
$150,000,000 - equipment and construction
$4,000,000 / year - facility champions$5,000,000 / year – injury prevention
nurses on each unit$10,000,000 – data system redesign /
support ASISTS inadequateWARIMS application to IDMC
CONSIDERATIONS:Decision-making criteria
• Is program necessary: can VHA afford not to do it?
• Does the program pay for itself (when does the program pay for itself)
• What happens if we do not implement the program?
CONSIDERATIONS
1. Construction vs. medical programs (80% vs. 20%): need national assessment at facility / patient room level
2. VISN roll-out experience: 2 – 3 years of VISN support and planning
3. Facility-level program management: Staff support (program development, leading assessment, equipment maintenance, peer safety leader training and coordination)Likely ~$4,300,000 / year
CONSIDERATIONS
4. Facility level – front-line worker support – peer and coordination) (.1 peer safety leader/injury prevention nurse / shift): $~$5,000,000 / year
5. IT Support: ASISTS does not address unit level rates, instrumentation/ equipment / track intervention recommendations (Accident Review Board solutions)
6. Roll-out timing: VISN, facility staffing; facility-level assessment, equipment
CONSIDERATIONS
7. Prior expenditures and early adopters: reimbursement issues (10N solution: include information on actual equipment/construction expenditures)
8. Budget shifts1. Initial estimates: no facility- or unit level
coordination
2. $16,000,000 in initial draft for 3 years of unit-level peer safety leaders
3. Move to 6 years: inadequate funding
CONSIDERATIONS
9. First year funds expenditures:1. Universally needed equipment (lateral
sliding devices ~ $15,000,000)2. $4,300,000 facility level staffing3. Reimbursement (10N model)
10.Program oversight in CO11.Future delays and reimbursement:
consequences of 6-year implementation delay and impatience in the field
OPTIONS
• Option 1: $30,000,000 / yr x 6– VHA CO staff support, national
assessment, facility level support, devolution of program to 10N in ~3 years
• Option 2: assign moneys to VISNs without oversight
• Option 3: do nothing
REPORTING NEEDS
10/1/08 F/u on $61,000,000 funding
NRM needs for June 08 $s
12/30/08 Estimate of equipment funding
Associated FY09 NRM funds
Identification of facilities with structural assessment needs
3/331/09 Equipment and NRM funding
status
Overall progress (Tampa data)