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Safer Healthcare Now Our Normothermia Surgical Site Infection Experience. Eating the SSI Elephant: A workshop to help Ontario Hospitals reduce SSI while meeting provincial reporting requirements March 12, 2009 Julie McBrien – Patient Care Manager PAC, SDC & PACU. Objectives.

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Safer healthcare now our normothermia surgical site infection experience l.jpg

Safer Healthcare NowOur Normothermia Surgical Site Infection Experience

Eating the SSI Elephant: A workshop to help Ontario Hospitals reduce SSI while meeting provincial reporting requirements

March 12, 2009

Julie McBrien – Patient Care Manager PAC, SDC & PACU


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Objectives

  • Background – HHS and SSI

  • Our Goal for Normothermia

  • Measures & the Data

  • Change Initiatives

  • Our Results

  • Lessons Learned/Challenges

  • Next Steps


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Our Hospitals

  • Halton Healthcare Services is comprised of three acute care community hospitals - Oakville-Trafalgar Memorial, Milton District and Georgetown Hospital.

  • Our mission - to provide quality compassionate care and services to meet the needs of our population in a timely and effective manner - grows out of a culture of care and is shared by our staff, physicians and volunteers.

  • HHS is committed to being an innovative centre of excellence in community hospital care.


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Facts and Figures

  • 294 Acute Inpatient beds

  • 61 Complex Continuing Care

  • 39 Rehab beds

  • 77,600 surgical procedures

  • 17,519 admissions

  • 132,470 Ambulatory visits

  • 97,700 ER visits

  • 2,346 staff


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Our SSI Team

  • Oakville Site: Cindy MacFarlane, Cathy Goacher, Lynn Singh, Julie McBrien

  • Milton Site: Dr. Kolbasnik, Dr. Chow, Barb Roelofson, Jan Dziapak, Susan Barrett

  • Georgetown Site: Deb Hill

  • Infection Control & Prevention: Dr. Szakacs, Cynthia Shorrock

  • Patient Safety: Lynn Budgell

  • Pharmacy: Jill White


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In the beginning with SSI ….

  • Oakville site initiated first (Nov 2005)

  • Our program sponsors - Surgical Care Committee

  • Established a small working group of key stakeholders

  • Use ‘Model for Improvement” and Plan-Do-Study-Act (PDSA) cycle to conduct small tests of change

  • Milton and Georgetown sites incorporated later


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In the beginning with SSI… Cont’d……

  • Selected & prioritized 3 of 4 components of care:

    • #1 appropriate hair removal

    • #2 antibiotic timing;

      • pre-incision & post-close discontinuation

    • #3 post-op normothermia (colorectal surgeries)

Done

Ongoing

Most Recent Challenge


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Aim: Through prevention, monitoring and action achieve Normothermia to Prevent Surgical Site Infections (SSI)

For identified at risk populations, maintain the patient’s core body temperature at a minimum of 36 degrees Celsius, throughout the entire surgical experience; admission through discharge from PACU


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Targeting the ‘Right’ Surgical Patients

  • Identified our surgical populations based on; risk, volumes, evidence of inconsistent practice & degree of support anticipated from the service;

    • Total Knee Arthroplasties

    • Total Hip Arthroplasties

    • Colo-Rectal Surgeries (elective only)


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Improvement Objectives

Maintain normothermia ( 36C) peri-operatively for selected surgical populations

Measures

Temperature documented at each phase of the surgical process (SDC, OR, PACU)

Report % open-body cavity surgical patients with Temps  360C post-op in PACU

Goal: To achieve 95% or higher in maintaining patients core temperature at 36 C

  • Key Changes

  • Use of pre-op, intra-op and post-op warming devices on populations at risk

  • Education

  • Efforts to improve temperature monitoring methods


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Normothermia Change Initiatives & Highlights

  • Patient gowns improved – Aug 2008

  • Change of warming blanket supplier – Sept 2008

    • Ease of IV and arterial line access

    • Fixed plastic head drape

    • Heat sensor at point of patient delivery heating

  • Warming units available in all ORs

  • Inventory increased in PACU and a unit dedicated to SDC - Sept 2008

  • Warming blankets are stocked, added to the picklist & picked in CSR for the case – Sept 2008


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Normothermia Change Initiatives & Highlights Cont’d…

  • Hot lines used regularly in cases over 1hour

  • Patient recliners in SDC with warming feature – Trial Jan 2009

  • Skin temperature probe trial & consistent placement of probe - Jan 2009

  • OR bed warmed with warm flannels or heating unit - more consistent practice

  • Normothermia Education: Dr. Szakacspresented to;

    • Surgeons – April 2008

    • Anesthesia – May 2008

    • Nursing - SDC, OR, PACU, and surgical floor – May 2008


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Halton Healthcare ServicesSurgical Program – Oakville Site (June – Dec 2007)


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Halton Healthcare ServicesSurgical Program – Oakville Site (2008)


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Lessons Learned…

  • Smaller sites able to get buy in and spur change forward quickly – i.e. DS patients bringing housecoats and slippers from home

  • Integration, collaboration and standardization across HHS sites

  • Don’t under-estimate the need/value of a physician champion and the importance of education and physician/staff support

  • Dedication and effective use ‘rapid cycle change’


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Lessons Learned…

  • Achieved a number of improvement changes – share with stakeholders

  • Tremendous sharing and support available

    • collaboration within HHS, LHIN and SHN community

  • Understand and analyze cost implications upfront

  • Be creative about keeping team engaged and moving forward in spite of competing projects and chaos

  • Data management is an enormous barrier without electronic solutions (in long-term)


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Challenges …

  • Physician culture/attitude/practice changes

  • Literature was challenged -- education needed

  • Ongoing data management

    • More paperwork!!

    • Resource intensive

    • Manual collection/collation

  • Cost implications of improvement changes


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Next Steps …

  • Continue to develop automation capacity in our data management process

    • Documentation

    • Reporting & analysis

  • Initiate new cycles of change for;

    • Check success of normothermia changes

  • Monitor and report results consistently

  • Ensure we have a plan to sustain ….

  • Celebrate well and often!


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Still Smiling and Moving Safety Forward

Questions?

Thank You…

Julie McBrien

Halton Healthcare Services

327 Reynolds St.

Oakville, ON

(905) 845-2571 x6420


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