Post on 17-Jan-2017
transcript
Welcome! Bienvenue à nos participants francophones Hélène Riverin
Carla Williams Patient Safety Improvement Lead
Please enter any questions in the chat box Today’s slides This call will be taped
Before we get started
- AHS-Surgery Strategic Clinical Network; Stacy Kozak
- Atlantic Health Quality & Patient Safety Collaborative; Amy Howard - BC Patient Safety & Quality Council; Geoff Schierbeck - Health Quality Ontario; Mina Viscardi-Johnson - Sask. Ministry of Health- Patient Safety Unit; Jocelyn Leblond
Thank you!
Patient Safety Metrics Team: - Virginia Flintoft - Alex Titeu - Anne MacLaurin - CPSI Dr. Curt Smecher Dr. Claude Laflamme
Cardiac OnPump /
Chirurgiecardiaque avec
pompe
Cardiac OffPump /
Chirurgiecardiaque sans
pompe
C-Section /Césarienne
GeneralSurgery /Chirurgiegénérale
Gynecology /Chirurgie
gynécologique
Ophthalmology/ Chirurgie
ophtalmologi..
Orthopedics /Orthopédique
Vascular /Chirurgievasculaire
Thoracic /Chirurgie
thoracique
Other / Autre No Response /Pas de
réponse
0%
10%
20%
30%
40%
50%
Re
239
298
570
211
501
6336
2052
71
29%
SitesPatients 1,998
52
Participants by Type of Surgery
How to interpret the indicator slides
Sites/Patients = Total counts Green bar = Best Practice Red Bar = Incorrect Practice Grey Bar = Not Recorded or No
Response Y-Axis = % Total Records - Green
+ Red + Grey bars (e.g. % overall Best Practice = 60%)
n = 900 Sum of green and red bar counts Green Bubble = Best Practice /
(Best + Incorrect Practice) x 100 Red Bubble = Incorrect Practice /
(Best + Incorrect Practice) x 100
67%
33%
Sites 52 Patients 1000 n = 900
C. Pre-op shower or bath with soap or antiseptic agent
Total Patients 867
81% 88%
88%
66%
n = 354 n = 338 n = 131 n = 74
D. Solution used for intra-operative intact skin cleansing
Sites 52 Patients 1998
Note: Yes includes • 2% CHD w alc, P-I with alc & Contraindicated for all • PI for Gyne and C-Section • PI Head and Neck for Ophthalmology and Other.
n = 1959
74%
26%
Sites 52 Patients 1998
D. Solution used for intra-operative intact skin cleansing
68% 82% 92% 88%
Total Patients 1487
n = 558 n = 500 n = 230 n = 173
Note: Yes includes • 2% CHD w alc, P-I with alc & Contraindicated for all • PI for Gyne and C-Section.
Antibiotics not indicated / Antibiotiques non indiqués,Within 120 minutes before incision for Vancomycin orFluoroquinolones / Dans les 120 minutes précédantl’incision, dans le cas de la vancomycine ou de la
fluoroquinolone, Within 60 minutes before incision /Dans les 60 minutes précédant l’incision chirurgicale
No antibiotics given / Aucun antibiotique n’a étéadministré & None of the above / Aucun de ces choix
No Response / Pas de réponse & Not Recorded / Nonconsigné
0%
20%
40%
60%
80%
100%
Re
1,779
178
41
E. Prophylactic Abx administration
Sites 52 Patients 1998
n = 1957
91%
9%
General Surgery / Chirurgiegénérale Orthopedics / Orthopédique
Gynecology / Chirurgiegynécologique C-Section / Césarienne
Antibiotics notindicated /
Antibiotiquesnon indiqués,
Within 120minutes before
incision forVancomycin orFluoroquinolo..
No antibioticsgiven / Aucunantibiotique
n’a étéadministré &None of the
above / Aucunde ces choix
No Response /Pas de
réponse & NotRecorded /
Non consigné
Antibiotics notindicated /
Antibiotiquesnon indiqués,
Within 120minutes before
incision forVancomycin orFluoroquinolo..
No antibioticsgiven / Aucunantibiotique
n’a étéadministré &None of the
above / Aucunde ces choix
No Response /Pas de
réponse & NotRecorded /
Non consigné
Antibiotics notindicated /
Antibiotiquesnon indiqués,
Within 120minutes before
incision forVancomycin orFluoroquinolo..
No antibioticsgiven / Aucunantibiotique
n’a étéadministré &None of the
above / Aucunde ces choix
No Response /Pas de
réponse & NotRecorded /
Non consigné
Antibiotics notindicated /
Antibiotiquesnon indiqués,
Within 120minutes before
incision forVancomycin orFluoroquinolo..
No antibioticsgiven / Aucunantibiotique
n’a étéadministré &None of the
above / Aucunde ces choix
No Response /Pas de
réponse & NotRecorded /
Non consigné
0%
20%
40%
60%
80%
100%
Re
481
75
14
478
16 7
214
24
1
180
15 16
E. Prophylactic Abx administration Total Patients 1521
87% 97% 90% 92%
n = 556 n = 494 n = 238 n = 195
1g < 80kg, 2g < 80kg, 2g > 120kg, 2g 80-120 kg, 3g >=120kg & Weight based dose for paediatric patient /
Posologie en fonction du poids pour les patients enpédiatrie
< 1g for any adult patient / pour tout patient adulte, > 3g,1g >= 80kg, 3g >= 120kg,
No antibiotics given / Aucun antibiotique administré &Other antibiotic used / Autre antibiotique
No Response / Pas de réponse & Not Recorded / Nonconsigné
0%
20%
40%
60%
80%
100%
Re 1,274
636
88
F. Dose of Cefazolin used as Prophylactic Abx
Sites 52 Patients 1998 n = 1910
67%
33%
General Surgery / Chirurgiegénérale Orthopedics / Orthopédique
Gynecology / Chirurgiegynécologique C-Section / Césarienne
1g < 80kg, 2g <80kg, 2g > 120kg,2g 80-120 kg, 3g
>= 120kg &Weight based
dose forpaediatric patient
/ Posologie enfonction du poidspour les patients
en pédiatrie
< 1g for any adultpatient / pour toutpatient adulte, >3g, 1g >= 80kg,
3g >= 120kg, No antibioticsgiven / Aucunantibiotiqueadministré &
Other antibioticused / Autreantibiotique
No Response /Pas de réponse &
Not Recorded /Non consigné
1g < 80kg, 2g <80kg, 2g > 120kg,2g 80-120 kg, 3g
>= 120kg &Weight based
dose forpaediatric patient
/ Posologie enfonction du poidspour les patients
en pédiatrie
< 1g for any adultpatient / pour toutpatient adulte, >3g, 1g >= 80kg,
3g >= 120kg, No antibioticsgiven / Aucunantibiotiqueadministré &
Other antibioticused / Autreantibiotique
No Response /Pas de réponse &
Not Recorded /Non consigné
1g < 80kg, 2g <80kg, 2g > 120kg,2g 80-120 kg, 3g
>= 120kg &Weight based
dose forpaediatric patient
/ Posologie enfonction du poidspour les patients
en pédiatrie
< 1g for any adultpatient / pour toutpatient adulte, >3g, 1g >= 80kg,
3g >= 120kg, No antibioticsgiven / Aucunantibiotiqueadministré &
Other antibioticused / Autreantibiotique
No Response /Pas de réponse &
Not Recorded /Non consigné
1g < 80kg, 2g <80kg, 2g > 120kg,2g 80-120 kg, 3g
>= 120kg &Weight based
dose forpaediatric patient
/ Posologie enfonction du poidspour les patients
en pédiatrie
< 1g for any adultpatient / pour toutpatient adulte, >3g, 1g >= 80kg,
3g >= 120kg, No antibioticsgiven / Aucunantibiotiqueadministré &
Other antibioticused / Autreantibiotique
No Response /Pas de réponse &
Not Recorded /Non consigné
0%
20%
40%
60%
80%
100%
Re 328
220
22
413
4939
145
89
5
146
54
11
F. Dose of Cefazolin used as Prophylactic Abx
Total Patients 1521
60% 89% 62% 73%
n = 548 n = 462 n = 234 n = 200
Yes / Oui & Redosing not required / Redosage nonrequis
No / Non No Response / Pas de réponse, No prophylacticantibiotic given / Aucune antibioprophylaxieadministrée, Not Recorded / Non consigné
0%
20%
40%
60%
80%
100%
Re
1,490
46 46
G. Appropriate Prophylactic Antibiotic Redosing according to guidelines
Sites 52 Patients 1582
97%
3%
n = 1536
General Surgery / Chirurgie générale Orthopedics / Orthopédique Gynecology / Chirurgie gynécologique C-Section / Césarienne
Yes / Oui &Redosing not
required /Redosage no..
No / Non No Response /Pas de
réponse, Noprophylactic a..
Yes / Oui &Redosing not
required /Redosage no..
No / Non No Response /Pas de
réponse, Noprophylactic a..
Yes / Oui &Redosing not
required /Redosage no..
No / Non No Response /Pas de
réponse, Noprophylactic a..
Yes / Oui &Redosing not
required /Redosage no..
No Response /Pas de
réponse, Noprophylactic a..
0%
20%
40%
60%
80%
100%
Re
376
1913
463
3 7
168
2 2
170
10
G. Appropriate Prophylactic Antibiotic Redosing according to guidelines
Total Patients 1233
97% 99% 99% 100%
n = 389 n = 466 n = 170 n = 170
G. Appropriate Prophylactic Antibiotic Redosing according to guidelines (Yes/No)
Total Patients 227
80%
20%
General Surgery / Chirurgiegénérale Orthopedics / Orthopédique
Gynecology / Chirurgiegynécologique C-Section / Césarienne
ABX discontinuedwithin 24 hours ofend of surgery /
L’administration desantibiotiques a
cessé dans les 24heures suivant la fin
de la chirurgie &ABX not received
after end of surgery/ Aucun antibiotiqueadministré après la..
ABX discontinuedmore than 24 hoursafter end of surgery
/ L’administrationdes antibiotiques acessé plus de 24
heures après la finde la chirurgie & No
antibiotics given /Aucun antibiotiquen’a été administré
No Response / Pasde réponse & NotRecorded / Non
consigné
ABX discontinuedwithin 24 hours ofend of surgery /
L’administration desantibiotiques a
cessé dans les 24heures suivant la fin
de la chirurgie &ABX not received
after end of surgery/ Aucun antibiotiqueadministré après la..
ABX discontinuedmore than 24 hoursafter end of surgery
/ L’administrationdes antibiotiques acessé plus de 24
heures après la finde la chirurgie & No
antibiotics given /Aucun antibiotiquen’a été administré
No Response / Pasde réponse & NotRecorded / Non
consigné
ABX discontinuedwithin 24 hours ofend of surgery /
L’administration desantibiotiques a
cessé dans les 24heures suivant la fin
de la chirurgie &ABX not received
after end of surgery/ Aucun antibiotiqueadministré après la..
ABX discontinuedmore than 24 hoursafter end of surgery
/ L’administrationdes antibiotiques acessé plus de 24
heures après la finde la chirurgie & No
antibiotics given /Aucun antibiotiquen’a été administré
No Response / Pasde réponse & NotRecorded / Non
consigné
ABX discontinuedwithin 24 hours ofend of surgery /
L’administration desantibiotiques a
cessé dans les 24heures suivant la fin
de la chirurgie &ABX not received
after end of surgery/ Aucun antibiotiqueadministré après la..
ABX discontinuedmore than 24 hoursafter end of surgery
/ L’administrationdes antibiotiques acessé plus de 24
heures après la finde la chirurgie & No
antibiotics given /Aucun antibiotiquen’a été administré
No Response / Pasde réponse & NotRecorded / Non
consigné
0%
20%
40%
60%
80%
100%
Re 433
88
49
417
10
74
170
13
56
202
36
H. Discontinuation of Prophylactic Abx Total Patients 1521
83% 85% 75% 97%
n = 521 n = 491 n = 226 n = 208
Clippers / Tondeuse, Depilatory / Dépilatoire, Hairremoval not required / Épilation non requise
Razor / Rasoir & Removal done at home / Épilationeffectuée à la maison
No Response / Pas de réponse & Not Recorded / Nonconsigné
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Re
1,743
182
73
I. Hair Removal Method
Sites 52 Patients 1998
96%
4%
n = 1816
Not Recorded = 15
General Surgery / Chirurgie généraleOrthopedics /Orthopédique Gynecology / Chirurgie gynécologique C-Section / Césarienne
Clippers /Tondeuse,Depilatory /
Dépilatoire, Hairremoval notrequired /
Épilation nonrequise
Razor / Rasoir& Removal
done at home /Épilation
effectuée à lamaison
No Response /Pas de réponse& Not Recorded/ Non consigné
Clippers /Tondeuse,Depilatory /
Dépilatoire, Hairremoval notrequired /
Épilation nonrequise
No Response /Pas de réponse& Not Recorded/ Non consigné
Clippers /Tondeuse,Depilatory /
Dépilatoire, Hairremoval notrequired /
Épilation nonrequise
Razor / Rasoir& Removal
done at home /Épilation
effectuée à lamaison
No Response /Pas de réponse& Not Recorded/ Non consigné
Clippers /Tondeuse,Depilatory /
Dépilatoire, Hairremoval notrequired /
Épilation nonrequise
Razor / Rasoir& Removal
done at home /Épilation
effectuée à lamaison
No Response /Pas de réponse& Not Recorded/ Non consigné
0%
20%
40%
60%
80%
100%
Re
517
1736
468
33
209
1812
134
13
64
I. Hair Removal Method Total Patients 1521
97% 100% 92% 91%
n = 534 n = 468 n = 227 n = 147
J. Glucose was below 11.1 mmol/L on each of POD 0, 1 and 2
Sites 34 Patients 474
Note: Not at Risk (not diabetic) excluded from this measure (n=1513)
n = 390
57%
43%
Not Recorded = 7
General Surgery / Chirurgiegénérale Orthopedics / Orthopédique
Gynecology / Chirurgiegynécologique C-Section / Césarienne
Yes / Oui Gluc. NotDone /
Glycémie nontestée & No /
Non
No Response /Pas de
réponse & NotRecorded /
Non consigné
Yes / Oui Gluc. NotDone /
Glycémie nontestée & No /
Non
No Response /Pas de
réponse & NotRecorded /
Non consigné
Yes / Oui Gluc. NotDone /
Glycémie nontestée & No /
Non
No Response /Pas de
réponse & NotRecorded /
Non consigné
Yes / Oui Gluc. NotDone /
Glycémie nontestée & No /
Non
No Response /Pas de
réponse & NotRecorded /
Non consigné
0%
20%
40%
60%
80%
100%
Re
49
28
62
48
93
5
13
10
21
16
6
4
J. Glucose was below 11.1 mmol/L on each of POD 0, 1 and 2
Total Patients 355
56%
66%
32% 60%
Note: Not at Risk (not diabetic) excluded from this measure
n = 111 n = 141 n = 31 n = 10
Induced Hypothermia / Hypothermie induite & Yes / Oui No / Non No Response / Pas de réponse & Not Recorded / Nonconsigné
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Re
1,329
435
234
K. Temperature at end of surgery or on arrival in PACU - 36.0 - 38.0 degrees C
Sites 52 Patients 1998 n = 1563
85%
15%
Not Recorded = 100
General Surgery / Chirurgiegénérale Orthopedics / Orthopédique
Gynecology / Chirurgiegynécologique C-Section / Césarienne
InducedHypothermia /Hypothermie
induite & Yes /Oui
No / Non No Response /Pas de
réponse & NotRecorded /
Non consigné
InducedHypothermia /Hypothermie
induite & Yes /Oui
No / Non No Response /Pas de
réponse & NotRecorded /
Non consigné
InducedHypothermia /Hypothermie
induite & Yes /Oui
No / Non No Response /Pas de
réponse & NotRecorded /
Non consigné
InducedHypothermia /Hypothermie
induite & Yes /Oui
No / Non No Response /Pas de
réponse & NotRecorded /
Non consigné
0%
20%
40%
60%
80%
100%
Re
394
84 92
285
180
36
158
3942
136
25
50
K. Temperature at end of surgery or on arrival in PACU - 36.0 - 38.0 degrees C
Total Patients 1521
82%
89%
79% 84%
n = 478 n = 321 n = 200 n = 161
Orthopedics – consistent high performers Ontario – 18 sites and 863 patients Nova Scotia – 8 sites and 477 patients
• Colchester East Hants submitting monthly since July ‘15
Yukon – 1 site & 132 patients: 1st National audit participation!
Summary
Limitations of a bundle of care Culture of Patient Safety Opportunities for Improvement
– High ‘Not Recorded’ rate – especially in Pre-op shower or bath with soap or antiseptic agent
– (F.) Dose of Cefazolin used as Prophylactic Abx – (J.) Glucose was below 11.1 mmol/L on each of POD 0, 1 & 2 – (K.) Temperature at end of surgery or on arrival in PACU -
36.0oC to 38.0oC
Summary
Continue with your improvement work (95%) Opportunities for learning
– New Centers for Disease Control (CDC) report
Topic for Next National Call Glucose Control (date tba)
Next Steps
Access your data and reports at any time in Patient Safety Metrics – Surgical Site Infection Pre-operative (Pre-op) Score (SSI 14) – Surgical Site Infection Perioperative Score (SSI 15) – Surgical Site Infection Postoperative (Post-op) Score (SSI 16) – Surgical Site Infection Score (SSI 17) – https://psmetrics.utoronto.ca/metrics/login.aspx
Overall organization results – ‘Report’ tab > ‘SSI’ sub-tab
Individual unit results – ‘Data’ tab > ‘SSI’ intervention > ‘Measurement Worksheet’
table
Your Results and Scores
The Surgical Safety Checklist; More Than Just a “Good Catch” April 8th- 12:00 est Guests: Stacy Kozak Leslie Deuchar
FYI…
For Audit forms and Data Questions CPSI Central Measurement Team metrics@saferhealthcarenow.ca Virginia Flintoft (416) 946-8350 Alexandru Titeu (416) 946-3103 For SSI intervention related questions: Carla Williams cwilliams@cpsi-icsp.ca (709) 685-8254
Contacts