teams: getting together for change baystate medical center adult intensive care mary ellen scales rn...
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Teams: Getting Together for Change
Baystate Medical Center Adult Intensive Care
Mary Ellen Scales RN MSN CIC
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Baystate Medical Center
653 beds Adult Med Surg Trauma ICU, Med Surg CICU Pediatric NICU, PICU
41,000 admissions/year and 27,000 surgeries/year
Members of UHC, Premier, IHI IMPACT and a Stand-up for Patient Safety NPSF Organization SCIP mentor hospital IHI mentor hospital NNIS member since 1994, NHSN charter member
2005 Performance improvement model: PDSA
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Intensive Care HAI Patient
Safety Inspiration Teamwork and communication Engaging front line staff and unit
leaders Developing and supporting
multidisciplinary clinical champions Hand hygiene; Environmental
cleaning and disinfection Feedback and motivation
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Teamwork for Patient Safety
Adult Intensive Care Facilitated by Infection Control and
Performance Improvement staff Meeting twice a month since February
2008 Walking rounds
Patients with HAI or Risk of HAI Issues with care delivery Best practice Suggestions/ Questions from staff caring
for patients
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www.funinstitute.com
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Performance Improvement Concepts:
IHI ‘Some is not a Number’ APIC ‘Pay it Forward’ Small tests of Change: PDSA Positive Deviance Lean Engineering
Murphy, D. Pay it forward. APIC News Fall 2007.29-33
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ICU Infection Prevention Rounds
All staff including Physicians, Residents, RNs, TAs, RTs, Dietary, Pharmacy:
are invited to participate in Infection Control Rounds every second and third Friday at 11 AM starting in POD A.
Let’s work as a team to eliminate Hospital Acquired Infections.Bring your ideas!!!
CONTACT PRECAUTI ONSVI SI TORS/ VI SI ANTES:
report to the Nurses stat ion before enter ing t he room . Favor de Reportarse a la Estación de Enferm eras Antes de Entrar al Cuarto
____________________________________________________________________• PRI VATE ROOM OR COHORT; room with patient with same microorganism.___________________________________________________________________________• GLOVES: to be worn by healthcare workers entering the room.• HAND HYGI ENE: to be performed after
glove removal and before leaving the room.• Lavarse las m anos inmediatamente con detergente
ant imicrobico ante de salir del cuarto del paciente____________________________________________________________________________• GOW N: To be worn for contact with patient,
laundry, trash, patient care equipment or room surfaces.• Remove gown, then gloves, before leaving the room.• Usa una bata si anticipa que su ropa tendré contacto
con el paciente, medio ambiente, o art ículos en el cuarto del paciente.____________________________________________________________________________• CLEAN AND DI SI NFECT all equipment between patients and when leaving this
room. Remember to clean stethoscopes.An alcohol wipe or hospital disinfectant can be used.
____________________________________________________________________________• TRANSPORT: Out of room for essential
purposes only. Maintain precautions during transport. ___________________________________________________________________________
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ICU
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ICU CLABSI rate 2004-2008
0
2
4
6
8
10
12
14
16
BS
I/100
0 L
ine
day
s
CVL BUNDLE
Antimicrobial CVC
CHG Prep
CHG Dressing
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ICU VAP Rate 2004-2008
0
2
4
6
8
10
12
14
16
VA
P/1
000
Ven
t day
s
VAP Bundle
CPOE Vent care set
IC-PI Rounds
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ICU
Unit PI Board record to break
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Motivation!
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CICU
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CICU Combined Medical and Surgical CLABSI 2006-2008
0
1
2
3
4
5
6
7
Q1-06 Q2-06 Q3-06 Q4-06 Q1-07 Q2-07 Q3-07 Q4-07 Q1-08
CL
AB
SI/1
000
line
day
s
IC PI teamCHG prep
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CICU Combined Medical and Surgical VAP 2006-2008
0
1
2
3
4
5
6
7
8
9
10
VA
P/1
000
Ven
t D
ays
IC PI Team
CPOE Vent Care set
VAP Bundles
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CICU Unit PI
Board Record to Break
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Measurement Tools
NHSN Criteria for CLABSI and VAP IHI Days between HAI IHI Bundle Compliance measurement
Real Tools:
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Positive Deviance
Massachusetts Coalition program Focus on MRSA
Western Massachusetts regional program this Spring Sharing implementation BMC: Expanded to include all infections with
prevention as the key
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Positive Deviance
Identified issues with increased rates of HAI
Brought to CICU and ICU CICU CPC team ICU PI team
Rounds concept developed Engagement of bedside and support staff Empowerment for improvement Personalization of each HAI
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‘Some is not a number’
A person is not a number…Goal is to personalize each HAI
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Do you know Do you know
who your numbers are?who your numbers are?
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Each one unique,
A loved one, A family member, friend or someone you have just met
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PDSA: Our PI model
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LEAN Engineering concepts
Simplification Standardization Automation Redundancy Recovery methods and Strategies Visual Cues Right sources, roles and
responsibilities Autonomy, empowerment Supportive Culture
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Feedback from Rounds: Bedside staffIssues identified, Areas to follow up on:
VAP: HOB:
Bed elevation and sliding down….. Elevate HOB for those w/ trach as well as ETT Guesstimating HOB height
Oral Care: Availability of Oral care supplies, visual cues Toothbrush too big, or No teeth. Still need oral care? Patients that cannot be elevated to 300 need more
aggressive mouth care and suctioning ETT holders changed, ETT tubes keeps sliding Enteral feed residuals and ventilated patients
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CLABSI: Attire for assistants as well as monitoring
staff IV team does not support critical care
sites Turn off portable fans when inserting
CVL Dedicated ports/lines for TPN? Specifics regarding changing IV tubing
and time
Feedback from Rounds: Bedside staffIssues identified, Areas to follow up on:
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Feedback from Rounds: Bedside staffIssues identified, Areas to follow up on:
Cleaning and Disinfection: New beds in the ICU ? About cleaning How can staff tell items have been cleaned? What are staff responsibility regarding
cleaning and disinfection of patient care supplies?
What about C dif rooms? Who is cleaning
WOW units? Request for keyboard cover Dopplers? Request for Wipes to be placed in rooms Monitoring devices (thermometers) between uses Bedside tables
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Feedback from Rounds: Bedside staffIssues identified, Areas to follow up on:
Hand Hygiene: Request for more AHR products, increased
availability Request for hand lotion Want dispensers highlighted for increased
visibility Dispenser issues with tab not removed Resident HH education, Glitterbug tool HH Observations done during rounds Request for feedback mechanism for those
non-compliant with HH All visitors should wash their hands upon
entering and leaving the room
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Paying it Forward
Stories: ICU HOB compliance support CICU supply management
challenges
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The Future of our Teams
Continue to meet Share ideas and outcomes Engage those who can offer support Learn from other teams Celebrate successes and continue to
work on areas for improvement
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"...a Hospital...should do the sick no harm."Florence Nightingale, Notes on Hospitals, 1859
Teamwork, Targeting Zero………….
Thank you.
For more information; contact [email protected]