Getting Started onSurgical Site Infections(SSI)

Travis DollakJill Hanson

Improvement AdvisorsWHA

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Today’s Call

1) Our Timeline and Process2) Measures (Q&A)3) Next 30 Days

A. View Science of Safety VideoB. Organizing the Team

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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

Initiative Timeline Overview• 9 Month Collaborative• 1-Hr Webinar Each Month – 2nd Tuesday of Each Month 10:00-11:00 PM

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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

Poll Question #1: What have you tried?Which of the following describes your facility best

in terms of progress on this initiative?

a) This is the first time we have worked on it b)We have worked on it in the past but feel we

have regressedc) We have really nailed it and are putting the

finishing touches on the programd)We have all but given up on finding ways to

improve

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DRIVER DIAGRAM

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DRIVER DIAGRAM continued

Poll Question #1: ResultsWhich of the following describes your facility best

in terms of progress on this initiative?

a) This is the first time we have worked on it b)We have worked on it in the past but feel we

have regressedc) We have really nailed it and are putting the

finishing touches on the programd)We have all but given up on finding ways to

improve

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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)

SSI Outcome Measure

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SSI Process Measures

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Process Measures: Focus on the workings 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)

Action Item #1 – Data Submission

Baseline outcome data due September 30th

• Submit via WHA Quality Center Portalo 2011 Data Aggregate (if available) and/oro 2012 Data Monthly (if available) OR

• Confer NHSN rights to WHA

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http://www.whaqualitycenter.org/PartnersforPatients/SurgicalSiteInfections.aspx

Plan for the Next 30 Days

1. Organize your Team2. View Science of Safety Video3. Complete Staff Safety Assessment

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Organizing your TeamConsiderations– 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?

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Action Item #2 - Organizing your TeamOptional Tools to Use

Agenda Team Charter

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Science of Safety Recipe

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

Tools

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The Swiss Cheese Model – by James Reason

Science of Safety – How Errors Happen

Seven Concepts of Patient Safety

# CONCEPT SSI SPECIFIC

1 Use-Centered Design (staff providing care) • Make things visible

Create poster with reminder to conduct the three pauses prior to surgery

2 Avoid Reliance on Memory Vigilance• Provide checklists, flags or alarms as reminders

Adoption of surgical safety checklist – walk thru checklist prior to surgery

3 Involve Patients in Their Care• Teach back

Surgical checklist allows patients the opportunity to verify important information with the surgical team before surgery.

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Seven Concepts of Patient Safety# CONCEPT HAC SPECIFIC

4 Anticipate the Unexpected Patients may not do three day pre-wash – develop protocol for skin cleansing day of surgery.

5 Build in Redundancy• Assume errors will occur and build a system to accommodate

Develop standardized order sets for preadmission skin cleansing.

6 Hardcode Your System (process, training, culture)

Develop standardized practices for application of skin antiseptic agents and educate staff

7 Improve Access to Timely Data• Data walls

Share real-time data with project team and unit staff

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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

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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

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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

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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!

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Available in SSI Getting Started Webinar Folder on the Quality Center

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

ACTION ITEMSSubmit Baseline Data

Organize Your Team

View Science of Safety Video

Conduct Staff Safety Assessment (Report Out in November)

Review Resources in Quality Center

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Questions?

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Reminders:• Please complete the 3 question survey when you

close the webinar window• Mid-month reminder survey• Next month Model for Improvement

Guide to Quality Centerhttp://www.whaqualitycenter.org/

Click Here

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