HELP : ) Core Measures!

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    just looking for some assistance on core measures...recently it has been designated to the primary nurse to make the patient a core and follow through on documentation, which is passed on from shift to shift. just trying to figure out the best process improvement so we don't fall out...best way to keep nurses accountable, education, etc. one of our biggest grey areas is scip....it seems that it's constantly debated as to what surgery is a scip and which isn't...and vte with scip...do scds count or does the dr have to specify why the patient doesn't need lovenox/heparin. does anyone have any suggestions?! thanks so much in advance!
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    We have a bright yellow paper that goes in the chart and is divided into fourths...one each for CHF, MI, SCIP, and pneumonia. Each section has the core measures for that specific diagnosis so it can be checked off as it's done. The d/c nurse is ultimately held responsible for ensuring that the form is filled out, but all the nurses are supposed to contribute as they care for the pt. The charge nurses are pretty good about making sure that the papers are on the chart, but it's not their responsibility; they just do it to be helpful. On our forms, SCDs do count for VTE prophylaxis, so I'm guessing the answer is yes.

    We have EPIC, and the specific discharge core measures for each diagnosis is built into the education record and the d/c paperwork.

    Our compliance percentages are consistently at 100% (for a 350+ bed hospital), with rare slips.

    As far as what is considered SCIP and not, if we have a question about it, we just assume it is...better to have the paperwork done and not need it than need it and not have it.

    Hope that helped.
    Esme12 and EMR*LPN like this.
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    That does help, thanks! That's similar to the process we just implemented. It's just you have some nurses who aren't real concerned or maybe educated enough about cores to make the patient a core if necessary. Our charge nurses are already swamped and can't go through every patient to make sure they are a core if indicated. With SCIP we are doing the same but it's hard to tell when anesthesia end time and antibiotic given are if OR doesn't start the process...Do you guys have any issue with primary nurses not making their patients cores? Our system also has CORE education built into discharge...but if the patient wasn't ever made a core..then it doesn't help. Also, does someone double check that the info filled out on the bright yellow paper is actually correct? When I've been checking it seems like some are just checked off or marked but the info wasn't actually verified...Ugh, so frustrating...How do you guys maintain the compliance!
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    Make compliance mandatory for staff and MD's. Tell staff that there will be audits and will be reflected on evaluations. That compliance is linked (however broadly) to reimbursement so it is tied to their paycheck ultimately. Have pre made charts for surgicals, PNA, CHF etc. with the core measures as a part of the chart. Make that the orders are a part of the pre-op checklist on the front of the chart "antibiotic give and time" and that the order sheet is on the chart prior to the OR. Make it apart of 24 hour checks.

    Have an inservice whether in person or have a educational packet that must be completed to prove competency and hold them accountable. Remind them that these measures are NOT optional and there will be consequences for non compliance.

    I get really annoyed at staff when compliance must be followed and you have those few who are "too busy" and "have enough on their plate" that they conveniently "forget". I speak to them individually and make it clear that compliance is mandatory. I am usually not a hard liner so when I am my staff know I mean business.....and they know I will follow through.
    Altra likes this.
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    Major Cardiac Surgery and CABG and Major Vascular Surgeries do not require reporting VTE prophylaxis in Core Measures and are always eliminated. Most all other cases do fall into the VTE measure. Most specialties have their own preferences such as GI might have process for compression boots and hep sc, where ortho might prefer compression boots and enoxaparin. Gyn may just select compression boots, but in most instances there is a pathway in process for most to follow. Does your hospital have certain pathways/processes to follow for certain procedures? If so you can possible can VTE addressed in that process.
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    these issues have been addressed by our infection control nurse, case managers and the quality analysists. They created checklists that are put on the chart as part of the care plan. They put colored stickers on the charts also. Now that we are using electronic health records the checklists are built into the program.
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    We had the hardest time tracking CM with politics and finger pointing everywhere. We recently installed a system that automatically identifies CM patients and then has a dashboard tool with red light/green light to easily identify when a CM is not met. Best of all, it automatically emails and texts the physician when it is their responsibility!

    The stress level has gone way down because we don't have to remember all the nuances of each measure or chase the physician (as much).
    GrnTea likes this.


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