Evaluate how Fielder Medical Center's three quality improvement initiatives comply with the necessary federal and New York state legal requirements. Please identify the federal and New York State requirements or laws and address if and how Fielder medical center meets them.

Initiative 1: Rescuing Patients with Severe Sepsis/Septic Shock When a patient has an infection, sepsis may occur. Sepsis is an inflammatory response throughout the body caused by chemicals released into the bloodstream to fight the infection. Fielder Medical Center has joined state agencies in working to prevent mortality from severe sepsis and septic shock. In 2013, our teams of doctors and nurses developed best practice "bundles" to identify and treat adults and children with sepsis. These bundles were implemented in 2014, and since then, we have been collecting data to measure compliance with the best practices for each patient. These efforts have shown a reduction in mortality related to severe sepsis and septic shock.

Initiative 2: Reducing Avoidable Readmissions: Striving for Safe Transitions Readmissions place undue physical, emotional, and financial burdens on our most vulnerable patients. Still, national data show that one in five Medicare patients will wind up back in a hospital within 30 days. Eager to provide our patients with more effective careand safer, more seamless transitions back to their home or a skilled nursing facility Fielder Medical Center continue an ambitious effort to improve the discharge experience. A key component of this effort involves identifying patients who are particularly at risk for readmission (for instance, patients who have been readmitted in the past or who have certain conditions like congestive heart failure or pneumonia), and then taking extra measures to support their discharges. The program empowers patients and families, providing more robust patient education about medicines (their unique purposes, potential side effects to watch for, etc.).

Exceptionally Safe Care Fielder Medical Center strives to provide exceptionally safe care by promoting a culture that emphasizes the role of all doctors, nurses, staff, patients, and families in being members of the care team who will speak up to address safety concerns. Fielder Medical Center teams are working diligently to prevent three specific types of infections through consistently practiced "bundles" of preventive measures.

Initiative 3: Catheter-Associated Urinary Tract Infections (CAUTI) Another indwelling catheter is often used to remove urine from the bladder when a patient undergoes surgery or cannot move easily. These catheters may cause a urinary tract infection in the bladder or kidney if germs travel along the catheter. Preventing catheter-associated urinary tract infections is important to help our patients avoid unpleasant symptoms, excessive antibiotic use, more serious complications such as sepsis, and extended hospital stays. Building on the previous successes with other types of infections related to medical devices used in the hospital, we currently have a team of doctors, nurses, and other caregivers identifying and implementing best practices regarding prevention throughout the hospital. This team has collaborated with other hospitals to obtain as current information as possible regarding effective strategies to address this complication. The team has focused on encouraging the use of alternatives to urinary catheters and educating doctors and nurses about the importance of removing the catheter as quickly as possible during the patient's stay in the hospital. Improvements have been made to ensure that the sterile technique is consistently adhered to in placing and maintaining the catheters. These efforts are beginning to show success as the number of catheter-associated urinary tract infections at Fielder Medical Center has decreased.