Teams: Getting Together for Change

1. Teams: Getting Together for Change Baystate Medical Center Adult Intensive Care Mary Ellen Scales RN MSN CIC

3. 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

4. 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

5. 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

6. www.funinstitute.com

7. 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

8. 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!!!

9. ICU

12. ICU Unit PI Board record to break

13. Motivation!

14. CICU

17. CICU Unit PI Board Record to Break

18. Measurement Tools • NHSN Criteria for CLABSI and VAP • IHI Days between HAI • IHI Bundle Compliance measurement • Real Tools:

21. 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

22. 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

23. ‘Some is not a number’ A person is not a number… Goal is to personalize each HAI

24. Do you know who your numbers are?

25. Each one unique, A loved one, A family member, friend or someone you have just met

26. PDSA: Our PI model

27. LEAN Engineering concepts • Simplification • Standardization • Automation • Redundancy • Recovery methods and Strategies • Visual Cues • Right sources, roles and responsibilities • Autonomy, empowerment • Supportive Culture

28. 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

29. Feedback from Rounds: Bedside staffIssues identified, Areas to follow up on: 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

30. 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

31. 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

32. Paying it Forward Stories: • ICU HOB compliance support • CICU supply management challenges

33. 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

37. Teamwork, Targeting Zero…………. "...a Hospital...should do the sick no harm." Florence Nightingale, Notes on Hospitals, 1859 Thank you. For more information; contact Mary.ellen.scales@bhs.org