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Metro
Alliance of Geriatric Providers
MINUTES
December
4, 2017
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Attendees: S. Atkinson, N. Buddensiek, M. Bullock, E.
Downing, K. Fichtner, C. Hanson, J.
Haycraft, S. Johnson, C Lauring, G. Leierwood,P. Lusian, M. McDonald, T. McCarthy, J. Mielke, C.
Montgomery, J. Pederson, N. Pelerine, K.
Petersen, C. Rasquinha, A. Romstad, E.
Schuld, A. Tong, T. von Sternberg, L.
Wenker
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Agenda
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Discussion
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Action/Next Steps
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1.
Welcome/ Introductions
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23 total attendees ; 20 in person and 3 phone
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12 health
care provider organization practices being represented: Allina, Fairview, Genevive,
Health East, Health Partners, HCMC,
Integrated Care by Medica, North Memorial Optage/ Presbyterian, Twin
Cities Physicians, UMP
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3 health organizations represented: Benedictine
Health Services, Care Choice, Stratis
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2.
Review minutes
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Reviewed September minutes
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Approved with no changes/additions and will
post to website
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3.
Current Metro Alliance Projects
a.
Computer Provider Order Entry (CPOE)
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Emily Downing
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Updated the group on the progress of CPOE work
group. Implementing process at Homestead at Anoka on 12/4/17. Timeline for implementation at other
Presbyterian Homes has been extended into 2018 due to competing priorities.
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Goals of the project include:
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Improving first pass completion for orders –
driving to a more consistent order writing process (including diagnoses and
other order details)
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Decreasing variability in order writing
process for providers in multiple facilities
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Providers writing orders on standardized order
form, which is entered into the computer by facility staff.
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Orders are processed as either routine (4
hours) or stat (1 hour). Thought it was important to standardize the order
format first, and then work with groups for EHR entry later.
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Developing First Pass Quality Standards for
orders with Metro Alliance endorsement
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Group discussion: about using the order form
as a faxed order to the facility instead of handwritten only. Group agreed
the order form could be used this way. Faxing hasn’t been part of the pilot
so far.
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Group discussion: adding the CPOE order form
on the Blog, so providers could start using the form, even if facilities
haven’t yet
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Group recommended to remove the order
clarification language at the end of the CPOE form as it was confusing
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Practice leaders to contact Veronica Polinske at: vpolinske@preshomes.org to set up portal
training for their providers that go in to PHS facilities.
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Continue to update group with pilot status at each meeting
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Post CPOE order form to Blog website
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Kristi from Stratis is willing to host a 20 minute presentation
to SNFs; will coordinate with Emily and others for the education session
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b.
Antibiotic stewardship project
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Cassandra Parker and Cathy Lauring
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Partnership between MDH, Stratis, Metro
Alliance
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Project is
UTI v. ASB with Walker
Methodist
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Intervention completed with UTI SBAR developed
and entered into PointClickCare
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Limited data available to first 3months of
data due to staff change at facility. So far, have seen:
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Decreased FQ use: 58% -> 22% (noting increased cephalosporin use)
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Slight decrease in incidence: 25% -> 22%
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Some residents treated for UTI despite not
meeting SBAR criteria
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Recommendations at this time:
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Routine follow up staff/provider education and
SBAR completion
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If criteria is met per the SBAR, provider
should consider empiric treatment (non FQ)
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If criteria is not met per the SBAR, close
monitoring, but no antibiotic treatment
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Results shared with MDH; MDH and CDC meeting
this month. If any follow up, will let Cassie know
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Facility is continuing data collection
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Update at next meeting
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c.
Current Alliance SHO – Combined Document
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Alison Romstad, Cathy Lauring, Cheri Montgomery,
Janine Nelson
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Reviewed combined SHO order
set
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Group reviewed order set and
made recommendations
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Per facility input/requests, recommend
separate LTC, TCU and combined LTC/TCU order documents. Facilities can choose
which one fits their facility needs best.
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Changes to all sets of SHO, per group
discussion/agreement:
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Add “Type II Diabetes Mellitus only” on all
sets of SHO orders
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Add “For Type I Diabetes Mellitus, contact
provider for individualized plan”
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Delete “Perform skin assessment….”
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Ensure language around psychotropic
medications is on all sets of SHO
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Care Choice going to survey facilities to
better understand which facilities are/are not using the standing orders
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Update group with results at next meeting
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d.
Quality Score Card
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Peg Lusian
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Discussion around current
Nursing Facility Quality Score Card being used, facility performance, staff
performance, measures being reported on, and different sources of data being
pulled to develop the report (facility self-report vs Epic).
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Discussion regarding the
incongruence between “30-day readmission” definition and typically TCU stays
of 20 days; what happens from day 21-30? How do we collect data? Most groups
using of 12 month rolling average for 30 day readmission rates
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Review the scorecard at the March meeting
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Clinical Issues
a. Casamba Provider Portal for therapy certifications
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Dr. Neal Buddensiek
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Wished to raise awareness
with the group regarding the Casamba Provider Portal. It is a therapy
platform for signing therapy certifications electronically. Saves time hand
signing the stack of therapy certifications when provider is at the facility
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60% of therapy certifications
are on this platform
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Talked through the process;
each therapy department would need to reach out to the provider for access to
the portal
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Some discussion about using
an additional site for documentation of provider work (provider EHR, facility
documentation system and a therapy portal.
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Follow up of Dr. Buddensiek portal trial
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Demo of portal at next meeting
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Will send out video with minutes
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b.
Narcotics After Hours
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Laurie Wenker
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Follow up from last meeting:
At a DON meeting, the group was asked if they were aware of the after-hours
narcotics issues – response was ‘no.’
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Discussion around this being
a larger issue: pharmacy refill process, continuity of care, ties into pain
rating on scorecard, opioid overuse, impact to many groups: nursing staff,
provider, patient, pharmacy, regulators, payment, etc
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Develop work group: Laurie Wenker, Jane
Pederson, and Kari to shape the issue and bring it back to the group next
meeting
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c.
Anti-psychotic Rules
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New rules coming November 2017 ; 14 day limit
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Kristi Wergen, Stratis, has a list of 35 MN
nursing facilities that haven’t shown a decrease or changes in their
anti-psychotropic meds.
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Ran short of time; discuss more next month
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Further discussion at March meeting
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Kristi will send out list to Metro Alliance
members for review
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Next Meeting
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Robyn Hastings announced her retirement. Lori
Wenker will be the Director for HealthPartners
and Park Nicollet Community Senior Care.
We will miss Robyn! It’s through her inspiration
and collaboration that Metro Alliance was formed and continues strong – 7
years later!! Thank you Robyn!
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Date of next meeting: 3/19/18
8:00-10:00 AM Conference room TBD
Community
Senior Care Office, CTC Bldg, 2nd Floor
8170 33rd Ave S, Bloomington, MN
55425
Please send any agenda items to Cathy Lauring or Ali Romstad
We will have a call-in option available – please email either
above for the call-in details 2 business days ahead of time.
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