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Scientific Poster:

Can I Really Do This?

By: Carolyn Fiutem, MT, CIC APIC Chapter 26 9/7/09

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Objectives:

Participant will be able to identify situations applicable for Performance Improvement (PI)

Participant will describe the steps in the FOCUS-PDCA PI process

Participant will be able to describe the steps to convert PI projects to a scientific poster

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Purpose of a poster…

Present information on current research that may not be totally complete

Present information on methods or observations that are the result of ongoing research

Problems can be discussed with peers Methods can be adjusted to give

optimum results

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…is more than presenting data

Enables your contribution to a conference Significant part of professional education Provides information Develops your experience Builds networks and contacts Incredible source of feedback

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Let the journey begin…

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FOCUS-PDCA

Developed by W. Edwards Deming Provides a model for improving

processes Acronym describes the basic

components of the improvement process

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FOCUS

Find a process to improve Organize a team to work on the process

improvement Clarify current knowledge of the process Understand/Uncover the process

variation and/or root causes Select a strategy for continued

improvement

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PDCA

a way of continuously checking your progress in each step of FOCUS process

Plan the process improvement Do the improvement, data collection and

analysis Check the results and lessons learned Act by adopting, adjusting, or

abandoning the change

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FIND – sources of improvement opportunities

Increasing rates of infection Sentinel events Closed record screens M & M reports Plaintiff claim allegations Congressional inquiries News media stories

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FIND – the first step of our journey…

Our C. difficile rates continued to rise regardless of hand hygiene, precautions, identification of cases, environmental cleaning….

What are others doing?... Watched and thought…. Researched and read… And researched again…

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FIND – a process to improve

Is there a clear, simple description of the process?

What is the process? What are the major process problems? What are the perceived boundaries? What are the resources? What are the key issues?

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Organize…

Who are the people involved in the process? (internal/external customers)

A team that knows the process Is there technical guidance and support

available?

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Organize…step 2

Nursing (pt care floors, ED, OR, PACU, ONC, SDS)

PCAs Physicians Materials services Administration

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Clarify…current knowledge

Who are the customers? What are their needs? Should boundaries/limits be defined? What is the actual process flow? Is there needless redundancy/

complexity? What are the outcomes/best way for the

process to work?

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Clarify…step 3

No process in place for cleaning BP cuffs

Attempts to use wipes Used EVERYWHERE on EVERYONE In rooms on wall and Dynamaps Research! Other processes at other facilities?

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Understand/Uncover – causes of process variation/poor quality

What are the major causes of variation or poor quality?

Which key characteristics are measurable? What/who/where/when/how will data be

collected? Does the data reflect common or special

cause? Which causes of variation can we change to

improve the process?

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Possible tools to use…

Brainstorming Cause and effect diagram Inverse tree diagrams Multi-voting Scatter diagrams Run & control charts Histograms

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Understand…step 4

No workable way to disinfect current BP cuffs

Vinyl cuffs very expensive No guarantee of partial or complete

compliance with cleaning even with vinyl Disposable BP cuffs available and

economical No reprocessing due to costs

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Select improvement process or Start PDCA Cycle

Select a portion of the process to improve

What is the proposed process improvement

Write the Mission Statement/Goal What changes to the process are most

feasible?

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Select…step 5

Performed cost analysis Performed force-field analysis Proposed use of disposable BP cuffs Received approval from Senior

Leadership Determined study time frame Determined implementation steps Determined final process

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The Cycle

Do

CheckAct

Plan

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Plan – the improvement

What is the process improvement selected?

Who will do the pilot? How will it be piloted? Where will it be tested? When will it be tested? What data must be collected to measure

improvement?

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Do

Do the improvement, collecting and analyzing the data

How or will data collection efforts need to be amended?

Education Communication

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Do…step 6

Implemented disposable BP cuffs Jan 1, 2005

Lots of “doubting Thomases” Lack of front-line management support Continued using same definitions Continued using same reporting

mechanism No other IC process changes

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Check – the results…and lessons learned

Did the process improve as expected? Did the process improve from a

customer’s point of view? Does the data support the improvement? How could the team efforts be

improved?

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Check…step 7

Results were 2X as good as expected Use was noticed by patients and families Nosocomial cases reduced by >50%

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CDI Rates per 1000 patient days per month

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Pre-Intervention Period 1 Post-intervention Period 1 Pre-Intervention Period 2

Post-Intervention Period 2

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Act

To hold the gain Adopt – our step 8 Adjust Abandon the change

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Act

What parts of the improved process needs to be standardized?

Policies or procedures to be revised Who needs to be made aware of the

change? What can be measured to ensure the

gain is held? What are the next steps in continuously

improving this process?

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Check – lessons learned (the hard way!) Don’t make assumptions about the

process without thorough follow-up! Don’t be too trusting. Never assume no one will change your

process and not tell you! Be prepared to defend your decision at

any time. Continuously review your process to

identify new improvements

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CDI Rates per 1000 patient days per month

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Post-Intervention Period 2

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From here to a poster how?

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Goal is….

Presenting a poster with -

Impact!

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Characteristics of an effective presentation…

OrganizedRehearsedVisual appealRelevant to your audienceDemonstrates enthusiasm

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Step 1

Prepare and submit your abstract Seek experts to help you Determine the requirements, such as

character limits and if spaces count! Format choices, which one applies Know the deadlines Financial disclosures Resolution of personal conflicts of

interest

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Title mistakes…

Title is too long. Avoid cutesy. Does not hew closely to the abstract’s

purpose Include abbreviations likely to be familiar

to many readers Using inappropriate humor

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Abstract mistakes…

Too long and packed with too much detail

Incorrect format Neglects to focus on the essential

findings of the project Includes extraneous material Writing in a condescending manner

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APIC Format I

For abstract involving scientific research Randomized clinical controlled trials Case controlled studies Cohort Observational Experimental design Disclose primary findings No preliminary results

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APIC Format I

Background/Objectives Methods Results Conclusions

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APIC Format II

Abstracts describing educational programs

Observations Case studies Outbreak investigations Infection prevention or quality

improvement activities

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APIC Format II

Issue Project Results Lessons Learned

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Requirements

Title – character limit is 200 Author – a short biographical summary

of both the submitting author and presenting author (if not the same)

Character limit is 1000 Abstract body – character limit is 2100 Charts tables and graphs count as 150

characters toward the 2100 limit

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Introduction mistakes…

Contains material that is unrelated to the paper’s findings

Lacks background information supporting the purpose of the project

Lacks a clear statement indicating the aim – what the author intends to establish

Contains data or findings that belong in other sections

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Results mistakes…

Was statistical analysis best suited to the data utilized?

Inadequately reporting of the data Unnecessarily duplicating data contained

in the tables Including material that belongs in the

discussion section

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Discussion mistakes…

Repeating text from the introduction Neglecting to address how the findings

relate to the practice of infection prevention & control

Reaching conclusions not supported by the project’s data

Failing to mention limitations or confounders of the study

Don’t be preachy or put in new information

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Step 2

Develop and construct the poster Components:1. Title2. Contributors & Affiliations3. Abstract4. Issue5. Project6. Results/Graphs7. Lessons learned8. References/Contact information

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Organization & Visualization

Organize results and notes for easy access

Visualize how you’d like to present your results

Put quantitative results in a format to show relationships and can stand alone

Select an appropriate poster format Be careful of designs and colors Simple and straightforward is best

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Assembly/Layout

Format size is important Top to bottom and left to right Legible from a distance of 3-4 feet Labels and logic Headers Font size and style Lay it out on the floor or a table Best quality pictures – logos – graphs

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Construction

Many programs available Powerpoint one of the most common Landscape format Poster taller by increasing height Poster longer by increasing width Size can be dictated by printer you are

using or the display space given

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Construction

Begin by adding text boxes Import pictures and graphs Don’t forget to include legends Leave adequate space as your border Both around the poster and between

columns Spell check is your friend!

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Print & Laminate

You may need to learn how to operate your facility’s poster printer

Work with a reputable printer…ask others

Always check a proof! Things can accidentally change from

computer to computer Laminate and admire

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Important details…

Plan for the space APIC is 4 ft by 8 ft One foot of display space for handouts Travel with your poster Have your poster available the entire

allowable time Be with your poster all of the

presentation time

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Step 3

Presenting your poster Enjoy presenting your poster Display enthusiasm about your project Smile Dress professionally Be inviting

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Poster presentations…

Require:

1. Planning

2. Preparation

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Poster presentations…

Provide rewards:

1. Can be extremely effective

2. Provide exposure for your data, your facility and you

3. Brings feedback from the experts

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At the end of presenting…

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