SAFE PATIENT MOVEMENT AND HANDLING: VHA NATIONAL PERSPECTIVE STEPS

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SAFE PATIENT MOVEMENT AND HANDLINGVHA NATIONAL
PERSPECTIVE STEPS

• Office of Public Health and Environmental
  Hazards
• Office of Nursing Services
• Office of Patient Care Services
• Tampa PSCI

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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

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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)

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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

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Injury Rates by SIC Codes
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Injury Type by Fiscal Year
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and Rate of Incidents by Skill Mix(from VANOD
ASISTS proclarity cube on VSSC)
Yellow Total Emp Count Orange of
Incidents Blue line Calc. Rate
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Incident Rate by Type of Incident (from VANOD
ASISTS proclarity cube on VSSC)
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Type of Incident by Skill Mix (from VANOD ASISTS
proclarity cube on VSSC)
Lifting moving patients most freq. reported
injury
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TOTAL AND PATIENT TRANSFER INJURIES BY GENDER
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PATIENT TRANSFER INJURY RATES BY GENDER AND
NURSING LEVEL
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TOTAL INJURY RATES BY GENDER AND NURSING LEVEL
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Patient Transfer Injury Rates and Age
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WEAKNESSES INHERENT IN ANY BUSINESS CASE
JUSTIFICATION APPROACH

• Under-reporting of injury and disease
• Attention and focus predict long-term
  consequences
• Horse-racing effect

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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

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BUSINESS CASE DEFINITIONS
Conservative scenario Documented 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
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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
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HISTORY OF SPMH in VHA

• 1998-1999 Tampa program development
• 1999 HSRD Tampa SPMH grant (expert panel)
• IOM Report Safe Work in the 21st Century
• 2001-2003 VISN 8 Demonstration project
• 2001 1st Conference on SPMH
• 2004 VISN 1 EDM and program roll-out
• Publications on economics
• VHA CO staff support for roll-out
• 2005-2007 VISN 3, 9, 11 initiatives
• 2006 10N data call on implementation initiatives
• 2007 SPMH initiative for FY2009-11 budget
  series
• 2008 VA OMB negotiations on 6 vs. 3 year
  roll-out
• Concurrence
• 61,500,000 distributed in June 2008

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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)

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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 inadequate
• WARIMS application to IDMC

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CONSIDERATIONSDecision-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?

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CONSIDERATIONS

• Construction vs. medical programs (80 vs. 20)
  need national assessment at facility / patient
  room level
• VISN roll-out experience 2 3 years of VISN
  support and planning
• Facility-level program management Staff support
  (program development, leading assessment,
  equipment maintenance, peer safety leader
  training and coordination)
• Likely 4,300,000 / year

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CONSIDERATIONS

• Facility level front-line worker support peer
  and coordination) (.1 peer safety leader/injury
  prevention nurse / shift) 5,000,000 / year
• IT Support ASISTS does not address unit level
  rates, instrumentation/ equipment / track
  intervention recommendations (Accident Review
  Board solutions)
• Roll-out timing VISN, facility staffing
  facility-level assessment, equipment

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CONSIDERATIONS

• Prior expenditures and early adopters
  reimbursement issues (10N solution include
  information on actual equipment/construction
  expenditures)
• Budget shifts
• Initial estimates no facility- or unit level
  coordination
• 16,000,000 in initial draft for 3 years of
  unit-level peer safety leaders
• Move to 6 years inadequate funding

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CONSIDERATIONS

• First year funds expenditures
• Universally needed equipment (lateral sliding
  devices 15,000,000)
• 4,300,000 facility level staffing
• Reimbursement (10N model)
• Program oversight in CO
• Future delays and reimbursement consequences of
  6-year implementation delay and impatience in the
  field

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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

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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)