Download
safer healthcare now our normothermia surgical site infection experience n.
Skip this Video
Loading SlideShow in 5 Seconds..
Safer Healthcare Now Our Normothermia Surgical Site Infection Experience PowerPoint Presentation
Download Presentation
Safer Healthcare Now Our Normothermia Surgical Site Infection Experience

Safer Healthcare Now Our Normothermia Surgical Site Infection Experience

728 Views Download Presentation
Download Presentation

Safer Healthcare Now Our Normothermia Surgical Site Infection Experience

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. 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

  2. Objectives • Background – HHS and SSI • Our Goal for Normothermia • Measures & the Data • Change Initiatives • Our Results • Lessons Learned/Challenges • Next Steps

  3. 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.

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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)

  10. 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

  11. 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

  12. 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

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

  14. Halton Healthcare ServicesSurgical Program – Oakville Site (2008)

  15. 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’

  16. 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)

  17. 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

  18. 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!

  19. Still Smiling and Moving Safety Forward Questions? Thank You… Julie McBrien Halton Healthcare Services 327 Reynolds St. Oakville, ON (905) 845-2571 x6420