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Table 3 Condition-specific QI activities

From: Chief nursing officers’ perspectives on Medicare’s hospital-acquired conditions non-payment policy: implications for policy design and implementation

Condition Timing Focus Barriers Facilitators Exemplars
CLABSI Pre-existing Prevention Attribution (Present on Admission), Implementation, Collaboration Access to correct equipment, Self-policing, Collaboration with external groups Access to correct equipment: ‘You have to do full garb, full layout of sterile field…we developed carts that have everything on it, so it made everybody’s life easier.’ Self-policing: ‘They also track central line infections… a unit that had a particular spike…did some special follow-up… they actually got right back on track.’ Collaboration with external groups: ‘…because everybody (in the state hospital association) was doing it…where you met with physician resistance, you could say, well, it’s being done at the hospital next door and the hospital north of us, south of us, east of us, west of us….’
CAUTI Concurrent or planned Prevention and Surveillance Attribution (Present on Admission) Adequate resources Piloting prior to scale up Adequate resources: ‘(prior to the policy) we were sharing (bladder scanners) between several units. Well, that’s not good enough…if you’re looking to get to zero, you have to have it as part of their practice.’ Piloting prior to scale up:’… a phenomenal geriatric CNS…has worked with us to try to…reduce or prevent CAUTIs in the geriatric patients across the hospital…we ‘started’ on our geriatric ACE unit ahead of time to help us put a template in place.’
Pressure Ulcer Concurrent Screening and documentation Attribution (Present on Admission), Shared responsibility, Preventability, Collaboration Collaboration with physicians, External reporting, and benchmarking Collaboration with physicians: ‘We knew our patients had them (pressure ulcers), but the doctors didn’t because it wasn’t on the forefront of what they do, and now that they have to document, they’re in there looking at the wound with the nurse…’ External reporting and benchmarking:’… we belong to NDNQI so we do the actual assessment of all patients quarterly and then do a rate…’