Getting Started on Surgical Site Infections(SSI)

1. Getting Started onSurgical Site Infections(SSI) Travis Dollak Jill Hanson Improvement Advisors WHA

2. Today’s Call • Our Timeline and Process • Measures (Q&A) • Next 30 Days • View Science of Safety Video • Organizing the Team

3. Surgical Site Infection Background • Between 750,000 and 1 Million SSI occur each year, extending hospital stays by 3.7 million days and generating more than $1.6 billion in excess cost • SSI are the third most frequently reported health care-associated infection • An SSI program should combine SSI prevention methods and a surgical Safety Checklist to promote teamwork and communication http://www.hret-hen.org/images/downloads/508changepacks/ssi_change%20package_508.pdf

4. Initiative Timeline Overview • 9 Month Collaborative • 1-Hr Webinar Each Month – 2nd Tuesday of Each Month 10:00-11:00 PM Webinars • Progress of last 30 days • New content • Plan for the next 30 days Discussion Group • Peer-to-Peer Sharing Quality Center • Data submissions • References and Toolkits

5. Poll Question #1: What have you tried? Which of the following describes your facility best in terms of progress on this initiative? • This is the first time we have worked on it • We have worked on it in the past but feel we have regressed • We have really nailed it and are putting the finishing touches on the program • We have all but given up on finding ways to improve

6. DRIVER DIAGRAM

7. DRIVER DIAGRAM continued

8. Poll Question #1: Results Which of the following describes your facility best in terms of progress on this initiative? • This is the first time we have worked on it • We have worked on it in the past but feel we have regressed • We have really nailed it and are putting the finishing touches on the program • We have all but given up on finding ways to improve

9. SSI Outcome Measure Outcome Measure:Focus on the customer or patient. What is the end result? SSI Outcome Measure: SSI rate based on CDC NHSN definition (# of SSI per 100 NHSN operative procedures)

10. SSI Process Measures Process Measures:Focus on theworkings of the system. Provide real time feedback. SSI Process Measures: • Adopt Surgical Safety Checklist • SCIP- Inf-1 – Antibiotic before incision • SCIP- Inf-2 – Antibiotic choice • SCIP-Inf-3 – Antibiotic discontinued • SCIP-Inf-4 – Perioperative Glucose Control • SCIP-Inf-10 – Normothermia • Perioperative Skin Antisepsis • Preadmission Skin Cleansing • Draft – Cefazolin Dosing based on (weight vs. BMI)

11. Action Item #1 – Data Submission Baseline outcome data due September 30th • Submit via WHA Quality Center Portal • 2011 Data Aggregate (if available) and/or • 2012 Data Monthly (if available) OR • Confer NHSN rights to WHA http://www.whaqualitycenter.org/PartnersforPatients/SurgicalSiteInfections.aspx

12. Plan for the Next 30 Days • Organize your Team • View Science of Safety Video • Complete Staff Safety Assessment

13. Organizing your Team Considerations • Who will you involve? • How will you communication? • Within your team? (notify of meetings) • To others outside of thee team? • How will you use the webinars? (use as weekly meeting?) • Identify team structure (key roles, expertise, leaders) • How will you keep everyone engaged?

14. Action Item #2 - Organizing your Team Optional Tools to Use Agenda Team Charter

15. Science of Safety Recipe • Educate on the Science of Safety • Identify Defects (Staff Safety Assessment) • Learn from Defects • Implement Teamwork & Communication Tools

16. Science of Safety – How Errors Happen The Swiss Cheese Model – by James Reason

17. Seven Concepts of Patient Safety

18. Seven Concepts of Patient Safety

19. Action Item # 3 – View Patient Safety Video Create a roster of who on your team/unit needs to view the Science of Safety video. http://www.youtube.com/watch?v=GOJJHHm7lnM&feature=results_main&playnext=1&list=PL048D28C888FE3871

20. Science of Safety Recipe • Educate on the Science of Safety • Identify Defects (Staff Safety Assessment)* • Learn from Defects • Implement Teamwork, Communication Tools, A standardized process

21. The Staff Safety Assessment • How will the next patient be harmed? One way to make harm visible– get staff thinking about safety and how to improve it Frontline caregivers are the eyes and ears of patient safety • Use the Staff Safety Assessment to identify patient safety issues as it relates to SSI

22. Action Item #4 – Staff Safety Assessment Just two (2) very important questions for any clinical unit: Please describe where you think breakdowns are occurring with Prophylactic Antibiotics/Surgical checklists/Skin Preparation/Perioperative Temperature Management. Please describe what you think can be done to prevent or minimize the breakdowns. Thank you for helping improve safety in our workplace! Available in SSI Getting Started Webinar Folder on the Quality Center

23. The Next 30 Days Tools Available On WHA Quality Center: • Meeting Agenda/ Team Charter • Science of Safety Video Link • Staff Safety Assessment Surveys • SSI References and Toolkits

24. Questions? Reminders: • Please complete the 3 question survey when you close the webinar window • Mid-month reminder survey • Next month Model for Improvement

25. Guide to Quality Centerhttp://www.whaqualitycenter.org/ Click Here