Surgical Site Infection Tools for Improvement SUSP

1. Surgical Site Infection Tools for ImprovementSUSP

2. Learning Objectives • Review approach to SSI reduction as part of SUSP project. • Review auditing tools to help identify local defects contributing to SSIs. • Next steps Armstrong Institute for Patient Safety and Quality

3. Surgical Care Improvement Project (SCIP) Armstrong Institute for Patient Safety and Quality

4. No single SSI prevention bundle • Deeper dive into SCIP measures to identify local defects • Emerging evidence • Abxredosing and weight based dosing • Maintenance of normogylcemia • Mechanical bowel preparation with oral abx • Standardization of skin preparation • Capitalize on frontline wisdom • CUSP/Staff Safety Assessment Armstrong Institute for Patient Safety and Quality

5. Deeper dive into SCIP measures to identify local defects Armstrong Institute for Patient Safety and Quality

6. Deeper Dive: Auditing www.visualthesaurus.com “…to make an audit of (performance) to evaluate or improve its safety, efficiency, or the like” http://dictionary.reference.com

7. Auditing Practice • Evaluate a sample of patients • (ie: the next 5-10 patients) • Practical and feasible strategy to evaluate performance and surface defects • Needs to be adapted to local environment • Empowers frontline staff Armstrong Institute for Patient Safety and Quality

8. Auditing tools • Antibiotic • Selection, dosing, redosing • Normothermia • Glucose Control • Skin Prep • Others? Armstrong Institute for Patient Safety and Quality

9. SCIP Measures Armstrong Institute for Patient Safety and Quality

10. Perioperative Antibiotic Compliance:Michigan Surgical Quality Collaborative Hendren et al. Am. J Surg 2011

11. SCIP measure performance Johns Hopkins Hospital May 2010 SCIP Hospital Compare www.medicare.gov Armstrong Institute for Patient Safety and Quality

12. SUSP Antibiotic Audit Tool

13. Antibiotic Compliance ProjectJohns Hopkins Interventions: • Increased amount of gentamicin available in the room • Added dose calculator in anesthesia record • Educated surgeons, anesthesia and nursing, anesthesia and nursing in grand rounds Wick et al, JACS 2012 Armstrong Institute for Patient Safety and Quality

14. SCIP Measures Armstrong Institute for Patient Safety and Quality

15. SCIP measure performance Johns Hopkins Hospital May 2010 SCIP Hospital Compare www.medicare.gov Armstrong Institute for Patient Safety and Quality

16. SUSP Normothermia Audit Tool Armstrong Institute for Patient Safety and Quality

17. Normothermia Project Johns Hopkins Interventions: • Confirmed that temperature probes were accurate (trial comparing foley and esophageal sensors) • Initiated forced air warming in the pre-operative area • Heightened awareness Armstrong Institute for Patient Safety and Quality

18. Use your hospitals glucose goal SUSP Glucose Control Audit Tool Armstrong Institute for Patient Safety and Quality

19. How Do We Conduct Audits? • Retrospective chart review • Concurrent review • Place audit tool on chart • Complete over continuum of care • We recommend auditing 5-10 patients • Larger samples yield better estimates of performance • Your data does not need to be submitted Armstrong Institute for Patient Safety and Quality

20. Summary • No single SSI prevention bundle • Need to identify local defects • Auditing is a practical and feasible strategy to evaluate performance and surface defects • Tools are adaptable to local environment • Empowers frontline staff Armstrong Institute for Patient Safety and Quality

21. Action Items • Pick 2-3 audit tools • [Add website for tools] • Audit 5-10 patients with each tool • Be prepared to share your experience with other teams on upcoming call • Share your tools and ideas for new tools on our next coaching call! Armstrong Institute for Patient Safety and Quality