Minutes, June 2018

 

Metro Alliance of Geriatric Providers - MAGIC MINUTES June 18, 2018

Attendees:  S. Atkinson, S Brown, N. Buddensiek, A Busker,  M. Bullock, J. Davis, E Evan, J. Haycraft, S. Johnson, V. Kasper, D Kibbesmeier, C Lauring, R Long, J. Mielke, K. Petersen,  J Phelps, A. Romstad, R Schoen, E. Schuld,  A. Tong, C. Weber, L. Wenker, K. Wergin Phone: E Downing, S. Mittal, N. Pelerine

Agenda	Discussion	Action/Next Steps
Welcome/ Introductions	·         26 total attendees ; 23 in person and 3phone ·         11  health care provider organization practices being represented: Allina, CentraCare, Fairview, Genevive, Health East, Health Partners/Park Nicollet,  Integrated Care by Medica, Lifesprk Health, LTC Professionals, Optage, Twin Cities Physicians, Rehab Medicine Associates ·         2 health organizations represented: Benedictine Health Services, Care Choice,  Stratis Health, Empira ·         Students from: University of MN (DNP), (Pharm D)
Review minutes	·         Reviewed March 2018 minutes	·         Approved with no changes – posted to webpage
Computer Provider Order Entry (CPOE)	Emily Downing Updated the group on the progress of CPOE work group. Started in 2017; Phase 2 is 2018. Goals of the project include: Improving first pass completion for orders – driving to a more consistent order writing process (including diagnoses and other order details): outcomes: fewer transcription errors and fewer clarification call requests Decreasing variability in order writing process for providers in multiple facilities Stratis training 6/4/2018 Using in LTC and TCU; not used in AL sites yet	·         Tool kit is available and ready for additional site dissemination in or outside of Presbyterian Homes. The order form and provider order work flow process in posted online. ·         Stratis training will be posted on Blog
Antibiotic stewardship project	Jessica Phelps ·         Partnership between MDH, Stratis,  and Metro Alliance with Walker Methodist. ·         UTI protocol developed to help providers assess/diagnose and treat UTIs. Protocol was reviewed, discussed by group ·         Care Choice project: has an IP Nurse at 18 participating facilities: showing a 35% reduction in inappropriate antibiotic use with no increase in sepsis rate so far this year ·         Stratis is working with AHRQ and antibiotics in hospitals; could be coming to LTC in future	·         Jessica and Ali will place a Antibiotic Stewardship page on the Metro Alliance page with a link to the Topics article ·         Protocol and information posted to Webpage
SHO	Alison Romstad, Cathy Lauring, Cheri Montgomery, Janine Nelson ·         Questions came up about use of diagnoses vs symptoms (angina vs chest pain) and RN ability to “diagnose” vs treat symptoms – scope of practice for RN and/or LPN ·         Question posed to Board of Nursing; waiting for response	·         Waiting for Board of Nursing response ·         JHACO vs DHS rules differ around SHO, protocols and delegation of orders ·         More to come; considering changing from diagnoses to symptoms on SHO
Influenza Protocol	Hanna Berhane, DNP student/Emily Evan, Pharm D student ·         Developing a consistent protocol across all provider groups for SNF/TCU; not AL at this time ·         Goal is to have it completed for use this fall (August ideally) ·         Discussion around GFR vs Cr Cl for dosing	·         Survey coming out ·         More info on protocol at next meeting
Professional Groups	Group discussion about Metro Alliance merging with MAGIC ·         Much discussion about Metro Alliance becoming a part of MAGIC (formerly MMDA) ·         Goal is for increased collaboration and improve the quality of care for older adults ·         Could Metro Alliance become the clinical arm of MAGIC? ·         Group prefers to continue town hall type meetings for Metro Alliance ·         Discussion about how we can include more technology for outstate MN providers to join the metro providers	·         Potential admin support from MAGIC/MMDA ·         Need bylaws/structure of professional groups ·         Need committee chair/co-chairs for “Metro Alliance” ·         More discussion at next meeting
Clinical Issues Casamba Provider Web Portal	Neil Buddensiek ·         Pilot update: Facilities included: BHC Duluth, Innsbruck, Cerenity WBL, Cerenity Residence Humboldt and St. Gertrude’s. ·         Outcomes so far: o    Large volume of certifications per facility o    Provider perspective: generally took the same amount of time to sign in portal vs paper. However, the entire process (provider + facility) was much quicker and easier o    Can sign on your phone o    Will be available at all Benedictine facilities; providers can use the app or not o    1 portal for all facilities that you attend o    Issues: the therapy software doesn’t integrate with Matrix or PCC yet.	·
b.      Narcotics After Hours	Laurie Wenker Group discussion found two subgroups: Larger picture of Opioid Epidemic and how it impacts SNF/TCU anticipate will play a part Continued work with SNF/Pharms for afterhours refills	·         Metro Alliance to develop “Best Practice” bullet points for the website – Dr Robert Long to assist?
c.       ResoLute PIPP Update	Sarah Brown ·         New Empira QI Program – 2 year funded project ·         Gave group overview of program: Palliative Care Approach – “living in the gap” ·         Using Atul Gwande philosophy ·         Looking at whole life: conditions, end of life, relationships, purpose, past, how they want to be remembered. 7 questions to drive the conversations ·         Outcomes: Decreased hospitalizations/ rehospitalizations; decreased medications and med alignment	Will send slides to post to website
d.      Facility Minimal Standards	Sarah Johnson Group Discussion: How to work with facilities that provide a sub level of care and how do we hold them accountable? Teams have exited facilities that were not able to improve care. Much time with education of staff, meetings, setting standards	More discussion with other groups off-line
Next Meeting		Date of next meeting: 9/17/18 8:00-10:00 AM Community Senior Care Office, CTC Bldg, 2nd Floor 8170 33rd Ave S, Bloomington, MN 55425 Please send any agenda items to Laurie Wenker or Ali Romstad