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University of Ottawa Heart Institute To Clip or Not Clip… How to Change an Organizations Practice Brainstorming with a Multidisciplinary Team. Who we are . University of Ottawa Heart Institute (UOHI) is a 134 bed institution Part of The Ottawa Hospital Cardiology/Cardiac Surgery Patients

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University of Ottawa Heart Institute

To Clip or Not Clip…

How to Change an Organizations Practice

Brainstorming with a Multidisciplinary Team

QHN Fall Forum 2008


Who we are l.jpg
Who we are

  • University of Ottawa Heart Institute (UOHI) is a 134 bed institution

  • Part of The Ottawa Hospital

  • Cardiology/Cardiac Surgery Patients

  • Cardiac Rehab

  • Ambulatory Care

QHN Fall Forum 2008


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Background

  • Appropriate hair removal on all patients in the University of Ottawa Heart Institute

  • To prevent surgical site infections in Coronary Artery Bypass Graft (CABG) patients by implementing the Safer Healthcare Now (SHN) Surgical Site Infection (SSI) bundle components as appropriate at the UOHI

  • Brainstorming with a multidisciplinary team was the quality improvement tool used. This tool enabled the SSI committee to generate many proactive ideas and measures in an effort to successfully implement a change in practice in our organization

QHN Fall Forum 2008


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Team Members

  • Dr. Paul Hendry (CHAIR), Department ofCardiac Surgery

  • Heather Sherrard, Vice President, Clinical Services

  • Dr. Kathy Suh, Infection Control

  • Dr. Michael Bourke, Department of Anaesthesiology

  • Natalie Bruce/Jenn Johnson, Infection Control

  • Erika MacPhee, SHN Project Facilitator

  • Sharon Ann Kearns, Manager Quality and Performance Measurement

  • Karen Charron, Clinical Manager H3

  • Elaine Vandenberg, Clinical Manager CSICU

  • Cynthia Holm, Clinical Manager COR/

  • Gloria Prendergast, Team Leader CSICU

  • Carol McKissock, Resource Nurse CSICU

  • Debbie Hubble, Manager Perfusion

  • Bob Boxell, Anaesthesia Tech

  • Dave Cecillon, Manager Pharmacy

QHN Fall Forum 2008


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Responsibilities of SSI Team

  • Identify and address areas for improvement in preventing Surgical Site Infections and to support the transfer of knowledge to improve patient care at The University of Ottawa Heart Institute

  • Advocating for policies and systems to be in place to reduce the rate of surgical site infections

  • Facilitating the development of a patient safety culture through education and other initiatives

QHN Fall Forum 2008


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Measures Used

  • Brainstorming with a multidisciplinary team

  • Reviewed entire process at UOHI to identify current practice

  • Identified practice concerns

  • Performed Chart Audits

  • Performed Surveys

QHN Fall Forum 2008


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Intended or Achieved Outcomes

  • Hair removal

    • Identified process issue here

      • to clip or not to clip…or just do whatever the heck you feel like!!!

    • Removal of all razors in building

    • More clippers in building

    • Re education/ in-services

    • Revise pre-op checklist

    • Policy and Procedure developed for hair removal at UOHI

QHN Fall Forum 2008


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Lessons Learned

  • Assembling a team is not as easy as one would think

  • Identify a champion or 2 (physician and one other health care team member).

  • Persistence with the physicians…face to face contact to get them to commit to meetings

  • Assign tasks to your team members and hold them accountable

  • Make the meetings formal

    • Establish Terms of Reference

    • Agendas

    • Minutes

  • Don’t Take it all on yourself!!!!

QHN Fall Forum 2008


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Key Success Factors/Enablers

  • Once a physician champion was enlisted, the key to the success of this initiative was the all or none principle

  • Every patient who sets foot in our institution is a potential surgical patient, therefore ALL razors were removed from the building

  • The clipper rep invited in for a 2 day blitz of in-services on clipper use

  • A designated manager ordered all the replacement clipper heads and policy drafted for appropriate hair removal

QHN Fall Forum 2008


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Potential or Actual Barriers

  • Staff reluctant to change

  • Referring centers don’t necessarily have the same practice as the UOHI

  • Physician buy in and compliance

  • Preconceived notions of who should get what kind of hair removal

QHN Fall Forum 2008


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Next Steps

  • All referring hospitals were notified by letter about the hair removal policy and this is a standard order on the transfer to UOHI documents

  • Ongoing audits to ensure compliance

  • Spot checks on units to ensure no razors

  • Social work will look after ordering of facial razors for our long term patients

  • Share the UOHI Policy and Procedure for Hair Removal with our colleagues at The Ottawa Hospital

QHN Fall Forum 2008


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Contact Information

Erika MacPhee RN, MHScN

University of Ottawa Heart Institute

Clinical Nurse Educator/Project Facilitator

613-798-5555 x15450

[email protected]

Sharon Ann Kearns RN,BScN, CPHQ

University of Ottawa Heart Institute

Manager Quality and Performance Measurement

613-761-4322

[email protected]

QHN Fall Forum 2008


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